USMLE Forum Archives - USMLE Step 2 CK - GI - Abdominal pain
GI - Abdominal pain
InSitu - 07-07-09 02:04 Bookmark and Share

A 13-year-old male comes to the emergency room with a one-day history of nausea and vomiting. He says that yesterday, he began having pain around his belly button and skipped dinner. Today, he felt nauseated. His mother thought he had a fever and kept him home from school. He says the pain moved to his right lower quadrant and, "it hurts there when I press it." On exam, he shows rebound tenderness and guarding in his right lower quadrant, 1/3 of the way between the right iliac crest and the umbilicus. A CBC shows an elevated white blood cell count to 14.2. What is the most appropriate next step?






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#1
Re: GI - Abdominal pain
bingousmle - 07-07-09 06:56

My answer is: a.

#2
Re: GI - Abdominal pain
drbasim - 07-07-09 12:39

My answer is: b.

#3
Re: GI - Abdominal pain
omojesu - 07-08-09 02:17

My answer is: b.


this is appendicitis so no need to further do additional test,go to mgt,which is debatable.

#4
Re: GI - Abdominal pain
crazyserb - 07-08-09 12:09

My answer is: b.

#5
Re: GI - Abdominal pain
conym5 - 07-09-09 09:31

BBB

#6
Re: GI - Abdominal pain
calypso - 07-09-09 20:49

My answer is: b.

#7
Re: GI - Abdominal pain
socrate - 07-10-09 11:34

My answer is: e.

#8
Re: GI - Abdominal pain
hameedkhatti - 07-12-09 11:25

My answer is: b.

#9
Re: GI - Abdominal pain
conym5 - 07-14-09 09:34

ans:AAA
If its only Appendicitis.. there ll be Pain from epigastrium , radiates to RLQ later.
But here rebound tenderness and guarding in his right lower quadrant...indicates something beyond that..may be Appendicular rupture,so Antibiotics to cover gram-negative organisms is the appropriate answer i guess

#10
Re: GI - Abdominal pain
ysemak - 07-14-09 16:57

My answer is: b.


that is a classical appendicitis

#11
Re: GI - Abdominal pain
adipocito - 07-18-09 07:33

My answer is: e.

#12
Re: GI - Abdominal pain
ramya123 - 07-19-09 02:18

My answer is: e.

#13
Re: GI - Abdominal pain
84ahsan - 07-19-09 10:30

My answer is: e.

#14
Re: GI - Abdominal pain
rockhill - 07-21-09 22:17

My answer is: b.

#15
Re: GI - Abdominal pain
xmfever - 07-21-09 23:19

My answer is: b.

#16
Re: GI - Abdominal pain
zkadhem - 07-22-09 14:19

My answer is: e.

#17
Re: GI - Abdominal pain
drsadia - 07-23-09 09:46

My answer is: b.

#18
Re: GI - Abdominal pain
graviton - 07-23-09 16:46

My answer is: b.

#19
Re: GI - Abdominal pain
usmlefever3 - 07-24-09 08:49

My answer is: a.

#20
Re: GI - Abdominal pain
chahinezr - 07-24-09 16:50

My answer is: c.

#21
Re: GI - Abdominal pain
mkinio - 07-24-09 21:18

My answer is: e.

#22
Re: GI - Abdominal pain
bahaeldin77 - 07-25-09 04:44

My answer is: b.


this is a clinical diagnosis

#23
Re: GI - Abdominal pain
hardas13 - 08-03-09 12:55

My answer is: b.

#24
Re: GI - Abdominal pain
neetzmathai123 - 08-05-09 06:55

My answer is: b.

#25
Re: GI - Abdominal pain
lugupa2005 - 08-05-09 23:57

My answer is: b.

#26
Re: GI - Abdominal pain
soyyodotcom - 08-14-09 13:52

My answer is: a.

#27
Re: GI - Abdominal pain
qingjie87 - 08-14-09 14:49

My answer is: e.

#28
Re: GI - Abdominal pain
doczuzu - 08-14-09 16:05

My answer is: b.

