{"id":2124,"date":"2021-02-17T18:50:00","date_gmt":"2021-02-17T18:50:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=2124"},"modified":"2025-10-01T11:42:38","modified_gmt":"2025-10-01T19:42:38","slug":"usmle-step-1-question-of-the-day-abdominal-pain","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-abdominal-pain","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Abdominal Pain"},"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-1-question-of-the-day-abdominal-pain\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-abdominal-pain\/#C_Lymphoid_hyperplasia\" >C. Lymphoid hyperplasia<\/a><\/li><\/ul><\/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-1-question-of-the-day-abdominal-pain\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-abdominal-pain\/#A_Noncaseating_granulomas\" >A. Noncaseating granulomas<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-abdominal-pain\/#B_Ectopic_gastric_tissue\" >B. Ectopic gastric tissue<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-abdominal-pain\/#D_Gram-negative_bacterial_infection\" >D. Gram-negative bacterial infection&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-abdominal-pain\/#E_%E2%80%9CTarget_sign%E2%80%9D_on_ultrasound\" >E. \u201cTarget sign\u201d on ultrasound<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-abdominal-pain\/#Main_Explanation\" >Main Explanation&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-abdominal-pain\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-abdominal-pain\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics and help you prepare for the boards. Today&#8217;s case involves an 8-year-old girl who&#8217;s experiencing abdominal pain, fever, nausea, and vomiting. Can you figure out the cause?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An 8-year-old girl is brought to the emergency department by her parents due to worsening abdominal pain, fever, nausea, and vomiting for the last two days. Her parents report she has also had mild non-bloody diarrhea and the pain does not improve with defecation. When asked to localize the pain, the patient points to the right lower quadrant of her abdomen. She rates the pain as a 9 on a 10-point scale. Her medical history is non-contributory. Her temperature is 38.7 \u00b0C (101.7 \u00b0F), pulse is 86\/min, respirations are 24\/min, and blood pressure is 102\/64 mmHg. On examination, palpation of the left lower quadrant of the abdomen elicits pain in the right lower quadrant. Laboratory tests are obtained and reveal a leukocyte count of 16,000\/mm3. Which of the following is most likely associated with this patient\u2019s condition?&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Noncaseating granulomas<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Ectopic gastric tissue&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Lymphoid hyperplasia&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Gram-negative bacterial infection<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. \u201cTarget sign\u201d on ultrasound<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down to find the answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at Georgetown University\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/2qVYL0dRQJI?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<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><u><em><strong>\u2192 Reinforce your understanding with more self-assessment items on Osmosis.<\/strong>&nbsp;<\/em><\/u><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Lymphoid_hyperplasia\"><\/span>C. Lymphoid hyperplasia<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/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\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Noncaseating_granulomas\"><\/span>A. Noncaseating granulomas<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Noncaseating granulomas can be seen in the affected bowel segments of patients with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Crohn's_disease\" target=\"_blank\" rel=\"noreferrer noopener\">Crohn&#8217;s disease<\/a>. Crohn&#8217;s disease typically presents with chronic fatigue, crampy abdominal pain, bloody&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diarrhea:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">diarrhea<\/a>, and low-grade fever. Moreover, non-caseating granulomas are also classically seen in&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Sarcoidosis\" target=\"_blank\" rel=\"noreferrer noopener\">sarcoidosis<\/a>. However, this condition rarely causes gastrointestinal symptoms.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Ectopic_gastric_tissue\"><\/span>B. Ectopic gastric tissue<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Ectopic gastric tissue is associated with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Meckel_diverticulum\" target=\"_blank\" rel=\"noreferrer noopener\">Meckel&#8217;s diverticulum<\/a>, a congenital gastrointestinal anomaly which results from&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Congenital_gastrointestinal_disorders:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">failure of involution of the omphalomesenteric (vitelline) duct<\/a>. Patients with Meckel&#8217;s diverticulum would present with abdominal pain and hematochezia. In this case, however, appendicitis is a much more likely diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Gram-negative_bacterial_infection\"><\/span>D. Gram-negative bacterial infection&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/learn\/Yersinia_enterocolitica\" target=\"_blank\" rel=\"noreferrer noopener\">Yersinia enterocolitica<\/a><\/em>, a gram-negative bacteria, can cause mesenteric lymphadenitis, which is also known as pseudoappendicitis due its similar presentation. Moreover, patients may experience bloody diarrhea. The pathogen is transmitted via undercooked foods, contaminated water, and contact with infected animals and their feces. In contrast, this patient has nonbloody diarrhea and no history of risk factors that may expose her to the pathogen.