92.A 71-year-old obese man is brought to the ED complaining of constant
left middle quadrant abdominal pain with radiation into his back. His past
medical history is significant for hypertension, peripheral vascular disease,
peptic ulcer disease, kidney stones, and gallstones. He smokes a pack of cig-
arettes and consumes a pint of vodka daily. His BP is 145/80 mm Hg, HR is
90 beats per minute, temperature is 98.9°F, and RR is 16 breaths per minute.
Abdominal examination is unremarkable. An ECG is read as sinus rhythm
with a HR of 88 beats per minute. An abdominal radiograph reveals normal
loops of bowel and curvilinear calcification of the aortic wall. Which of the
following is the most likely diagnosis?
a. Biliary colic
b. Nephrolithiasis
c. Pancreatitis
d. Small bowel obstruction (SBO)
e. Abdominal aortic aneurysm
93.A 51-year-old man presents to the ED complaining of epigastric pain
that radiates to his back. He states that he drinks a 6 pack of beer daily. You
suspect he has pancreatitis. His BP is 135/75 mm Hg, HR is 90 beats per
minute, temperature is 100.1°F, and his RR is 17 breaths per minute. Lab-
oratory results reveal WBC 13,000/μL, hematocrit 48%, platelets 110/μL,
amylase 1150 U/L, lipase 1450 IU, lactate dehydrogenase (LDH) 150 U/L,
sodium 135 mEq/L, potassium 3.5 mEq/L, chloride 105 mEq/L, bicarbonate
23 mEq/L, BUN 15 mg/dL, creatinine 1.1 mg/dL, and glucose 125 mg/dL.
Which of the following laboratory values are most specific for pancreatitis?
a. Elevated amylase
b. Hyperglycemia
c. Elevated lipase
d. Elevated LDH
e. Leukocytosis
88 Emergency Medicine