{"id":10340,"date":"2026-07-20T00:10:44","date_gmt":"2026-07-20T08:10:44","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=10340"},"modified":"2026-06-30T12:27:51","modified_gmt":"2026-06-30T20:27:51","slug":"usmle-step-2-ck-question-of-the-day-scout-ct","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scout-ct","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Scout CT"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scout-ct\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 2 CK Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scout-ct\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scout-ct\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scout-ct\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scout-ct\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scout-ct\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today\u2019s USMLE\u00ae Step 2 CK question of the day features a 52 -year-old man with worsening <strong>abdominal pain<\/strong>&nbsp;and&nbsp;<strong>distension&nbsp;<\/strong>over the&nbsp;<strong>past 3 days<\/strong>. What\u2019s his diagnosis<\/em><\/strong>m<strong><em>and the best next steps? Let\u2019s find out!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 52-year-old man presents to the emergency department for evaluation of&nbsp;<strong>worsening abdominal pain<\/strong>&nbsp;and&nbsp;<strong>distension&nbsp;<\/strong>over the&nbsp;<strong>past 3 days<\/strong>.&nbsp;He has not had a&nbsp;<strong>bowel movement<\/strong>&nbsp;over this period of time.&nbsp; He had a severe lumbar sprain 2 weeks ago and was prescribed medications for&nbsp;pain control. Temperature is 37 \u00b0C (98.6 \u00b0F), heart rate is 82\/min, respiratory rate is 16\/min, blood pressure is 120\/80 mmHg, and oxygen saturation is 98% on room air. On examination, the&nbsp;<strong>abdomen is distended<\/strong>&nbsp;and&nbsp;<strong>tympanic to percussion<\/strong>&nbsp;with&nbsp;<strong>decreased bowel sounds<\/strong>&nbsp;on auscultation.&nbsp;The&nbsp;patient\u2019s&nbsp;scout&nbsp;<strong>CT image<\/strong>&nbsp;is displayed below.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"936\" height=\"936\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_9746c4.png\" alt=\"Abdominal X-ray showing multiple dilated loops of bowel throughout the abdomen and pelvis, with prominent gas-filled intestinal segments visible against the spine and abdominal organs. The image demonstrates an abnormal bowel gas pattern consistent with significant intestinal distension.\" class=\"wp-image-10348\" style=\"width:361px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_9746c4.png 936w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_9746c4.png?resize=150,150 150w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_9746c4.png?resize=300,300 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_9746c4.png?resize=768,768 768w\" sizes=\"auto, (max-width: 936px) 100vw, 936px\" \/><figcaption class=\"wp-element-caption\">Image courtesy of&nbsp;<a href=\"https:\/\/radiopaedia.org\/cases\/paralytic-ileus-1?lang=us\" target=\"_blank\" rel=\"noreferrer noopener\">Radiopaedia<\/a><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following would be most&nbsp;<em>consistent&nbsp;<\/em>with the&nbsp;<em>suspected diagnosis<\/em>?&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Recent traumatic abdominal injury<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. History of chronic constipation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Use of opioid analgesics<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Positive Murphy&#8217;s sign on abdominal examination<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Heavy alcohol consumption<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 2 CK Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Use of opioid analgesics<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Recent traumatic abdominal injury<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Traumatic abdominal injury, such as blunt force trauma, can cause intra-abdominal adhesions and mechanical small bowel obstruction. This patient\u2019s imaging and likely opioid use are more consistent with ileus.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. History of chronic constipation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Chronic constipation can cause abdominal distension and discomfort, but it would not likely precipitate the acute presentation seen in this patient and findings of ileus on imaging.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Positive Murphy&#8217;s sign on abdominal examination<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> A positive Murphy&#8217;s sign (pain upon deep inspiration while the examiner&#8217;s fingers are placed under the right costal margin) suggests acute cholecystitis or inflammation of the gallbladder and not ileus.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Heavy alcohol consumption<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> A history of heavy alcohol consumption would not typically be associated with causing generalized abdominal distension, lack of bowel movements, and ileus.