USMLE PRACTICE QUESTION OF THE WEEK

Question for November 7, 2025

A 46-year-old man presents with 12 hours of severe, constant epigastric pain radiating to the back that worsens when lying supine and improves when leaning forward. He had several episodes of nonbloody emesis. He drinks 5–6 shots of liquor nightly and took ibuprofen yesterday for a headache. Temperature is 38.1°C (100.6°F), pulse 108/min, blood pressure 118/72 mm Hg. Abdomen is soft with marked epigastric tenderness and decreased bowel sounds.

Labs show:
  • Serum lipase: 1,650 U/L (normal < 60)
  • AST: 62 U/L, ALT: 58 U/L
  • Total bilirubin: 0.9 mg/dL
  • Triglycerides: 160 mg/dL
Which of the following structures is most likely inflamed in this patient?

Correct Answer:

D. Pancreas

Correct Answer Explanation:

Epigastric pain radiating to the back with marked lipase elevation is diagnostic of acute pancreatitis. Alcohol and gallstones are the most common causes. Duodenitis, gastritis, cholecystitis, or hepatitis do not produce such a large lipase elevation with classic positional pain.

Further Insight:

  • Initial management: aggressive IV fluids, analgesia, NPO.
  • Assess severity and complications (e.g., necrosis, organ failure).