LLQ tenderness...what is next test ? EXPLN PLZ - 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 05-31-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Surgery LLQ tenderness...what is next test ? EXPLN PLZ

A 67-year-old woman is evaluated in the hospital for acute abdominal pain. She was admitted
for community-acquired pneumonia, and her condition was improving on therapy with
antibiotics and fluids. However, on day 3 she developed acute abdominal pain associated with
nausea. Her medical history includes a 7-year history of peripheral arterial disease, type 2
diabetes mellitus, hyperlipidemia, and an episode of diverticulitis 2 years ago. Her medications
are pravastatin, aspirin, dipyridamole, and metformin.
On physical examination, she is in distress; temperature is 38.3C (101.0F), blood pressure
is 170/100 mm Hg, pulse rate is 120/min, and respiration rate is 25/min. She rates her pain
as 10 out of 10. She has diffuse abdominal tenderness, more pronounced in the left lower
quadrant with rebound tenderness.

Which of the following is the most appropriate next diagnostic test?
(A) Colonoscopy
(B) CT scan of the abdomen
(C) Left pelvic ultrasonography
(D) Supine and upright abdominal radiographs
Reply With Quote Quick reply to this message
The above post was thanked by:
step1an (06-04-2012)



  #2  
Old 05-31-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

CT Abd/Pelvis, Dx is mostly diverticulitis, though could be ischemic colitis also
Reply With Quote Quick reply to this message
  #3  
Old 05-31-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 137
Threads: 2
Thanked 65 Times in 40 Posts
Reputation: 75
Default

Quote:
Originally Posted by tyagee View Post
A 67-year-old woman is evaluated in the hospital for acute abdominal pain. She was admitted
for community-acquired pneumonia, and her condition was improving on therapy with
antibiotics and fluids. However, on day 3 she developed acute abdominal pain associated with
nausea. Her medical history includes a 7-year history of peripheral arterial disease, type 2
diabetes mellitus, hyperlipidemia, and an episode of diverticulitis 2 years ago. Her medications
are pravastatin, aspirin, dipyridamole, and metformin.
On physical examination, she is in distress; temperature is 38.3C (101.0F), blood pressure
is 170/100 mm Hg, pulse rate is 120/min, and respiration rate is 25/min. She rates her pain
as 10 out of 10. She has diffuse abdominal tenderness, more pronounced in the left lower
quadrant with rebound tenderness.
Which of the following is the most appropriate next diagnostic test?
(A) Colonoscopy
(B) CT scan of the abdomen
(C) Left pelvic ultrasonography
(D) Supine and upright abdominal radiographs
-despit the consedration of deverticulitis ,but susption of ischemia is high due to her risk factors,so (B) is most useful here.
Reply With Quote Quick reply to this message
 
  #4  
Old 05-31-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 460 Times in 289 Posts
Reputation: 470
Default

Quote:
Originally Posted by tyagee View Post
A 67-year-old woman is evaluated in the hospital for acute abdominal pain. She was admitted
for community-acquired pneumonia, and her condition was improving on therapy with
antibiotics and fluids. However, on day 3 she developed acute abdominal pain associated with
nausea. Her medical history includes a 7-year history of peripheral arterial disease, type 2
diabetes mellitus, hyperlipidemia, and an episode of diverticulitis 2 years ago. Her medications
are pravastatin, aspirin, dipyridamole, and metformin.
On physical examination, she is in distress; temperature is 38.3C (101.0F), blood pressure
is 170/100 mm Hg, pulse rate is 120/min, and respiration rate is 25/min. She rates her pain
as 10 out of 10. She has diffuse abdominal tenderness, more pronounced in the left lower
quadrant with rebound tenderness.

Which of the following is the most appropriate next diagnostic test?
(A) Colonoscopy
(B) CT scan of the abdomen
(C) Left pelvic ultrasonography
(D) Supine and upright abdominal radiographs

i think B......
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
  #5  
Old 05-31-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 63
Threads: 13
Thanked 0 Times in 0 Posts
Reputation: 10
Default

I think this is an emergency and whatever the cause it looks like there is peritonitis and possibly perforation so D
Reply With Quote Quick reply to this message
  #6  
Old 05-31-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

seems like either bowel infarction




CT abdo shud be next
Reply With Quote Quick reply to this message
  #7  
Old 05-31-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

(D) Supine and upright abdominal radiographs
Reply With Quote Quick reply to this message
The above post was thanked by:
step1an (06-04-2012)
  #8  
Old 05-31-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

Quote:
Originally Posted by Novobiocin View Post
(D) Supine and upright abdominal radiographs
"explanation plz" is rule of thumb for all the questions...
Reply With Quote Quick reply to this message
  #9  
Old 05-31-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

Quote:
Originally Posted by tyagee View Post
"explanation plz" is rule of thumb for all the questions...
There are only two possibilities:
1. Mesenteric ischemia leading to bowel infarction and perforation--will show dilated bowel and/or gas under diaphragm.
2. Diverticular perforation-usually a localized perforation with abscess formation.

If it just a loalized perforation then she doesn't need a Lap. but if it shows gas under diaphragm them she should at least have a look inside.

Moreover, she appears too sick to be sent for a Ct scan.
Reply With Quote Quick reply to this message
The above post was thanked by:
step1an (06-04-2012)
  #10  
Old 05-31-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

-the pt is HYPERTENSIVE & TACHYCARDIC with FEVER
-Mesenteric ischemia dont present will localized tenderness on PE, and there's pain out of proportion to PE
-ischemic colitis usually complicate Hypotension/Hypovolemia and usually accompanied by bloody stool (though it can happen in diverticulitis also)
-KUB/AXR in settings of ischemia is not specific and peroration is the complication but Full thickness Necrosis !!
Reply With Quote Quick reply to this message
  #11  
Old 05-31-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 63
Threads: 13
Thanked 0 Times in 0 Posts
Reputation: 10
Default

@tyagee would you post the answers plz?
Reply With Quote Quick reply to this message
  #12  
Old 05-31-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

Quote:
Originally Posted by Aajj View Post
@tyagee would you post the answers plz?
I don't have exact explanation but point s patient has acute abdomen and xray is initial test to rule out perforation which is our main concern in acute abdomen. Make sense?
Reply With Quote Quick reply to this message



Reply

Tags
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
Which anemia is this? tyagee USMLE Step 2 CK Forum 2 07-29-2012 07:44 PM
next step after pleural tap...expln plz tyagee USMLE Step 2 CK Forum 7 05-29-2012 06:50 AM
attributable risk q...please expln tyagee USMLE Step 1 Forum 2 04-25-2012 02:00 PM
which ix ? plz give expln tyagee USMLE Step 2 CK Forum 5 03-04-2012 10:34 PM
Flank tenderness jinni USMLE Step 1 Forum 6 03-02-2012 03:52 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)