WBR0657: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 1: Line 1:
{{WBRQuestion
{{WBRQuestion
|QuestionAuthor=Gerald {{Alison}}
|QuestionAuthor=Anonymous {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
Line 21: Line 21:
|MainCategory=Pathophysiology
|MainCategory=Pathophysiology
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|Prompt=An obese 48-year-old, multiparous female, presents to the physician's office with nonradiating right upper quadrant pain, nausea, bloating, and vomiting that becomes worse after the consumption of fries and a hamburger. Ultrasonography displays hyperechogenic foci within the right upper quadrant. Laboratory testing reveals a WBC count of 16,000/mm<sup>3</sup> and a serum amylase level of 70 U/L. Which of the following substances results in her right upper quadrant pain?
|Explanation=The patient in this scenario demonstrates symptoms, as well as laboratory and imaging results, which are suggestive of gallstone cholecystitis. Gallstone cholecystitis is typically presented in patients who fit the profile of the “4F’s”: Female, Fat, Fertile, and Forty. The right upper-quadrant pain that results from gallbladder contraction, is induced by cholecystokinin (CCK), which secretes in response to the presence of peptides, amino acids, and fatty acids in the duodenum.


'''ADD TABLE'''
 
|Prompt=An obese, multiparous, 48-year-old female presents to the physician's office with a nonradiating right upper quadrant abdominal pain with bloating, nausea, and vomiting that worsens after the consumption of fries and a hamburger. Abdominal ultrasonography displays hyperechogenic foci within the thickened gallbladder wall. Laboratory testing reveals a WBC count of 16,000/μL and serum amylase and lipase levels of 75 U/L and 150 U/L, respectively. Which of the following secreted substances most likely accounts for her abdominal pain?
 
 
|Explanation=The patient in this scenario demonstrates classic findings of acute [[gallstone|calculous]] [[cholecystitis]]. Acute [[gallstone|calculous]] [[cholecystitis]] typically develops in patients who fit the profile of the '''4F's: <u>F</u>emale, <u>F</u>at, <u>F</u>ertile, and in her <u>F</u>orties'''. Strenuous contraction of the [[gallbladder]], described as a nonradiating abdominal pain in the right upper quadrant, is secondary to the effect of [[cholecystokinin]], which is secreted in response to ingestion of lipids and proteins.
 
[[File:GI hormones.png|800px]]


|AnswerA=Cholecystokinin
|AnswerA=Cholecystokinin
Line 32: Line 36:
|AnswerD=Secretin
|AnswerD=Secretin
|AnswerE=Gastric inhibitory peptide
|AnswerE=Gastric inhibitory peptide
|EducationalObjectives=Gallstone cholecystitis, induced by cholecystokinin, is typically presented in patients who fit the profile of the “4F’s”: Female, Fat, Fertile, and Forty.
|EducationalObjectives= Acute [[gallstone|calculous]] [[cholecystitis]] typically develops in patients who fit the profile of the '''4F's (<u>F</u>emale, <u>F</u>at, <u>F</u>ertile, and in her <u>F</u>orties'''). It is often manifested as a nonradiating right upper quadrant pain due to strenuous contraction of the gallbladder induced by [[cholecystokinin]].
|References=Le T, Bhushan V. First Aid for the USMLE Step 1 2014. McGraw-Hill Medical; 2014.
|References=Le T, Bhushan V. First Aid for the USMLE Step 1 2014. McGraw-Hill Medical; 2014.
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=Gallstone ileus, Cholelithiasis, Cholecystitis
|WBRKeyword=Cholelithiasis, Cholecystitis, Cholecystokinin
|Approved=No
|Approved=No
}}
}}

Revision as of 01:13, 8 July 2014
Author [[PageAuthor::Anonymous (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathophysiology
Sub Category SubCategory::Gastrointestinal
Prompt [[Prompt::An obese, multiparous, 48-year-old female presents to the physician's office with a nonradiating right upper quadrant abdominal pain with bloating, nausea, and vomiting that worsens after the consumption of fries and a hamburger. Abdominal ultrasonography displays hyperechogenic foci within the thickened gallbladder wall. Laboratory testing reveals a WBC count of 16,000/μL and serum amylase and lipase levels of 75 U/L and 150 U/L, respectively. Which of the following secreted substances most likely accounts for her abdominal pain?]]
Answer A AnswerA::Cholecystokinin
Answer A Explanation AnswerAExp::See overall explanation
Answer B AnswerB::Gastrin
Answer B Explanation AnswerBExp::
Answer C AnswerC::Pepsin
Answer C Explanation AnswerCExp::
Answer D AnswerD::Secretin
Answer D Explanation AnswerDExp::
Answer E AnswerE::Gastric inhibitory peptide
Answer E Explanation AnswerEExp::
Right Answer RightAnswer::A
Explanation [[Explanation::The patient in this scenario demonstrates classic findings of acute calculous cholecystitis. Acute calculous cholecystitis typically develops in patients who fit the profile of the 4F's: Female, Fat, Fertile, and in her Forties. Strenuous contraction of the gallbladder, described as a nonradiating abdominal pain in the right upper quadrant, is secondary to the effect of cholecystokinin, which is secreted in response to ingestion of lipids and proteins.


Educational Objective: Acute calculous cholecystitis typically develops in patients who fit the profile of the 4F's (Female, Fat, Fertile, and in her Forties). It is often manifested as a nonradiating right upper quadrant pain due to strenuous contraction of the gallbladder induced by cholecystokinin.
References: Le T, Bhushan V. First Aid for the USMLE Step 1 2014. McGraw-Hill Medical; 2014.]]

Approved Approved::No
Keyword WBRKeyword::Cholelithiasis, WBRKeyword::Cholecystitis, WBRKeyword::Cholecystokinin
Linked Question Linked::
Order in Linked Questions LinkedOrder::
Retrieved from "https://www.wikidoc.org/index.php?title=WBR0657&oldid=990092"