USMLE Forum Archives - USMLE Step 2 CK - Surgery 2
Surgery 2
TheOne - 02-23-07 17:56
A 60-year-old man comes to the emergency department because of abdominal pain. he states that the pain is sharp in nature, constant, nonradiating, unchanged with position, and does not improve with acetaminophen. he also complains of a low-grade fever with chills but no vomiting. he has had 1 similar episode in the past that required hospitalization and intravenous antibiotics. His temperature is 38 C (101 F), blood pressure is 120/70 mm Hg, and pulse is 110/min. On physical examination, he is diaphoretic and lying motionless. His abdomen is nondistended with decreased bowel sounds. There is tenderness with rebound and guarding in the left lower quadrant. White blood cell count is elevated. Which of the following is the most likely diagnosis in this patient?
A. Acute pancreatitis
B. Acute appendicitis
C. Pelvic inflammatory disease
D. Acute diverticulitis
E. Renal colic
TheOne - 02-23-07 17:56
A 60-year-old man comes to the emergency department because of abdominal pain. he states that the pain is sharp in nature, constant, nonradiating, unchanged with position, and does not improve with acetaminophen. he also complains of a low-grade fever with chills but no vomiting. he has had 1 similar episode in the past that required hospitalization and intravenous antibiotics. His temperature is 38 C (101 F), blood pressure is 120/70 mm Hg, and pulse is 110/min. On physical examination, he is diaphoretic and lying motionless. His abdomen is nondistended with decreased bowel sounds. There is tenderness with rebound and guarding in the left lower quadrant. White blood cell count is elevated. Which of the following is the most likely diagnosis in this patient?
A. Acute pancreatitis
B. Acute appendicitis
C. Pelvic inflammatory disease
D. Acute diverticulitis
E. Renal colic
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#2
Re: Surgery 2
TheOne - 03-01-07 18:25 thanx for the quick reply HIV, but guys... what do you think??
#3
Re: Surgery 2 TheOne - 03-07-07 08:46 The correct answer is D. Acute diverticulitis is one of the few inflammatory processes that gives acute abdominal pain in the left lower quadrant. Patients are middle-aged or older; there is fever, leukocytosis, physical findings of peritoneal irritation in the left lower quadrant, and sometimes a palpable mass. CT scan is diagnostic. Initial treatment is NPO, IV fluids, and antibiotics. Once the patient "cools down," they often require sigmoid resection.
Buzz Words: Middle-aged or older + Left lower Abd. pain + Fever (sometimes palpable mass).
#5
Re: Surgery 2 babbu5508 - 07-06-10 23:10 D. Acute diverticulitis depending on the age of presentation, localisation of tenderness to the left lower quadrant point to diagnosis
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