A 43 year old female patient PANCE question

[curiousprepa]

A 43 year old female presents with fever and abdominal pain precipitated by a large, fatty meal. There is tenderness and guarding in the right upper quadrant. What diagnostic test is most specific for the suspected diagnosis?

 

A. Abdominal film

B. Abdominal ultrasound

C. CT scan of the abdomen

D. Hepatobiliary nuclear imaging

 

I eliminated A and B from my answer choice.

 

The answer is D. The book states this: Hepatobiliary imaging using aminoacetic acid compounds is physiologic and will reveal an obstructed cystic duct. The test is relaible if the bilirubin is <5 mg/dL with a 98% sensitivity, and an 81% specifcity for acute cholecystits.

 

I'm confused about what to look for when answering this question.

 

Once again, any input can help.

[EMEDPA]

all of those tests can potentially dx cholecystitis under some conditions.

the trick to this question is the word "specific".

if someone has a plain film, ct, or u/s "suspicious for cholecystitis" a HIDA scan can be used as the definitive test.

it's like those questions about the best test for DVT. they don't want u/s, they want venogram.

[rev ronin]

You do know spin/snout, right?

 

A Specific Positive test rules a condition IN (spin)

A Sensitive Negative test rules a condition OUT (snout)

 

A test can be specific but not sensitive, sensitive but not specific, both, or neither.  The trick is knowing which does what.  For example, D-Dimer is sensitive for DVT, but not very specific.

[gbrothers98]

Not sure what prep book you got this from but overall it is mental masturbation and not a true indication of real applicable knowledge.

Reality is you would do u/s and/or CT. Likely these would have to happen prior to the nuc med scan, if that is even available to obtain. Questions like this boil my blood and are nothing but academic trickery. It is also a bad question because it relies on factoid knowledge rather than true application of one's knowledge base. While I have my issues with the PANCE/PANRE questions, my faint recall is also that I never felt the answer to a question hinged on my recall of a simple factoid relating to a medical condtion.

GB PA-C

[curiousprepa]

Thanks for the input. I'll keep chugging along.