75 yr old male with abd pain - 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 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 12-05-2011
bassatom's Avatar
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 260
Threads: 28
Thanked 156 Times in 54 Posts
Reputation: 166
Send a message via Skype™ to bassatom
Question 75 yr old male with abd pain

A 75-year-old white man complains to a physician of abdominal pain. His temperature is 37 C (98.6 F), blood pressure is 110/65 mm Hg, pulse is 63/min, and respirations are 16/min. The abdomen is soft, with focal tenderness in the left lower quadrant. His erythrocyte count is 4.5 million/cu mm, leukocyte count is 9000/mm3 with 60% neutrophils and 50/0bands, and platelet count is 250,000/mm3. Serum chemistries show:
Sodium 140 mEq/L
Potassium 5 mEq/L
Chloride 102 mEq/L
Creatinine 1.1 mg/dl,
Urea nitrogen 12 mg/dl,

Which of the following is the most appropriate next step in diagnosis?

(A) Barium enema
(B) Colonoscopy
(C) CT of abdomen
(D) Plain film of abdomen
(E) Trial therapy of a liquid diet
Reply With Quote Quick reply to this message
The above post was thanked by:
bebix (12-06-2011), Mondoshawan (12-06-2011), qurat21 (12-06-2011)



  #2  
Old 12-06-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 537
Threads: 80
Thanked 343 Times in 138 Posts
Reputation: 375
Default

CT abdomen
Reply With Quote Quick reply to this message
  #3  
Old 12-06-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 537
Threads: 80
Thanked 343 Times in 138 Posts
Reputation: 375
Default

case of diverticulitis so barium enema n colonoscopy are contraindicated.the best method to diagnose would be ct abdomen
Reply With Quote Quick reply to this message
 
  #4  
Old 12-06-2011
jaimin's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 264
Threads: 15
Thanked 98 Times in 56 Posts
Reputation: 108
Default

(E) Trial therapy of a liquid diet
Reply With Quote Quick reply to this message
  #5  
Old 12-06-2011
pass7's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS+3
Posts: 406
Threads: 30
Thanked 141 Times in 109 Posts
Reputation: 151
Default

(C) CT of abdomen
Reply With Quote Quick reply to this message
  #6  
Old 12-06-2011
bassatom's Avatar
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 260
Threads: 28
Thanked 156 Times in 54 Posts
Reputation: 166
Send a message via Skype™ to bassatom
Default

The problem here is the Kaplan CK Qbank says that u should give a trial of liquid therapy because the patient only has abd pain and no raised counts, fever etc..

MTB says that we should do a CT scan...

Any views?
Reply With Quote Quick reply to this message
  #7  
Old 12-06-2011
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 239
Threads: 3
Thanked 48 Times in 37 Posts
Reputation: 58
Default

(C) CT of abdomen
__________________
I'm Predictable In The Unpredictable Future !
Reply With Quote Quick reply to this message
  #8  
Old 12-06-2011
Seetal's Avatar
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 919
Threads: 134
Thanked 1,310 Times in 364 Posts
Reputation: 1333
Send a message via MSN to Seetal
Default

the answer is E. LLQ is usually due to constipation. no need for CT scan unless the patient has bloody stools or suspicion of diverticulosis (or colon cancer which is usually accompanied by bloody stools)
Reply With Quote Quick reply to this message
The above post was thanked by:
sam88 (12-06-2011)
  #9  
Old 12-06-2011
jaimin's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 264
Threads: 15
Thanked 98 Times in 56 Posts
Reputation: 108
Default

Quote:
Originally Posted by bassatom View Post
The problem here is the Kaplan says that u should give a trial of liquid therapy because the patient only has abd pain and no raised counts, fever etc..

MTB says that we should do a CT scan...

Any views?
I think CT is not necessary , as it is not a case of diverticulitis .
And according to MTB ,Colonoscopy most accurate.
Reply With Quote Quick reply to this message
  #10  
Old 12-06-2011
qurat21's Avatar
USMLE Forums Master
 
Steps History: 1 + CK
Posts: 623
Threads: 62
Thanked 287 Times in 186 Posts
Reputation: 297
Default

i think its a case of diverticulosis considering the age of pt. so ill go for colonoscopy.
Reply With Quote Quick reply to this message
  #11  
Old 12-06-2011
USMLE Forums Addict
 
Steps History: Not yet
Posts: 129
Threads: 18
Thanked 186 Times in 62 Posts
Reputation: 196
Default

hmm well for this one E) a trial therapy of a liquid diet..
he has no fever no high wbc no blood in the stool why would i do a ct scan now.
i would give him a trial of liquid therapy now and then will see what happens.
Reply With Quote Quick reply to this message
  #12  
Old 12-07-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 537
Threads: 80
Thanked 343 Times in 138 Posts
Reputation: 375
Default

do we have tenderness if its plain constipation.and why would the tenderness be localised to LLQ?it should be more diffuse right?in a 75 yr old the chances of diverticulitis is more than any other cause.
Reply With Quote Quick reply to this message



Reply

Tags
Gastroenterology-, Step-2-Questions, Surgery-

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
male newborn with abnormal TSH doc Mm USMLE Step 1 Forum 1 10-22-2011 12:53 PM
43 -year - old male ..... achistikbenny USMLE Step 1 Forum 6 08-31-2011 07:36 PM
Male Erectile Dysfunction Mnemonic jackat1000 USMLE Step 1 Mnemonics 0 06-27-2010 05:55 PM
Male Breast Cancer rasheed USMLE Step 2 CK Buzzwords 0 02-13-2010 12:57 PM
Male with sole rash Sabio USMLE Step 1 Forum 4 11-22-2009 10:40 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)