QBDOTW: A Obese 49-year-old, G3, P3 Female Patient
Welcome to MedSmarter’s USMLE Style Question Break Down of the Week. For those preparing for the USMLE Step 1, this week we break down a high-yield Gastrointestinal question. As always you want to begin with reading the last sentence of the vignette first to get an understanding of what the question is asking for.
Question Break Down of the Week:
An obese 49-year-old, G3, P3 woman presents to the physician with right upper quadrant pain and fever that was preceded by nausea and vomiting. Ultrasonography shows hyperechogenic structures in the right upper quadrant. Laboratory testing reveals a WBC count of 15,000/mm3, an erythrocyte sedimentation rate of 45 mm/hr., and a serum amylase level of 75 U/L. Which of the following is the most likely diagnosis in this patient?
A) Acute pancreatitis
B) Acute calculous cholecystitis
C) Carcinoma of the pancreas
E) Acute acalculous cholecystitis
The correct answer choice is B: Right upper quadrant pain in an obese, middle-aged, multiparous woman with ultrasonographic findings consistent with gallstones is a classic presentation of acute calculous cholecystitis. Acute calculous cholecystitis is an acute mechanical inflammation of the gallbladder commonly resulting from a gallbladder stone obstructing the gallbladder neck or cystic duct. Treatment if symptomatic is surgical removal. Risk factors are the “4F’s”: Female, “Fat,” Fertile, and Forty. Definitive treatment is cholecystectomy.
Did you think the answer was different?
Did you think that the correct answer choice was other than B? You can view this video for a deeper discussion of why A, C, D, and E were not the correct answer choices.
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