USMLE Step 2 CK - #1
#1
bingousmle - 10-24-08 01:33
A 54-year-old male presents with a high fever, jaundice, and colicky abdominal pain in the right upper quadrant. The gallbladder cannot be palpated on physical examination. Workup reveals a hemoglobin level of 15.3 g/dL, unconjugated bilirubin level of 0.9 mg/dL, conjugated bilirubin level of 1.1 mg/dL, and alkaline phosphatase level of 180 IU/L.
bingousmle - 10-24-08 01:33
A 54-year-old male presents with a high fever, jaundice, and colicky abdominal pain in the right upper quadrant. The gallbladder cannot be palpated on physical examination. Workup reveals a hemoglobin level of 15.3 g/dL, unconjugated bilirubin level of 0.9 mg/dL, conjugated bilirubin level of 1.1 mg/dL, and alkaline phosphatase level of 180 IU/L.
Page 1
[Refresh]
#4
Re: #1
bingousmle - 10-24-08 08:55 Patients with obstruction of the CBD present clinically with Charcot's triad, which consists of biliary colic, high fever (secondary to cholangitis), and jaundice. Jaundice secondary to extrahepatic obstruction is associated with normal hemoglobin levels, normal serum indirect bilirubin levels, and increased levels of direct bilirubin and alkaline phosphatase. Common causes of obstruction of the common bile duct include cancer in the head of the pancreas and obstruction by a gallstone. Clinically, these two can be differentiated using Courvoisier's law, which states that in a patient with obstructive jaundice, the presence of a palpable gallbladder is indicative of obstruction due to a cancer of the head of the pancreas. This is because the obstruction causes the gallbladder to dilate. In contrast, most patients with gallstones have cholecystitis, which is associated with a thickened gallbladder wall that prevents the gallbladder from dilating. Therefore, if the obstruction is due to a gallstone, the gallbladder will not dilate and will not be palpable. Cholecystitis (inflammation of the gallbladder) may be either an acute or a chronic response. In acute cholecystitis, which may be associated with a stone (calculous type) or lack a stone (acalculous type), there is an acute inflammatory response that consists mainly of neutrophils. Acute cholecystitis usually presents with right upper quadrant pain and may constitute a surgical emergency. Chronic cholecystitis, which is associated with stones in more than 90% of cases, has a variable histologic appearance, but findings include a thickened muscular wall, scattered chronic inflammatory cells (lymphocytes), and outpouchings of the mucosa (Rokitansky-Aschoff sinuses).
#5
Re: #1 sackatdoc - 10-25-08 07:19 how will you explain raised alkaline po4 in acute cholecystitis, i think cholangitis is the right answer coz it cause derranged liver enzymes with the above mentioned triad, Remmeber Haider ATTENTION!!! that scared you.
#6
Re: #1 bingousmle - 10-25-08 07:28 ya the answer is obstruction of the cbd, thats what i have written in the explanatory note.... by the way what is it about attention.. i seem to have missed the thread
#7
Re: #1 sackatdoc - 10-25-08 07:34 YEAH, probably you have joined after your step1, am i right?how was it? i remember you thru step1
about attention, one day haider answered this triad with some other disease and niusha said, attention which scared haider, dont know for some funny reasons he had with this word.
#8
Re: #1 bingousmle - 10-25-08 07:43 no i am not done with my step one yet. my internship is hecctic. plus now when i want to plan it in jan i am stuck with my ECFMG id
#9
Re: #1 sackatdoc - 10-25-08 07:47 still stuck!!!!, you didnt call them?what did they say?what is the cause of non-issuance??
internship is great time to take steps, good luck
#10
Re: #1 bingousmle - 10-25-08 08:04 i am kind of an impatient person, their line is continuously busy, have given my third try, lets see.dont you think it is weird that three people are facing the same problem at this time
#11
Re: #1 sackatdoc - 10-25-08 08:17 if three people are facing same problem, then it isnt wierd, coz then there is a geniune difficulty, so just try ansd be patient, these months are worst for calling or even mailing ECFMG coz they they are damn busy with everything right from receiving documents to uploading to answering match and application queries!!
#12
Re: #1 bingousmle - 11-25-08 14:31 hi sackatdoc. how are you. long time that your mindteasers were seen..
i finally got my id no. !!!
#13
Re: #1 sackatdoc - 11-25-08 23:45 congratulations,bingo, go and rock your exams now, show them how great you are!!!
#14
Re: #1 bingousmle - 11-26-08 00:24 i am nowhere close to great, dear, still need to put a lot of efforts, hope you will be seen henceforth , to support and guide, need that like anything!!
#15
Re: #1 sackatdoc - 11-26-08 00:43 at your service my friend,am always here, just you have to to look around a little,time after time.
Page 1
[Refresh]