Repeated USMLE Questions Step 2 CK- 437

A 51-year-old man is brought to the emergency room because of severe abdominal pain which is radiating to his back. Today, the patient had many episodes of vomiting. He is an alcoholic, drinking daily but he does not smoke or take any recreational drugs. On physical examination, the patient is lying down in the fetal position and appearing to be ill and febrile. There is also an area of bluish periumbilical discoloration on the skin of his abdomen. However, there is no flank discoloration. There are also reduced bowel sounds and he is having severe mid epigastric tenderness upon palpitation. The rectal examination is normal.

What is your primary diagnosis?

A- Appendicitis

B- Pyelonephritis

C- Necrotizing pancreatitis

D- Acute cholecystitis


Necrotizing pancreatitis is a condition where acute pancreatitis develops severe complications. The pancreas becomes inflamed, leaking its enzymes into the other parts of the pancreas. These enzymes can cause the death of the pancreatic tissue, thus causing necrotizing pancreatitis. Once the dead tissue becomes infected, it can lead to life-threatening complications. Immediate surgery for removing the dead tissue and medical treatment are required.

The correct answer is C

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