View source for WBR0526

{{WBRQuestion
|QuestionAuthor={{M.P}}
|ExamType=USMLE Step 3
|MainCategory=Emergency Room
|SubCategory=Gastrointestinal
|MainCategory=Emergency Room
|SubCategory=Gastrointestinal
|MainCategory=Emergency Room
|SubCategory=Gastrointestinal
|MainCategory=Emergency Room
|MainCategory=Emergency Room
|SubCategory=Gastrointestinal
|MainCategory=Emergency Room
|SubCategory=Gastrointestinal
|MainCategory=Emergency Room
|SubCategory=Gastrointestinal
|MainCategory=Emergency Room
|SubCategory=Gastrointestinal
|MainCategory=Emergency Room
|MainCategory=Emergency Room
|SubCategory=Gastrointestinal
|Prompt=A 71 yr old male comes to the emergency department with severe epigastric pain and vomiting.  His past history is insignificant with no surgery and medications intake.  He doesn’t smoke or consume alcohol.  He denies any bloody vomit, constipation, diarrhea and black stools.  On examination pulse is 92/min and BP is 110/80 mmHg.  Abdomen is tender.  Cardiovascular and respiratory examinations are normal.  Lab investigations show hemoglobin and hematocrit of 13 g/dl and 36, respectively, Na:142 mEq/L, K : 3 mEq/L,  Cl: 105 mEq/L, Bi: 24 mEq/L, BUN:  mg/dl, glucose: 170 mg/dl and Ca: 10mg/dl and elevated amylase and lipase levels.  WBC count is 16,000/mm3, AST 200 IU/L and LDH 350 IU/L. Which of the following admission criteria is indicative of severe attack in this patient?
|Explanation=[[Ranson criteria]] for [[gallstone]] [[pancreatitis]] severity: 

At admission: 
1.	Age in years > 70 years 
2.	[[White blood cell count]] > 18000 cells/mm3 
3.	[[Blood glucose[[ > 12.2 mmol/L (> 220 mg/dL) 
4.	Serum [[AST]] > 250 IU/L 
5.	Serum [[LDH]] > 400 IU/L 

At 48 hours: 
1.	[[Hematocrit]] fall > 10% 
2.	[[Calcium]] (serum calcium < 2.0 mmol/L (< 8.0 mg/dL) 
3.	Oxygen ([[hypoxemia]] PO2 < 60 mmHg) 
4.	[[BUN]] increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration 
5.	Base deficit (negative base excess) > 5 mEq/L 
6.	Sequestration of fluids > 4 L 

|AnswerA=Hypokalemia


|AnswerAExp='''Incorrect''' : [[Hypokalemia]] are not considered as significant prognostic factor.
|AnswerB=Elevated AST

|AnswerBExp='''Incorrect''' : Serum AST > 250 IU/L is a prognostic indicator at the admission time and this patient has lower values of AST.
|AnswerC=Older age

|AnswerCExp='''Correct''' : Age in years > 70 years meets the Ransons prognostic criteria in this patient.
|AnswerD=Elevated LDH

|AnswerDExp='''Incorrect''' : Serum LDH > 400 IU/L is a prognostic indicator at the admission time and this patient has lower values of LDH.
|AnswerE=Elevated WBC
|AnswerEExp='''Incorrect''' : White blood cell count > 18000 cells/mm3 is a prognostic indicator at the admission time and this patient has lower WBC count .
|RightAnswer=C
|WBRKeyword=Ranson criteria, Pancreatitis
|Approved=Yes
}}