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"936\" height=\"504\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_d71a52.png\" alt=\"Educational diagram explaining ileus, a functional obstruction of the intestines. It compares ileus with mechanical bowel obstruction and shows common causes of ileus, including abdominal surgery (postoperative ileus) and conditions such as heart failure, systemic infection, or opioid use (non-postoperative ileus). Arrows illustrate how these factors can lead to impaired intestinal motility despite the absence of a physical blockage.\" class=\"wp-image-10350\" style=\"aspect-ratio:1.8571803450764286;width:561px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_d71a52.png 936w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_d71a52.png?resize=300,162 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_d71a52.png?resize=768,414 768w\" sizes=\"auto, (max-width: 936px) 100vw, 936px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents with symptoms (e.g., abdominal pain, inability to pass stool) and signs (e.g., abdominal distention, tympany, decreased bowel sounds) of ileus in the setting of recent analgesia use. His scout CT demonstrates diffuse dilation of the intestines without a clear transition point, consistent with ileus. <strong>Recent use of opiate analgesics is most likely to have caused this condition.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Ileus refers to a functional obstruction of the intestines that may arise due to reduced or absent peristalsis without an underlying mechanical blockage.<\/strong> This is a common postoperative complication, particularly following abdominal surgeries. <strong>Non-postoperative causes of ileus include medications that slow peristalsis (e.g., opiates, anticholinergics), systemic conditions (e.g., metabolic abnormalities, sepsis), intra-abdominal pathology (e.g., diverticulitis, appendicitis), and radiation.<\/strong> For a nonsurgical ileus, the etiology can usually be elucidated by taking a careful patient history.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Patients presenting with ileus will often have signs and symptoms similar to small bowel obstruction. <\/strong>This can include abdominal pain, bloating, obstipation, nausea, and vomiting. Physical examination may demonstrate abdominal distention, tenderness to palpation, tympany to percussion, and diminished or absent bowel sounds. Abdominal imaging, such as an X-ray or CT, can help differentiate ileus from small bowel obstruction. Radiographic findings of ileus include small bowel dilation without evidence of a transition point.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Medications that slow peristalsis, such as opiate analgesics, are a potential cause of non-postoperative ileus. Imaging findings of ileus include small bowel dilation without evidence of a transition point.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video:<\/strong> <a href=\"https:\/\/www.osmosis.org\/learn\/Ileus:_Clinical_sciences\">Ileus: Clinical sciences<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Vilz, T.O., et al. (2017). <strong>Ileus in adults.<\/strong> Deutsches Arzteblatt International, 114:29\u201330. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5569564\/<\/li>\n\n\n\n<li>Weledji, E.P. (2020). <strong>Perspectives on paralytic ileus.<\/strong> Acute Medicine &amp; Surgery, 7(1):e573. https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1002\/ams2.573<\/li>\n\n\n\n<li>Cuete, D. (n.d.). <strong>Paralytic ileus [Image]<\/strong>. Radiopaedia. https:\/\/radiopaedia.org\/cases\/paralytic-ileus-1?lang=us<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>Get your&nbsp;<em><a href=\"http:\/\/osmosis.org\/create\" target=\"_blank\" rel=\"noreferrer noopener\">f<\/a><a href=\"http:\/\/osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\">ree trial<\/a><\/em>&nbsp;of Osmosis from Elsevier today to discover why millions of clinicians and caregivers love learning by Osmosis.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A patient develops worsening abdominal pain, distension, and obstipation after recent treatment for an injury. Can you identify the most likely underlying cause in this USMLE-style clinical scenario?<\/p>\n","protected":false},"author":208,"featured_media":10349,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,10,20,16,1366,1370,45],"tags":[3197,1432,2967,489,3108,3195,704,3196,3199,84,3198,462,279,261,671],"class_list":["post-10340","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-clinical-skills","category-exam-prep","category-do","category-questions","category-step-2-questions","category-step-2","tag-abdominal-distension","tag-abdominal-pain","tag-board-exam-prep","tag-clinical-reasoning","tag-clinical-vignette","tag-gastroenterology","tag-gastrointestinal-disorders","tag-ileus","tag-intestinal-obstruction","tag-medical-education","tag-opioid-medications","tag-osmosis","tag-patient-assessment","tag-pharmacology","tag-usmle-step-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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