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  #1  
Old 03-24-2015
spasemaster's Avatar
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Question Haaard question

I passed by this in my step 2 CK prep and I noticed that it also can be asked in step 1. So thought about sharing it:



A 77-year-old woman comes to the physician because of a 2-day history of cramping abdominal
pain and distention accompanied by nausea and vomiting. She is otherwise healthy and has no
history of abdominal operations. Her temperature is 37.4 C (99.4 F), blood pressure is 110/86 mm
Hg, pulse is 112/min, and respirations are 24/min. Cardiopulmonary examination shows no
abnormalities. Examination of the abdomen shows distention and mild diffuse tenderness; bowel
sounds are high-pitched. An x-ray film of the abdomen shows air-fluid levels throughout the small
bowel and air in the liver; there is no gas in the colon or free air. Which of the following is the most
likely diagnosis?
A
) Adhesive small-bowel obstruction
B
) Cecal cancer
C
) Gallstone ileus
D
) Intussusception
E
) Mesenteric infarction
F
) Ruptured appendicitis
G
) Small bowel lymphoma
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  #2  
Old 03-24-2015
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I'd go with A
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  #3  
Old 03-24-2015
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Quote:
Originally Posted by spasemaster View Post
I passed by this in my step 2 CK prep and I noticed that it also can be asked in step 1. So thought about sharing it:



A 77-year-old woman comes to the physician because of a 2-day history of cramping abdominal
pain and distention accompanied by nausea and vomiting. She is otherwise healthy and has no
history of abdominal operations. Her temperature is 37.4 C (99.4 F), blood pressure is 110/86 mm
Hg, pulse is 112/min, and respirations are 24/min. Cardiopulmonary examination shows no
abnormalities. Examination of the abdomen shows distention and mild diffuse tenderness; bowel
sounds are high-pitched. An x-ray film of the abdomen shows air-fluid levels throughout the small
bowel and air in the liver; there is no gas in the colon or free air. Which of the following is the most
likely diagnosis?
A
) Adhesive small-bowel obstruction
B
) Cecal cancer
C
) Gallstone ileus
D
) Intussusception
E
) Mesenteric infarction
F
) Ruptured appendicitis
G
) Small bowel lymphoma
Its a gallstone ileus C causing intestinal obstruction by forming a fistula with the intestine. The gas in the liver also supports the diagnosis.
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  #4  
Old 03-24-2015
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I'll guess C
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  #5  
Old 03-24-2015
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gallstone ileus
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  #6  
Old 03-24-2015
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C. A spin off this question is also in Uworld.
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  #7  
Old 03-24-2015
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Correct Answer

Veeeery veeeery goooood, Yes it is choice C

I'm still doing Goljan, so still haven't gotten to UWORLD yet.
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