These are the blue sheet, physical exam, diagnostic studies and differential diagnosis needed for a Jaundice in adults case in the USMLE Step 2 CS exam:
BLUE SHEET JAUNDICE:
MNEMONIC JAUNDICE:
“JAUNDICE B”
J: Joint pain/Journey recently (travel)
A: Abdominal pain
U: Up temperature (fever)
N: Nausea and vomiting
D: Diarrhea/Constipation
I: Itchiness/Immunizations in the past (hepatitis)
C: Color urine and stool, cancer screening status (colonoscopy, mammography, prostate exams/PSA)
E: Pain while Eating
B: Blood transfusions in the past (risk for viral hepatitis), recent (hemolytic transfusion reaction).
PHYSICAL EXAMINATION
1. HEENT:
Inspection of the head, sclerae for jaundice.
Neck: Lymphadenopathy, masses.
2. Lungs:
Auscultation.
3. Heart:
Auscultation.
4. Abdomen:
Inspection.
Auscultation.
Palpation, look for masses and hepatosplenomegaly.
Percussion.
5. Extremities:
Inspection: look for asterixis, edema.
6. Skin:
Inspection for excoriations in the abdomen due to itchiness secondary to jaundice. Look for stigmata of chronic liver disease like spider nevi, telangiectasis, palmar erythema.
POSSIBLE DIAGNOSTIC STUDIES:
- CBC.
- AST, ALT, bilirubins, alkaline phosphatase.
- PT, PTT.
- Viral hepatitis serologies.
- Acetaminophen level when appropriate.
- U/S RUQ abdomen.
- CT of the abdomen.
- MRCP/ERCP.
DIFFERENTIAL DIAGNOSIS:
- Hepatitis: viral, alcoholic, drug induced.
- Extrahepatic biliary obstruction.
- Primary biliary cholangitis.
- Primary sclerosing cholangitis.
- Gilbert syndrome.
- Wilson’s disease.
- Hemochromatosis.
- Metastatic cancer.
- Choledocholithiasis.
- Cholecystitis.
- Cholangitis.
I hope this information was helpful for you, please leave your comments below and I will try to answer as soon as possible. Start practicing early the mnemonics for easier memorization. Good luck with your studies.
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