NBME Step 2 CK Form 6 Gram stain of abdominal fluid (NBME Answers)

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Retired NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 1/Question#43 (reveal difficulty score)
A 70-year-old woman has had increasing ...
Gram stain of abdominal fluid 🔍 / 📺 / 🌳 / 📖
tags: renal GI

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submitted by ∗sugaplum(487)

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she has peritonitis, a known complication of peritoneal dialysis. We want to know what the bug is. so gram stain to direct treatment appropriately

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lindasmith462 ugh this is a dumb question. the dx of peritonitis (and thus empiric abx tx) is based on the leukocytes (>100 or >50% PMNs). the gram stain NOT used to determine whether to treat or not, and is usually negative. you basically just get it w/ white count and culture because if it is positive it can help direct abx tx but as far as the question is concerned we dont even have enough info to decide IF we're treating dialysis related peritonitis. +2

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submitted by ∗step_prep7(71)

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Patient with ascites who presents with diffuse abdominal pain/tenderness + fever + leukocytosis = Spontaneous bacterial peritonitis
Diagnosis of SBP is actually typically made after paracentesis if the ascitic fluid has >250 PMNs (neutrophils) per mL
Although we often think of Spontaneous Bacterial Peritonitis (SBP) as being a disease exclusively seen in patients with cirrhosis, in reality it can affect patients with any conditions that lead to ascites (fluid in the abdomen), with patients who undergo peritoneal dialysis being at higher risk given the fact that significant opportunities for contamination during catheter exchanges, etc.

https://step-prep.org/tutoring/

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submitted by lubdub(14)

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This one irked me. Of course you'll start with ultrasound to find you fluid pocket to get the sample to look for bacterial peritonitis...

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jlbae They already have the fluid collected, just need to stain it and put it under the microscope. No need for imaging. +2

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