Step 2

Gastrointestinal 3

A 45-year-old woman presents to the emergency department 5 hours after a sudden onset of severe constant epigastric pain that radiates straight through to the back. Past medical history is significant for alcohol use disorder and hyperlipidemia. Family history includes hypertension in her father and breast cancer in her mother. She reports drinking 7-9 beers every day for the past 6 years and smoking 1 pack per day since age 20. She reports nausea and vomiting but denies hematemesis, diarrhea, melena, chest pain, or shortness of breath. She was prescribed atorvastatin in the past but reports not refilling her prescription in several months. Vital signs are temperature 38.3°C (101.0°F), pulse 108 beats/min, respirations 20/min, and blood pressure 148/82 mmHg. Physical examination reveals a non-distended abdomen with upper abdominal tenderness and guarding, no organomegaly, a negative Murphy sign, and no skin abnormalities.

Which of the following laboratory tests is most likely to confirm her diagnosis?

  • A) Alkaline phosphatase
  • B) Amylase
  • C) Aspartate transaminase : Alanine transaminase (AST:ALT) ratio
  • D) High-sensitivity troponin
  • E) Lipase


Dawid Karapuda


Dr. Raj Dasgupta

Last updated

Oct 25, 2022

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