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Pancreatic adenocarcinoma — USMLE Step 2 CK MCQ

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ModerateSurgeryPancreatic adenocarcinomaUSMLE Step 2 CK

A 58-year-old Native American woman comes to the urgent care clinic because of abdominal pain or gastrointestinal symptoms. History and focused examination are notable for painless jaundice, weight loss, pruritus, and double-duct sign. 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 appropriate initial diagnostic study?

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Correct answer: A — Pancreatic protocol CT scan

The vignette describes Pancreatic adenocarcinoma, supported by painless jaundice, weight loss, pruritus, and double-duct sign. Pancreatic protocol CT scan 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-95