Best next diagnostic or management step for adult GI, hepatic, and renal presentations tested on USMLE Step 2 CK.
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- A patient has typical GERD symptoms (heartburn, regurgitation) with no alarm features. What is the best initial management step?
- Empiric trial of a proton pump inhibitor
- A patient with dysphagia also has weight loss and is over 50 years old. What is the next diagnostic step?
- Upper endoscopy (EGD)
- A barium esophagram shows a dilated esophagus with distal tapering ('bird's beak'). What diagnosis does this suggest?
- Achalasia
- After a barium esophagram suggests achalasia, what test confirms the diagnosis?
- Esophageal manometry
- Which single lab test is most useful for diagnosing acute pancreatitis?
- Serum lipase
- Diagnosing acute pancreatitis requires meeting 2 of which 3 criteria?
- Characteristic abdominal pain, lipase or amylase over 3 times the upper limit of normal, and characteristic imaging findings
- What is the best initial imaging study for suspected acute cholecystitis?
- Right upper quadrant ultrasound
- RUQ ultrasound is equivocal for acute cholecystitis. What is the next best test?
- HIDA scan (cholescintigraphy)
- A patient has a dilated common bile duct and rising liver enzymes suggesting choledocholithiasis. What is the best next imaging step?
- MRCP (magnetic resonance cholangiopancreatography)
- A hemodynamically stable patient presents with an acute upper GI bleed. Within what timeframe should endoscopy be performed after resuscitation?
- Within 24 hours
- A cirrhotic patient presents with suspected variceal hemorrhage. What medication should be started before endoscopy?
- Octreotide
- A hospitalized patient develops new watery diarrhea after antibiotic use. What is the best initial diagnostic test?
- Stool PCR or toxin assay for Clostridioides difficile
- What is the best initial screening test for celiac disease?
- Tissue transglutaminase IgA antibody (tTG-IgA)
- A patient has a positive tTG-IgA antibody test. What confirms the diagnosis of celiac disease?
- Duodenal biopsy showing villous atrophy
- A patient with suspected peptic ulcer disease needs testing for H. pylori without endoscopy. Which noninvasive tests are used?
- Urea breath test or stool antigen test