Step 2 CS Blue sheet Case Jaundice in adults

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.