Repeated USMLE Questions Step 1- 166

A 70-year-old woman, having had an appendectomy 25 years ago, is brought to the emergency room with severe abdominal pain. The patient describes the pain as being crampy and colicky. She also says that the pain seems to increase and then improve on its own. She has already vomited 10 times since the pain started in the morning. She has also not had a bowel movement since last 2 days or passed flatus in last couple of days. Physical examination shows that the abdomen is distended slightly. Auscultation of the abdomen shows peristaltic rushes and high-pitched bowel sounds. Tympanic abdomen is revealed during percussion. The patient is also diffusely tender with palpitation but there is no rebound tenderness. Rectal examination also shows an absence of stool.

What would be the likely diagnosis?

A- Intestinal obstruction

B- Gastroenteritis

C- Diverticulitis

D- Pancreatitis


The patient is suffering from intestinal obstruction, which is a condition in which a blockage occurs that prevents food and beverages from passing through either the small intestine or the large intestine. One of the common causes of intestinal obstruction is the formation of fibrous bands of tissues or adhesions in the abdomen after a surgery. As the patient earlier had an appendectomy this could be the most likely cause of intestinal obstruction.

The correct answer is A

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