Step 2 CS Blue sheet Case Abdominal pain

These are the blue sheet, physical exam, diagnostic studies and differential diagnosis needed for an abdominal pain case in the USMLE Step 2 CS exam:

BLUE SHEET abdominal pain:

MNEMONIC ABDOMINAL PAIN: BRAVO

B: Bloody stools.

R: Relation with food.

A: Anorexia.

V: Vaginal discharge/penile discharge.

O: Orthostatic hypotension/fainting due to massive bleeding.

PHYSICAL EXAMINATION

1. Lungs: 

Auscultation

2. Heart:

Auscultation

3. Abdomen:

Inspection

Auscultation (start distal to the site of current pain)

Palpation. Murphy sign. Mc Burney point tenderness. Rovsing sign. Psoas sign. Obturator sign. Rebound tenderness. CVA tenderness.

Percussion.

POSSIBLE DIAGNOSTIC STUDIES:

1. Pelvic and rectal exams.
2. CBC.
3. CRP or ESR.
4. Electrolytes.
5. Amylase, lipase (pancreatitis).
6. AST, ALT,  alkaline phosphatase (liver problems like hepatitis).
7. Urinalysis C/S (culture and sensitivity).
8. U/S abdomen.
9. Fecal occult blood test (FOBT).
10. CT scan of the abdomen.
11. Upper GI endoscopy.

DIFFERENTIAL DIAGNOSIS:

• Appendicitis.
• Peptic ulcer disease.
• Diverticulitis.
• Cholecystitis.
• Biliary colic.
• Ischemic colitis.
• Gastritis.
• Pancreatitis.
• Pelvic inflammatory disease (PID).
• Pregnancy related abdominal pain: Ectopic pregnancy.
• Hepatitis.
• Gastric cancer.

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Juan Chango Azanza

Founder & Autor at Ecuadoctors.com

Hematology/Oncology Fellow at BUSM | Former Internal Medicine Residency/Chief Resident at UCONN | Website Developer & Author at Ecuadoctors.com

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