WBR0003

Author	PageAuthor::
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Gastrointestinal, SubCategory::Gastrointestinal
Prompt	[[Prompt::A 56-year-old man comes to the health clinic with complaints of constant epigastric pain. He states he has a history of gastrointestinal ulcers and that this occurrence "feels like an ulcer." He reports taking a 2-week course of medication several years ago but can't remember the medication names. While waiting for results, the patient's condition rapidly deteriorates. He suddenly complains of severe pain in the epigastrium and turns pale. His blood pressure acutely rises and he becomes tachycardic. What is the best imaging study for diagnosis of the most likely condition?]]
Answer A	AnswerA::Lateral decubitus chest x-ray.
Answer A Explanation	AnswerAExp::
Answer B	AnswerB::Plain upright chest x-ray.
Answer B Explanation	AnswerBExp::
Answer C	AnswerC::CT scan abdomen.
Answer C Explanation	AnswerCExp::
Answer D	AnswerD::Ultrasound abdomen.
Answer D Explanation	AnswerDExp::
Answer E	AnswerE::Emergency EGD investigation.
Answer E Explanation	AnswerEExp::
Right Answer	RightAnswer::B
Explanation	[[Explanation::This patient exhibits signs of acute ulcer perforation. As this is a surgical emergency, fast and accurate testing is very important; thus plain upright chest x-ray is preferred. This will commonly show free air concentrated under the diaphragm. Educational Objective: References: ]]
Approved	Approved::No
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