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Kaplan Q bank Q

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cirus
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07/14/07 - 12:09 PM

A 44 years old bus driver comes to the emergency department complaining of sever abdominal pain. She reports that the pain started 8hrs ago after lunch at a fast food restaur. The pain became increasingly severe & radiates to the back, & she recalls a similar episode for 2hrs, 3 ms ago, & an earlier one lasting 12 hrs. She is febrile with a temp of 38.5 & has Right upper Quadrant pain & tenderness with deep palpation. Leukocyte is 12900, Hc 39%, & her total bilirubin is 2.1mg/dl.

Which of the following is the most appropriate diagnostic test?

1. CT abd & Pelvis

2. ERCP

3. HIDA scan

4. Percut transhepatic cholngiogram

5. Upper GI Barium study

young_doc
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07/14/07 - 12:29 PM

Acute chole? I would do U/S first... but since that's not an option, HIDA?

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cirus
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07/14/07 - 12:33 PM

ur right

but isn't Charcots triad---> Jaundice, Fever & Rt upper quad pain.

Why isn't this Cholangitis

young_doc
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07/14/07 - 12:37 PM

there is no jaundice here!

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cirus
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07/14/07 - 12:40 PM

oh God it just hit me now that there is NO jaundice before 3-3.5 so now its cholicyst

I just don't know what to do with this amnesia

Thanks,

dr19
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07/14/07 - 12:41 PM

ERCP ......cholangitis

dr19
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07/14/07 - 12:58 PM

cholangitis.....fever is present in95%of the pts,also hyperbilirubinemia
cholesystitis...nausea & vomiting are generally present

young_doc
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07/14/07 - 01:37 PM

cirus wrote:
oh God it just hit me now that there is NO jaundice before 3-3.5 so now its cholicyst

I just don't know what to do with this amnesia

Thanks,

your welcome smiling face

Just as long as have amnesia now, and not during the test!!!

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dr in trouble
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07/14/07 - 08:36 PM

To me it looks like acute pancreatitis, as pain is radiating to back while in cholecystitis the pain usualy radiates to tip of scapula.

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young_doc
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07/15/07 - 07:40 AM

#10

dr in trouble wrote:
To me it looks like acute pancreatitis, as pain is radiating to back while in cholecystitis the pain usualy radiates to tip of scapula.

Pain in cholecystitis can radiate to the back as well..

Also, Pancreatitis rarely presents with RUQ pain or RUQ-tenderness on deep palpation. It would usually present with epigastric or deep-epigastric pain.

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elitoki
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07/15/07 - 11:08 AM

#11

3. HIDA scan to rule out cholecystitis. The patient is forty, female with pain present after fatty food.

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