#29
Re: GI - Abdominal pain
drusmleworld - 08-19-09 07:54

My answer is: a.

#30
Re: GI - Abdominal pain
dinmenace - 08-21-09 01:16

My answer is: e.

#31
Re: GI - Abdominal pain
surendra - 08-21-09 11:26

My answer is: e.

#32
Re: GI - Abdominal pain
burova - 08-21-09 19:15

My answer is: b.

#33
Re: GI - Abdominal pain
docraj - 08-21-09 22:10

My answer is: e.

#34
Re: GI - Abdominal pain
rasay1983 - 08-26-09 14:18

My answer is: b.

#35
Re: GI - Abdominal pain
grantyh - 08-27-09 11:08

My answer is: b.

#36
Re: GI - Abdominal pain
wahwah - 08-29-09 07:46

My answer is: e.

#37
Re: GI - Abdominal pain
pvaswani21 - 08-29-09 11:06

My answer is: b.

#38
Re: GI - Abdominal pain
jianyingfang2008 - 08-31-09 17:26

My answer is: b.

#39
Re: GI - Abdominal pain
dranu78 - 09-08-09 04:23

My answer is: b.

#40
Re: GI - Abdominal pain
mtniharika - 09-09-09 15:21

My answer is: b.

#41
Re: GI - Abdominal pain
alein2009 - 09-10-09 06:38

My answer is: b.

#42
Re: GI - Abdominal pain
mangesh - 09-10-09 12:15

My answer is: e.

#43
Re: GI - Abdominal pain
tvaqar - 09-14-09 17:50

My answer is: c.

#44
Re: GI - Abdominal pain
tvaqar - 09-14-09 17:52

CT scan is only useful for doubtful cases of appendicitis; otherwise go straight for appendectomy based on the clinical assessment alone.

#45
Re: GI - Abdominal pain
saurabhsingh - 09-16-09 13:20

My answer is: e.

#46
Re: GI - Abdominal pain
lakreol - 09-16-09 22:08

My answer is: b.

#47
Re: GI - Abdominal pain
pattusanju - 09-17-09 15:15

My answer is: b.

#48
Re: GI - Abdominal pain
obafemi - 09-20-09 17:44

My answer is: d.

#49
Re: GI - Abdominal pain
afinaish - 09-21-09 05:12

My answer is: b.

#50
Re: GI - Abdominal pain
reksarma - 09-23-09 09:16

My answer is: b.

#51
Re: GI - Abdominal pain
amaniagz - 10-02-09 07:43

My answer is: b.

#52
Re: GI - Abdominal pain
vernette - 11-07-09 18:23

My answer is: b.

#53
Re: GI - Abdominal pain
rawa3h - 11-13-09 16:05

My answer is: e.

#54
Re: GI - Abdominal pain
tonion - 11-16-09 13:52

My answer is: b.

#55
Re: GI - Abdominal pain
dadukids - 12-05-09 08:37

My answer is: e.

#56
Re: GI - Abdominal pain
tianjin - 12-06-09 03:34

My answer is: e.

#57
Re: GI - Abdominal pain
medusmle01 - 12-21-09 07:49

My answer is: b.

#58
Re: GI - Abdominal pain
demolition - 12-21-09 09:41

My answer is: b.

#59
Re: GI - Abdominal pain
jordanrobin - 12-31-09 13:50

My answer is: b.

#60
Re: GI - Abdominal pain
nidayasir - 01-01-10 05:37

My answer is: e.

#61
Re: GI - Abdominal pain
drthapa - 01-01-10 08:51

My answer is: b.

#62
Re: GI - Abdominal pain
zoah2005 - 01-01-10 11:13

My answer is: b.

#63
Re: GI - Abdominal pain
aaronhurowitz - 01-01-10 12:20

My answer is: b.

#64
Re: GI - Abdominal pain
roazaher - 01-03-10 04:12

My answer is: c.

#65
Re: GI - Abdominal pain
pat2005 - 01-09-10 12:07

My answer is: b.

#66
Re: GI - Abdominal pain
oldman - 01-11-10 05:49

My answer is: b.

