USMLE Forum Archives - USMLE Step 2 CK - Question
Question
Sarahhh - 12-18-06 14:05
a 34 year old man is brought to the emergency department after being involved in a motor vehicle collision. he was the restrained front passenger. he has had epigastric pain since the accident. He is hemodynamically stable and has no obvious injury or complaint other than epigastric pain. An X ray film of the abdomen shows retroperitoneal air. Which of the following is the most appropriate test to confirm the diagnosis?
a) plain CT scans of abdomen
b) Diagnostic peritoneal lavage
c) Exploratory laparotomy
d) CT scans of abdomen with oral contrast
e) USG of abdomen
Sarahhh - 12-18-06 14:05
a 34 year old man is brought to the emergency department after being involved in a motor vehicle collision. he was the restrained front passenger. he has had epigastric pain since the accident. He is hemodynamically stable and has no obvious injury or complaint other than epigastric pain. An X ray film of the abdomen shows retroperitoneal air. Which of the following is the most appropriate test to confirm the diagnosis?
a) plain CT scans of abdomen
b) Diagnostic peritoneal lavage
c) Exploratory laparotomy
d) CT scans of abdomen with oral contrast
e) USG of abdomen
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#4
Re: Question
Sarahhh - 12-18-06 16:21 yeah its D..duodenal injuries are best diagnosed with a CT scan of the abdomen with oral contrast.
#6
Re: Question TheOne - 12-19-06 21:21 CT with contrast??? what!!!
But we will end up with chemoperitonium beside the already ongoing hemoperitonium.
Clinically, we usually check the patient with U/S, if nothing, we immediatly send'em to the CT room...
#7
Re: Question Brainlab - 12-19-06 22:05 Why have you decided that patient has hemoperitonium?
He has retroperitoneal air.
#8
Re: Question TheOne - 12-20-06 11:47 ok, where did the air come from??? "Perforated Viscus"
if i gave him contast, won't it leak through this area of disrupted mucosal lining and eventually add to the problem???
#9
Re: Question Sarahhh - 12-20-06 12:06 Retroperitoneal air or obliteration of right psoas margin on abdominall xray is very suggestive of a duodenal injury. CT scan of the abdomen , with administration of oral contrast material confirms the diagnosis of duodenal injuty. If CT scan is not available then upper GI study with gastrograffin , and if negative, barium can be used.
choice A and E : Plain CT scan of the abdomen and USG are not sensitive for duodenal injuries, though they would diagnose the associated injuries.
choice B : DPL is not sensitive for duodenal injuries as the second part of the duodenum is the most commonly injuried portion and is retroperitoneal.
choice C: the patient is hemodynamically sable with no signs of penetrative abdominal injury, so exploratory lap is not needed.
#12
Re: Question TheOne - 12-24-06 13:18 Retroperitoneal air or obliteration of right psoas margin on abdominall xray is very suggestive of a duodenal injury.
#14
Re: Question babbu5508 - 07-06-10 22:47 d) CT scans of abdomen with oral contrast...best test for suspected hollow viscus perforation in the abdomen....so my answer id d
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