USMLE Forum Archives - USMLE Step 2 CK - IM 10
IM 10
TheOne - 11-06-06 12:46
A 70-year-old woman comes to the emergency department complaining of abdominal pain. She describes a dull, aching, constant pain in her mid-umbilical region. The pain has persisted over the past few days with increasing intensity, and it is not relieved by changes in position or eating. The patient has a past medical history significant for hypertension and coronary artery disease. She had a myocardial infarction 3 years ago. The woman has moderate peripheral vascular disease with a prior femoral-popliteal bypass graft on the left. On physical examination, her blood pressure is 180/100 mm Hg, and her pulse is 86/min. She has a loud S4, a pulsatile, midline abdominal mass and venous stasis changes bilaterally on her lower extremities. Which of the following is the most appropriate diagnostic test at this time?
A. Abdominal ultrasound (U/S)
B. Lumbosacral (L/S) spine films
C. CT of the spine
D. CT of the abdomen
E. Spinal MRI
TheOne - 11-06-06 12:46
A 70-year-old woman comes to the emergency department complaining of abdominal pain. She describes a dull, aching, constant pain in her mid-umbilical region. The pain has persisted over the past few days with increasing intensity, and it is not relieved by changes in position or eating. The patient has a past medical history significant for hypertension and coronary artery disease. She had a myocardial infarction 3 years ago. The woman has moderate peripheral vascular disease with a prior femoral-popliteal bypass graft on the left. On physical examination, her blood pressure is 180/100 mm Hg, and her pulse is 86/min. She has a loud S4, a pulsatile, midline abdominal mass and venous stasis changes bilaterally on her lower extremities. Which of the following is the most appropriate diagnostic test at this time?
A. Abdominal ultrasound (U/S)
B. Lumbosacral (L/S) spine films
C. CT of the spine
D. CT of the abdomen
E. Spinal MRI
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#1
Re: IM 10 kingkong - 11-06-06 20:46 ABDOMINAL ULTRASOUND SHOULD BE DONE AT THIS STAGE. AORTIC ANEURYSM IS EASILY PICKED UP BY ABDOMINAL U/S.
#2
Re: IM 10
TheOne - 11-09-06 12:48 Explanation: The correct answer is A. Abdominal ultrasound (U/S) is the most cost-effective screening test for a suspected abdominal aortic aneurysm (AAA). A CT of the abdomen (choice D) with IV contrast is about twice as expensive as U/S, adds little if any benefit, and exposes the patient to unnecessary radiation.
The other choices, lumbosacral (L/S) spine film (choice B), CT of the spine (choice C), and spinal MRI (choice E) are imaging studies directed at evaluating spinal pathology, which is not suspected here. MRI provides the highest resolution and is useful for detecting abscesses or cord compression. CT is excellent for disk pathology and even bone pathology. Plain radiographs are useful for very gross visualization of the bony density and integrity.
#4
Re: IM 10 bingousmle - 07-21-10 01:20 nice question.. the best tool to screen for the presence of abdominal aortic aneurysm as is suggested by this case is ultrasound of the abdomen
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