#march2020mccqe1
A 40-year-old man with a history of type V hyperlipoproteinemia is brought to the emergency department 3 hours following the abrupt onset of severe deep epigastric pain, nausea, and vomiting. The pain is steady and radiates to the back. The patient is agitated and has cool, clammy skin. His temperature is 38.5 C (101 F), blood pressure is 100/70 mm Hg, pulse is 110/min, and respirations are 22/min. Abdominal examination reveals tenderness in the upper abdomen, without guarding. A plain x-ray film shows an air-filled intestinal loop in the left upper quadrant. Laboratory investigations show:
Glucose 150 mg/dL
LDH 150U/L
ALT 90U/L
AST 80U/L
Amylase 120 U/L
Lipase 30 U/L
Calcium 7 mg/dL
C-reactive protein 1.2 mg/dL
Which of the following is the most likely diagnosis?
(A) Acute cholecystitis
(B) Acute hepatitis
(C) Acute pancreatitis
(D) Bowel perforation
(E) Mesenteric ischemia
A 40-year-old man with a history of type V hyperlipoproteinemia is brought to the emergency department 3 hours following the abrupt onset of severe deep epigastric pain, nausea, and vomiting. The pain is steady and radiates to the back. The patient is agitated and has cool, clammy skin. His temperature is 38.5 C (101 F), blood pressure is 100/70 mm Hg, pulse is 110/min, and respirations are 22/min. Abdominal examination reveals tenderness in the upper abdomen, without guarding. A plain x-ray film shows an air-filled intestinal loop in the left upper quadrant. Laboratory investigations show:
Glucose 150 mg/dL
LDH 150U/L
ALT 90U/L
AST 80U/L
Amylase 120 U/L
Lipase 30 U/L
Calcium 7 mg/dL
C-reactive protein 1.2 mg/dL
Which of the following is the most likely diagnosis?
(A) Acute cholecystitis
(B) Acute hepatitis
(C) Acute pancreatitis
(D) Bowel perforation
(E) Mesenteric ischemia
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