vradojc1
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I was doing Kaplan qBook and stumbled upon question where a patient with a history of peptic ulcer presents with acute abdominal pain with rigidity and rebound tenderness. She has no fever/nausea/vomiting/diarrhea. She is only tachycardic in addition to above findingsq was "the most appropriate next step in management".
And their answer was - upright chest x-ray?
Although notes state that it confirms the Dx, is that what you'd do next?
I opted for laparotomy and, of course, missed the answer.
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| Justice
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Yes, upright abdominal XR - free air will be diagnostic...
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| vradojc1
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X-rays will be diagnostic, but all generalized acute abdomens have the same sequence - laparotomy without need to look for a specific Dx. And especially in the case where there is high suspicion of perforated ulcer, what benefit does X-ray provide us with? If it's negative, patient is still going to end on the operating table.
Makes no sense
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| Aashi
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Well i agree with u vradocj1----->but u shld know that we dont open up anybody or do a surgery( MOST INVASIVE) without doing the LEAST INVASIVE preliminary testing ,say a xray,and matter of fact is that all the case i have seen in pts coming to ER, with suspected ruptured PUD or say any cases of acute abdomen, will undergo abd xray in the ER------>and then they are referred to the surgeons------>so I am not surprised abt kaplans answer., and i think even UW and pretest ER q bank has similar qs, and answer is upright xray to chk free air under the diaphragm..
GL
Edited by Aashi on 04/27/07 - 06:06 PM
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| vradojc1
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I like how they state that go to OR without delay and without exceptions, and than give you all the exceptions.
LOL
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