A 14-year-old boy has sickle cell disease. He presents to the emergency room with the complaints of increased jaundice, abdominal pain, nausea, vomiting, and fever. His examination is remarkable for jaundice, pain of the right upper quadrant with guarding, and a clear chest. Chest radiographs appear normal. Which of the following tests is most likely to reveal the cause of this pain?
a. Serum chemistries
b. Complete blood count with platelets and differential
c. Ultrasound of the right upper quadrant
d. Upper GI series
e. Tracheoesophageal fistula
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 d; Gastroesophageal reflux disease.
Gastroesophageal reflux is a common pediatric complaint, often seen in the first 1 to 2 months of life and resolving by 1 to 2 years of age. About 7% of children have reflux severe enough to come to medical attention, and only 2% of that group requires investigation. For children who are growing well and do not have respiratory symptoms attributed to reflux, conservative treatment (small feeds, thickened formula, avoiding high-fat meals, etc.) suffices. A small number need pharmacologic therapy and an even smaller number require surgery.