Question of the Week #490

490. An 18-year-old male presents to the Emergency Department for evaluation of chest pressure for an hour. The pain is radiating to his jaw. On examination, he is diaphoretic, and he complains of nausea. Past medical history is unremarkable. Urine reveals positive benzolegonine. Below is his ECG. What is the most likely cause of the patient’s symptoms?


A. Early repolarization

B. Ischemia

C. Cocaine induced myocardial infarction

D. Atrial fibrillation

E. Wolf-Parkinson-White Syndrome

USMLE Step 2CK Question #1

A 48-year-old homeless man presenting with severe abdominal pain. He has been hospitalized 6 times in the past year for similar complaints. Hospital records indicate multiple admissions with alcohol intoxication. The pain radiates to his back, and is accompanied by nausea and vomiting. The patient has a temperature of 103F, but does not permit an abdominal exam. Laboratory analysis indicates elevated gamma glutamyl transpeptidase and an AST/ALT ratio > 2. What is the most likely diagnosis?

A – Cholecystitis

B – Pancreatitis

C – Choledocholithiasis

D – Duodenal peptic ulcer

E – Gallbladder cancer

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