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Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 3/Question#43 (reveal difficulty score)
A 37-year-old woman with sickle cell disease ...
Acute cholecystitis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: GI HPB repeat

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submitted by โˆ—step_prep5(246)
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  • Patient with sickle cell disease presenting with fever, RUQ pain, mild scleral icterus and positive Murphy sign (specific for acute cholecystitis on NBME exams) with an ultrasound showing cholelithiasis and pericholecystic fluid, most consistent with acute cholecystitis
  • Key idea: Acute cholecystitis classically does NOT lead to jaundice or hyperbilirubinemia, but this patient has another reason to have jaundice because sickle cell disease โ€“> chronic hemolysis โ€“> unconjugated hyperbilirubinemia
  • Risk factors for cholesterol gallstones: Female, Fat, Forty, Fertile
  • Risk factors for bilirubin gallstones โ€“> Chronic hemolysis
  • Cholangitis โ€“> Negative Murphy sign, signs of cholestasis (alkaline phosphatase > ALT/AST), dilated common bile duct

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sahusema  In addition, cholangitis โ†’ cholestasis โ†’ โ†‘Alk phos. This patient has a normal alk phos +2
azibird  Goddamn, this comment is deep. I agonized over the jaundice, but this makes sense. Would have been easier if they gave the breakdown of total/direct +1



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submitted by โˆ—namesthegame22(13)
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DDx with acute pancreatitis = Acute pancreatitis (Choice A) presents with epigastric abdominal pain, nausea, and emesis, often in patients with a history of gallstones, alcoholism, trauma, hypertriglyceridemia, or hypercalcemia. It can be complicated by necrosis, hemorrhage, abscess, or the formation of pseudocysts. Labs: increased lipase.

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