gastroenterology q14 - 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 3 Forum

USMLE Step 3 Forum USMLE Step 3 Discussion Forum: Let's talk about anything related to USMLE Step 3 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 05-20-2013
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 551 Times in 308 Posts
Reputation: 561
Default gastroenterology q14

. A 32-year-old woman is evaluated in the emer-gency department for abdominal pain. She reports a vague loss of appetite for the past day and has had progressively severe abdominal pain, initially at her umbilicus, but now localized to her right lower quadrant. The pain is crampy.
She has not moved her bowels or vomited. She reports that she is otherwise healthy and has had no sick contact.
Exam is notable for a temperature of 100.7F, heart rate of 105 beats/min, and otherwise normal vital signs. Her abdomen is tender in the right lower quadrant and pelvic examination is normal. Urine pregnancy test is negative.
Which of the following imaging modalities is most likely to confirm her diagnosis?

A. CT of the abdomen without contrast
B. Colonoscopy
C. Pelvic ultrasound
D. Plain film of the abdomen
E. Ultrasound of the abdomen
Reply With Quote Quick reply to this message



  #2  
Old 05-20-2013
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,316 Times in 706 Posts
Reputation: 1331
Default

Quote:
Originally Posted by cingulate.gyrus View Post
. A 32-year-old woman is evaluated in the emer-gency department for abdominal pain. She reports a vague loss of appetite for the past day and has had progressively severe abdominal pain, initially at her umbilicus, but now localized to her right lower quadrant. The pain is crampy.
She has not moved her bowels or vomited. She reports that she is otherwise healthy and has had no sick contact.
Exam is notable for a temperature of 100.7F, heart rate of 105 beats/min, and otherwise normal vital signs. Her abdomen is tender in the right lower quadrant and pelvic examination is normal. Urine pregnancy test is negative.
Which of the following imaging modalities is most likely to confirm her diagnosis?

A. CT of the abdomen without contrast
B. Colonoscopy
C. Pelvic ultrasound
D. Plain film of the abdomen
E. Ultrasound of the abdomen
Eventho is not needed.. this is a clear cut case and the next step would be go straight to the OR.. CT scan is the standard of care in the US
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (05-21-2013)
  #3  
Old 05-21-2013
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 551 Times in 308 Posts
Reputation: 561
Default

Quote:
Originally Posted by XpaezX View Post
Eventho is not needed.. this is a clear cut case and the next step would be go straight to the OR.. CT scan is the standard of care in the US

answer is A.

The patient presents with classic findings for acute appendi-citis with anorexia, progressing to vague periumbilical pain, followed by localization to the right lower quadrant. Low-grade fever and leukocytosis are frequently present. Although acute appendicitis is primarily a clinical diagnosis, imaging modalities are frequently employed as the symptoms are not always classic. Plain radiographs are rarely helpful except when an opaque fecalith is found in the right lower quadrant (<5% of cases). Ultra-sound may demonstrate an enlarged appendix with a thick wall, but is most useful to rule out ovarian pathology, tuboovarian abscess, or ectopic pregnancy. Recently both nonen-hanced and contrasted CT have been shown be superior to ultrasound or plain radiograph in the diagnosis of acute appendicitis, with a positive predictive value of 9597% and overall accuracy of 9097%. Findings often include a thickened appendix with peri* appendiceal stranding and often the presence of a fecalith. Free air is uncommon, even in the case of a perforated appendix. Nonvisualization of the appendix on CT is associated with surgical findings of a normal appendix 98% of the time. Colonoscopy has no role in the diagnosis of acute appendicitis.
Reply With Quote Quick reply to this message



Reply

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
Gastroenterology q6 cingulate.gyrus USMLE Step 3 Forum 6 05-26-2013 01:42 AM
gastroenterology q10 I B D cingulate.gyrus USMLE Step 3 Forum 2 05-20-2013 12:01 PM
gastroenterology q9 cingulate.gyrus USMLE Step 3 Forum 2 05-20-2013 11:49 AM
Gastroenterology q7 cingulate.gyrus USMLE Step 3 Forum 2 05-20-2013 10:54 AM
Gastroenterology q5 cingulate.gyrus USMLE Step 3 Forum 2 05-19-2013 01:27 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)