An 8-year-old is accidentally hit in the abdomen by a baseball bat. After several minutes of discomfort, he seems to be fine. Over the ensuing 24 h, however, he develops a fever, abdominal pain radiating to the back, and persistent vomiting. On examination, the child appears quite uncomfortable. The abdomen is tender, with decreased bowel sounds throughout, but especially painful, with guarding in the midepigastric region. Which of the following tests is most likely to confirm the diagnosis?
a. Serum amylase
b. Complete blood count with differential and platelets
c. Serum total and direct bilirubin levels
d. Abdominal radiograph
e. Electrolyte panel
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is a; Serum amylase.
The causes of pancreatitis in children are varied, with about one-fourth of cases without predisposing etiology and about one-third of cases as a feature of another systemic disease. Traumatic cases are usually due to blunt trauma to the abdomen. Acute pancreatitis is difficult to diagnose; a high index of suspicion is necessary. Common clinical features include severe pain with nausea and vomiting. Tenderness, guarding or rebound pain, abdominal distention, and a paralytic ileus are signs and symptoms often seen. No diagnostic test is completely accurate. An elevated total serum amylase with the correct clinical history and signs and symptoms is the best diagnostic tool. Plain films of the abdomen may exclude other diagnoses; ultrasonography of the pancreas can reveal enlargement of the pancreas, gallstones, cysts, and pseudocysts. Supportive care is indicated until the condition resolves.