#67
Re: GI - Abdominal pain
agshaikh - 01-29-10 18:25

My answer is: b.

#68
Re: GI - Abdominal pain
agshaikh - 01-29-10 18:25

b

#69
Re: GI - Abdominal pain
tamaramahmood - 02-01-10 21:21

My answer is: b.

#70
Re: GI - Abdominal pain
tahiraraees - 02-07-10 02:26

My answer is: b.

#71
Re: GI - Abdominal pain
medicoholic - 02-07-10 08:36

My answer is: b.

#72
Re: GI - Abdominal pain
vaishali - 02-07-10 08:56

My answer is: b.

#73
Re: GI - Abdominal pain
shahra - 02-17-10 00:50

My answer is: b.

#74
Re: GI - Abdominal pain
nothing - 02-20-10 03:44

My answer is: c.

#75
Re: GI - Abdominal pain
hind708 - 03-04-10 07:29

My answer is: b.

#76
Re: GI - Abdominal pain
joseph - 03-04-10 09:56

My answer is: b.


my answer is b.

#77
Re: GI - Abdominal pain
manny1964 - 03-05-10 01:37

My answer is: b.

#78
Re: GI - Abdominal pain
gill2010 - 03-05-10 11:52

My answer is: b.

#79
Re: GI - Abdominal pain
dreguieg - 03-06-10 21:46

My answer is: b.

#80
Re: GI - Abdominal pain
pawan238 - 03-09-10 04:04

My answer is: e.

#81
Re: GI - Abdominal pain
noor2007 - 03-09-10 05:08

My answer is: e.

#82
Re: GI - Abdominal pain
ammulufy - 03-13-10 19:15

My answer is: b.


Its a classic prsntn of acute appendicitis with the pain frst prsnting in the periumbilical region n den radiating to Mc Burney's point......hence the patient immediately shud b taken up for appendicectomy.

#83
Re: GI - Abdominal pain
babsin - 03-14-10 07:51

My answer is: b.

#84
Re: GI - Abdominal pain
therockbigfight - 04-30-10 15:51

My answer is: e.

#85
Re: GI - Abdominal pain
zienab - 04-30-10 17:04

My answer is: e.


to sure that these symptom of appendicitis,then when we sure ,we can do appendectomy

#86
Re: GI - Abdominal pain
saraabdelaal - 05-01-10 01:28

My answer is: b.


because abdomen pain shift to the right, nausia and vomiting, fever, rebounnd tenderness ang guardin on the right loer quadrant ,elevated WBCs

#87
Re: GI - Abdominal pain
kutilik - 05-01-10 08:23

My answer is: b.

#88
Re: GI - Abdominal pain
zubiashoaib - 05-02-10 20:32

My answer is: b.

#89
Re: GI - Abdominal pain
fugeran - 05-03-10 11:50

My answer is: b.

#90
Re: GI - Abdominal pain
babbu5508 - 05-21-10 02:48

My answer is: b.


with the classical features of an acute appendicitis, shifting of pain to RIF,fever,nausea,tenderness,blumberg sign...appendicectomy is the next step...

#91
Re: GI - Abdominal pain
samyou - 05-25-10 23:22

My answer is: b.

#92
Re: GI - Abdominal pain
luckyveda - 05-28-10 14:20

My answer is: b.

#93
Re: GI - Abdominal pain
residencyrace - 05-29-10 11:30

My answer is: c.

#94
Re: GI - Abdominal pain
chowdhury84 - 12-25-11 20:50

My answer is: b.

#95
Re: GI - Abdominal pain
juniapapillon - 12-25-11 22:33

My answer is: e.

#96
Re: GI - Abdominal pain
angelgonz24 - 12-26-11 01:04

My answer is: c.

#97
Re: GI - Abdominal pain
paresha - 02-01-12 18:31

My answer is: b.

#98
Re: GI - Abdominal pain
medical1212 - 02-02-12 09:06

My answer is: b.

#99
Re: GI - Abdominal pain
drmanoj - 02-08-12 07:01

My answer is: c.

#100
Re: GI - Abdominal pain
shaiza - 03-31-12 21:02

My answer is: b.

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