GIT Question - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 06-08-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 27
Threads: 8
Thanked 18 Times in 12 Posts
Reputation: 28
GIT GIT Question

45 Year old man comes to the emergency department because of a 4.5 kg weight loss in the past 3 months. He has a history of alcohol abuse and multiple past admissions for epigastric pain. He has symptoms of upper abdominal pain raidiating to his back and bulky 'greasy' stools. Labratory studies show elevated PT and PTT. Which of the following is the most likely underlying cause of his disease.

A) Adenocarcinoma arising from the pancreatic epithelium
B) Carcinoma of the intrahepatic bile ducts
C) Fobrosis of the intrahepatic and extrahepatic bile ducts
D) Gastric outlet obstruction
E) Insufficient secretion of pancreatic enzymes
Reply With Quote Quick reply to this message



  #2  
Old 06-08-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,262 Times in 881 Posts
Reputation: 3272
Default

I think is E)
Reply With Quote Quick reply to this message
  #3  
Old 06-08-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 27
Threads: 8
Thanked 18 Times in 12 Posts
Reputation: 28
Default

Can you explain to me how you got E as the right answer. Whats your reasoning. Thanks
Reply With Quote Quick reply to this message
 
  #4  
Old 06-08-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,262 Times in 881 Posts
Reputation: 3272
Default

chronic OH = chronic pancreatitis
bulky 'greasy' stools + PT and PTT = Malabsorption due to lack of digestive enzymes produces by the pancreas
Reply With Quote Quick reply to this message
  #5  
Old 06-08-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 27
Threads: 8
Thanked 18 Times in 12 Posts
Reputation: 28
Default

I see, how did you rule out the adenocarcinoma based on this question?
Reply With Quote Quick reply to this message
  #6  
Old 06-08-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,262 Times in 881 Posts
Reputation: 3272
Default

Quote:
Originally Posted by moe2185 View Post
I see, how did you rule out the adenocarcinoma based on this question?

Well, chronic pancreatitis is associated with pseudocysts...and as far as I know, this is not adenocarcinoma...
Reply With Quote Quick reply to this message
  #7  
Old 06-08-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 27
Threads: 8
Thanked 18 Times in 12 Posts
Reputation: 28
Default

I don't know why but I just cant make the connection of this scenario being an insufficient lipase issue with his symptoms. His weight loss and fat malabsorption seems like it would be caused by a bile duct obstruction due to carcinoma in head of the pancreas. He is also currently having an attack as the question says (pain radiating to his back etc) which would imply a pancreatitis attack and thus diagnostically they would check for his ELEVATED enzymes.

What am I missing here? The answer explanation on the site for this question is really not helpful.
Reply With Quote Quick reply to this message
  #8  
Old 06-08-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,262 Times in 881 Posts
Reputation: 3272
Default

In chronic pancreatitis you also have weight lost & malabsorption...

"He has a history of alcohol abuse and multiple past admissions for epigastric pain." that is consistent with previous acute attacks

So, I guess you just have to play odds...most likely underlying cause of his disease?...Insufficient secretion of pancreatic enzymes
Reply With Quote Quick reply to this message
  #9  
Old 06-08-2011
USMLE Forums Guru
 
Steps History: Not yet
Posts: 324
Threads: 70
Thanked 238 Times in 144 Posts
Reputation: 248
Default

Also as it is retroperitoneal..pain is referred to back..
Reply With Quote Quick reply to this message
  #10  
Old 06-08-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 71
Threads: 12
Thanked 60 Times in 23 Posts
Reputation: 70
Default

Quote:
Originally Posted by moe2185 View Post
45 Year old man comes to the emergency department because of a 4.5 kg weight loss in the past 3 months. He has a history of alcohol abuse and multiple past admissions for epigastric pain. He has symptoms of upper abdominal pain raidiating to his back and bulky 'greasy' stools. Labratory studies show elevated PT and PTT. Which of the following is the most likely underlying cause of his disease.

A) Adenocarcinoma arising from the pancreatic epithelium
B) Carcinoma of the intrahepatic bile ducts
C) Fobrosis of the intrahepatic and extrahepatic bile ducts
D) Gastric outlet obstruction
E) Insufficient secretion of pancreatic enzymes
I'll go with E, malabsorption --> impaired absorption of fat soluble vitamins (in this case K, which is messing with his PT and PTT) and bulky greasy stools is steatorrhea

It's not pancreatic cancer because the most common sign is Painless Jaundice, and since this guy has no elevation of AST or ALT or elevation of Bilirubin (direct or indirect) for me that rules out bile duct or liver problems.

That's how I would answer this one...in my head at least...what's the correct answer?
Reply With Quote Quick reply to this message
  #11  
Old 06-08-2011
USMLE Forums Addict
 
Steps History: Not yet
Posts: 140
Threads: 5
Thanked 118 Times in 66 Posts
Reputation: 128
Default

yeah i think E as well coz if they wanted us to think that it was cancer, theyd probably mention the enzymes or something more. also the weight loss i think can easily be attributed to the malabsorption...So whats the consensus going to be like?
Reply With Quote Quick reply to this message



Reply

Tags
Gastrointestinal-Tract-, Pathology-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
question help: diabetic foot related question dezirablize USMLE Step 2 CK Forum 5 01-15-2015 02:42 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)