WBR0003

Author	PageAuthor::Anonymous (Edited by Will Gibson)
Exam Type	ExamType::USMLE Step 2 CK
Main Category
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 56-year-old man presents to the urgent care clinic for constant epigastric pain. He reports a history of gastrointestinal ulcers, which felt similar to the patient's current presentation. He recalls taking a 2-week course of medication several years ago after which his ulcers resolved. While waiting for preliminary laboratory results, the patient's condition rapidly deteriorates. He suddenly complains of severe pain in the epigastrium and turns pale. His blood pressure acutely rises to 150/110 mmHg and his heart rate increases to 120 bpm. What is the best imaging study for diagnosis of the most likely condition?]]
Answer A	AnswerA::Lateral decubitus chest x-ray.
Answer A Explanation	[[AnswerAExp::Incorrect: In a decubitus X-ray, the patient lays down on her side while films are taken. A lateral decubitus X-ray is useful for determining whether a patient is suffering from a pneumonia or a pleural effusion. If an effusion is present, the fluid will form a freely mobile layer on the dependent side of the chest wall.]]
Answer B	AnswerB::Plain upright chest x-ray.
Answer B Explanation	[[AnswerBExp::Correct: As a general rule, chest X-ray is the best initial radiographic test for any pulmonary complaint.]]
Answer C	AnswerC::Abdominal CT scan
Answer C Explanation	AnswerCExp::
Answer D	AnswerD::Abdominal X-ray
Answer D Explanation	[[AnswerDExp::'Incorrect: Abdominal X-ray is not the best initial radiographic test for suspected perforation of the stomach or bowel. Instead, a plain upright X-ray is more appropriate. Abdominal X-ray will often fail to detect free air under the diaphragm generated by a perforation, especially in tall people. Abdominal X-ray is the appropriate imaging test for suspected cases of bowel obstruction or ileus.]]
Answer E	AnswerE::Emergency esophagogastroduodenoscopy
Answer E Explanation	AnswerEExp::
Right Answer	RightAnswer::B
Explanation	[[Explanation::This patient exhibits signs of acute ulcer perforation. As this is a surgical emergency, fast and accurate testing is very important; thus plain upright chest x-ray is preferred. This will commonly show free air concentrated under the diaphragm. References: Master the Boards 2013 page 389-492 Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::Gastric, WBRKeyword::Ulcer, WBRKeyword::Gastic Ulcer, WBRKeyword::Perforation, WBRKeyword::Xray, WBRKeyword::X-ray
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::