nbme2 block2 - munmun

[ArchivalUser]

An obese 33-year-old woman has had four 12-hour
episodes of
severe, sharp, penetrating pain in the right upper
quadrant of the abdomen
associated with vomiting but no fever. She has no
diarrhea, dysuria, or
jaundice and is asymptomatic between episodes. There
is slight
tenderness to deep palpation in the right upper
quadrant. Which of the
following is the most appropriate next step in
diagnosis?

A
) Supine and erect x-ray films of the abdomen

B
) Upper gastrointestinal series

C
) Ultrasonography of the upper abdomen

D
) CT scan of the abdomen

E
) HIDA scan of the biliary tract

[ArchivalUser]

it's C

[ArchivalUser]

agree ..c) ultrasound

the case looks like acute cholecystitis

[ArchivalUser]

it is BILIARY COLIC..pt doesn't hav fever,intermittent pain..,jaundice

ans wud be EE HIDA scan for next step diagnosis.....


anyone correct me if am wrong..

[ArchivalUser]

sry i meant pt hav only intermittent pain.no fever, no jaundice.

[ArchivalUser]

C
) Ultrasonography of the upper abdomen

[ArchivalUser]

ok thanks..agree C.

[ArchivalUser]

C.......ultrasound......the patient does have biliary colic.......as no fever, and the tenderness is only mild.....will be offered an elective cholecystectomy if gallstones r identified

for acute cholecystitis......there will just be fever, RUQ pain, Murphys sign positive, and leukocytosis......

charcots triad ie fever RUQ pain and jaundice is for acute ascending cholangitis.......can also have reynolds pentad (AMS and hypotension)

[ArchivalUser]

ALways start w/ the most economic and highest sensitivity test