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_%E2%80%9CTarget_sign%E2%80%9D_on_ultrasound\"><\/span>E. \u201cTarget sign\u201d on ultrasound<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;A \u201ctarget sign\u201d on ultrasound is associated with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Intussusception\" target=\"_blank\" rel=\"noreferrer noopener\">intussusception<\/a>, which is defined as telescoping of one segment of the bowel into an adjacent segment. Patients with intussusception would present with colicky abdominal pain and currant jelly stools. Moreover, a sausage-shaped mass may be palpable on physical examination.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This 8-year-old girl presents with greater than 24 hours of fever, nausea, vomiting, positive Rovsing sign (right lower quadrant pain that is elicited with palpation of the left lower quadrant), and worsening right lower quadrant abdominal pain. She most likely has&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Appendicitis:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">appendicitis<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Appendicitis is caused by an initial obstruction of the appendix, which leads to buildup of intestinal fluid, mucous, and gut flora (primarily&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Escherichia_coli\" target=\"_blank\" rel=\"noreferrer noopener\"><em>Escherichia coli<\/em><\/a>&nbsp;and&nbsp;<em>Bacillus fragilis<\/em>) in the obstructed appendix. In children, the most common cause of appendiceal obstruction is lymphoid hyperplasia. In adults, the most common cause of obstruction is fecalith impaction. Other rarer causes include&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Carcinoid_tumor\" target=\"_blank\" rel=\"noreferrer noopener\">carcinoid tumor&nbsp;<\/a>of the appendix,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Enterobius_vermicularis_(Pinworm)\" target=\"_blank\" rel=\"noreferrer noopener\">pinworm<\/a>, eosinophilic appendicitis, and actinomycosis.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">As a result of the obstruction and subsequent buildup, the appendix grows in size and compresses the nearby afferent visceral nerves, which are carried to the T10 segment of the spinal cord, resulting in the initial periumbilical pain. The inflammation can then spread to the serosa of the appendix and the parietal peritoneum of the abdomen. Irritation of the parietal peritoneum, which is innervated by somatic nerves that also supply the overlying skin, results in migration of the pain to the right lower quadrant of the abdomen.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The spread of this inflammation ultimately leads to weakening of the appendix wall, which can lead to appendiceal rupture. Bacteria can then escape into the peritoneum, leading to peritonitis and abscess formation.&nbsp;<\/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=\"Appendicitis: Pathology review\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/K86eIZyKVmc?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=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Appendicitis is defined as inflammation of the appendix. In children, it typically results from lymphoid hyperplasia that obstructs the appendix. In adults, the obstruction is often the result of a fecalith. Patients present with acute-onset fever, nausea, vomiting, and right lower quadrant abdominal pain.<\/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><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S2210261217302262\" target=\"_blank\" rel=\"noreferrer noopener\">A rare case of subacute appendicitis, actinomycosis as the final pathology reports: A case report and literature review<\/a>.<\/li>\n\n\n\n<li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK499946\/\" target=\"_blank\" rel=\"noreferrer noopener\">Pseudoappendicitis<\/a>.<\/li>\n\n\n\n<li><a href=\"http:\/\/10.0.4.31\/s-0036-1593429\" target=\"_blank\" rel=\"noreferrer noopener\">Intestinal Intussusception: Etiology, Diagnosis, and Treatment.<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0022346802397938#aep-article-footnote-id1\" target=\"_blank\" rel=\"noreferrer noopener\">Pediatric appendicitis score.<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>_________________________<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your&nbsp;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/em><\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image 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\/2024\/09\/image_1b95f1.png\" alt=\"The most powerful platform for learning medicine. Try it free today ad\" class=\"wp-image-2129\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_1b95f1.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_1b95f1.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/em><\/strong><em>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics and help you prepare for the boards. Today&#8217;s case involves an 8-year-old girl who&#8217;s experiencing abdominal pain, fever, nausea, and vomiting. Can you figure out the cause? An 8-year-old girl is brought to the emergency department by her [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":2126,"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":[27,20,1369,44],"tags":[],"class_list":["post-2124","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-1-questions","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Abdominal Pain - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-abdominal-pain\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Abdominal Pain - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics and help you prepare for the boards. Today&#8217;s case involves an 8-year-old girl who&#8217;s experiencing abdominal pain, fever, nausea, and vomiting. Can you figure out the cause? 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