WBR0523

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 40 yr old male comes to the emergency department with severe epigastric pain and vomiting. His past history is significant for similar episodes last year. He is a smoker and admits drinking heavily over the past 1 month. He denies any bloody vomit, dizziness and black stools. On examination pulse is 92/min and BP is 110/80 mmHg. Abdomen is tender with marked rigidity and decreased bowel sounds. Cardiovascular and respiratory examinations are normal. Initial lab investigations show hemoglobin and hematocrit of 12.3 g/dl and 36.5, respectively, Na:135 mEq/L, K : 3.6 mEq/L, Cl: 104mEq/L, Bi: 24 mEq/L, BUN: 40 mg/dl, glucose: 170 mg/dl and Ca: 10mg/dl and elevated amylase and lipase levels. The patient is treated with analgesics and IV fluids. After 48 hrs you assess the patient’s status. Which of the following lab values at this point would be ab indicator of severe prognosis in this patient?]]
Answer A	[[AnswerA::Serum calcium > 11 mg/dl]]
Answer A Explanation	AnswerAExp::'''Incorrect''' : Hypocalcemia is an indicator of severity of acute pancreatitis but not hypercalcemia.
Answer B	[[AnswerB::Blood glucose > 200mg/dl]]
Answer B Explanation	[[AnswerBExp::Incorrect : Blood glucose > 11 mmol/L (>200 mg/dL) is an indicator of severity at the time of admission and not at 48 hours.]]
Answer C	AnswerC::WBC 14000/mm3
Answer C Explanation	[[AnswerCExp::Incorrect : White blood cell count > 16000/mcL is an indicator of severity at the time of admission and not at 48 hours.]]
Answer D	AnswerD::BUN : 45 mg/dl
Answer D Explanation	AnswerDExp::'''Correct''' : Increase in BUN by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration which meets this patients lab findings.
Answer E	AnswerE::Hematocrit  : 35
Answer E Explanation	[[AnswerEExp::Incorrect : Haematocrit fall > 10% is an indicator of severity but this patient dint have > 10% fall.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::Ranson criteria is a clinical prediction rule for predicting the severity of acute pancreatitis. Parameters used: At admission: 1. Age in years >55years 2. White blood cell count > 16000/mcL 3. Blood glucose > 11 mmol/L (>200 mg/dL) 4. Serum AST > 250 IU/L 5. Serum LDH > 350 IU/L. After 48 hours: 1. Haematocrit fall > 10% 2. Increase in BUN by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration 3. Hypocalcemia (serum calcium < 2.0 mmol/L (<8.0 mg/dL)) 4. Hypoxemia (PO2 < 60 mmHg) 5. Base deficit > 4Meq/L 6. Estimated fluid sequestration > 6L. The criteria for point assignment is that a certain breakpoint be met at anytime during that 48 hour period, so that in some situations it can be calculated shortly after admission. It is applicable to both biliary and alcoholic pancreatitis. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Ranson criteria, WBRKeyword::Pancreatitis
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::