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Small bowel obstruction — USMLE Step 2 CK MCQ

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ModerateSurgerySmall bowel obstructionUSMLE Step 2 CK

A 56-year-old Asian American woman comes to the hospital because of abdominal pain or gastrointestinal symptoms. History and focused examination are notable for colicky abdominal pain, vomiting, distention, and dilated loops with air-fluid levels. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and imaging support an acute surgical process without suggesting a safer outpatient approach. Which of the following is the most likely diagnosis?

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Correct answer: D — Small bowel obstruction

The vignette describes Small bowel obstruction, supported by colicky abdominal pain, vomiting, distention, and dilated loops with air-fluid levels. Small bowel obstruction is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: https://www.ncbi.nlm.nih.gov/books/#stage-9-order-90