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git q -
#1
abrar

A 42-year-old woman presents to the emergency room complaining of the sudden onset of right upper abdominal pain. Her pain started after she ate a hamburger for lunch. She is nauseated and vomited twice at home. She denies diarrhea. Her temperature is 102.2°F, blood pressure is 140/90 mmHg, and pulse is 110/min. She appears anxious and distressed. She is not jaundiced. Abdominal examination reveals normal bowel sounds. While you are palpating under her right costal margin, the patient abruptly arrests her inspiration and pulls away because of sharp pain. Which of the following is the most appropriate next step in management?

A. Abdominal radiograph
B. Ultrasound of the abdomen
C. HIDA scan
D. MRI of the abdomen
E. Upper endoscopy
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#2
river

B?
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#3
Sunny

Its B- USG abdomen to r/o A. Cholecystitis.
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#4
rew

B? pain due to? fever 102 due to?
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#5
angel

usscan
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#6
abrar

Thanks for replying.
This is a usmleasy q.
I too thought the ans would be USG first for Ac Cholecystitis.....but the ans is C...HIDA scan.
Any comments.
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#7
lipas

not obvious cholecystitis are detected by HIDA scan...am i right?
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#8
Sunny

Interesting, I always thought that USG will be first before any invasive HIDA scan. I think I will still go for USG abndomen.
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#9
dude

HIDA is used for the defining of biliary tract,especiallin when you are suspecting stones.In kaplan,he clearly mentions that its very difficult to find stones on an USG.I would imply from the vignette that since the diagnosis of a cholecystitis is not much in doubt, and its more important to deduce the cause for the progressive jaundice.hence,HIDA looks to be right.Maybe i would have put USG too, but ....HIDA looks to be a better option
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