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Discussion Starter · #1 ·
A 50 yrs patient presents with pain in left mid quadrant of abdomen that radiates to left lower quadrants and mid lower abdomen . He has 10 years history of crohns disease , he has no other findings .. What is the next step for the condition of this patient ......
a. colonoscopy
b. helical CT with out contrast
c. barium enema
d. endoscopy
e. CT with contrast
 

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Howdy

*woops, was thinking very Step 1 like.. Didn't notice this was the Step 2 forum (thanks google). but my comment still stands...* :)

Ahem, excuse me if I offend but where did you get this question from? Seems poorly written when compared to other sourcse, such as wikitestprep, usmleworld, usmlerx, Kaplan or NBME in terms of academia/learning potential.

If you know he has Crohn's, why such studies? Just think of Crohn's potential complications, such as fistulas, malabsorption consequences, Colon cancer etc... none of the answer choices really solve any of the issues there, considering the diagnosis is already made.

By the way, choice A and Choice E are the same thing. Of course you can specify where the point of entry is (mouth vs anus) to truly and accurately signify a difference.

Helical? Why helical? Standard is fine.

Barium? to detect fistulas? Perhaps, but trust in your clinical picture observation first, i.e infection, peritonitis, air in organs that dont have air in em (gallbladder), etc... CT with contrast? Same thing, why, why, why?

Thats why I ponder on where you got this question from, and why you post it for others... If you are trying to learn more, I applaud you. If you post it so we can help you on your homework, then... I have other things to think about.

Take it easy and much luck.

Cheers
-RM
 

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Discussion Starter · #3 ·
lols , ...... its not the whole ques ... i made it short ...... its seems very easy ... but ans is in this 2 lines of ques .. but of course u need to think deeply ....
I have good explanation for this ques , for that reason i shared as a discussion ........ Its simple
 

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I agree with dr. laithbv. The fact that this pt suffers from CD over a long period is both helpful and distracting. It's helpful, because it indicates this pt's tendency to develop calcium oxalate stones through the urinary system, a scenario that is compatible to the distribution of pain troughout the course of the left ureter. At the same time, one may focus on Crohn's disease itself, not give much attention to the pain (considering that it is part of the intestinal syndrome), and thus miss the differential of urinary stones.

With these arguments in mind, I think that the correct answer is hCT without contrast (b); this is the only imaging study among the rest that can prove the existence a urinary calculus.
 

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Discussion Starter · #7 ·
I agree with Dr. Laithbv too , you are absolutely right .... Its Oxalate stone of kidney ..
Mainly in intestine oxalate bind with calcium and excrete , but due to malabsorption of fat and fat soluble vitamin , calcium binds( req fat soluble vit D to absorb ) with fat which causes free oxalate in gut that absorb easily and causes oxalate stone , stone in kidney usually presents with flank pain radiates to groin and suprapubic area ( which are written in ques as a location of quadrant of abdomen) ... Kidney stone are usually diagnose with helical / spiral CT scan without contrast ( contrast usually used to see mass , abscess , tumour ) ...

When i did that ques , i picked up colonoscopy ... It true Dr. ath.pantelis , CD is most helpful and distracting point in this ques ......
 

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good learning point

Hm! Not a straight forward as I thought when I read the question.

Would you go for -Ba study or colonoscopy if for example this patient had Crohn's complications like obstruction or fistula? What do you think FSUSTC?

Good learning point

Thanks
 

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Thanks for posting FS. I appreciate the review. I had already done this question, but I still didn't catch the diagnosis the second time around...

I guess this just reinforces my studying motto: rinse, repeat, review :happy:
 
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