Gastrointestinal confusion pairs
20 Gastrointestinal topics students commonly mix up on Step 2 CK, each with the fastest separator, a side-by-side comparison, and a free practice question.
Step 2 CK pairs are in open beta while clinical review finishes. Spot an issue? Tell us.
- IBD vs IBSObjective inflammatory evidence such as elevated fecal calprotectin is the fastest discriminator favoring IBD.
- Mesenteric ischemia acute vs Mesenteric ischemia chronicPain out of proportion to exam with abrupt onset.
- Small bowel obstruction vs Large bowel obstructionPredominant colonic dilation with distal obstructing lesion indicates large bowel obstruction.
- Crohn disease vs Ulcerative colitisContinuous rectal involvement favors ulcerative colitis, while skip lesions and perianal fistula favor Crohn disease.
- Cholecystitis vs CholangitisJaundice with cholestatic pattern points to cholangitis and urgent biliary drainage need.
- GERD vs Functional dyspepsiaAcid regurgitation into the throat strongly favors GERD over functional dyspepsia.
- Diverticulosis vs DiverticulitisCT evidence of pericolic fat stranding with left lower quadrant pain separates diverticulitis from uncomplicated diverticulosis.
- Upper GI bleed vs Lower GI bleedBUN:creatinine ratio above 20:1 with melena strongly points to an upper GI bleeding source.
- Primary biliary cholangitis vs Primary sclerosing cholangitisPositive antimitochondrial antibody is the quickest discriminator for primary biliary cholangitis.
- Alcoholic hepatitis vs NAFLD/NASHAST to ALT ratio above 2 with recent heavy alcohol use is the fastest discriminator for alcoholic hepatitis.
- Hepatitis B acute vs Hepatitis B chronicIgM anti-HBc positivity identifies acute hepatitis B rather than chronic infection.
- Acute pancreatitis mild vs Acute pancreatitis severePersistent organ failure lasting more than 48 hours defines severe acute pancreatitis.
- Hepatitis A vs Hepatitis EAcute hepatitis in a pregnant patient with contaminated-water exposure should immediately raise concern for hepatitis E.
- Esophageal achalasia vs Diffuse esophageal spasmElevated LES integrated relaxation pressure on manometry identifies achalasia rather than diffuse esophageal spasm.
- Variceal bleed vs Non-variceal upper GI bleedIn suspected cirrhosis with hematemesis, start vasoactive therapy and antibiotic prophylaxis before endoscopy because this pathway is…
- C. difficile colitis vs Ischemic colitisPositive stool C. difficile toxin or NAAT after recent antibiotic exposure is the fastest discriminator toward infectious pseudomembranous…
- Pancreatic sterile necrosis vs Pancreatic infected necrosisGas within a pancreatic necrotic collection on contrast CT is the fastest discriminator for infected necrosis.
- Biliary colic vs CholedocholithiasisCholestatic labs with dilated common bile duct on imaging is the key discriminator for choledocholithiasis.
- Tropical sprue vs Celiac diseasePositive celiac serology, especially IgA tissue transglutaminase, is the fastest discriminator toward celiac disease.
- Hepatitis B treatment vs Hepatitis C treatmentHBV treatment is usually indefinite viral suppression, while HCV treatment is a time-limited curative DAA course.