WBR0003
| Author | PageAuthor::Anonymous (Edited by Will Gibson) |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Surgery |
| 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:: |
| Answer C | AnswerC::CT scan abdomen. |
| Answer C Explanation | AnswerCExp:: |
| Answer D | AnswerD::Abdominal ultrasound |
| Answer D Explanation | AnswerDExp:: |
| 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 |
| 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:: |