{"id":3024,"date":"2023-09-13T12:51:00","date_gmt":"2023-09-13T12:51:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3024"},"modified":"2025-10-01T11:39:33","modified_gmt":"2025-10-01T19:39:33","slug":"usmle-step-2-ck-question-of-the-day-jaundice","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-jaundice","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day: Jaundice"},"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-jaundice\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 2 CK 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-2-ck-question-of-the-day-jaundice\/#B_Gastroenterology_consult_for_endoscopic_retrograde_cholangiopancreatography\" >B.&nbsp;Gastroenterology consult for endoscopic retrograde cholangiopancreatography<\/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-2-ck-question-of-the-day-jaundice\/#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-2-ck-question-of-the-day-jaundice\/#A_Emergent_general_surgery_consult\" >A. Emergent general surgery consult<\/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-2-ck-question-of-the-day-jaundice\/#C_CT_of_the_abdomen_and_pelvis_with_IV_contrast\" >C. CT of the abdomen and pelvis with IV contrast<\/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-2-ck-question-of-the-day-jaundice\/#D_Administration_of_IV_antibiotics_with_ceftriaxone\" >D. Administration of IV antibiotics with ceftriaxone<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-jaundice\/#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-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-jaundice\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Uncover a medical case study: 53-year-old man with abdominal pain, jaundice, and fever. Learn about the next steps in management. Enhance your medical knowledge with this USMLE\u00ae Step 2-style practice question.<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 53-year-old man presents to the emergency department for evaluation of cramping abdominal pain, and yellow skin. The pain started last night and is associated with nausea and non-bloody vomiting. The patient has no significant past medical history. Temperature is 39 \u00baC (102.2 \u00baF), pulse is 108\/min, blood pressure is 140\/75 mmHg, respiratory rate is 18\/min, and SpO2 is 100% on room air. On physical examination, the patient appears ill with jaundice and scleral icterus. There is moderate tenderness to palpation in the right upper quadrant. Laboratory evaluation shows leukocytosis and hyperbilirubinemia. Which of the following is the most appropriate next step in management?<strong>A. Emergent general surgery consult<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Gastroenterology consult for endoscopic retrograde cholangiopancreatography<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. CT of the abdomen and pelvis with IV contrast<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Administration of IV antibiotics with ceftriaxone<\/strong><\/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_2_CK_Question_is%E2%80%A6\"><\/span><strong>The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Gastroenterology_consult_for_endoscopic_retrograde_cholangiopancreatography\"><\/span><strong>B.&nbsp;Gastroenterology consult for endoscopic retrograde cholangiopancreatography<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Before we get to the Main Explanation, let&#8217;s see why the answer wasn&#8217;t A, C, D. Skip to the bottom if you want to see the correct answer right away!<\/em><\/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<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Emergent_general_surgery_consult\"><\/span>A. Emergent general surgery consult<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>This patient likely has acute cholangitis suspected because of the findings of right upper quadrant abdominal pain, fever, and jaundice (Charcot Triad). Gastroenterology should be consulted for an ERCP.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_CT_of_the_abdomen_and_pelvis_with_IV_contrast\"><\/span>C. CT of the abdomen and pelvis with IV contrast<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Abdominal CT can detect biliary duct dilatation and biliary stenosis; however, it has low sensitivity for detecting biliary tract stones. This patient has features suggestive of acute cholangitis\u2013warranting ERCP for diagnosis and treatment.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Administration_of_IV_antibiotics_with_ceftriaxone\"><\/span>D. Administration of IV antibiotics with ceftriaxone<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;This patient with acute cholangitis should have empiric antibiotics initiated to cover enteric streptococci, coliforms, and anaerobes. Ceftriaxone should not be used alone in acute cholangitis, but should be prescribed in combination with metronidazole.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Biliary colic is described as an intense, dull discomfort, typically constant in nature in the right upper quadrant, epigastrium, or substernal area with possible&nbsp;<strong>radiation to the back or right shoulder blade<\/strong>. Pain from biliary colic is often associated with fatty food intake, nausea, and vomiting. Biliary colic is typically caused by the gallbladder contracting and forcing a&nbsp;<strong>gallstone or sludge<\/strong>&nbsp;against the gallbladder outlet or cystic duct opening.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Complications of gallstones<\/strong>&nbsp;include&nbsp;<strong>cholecystitis<\/strong>&nbsp;which is right upper quadrant pain, fever, and leukocytosis from gallbladder inflammation secondary to gallstones. Another complication of gallstones is&nbsp;<strong>choledocholithiasis<\/strong>&nbsp;which is the presence of a&nbsp;<strong>gallstone in the common bile duct<\/strong>. This can be further complicated by&nbsp;<strong>acute cholangitis<\/strong>&nbsp;which presents with fever, abdominal pain, and jaundice caused by infection from biliary obstruction. This patient has evidence of right upper quadrant pain, jaundice, fever, leukocytosis, and hyperbilirubinemia suggesting&nbsp;<strong>acute cholangitis<\/strong>. The combination of&nbsp;<strong>fever, abdominal pain<\/strong>, and&nbsp;<strong>jaundice<\/strong>&nbsp;is known as&nbsp;<strong>Charcot\u2019s triad<\/strong>, which is highly suggestive of acute cholangitis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with biliary colic should have lab work including a CBC to assess for leukocytosis and a CMP, and liver function tests. The initial imaging for&nbsp;<strong>biliary colic<\/strong>&nbsp;is typically&nbsp;<strong>abdominal ultrasound<\/strong>&nbsp;to look for gallstones. For patients with obesity or other anatomic considerations endoscopic ultrasound can be used.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Endoscopic retrograde cholangiopancreatography (ERCP)<\/strong>, with or without an initial ultrasound, should be performed in patients with suspected&nbsp;<strong>acute cholangitis<\/strong>&nbsp;since it can be used to both&nbsp;<strong>diagnose and treat<\/strong>&nbsp;the underlying obstruction via b<strong>iliary duct decompression and removal of stones<\/strong>. In addition, patients with acute cholangitis should be admitted to the hospital and administered IV hydration, antiemetics, analgesia, and empiric antibiotics.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\">Patients with suspected acute cholangitis should undergo ERCP for both diagnosis and treatment with biliary drainage.&nbsp;<em>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;__________________________<\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"http:\/\/osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_6d8a2d.png?w=700\" alt=\"\" class=\"wp-image-2709\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_6d8a2d.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_6d8a2d.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; ____________________________<\/em><br><em><strong><em>Try Osmosis today! Access your&nbsp;<\/em><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\"><em>free<\/em><em>&nbsp;<\/em><em>trial<\/em><\/a><em>&nbsp;and find out why millions of clinicians and caregivers love learning with us.<\/em><\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Uncover a medical case study: 53-year-old man with abdominal pain, jaundice, and fever. Learn about the next steps in management. Enhance your medical knowledge with this USMLE\u00ae Step 2-style practice question. A 53-year-old man presents to the emergency department for evaluation of cramping abdominal pain, and yellow skin. The pain started last night and is [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3025,"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":[27,20,45],"tags":[],"class_list":["post-3024","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day: Jaundice - 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-2-ck-question-of-the-day-jaundice\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day: Jaundice - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Uncover a medical case study: 53-year-old man with abdominal pain, jaundice, and fever. Learn about the next steps in management. Enhance your medical knowledge with this USMLE\u00ae Step 2-style practice question. A 53-year-old man presents to the emergency department for evaluation of cramping abdominal pain, and yellow skin. 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