Abdominal pain, Hypertension, Raynaud's, and Mesenteric Aneurysm! - 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 09-14-2011
USMLE Forums Master
 
Steps History: Not yet
Posts: 674
Threads: 264
Thanked 963 Times in 394 Posts
Reputation: 973
Send a message via Yahoo to ricko335
Question Abdominal pain, Hypertension, Raynaud's, and Mesenteric Aneurysm!

A 54-year-old man is admitted for persistent lower abdominal and groin pain that began 7 months previously. Two months before his present admission, he required exploratory laparoscopy for acute abdominal pain and presumed cholecystitis. This revealed necrotic omental tissue and pericholecystitis necessitating omentectomy and cholecystectomy. However, the pain continued unchanged. He currently describes it as periumbilical and radiating into his groin and legs. It becomes worse with eating. The patient has also had episodic severe testicular pain, bowel urgency, nausea, vomiting, and diuresis. He has lost ~22.7 kg over the preceding 6 months. His past medical history is significant of hypertension that has recently become difficult to control.
Medications on admission include aspirin, hydrochlorothiazide, hydromorphone, lansoprazole, metoprolol, and quinapril. On physical examination, the patient appears comfortable. His blood pressure is 170/100 mmHg, his heart rate is 88 beats/min, and he is afebrile. He has normal first and second heart sounds without murmurs, and an S4 is present. There are no carotid, renal, abdominal, or femoral bruits.
His lungs are clear to auscultation. Bowel sounds are normal. Abdominal palpation demonstrates minimal diffuse tenderness without rebound or guarding. No masses are present, and the stool is negative for occult blood. During the examination, the patient develops Raynaud's phenomenon in his right hand that persists for several minutes. His neurologic examination is intact. Admission laboratory studies reveal an erythrocyte sedimentation rate of 72 mm/h, a BUN of 17 mg/dL, and a creatinine of 0.8 mg/dL. The patient has no proteinuria or hematuria. Tests for antinuclear antibodies, anti-double-stranded-DNA antibodies, and antineutrophil cytoplasmic antibodies are negative. Liver function tests are abnormal with an AST of 89 IU/L and an ALT of 112 IU/L. Hepatitis B surface antigen and e antigen are positive. Mesenteric angiography demonstrates small beaded aneurysms of the superior and inferior mesenteric veins. What is the most likely diagnosis?
A. Hepatocellular carcinoma
B. Ischemic colitis
C. Microscopic polyangiitis
D. Mixed cryoglobulinemia
E. Polyarteritis nodosa
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (09-14-2011), cardio10 (09-15-2011), curiousmind (07-26-2012), m82_ghasemi (09-14-2011), riya10 (09-15-2011), roodiemd (09-14-2011), viraj311 (09-14-2011)



  #2  
Old 09-14-2011
nikhilesh's Avatar
USMLE Forums Scout
 
Steps History: Not yet
Posts: 45
Threads: 3
Thanked 29 Times in 22 Posts
Reputation: 39
Default

the answer is polyarteritis nodosa......
Reply With Quote Quick reply to this message
  #3  
Old 09-14-2011
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 288
Threads: 28
Thanked 91 Times in 73 Posts
Reputation: 101
Default

wow, very lengthy question but good to practice.it is PAN----associated with HbsAg, mesentric artery involvement, middle age man
__________________
When you know what you want,and you want it badly enough,you'll find a way to get it!!
Reply With Quote Quick reply to this message
 
  #4  
Old 09-14-2011
USMLE Forums Newbie
 
Steps History: CS Only
Posts: 6
Threads: 0
Thanked 0 Times in 0 Posts
Reputation: 10
Default

Dat was a loooooooooooong question.
I think it is E. Polyarteritis nodosa
as HBV is positive,plus mesentric involment, sparing Pulmonary which is not mentioned but can seen.
Reply With Quote Quick reply to this message
  #5  
Old 09-14-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 10
Threads: 2
Thanked 0 Times in 0 Posts
Reputation: 10
Default

Long question...but the last few sentences gave away the diagnosis. E- PAN ass with HBV infection.
Reply With Quote Quick reply to this message
  #6  
Old 09-14-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 623
Threads: 111
Thanked 424 Times in 264 Posts
Reputation: 434
Default

Polyarteritis nodosa
Reply With Quote Quick reply to this message
The above post was thanked by:
m82_ghasemi (09-14-2011)
  #7  
Old 09-15-2011
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 5
Threads: 1
Thanked 0 Times in 0 Posts
Reputation: 10
Default

polyartritis nodosa
Reply With Quote Quick reply to this message
  #8  
Old 09-16-2011
USMLE Forums Master
 
Steps History: Not yet
Posts: 674
Threads: 264
Thanked 963 Times in 394 Posts
Reputation: 973
Send a message via Yahoo to ricko335
Default

The correct answer is polyarteritis nodosa
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (09-16-2011)



Reply

Tags
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
Treat hypertension or stop smoking for abdominal aneurysm! drarnab USMLE Step 2 CK Forum 1 09-13-2011 06:17 AM
abdominal pain usmleman2020 USMLE Step 1 Forum 8 08-13-2011 09:55 PM
Management of abdominal aortic aneurysm >5cm and <5cm? Ace3 USMLE Step 2 CK Forum 2 07-01-2011 08:00 PM
Diagnosis of Abdominal Aneurysm? Seetal USMLE Step 2 CK Forum 11 04-23-2011 06:28 PM
An old man with abdominal pain DrSeddik USMLE Step 1 Forum 11 12-28-2009 11:36 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)