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Question » Stem » Lead in click-05

A 28-year-old girl presents with several hours of epigastric abdominal pain. The pain radiates to her back and is relieved by sitting up. Her symptoms are accompanied by nausea and nonbilious vomiting. On physical examination she has hypoactive bowel sounds and tenderness to palpation over the epigastrium. Laboratory findings reveal AST 56 units/L, ALT 70 units/L, serum amylase 330 units/L, serum lipase 600 units/L, and BUN 30 mg/dL. Which of the following is the most likely diagnosis?

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Every question contains a detailed explanation for the correct and incorrect answer choices and integrated media for those that learn best by visual stimuli. Understanding a topic cannot be learned in isolation. You require context. We take deliberate steps to deliver a comprehensive explanation linking the most important components to master a topic.

This woman has signs, symptoms and laboratory findings consistent with acute pancreatitis. Acute pancreatitis is an acute inflammatory process of the pancreas most commonly caused by gallstones blocking the pancreatic duct (most common in USA) or from alcohol use (second most common in USA). Most patients present with acute onset of persistent epigastric abdominal pain that often radiates to the back (the pancreas is a retroperitoneal organ). Patients may experience relief by leaning forward such as situating themselves in the fetal position. Associated symptoms include nausea, vomiting, and anorexia. Physical exam often reveals epigastric tenderness. Acute pancreatitis is associated with an elevation in amylase (sensitive) and lipase (specific). The diagnosis of pancreatitis requires the presence of two of the following criteria: (1) acute onset of persistent, severe, epigastric pain often radiating to the back; (2) the amylase or lipase is elevation at least three-fold from the upper limit of normal; and (3) characteristic findings of acute pancreatitis on imaging. Management includes mainly supportive care with intravenous fluids and no oral intake. Some complications include shock, sepsis and pseudocyst.

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After each question explanation is a straightforward factoid-based questions with a simple, memorizable answer that serves as reinforcement for the corresponding topic.

(Q) What is a classic ECG finding of hypercalcemia?

(A) Shortened QT interval.


Break it down, Keep it simple.

Boiling it down to the most high yield concepts

Acute Pancreatitis

  • Gallstones (most common), alcohol
  • Epigastric pain radiating to back
  • Grey-Turner sign: ecchymosis of left flank
  • Cullen sign: umbilical ecchymosis
  • Lipase: best laboratory marker
  • Ranson’s criteria

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