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Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 1/Question#9 (reveal difficulty score)
A 32-year-old woman is brought to the ...
Triglycerides ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: lipids

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submitted by โˆ—step_prep5(246)
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  • Young woman with signs of pancreatitis (epigastric abdominal pain with nausea/vomiting) and elevated amylase, most consistent with acute pancreatitis
  • Diagnosis of acute pancreatitis requires 2/3: (1) Acute epigastric pain radiating to the back (2) Increased serum amylase or lipase to at least 3X upper limit of normal (3) Characteristic imaging findings
  • Key idea: Two most common causes of acute pancreatitis are gallstones and alcohol, so in this patient who had a cholecystectomy and does not use alcohol, we would think of other potential causes such as hypertriglyceridemia, hypercalcemia (this patient has normal calcium), steroids, autoimmune pancreatitis, post-ERCP, drugs (diuretics, IBD drugs, anticonvulsants, etc.)

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 -1  upvote downvote
submitted by โˆ—russnels(20)
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I'm guessing she had a chylothorax seeing that the answer was triglycerides? Anything jumping out at anyone that points to that?

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trevor663  I believe it is acute pancreatitis secondary to hypertriglyceridemia from the cholecystectomy. Could be wrong, but thats where I went with the increased amylase, although not specific for pancreatitis, and epigastric pain in an acutely ill patient. +
step_prep5  Two most common causes of acute pancreatitis are gallstones and alcohol, so in this patient who had a cholecystectomy and does not use alcohol, we would think of other potential causes such as hypertriglyceridemia, hypercalcemia (this patient has normal calcium), steroids, autoimmune pancreatitis, post-ERCP, drugs (diuretics, IBD drugs, anticonvulsants, etc.) +1



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