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* nbme 4 bl3 q24
 #413948  
  unstableangina - 05/27/09 05:33
 
  24 A hospitalized 37-year-old woman has the sudden onset of fever 7 days after undergoing splenectomy for immune thrombocvtopenic purpura. She has had moderate
abdominal pain and mild left shoulder pain for 2 days Her hemoglobin concentration has ranged from 9.5 g”dL to 10 g/dL since the operation Current medications include
hydrocodonie and docusate Her temperature is 39 1°C (102 4°F) Abdominal examination shows mild distention and diffuse tenderness without rebound, rigidity, or guarding
Bowel sounds are absent Laboratory studies show:
Hemoglobin 98 g/dL
Leukocyte count 21,3oo1mm3
Segmented neutrophils 50%
Bands 17%
Eosinophils 3%
Lymphocytes 25%
Monocytes 5%
Platelet count 105,000/mm3
Serum amylase 124 U/L
A chest x-ray shows a left pleural effusion. Which of the following is the most likely cause of these findings?
O A) Aspiration
O B) Gastric perforation
O C) Pancreatitis
O D) Pneumonia
0 E) Subphrenic abscess
 
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* Re:nbme 4 bl3 q24
#1766678
  unstableangina - 05/27/09 05:37
 
  e or d??  
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* Re:nbme 4 bl3 q24
#1766680
  counterattack - 05/27/09 05:46
 
  I went fr EE in this...
looked more of an Abscess to me rather than pneum...
 
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* Re:nbme 4 bl3 q24
#1767398
  azmas - 05/27/09 16:32
 
  what abt absent bowel sound????  
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* Re:nbme 4 bl3 q24
#1767547
  doc_happi - 05/27/09 18:16
 
  ee  
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* Re:nbme 4 bl3 q24
#1767577
  waqi - 05/27/09 18:27
 
  ee  
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* Re:nbme 4 bl3 q24
#3080832
  habib718 - 04/23/14 21:35
 
  i choose D on feedback and it was wrong  
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* Re:nbme 4 bl3 q24
#3081322
  daraymond2 - 04/25/14 07:40
 
  E........subphrenic abscess irritates the diaphragm and causes a refered pain to the shoulder.  
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* Re:nbme 4 bl3 q24
#3081386
  jhcb - 04/25/14 13:38
 
  Guys the answer is Pancreatitis. Amylase is normal in up to 10% of cases and the value is upper limit of normal. There is a reason why the lipase value was not provided. Don't over think it.  
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* Re:nbme 4 bl3 q24
#3081453
  daraymond2 - 04/25/14 15:59
 
  I got this right on the online NBME 4 i took 3 days back, the answer is E.  
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* Re:nbme 4 bl3 q24
#3309117
  habib718 - 09/12/16 13:50
 
  i picked pancreatitis and it was wrong  
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