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51 Cards in this Set
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- Back
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Q450. Diff Dx: RUQ Pain; Hepatobiliary (4); GI (1)
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A450. Cholelithiasis; Cholecystitis; Cholangitis; Hepatitis; Peptic Ulcer
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Q451. Diff Dx: LUQ Pain; Splenic (5); GI (1)
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A451. Spleen trauma; infarction; abscess; rupture; Mononucleosis; Gastric Ulcer
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Q452. Diff Dx: RLQ Pain; GI (3)
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A452. Small bowel obstruction;; Appendicitis;; Crohn's Disease
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Q453. Diff Dx: LLQ Pain; GI (2)
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A453. Inflammatory Bowel Disease;; Diverticulitis
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Q454. Diff Dx: Flank Pain; GU (5)
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A454. NET PP:; Nephrolithiasis;; Epididymitis;; Testicular Torsion;; Pyelonephritis;; Prostatitis
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Q455. Diff Dx Pain: Adnexal (lower abdominal) Pain; (6)
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A455. PET SOCk:; PID;; Ectopic Pregnancy;; Tubo-ovarian abscess;; Salpingitis;; Ovarian torsion;; Cystitis
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Q456. Dx: 26-yo woman has severe LLQ pain, vaginal bleeding and light-headedness. Last menstrual period was 6 weeks ago
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A456. Ectopic Pregnancy
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Q457. Diff Dx: Pain Anywhere in Abdomen; (4)
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A457. Strangulated hernia;; Large Bowel Obstruction;; Sigmoid Volvulus;; Mesenteric Ischemia
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Q458. Dx: 28-yo woman presents with diffuse abdominal pain, nausea, and confusion. She is not pregnant but takes a stained-glass class.
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A458. Lead poisoning
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Q459. Diff Dx: Abdominal wall Pain; (2)
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A459. Hernia; Rectus sheath hematoma
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Q460. Diff Dx: Metabolic/genetic-related Abdominal pain; (4)
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A460. HyperC;; Acute Intermittent Porphyria;; DKA;; Sickle cell
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Q461. Diff Dx: Viral-related Abdominal Pain; (3)
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A461. Herpes Zoster;; Mononucleosis;; HIV
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Q462. Diff Dx: Toxin-related Abdominal Pain; (2)
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A462. Heavy Metal poisoning; Black Widow Spider venom
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Q463. (3) vascular causes of abdominal pain to always consider in the elderly
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A463. MAM:; Mesenteric Ischemia;; AAA;; MI
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Q464. Diff Dx of an emergency patient with absent bowel sounds (3) or high-pitched sounds (1)
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A464. Absent: Pancreatitis;; Ischemia;; Acute Abdomen; High-pitched: Obstruction
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Q465. 63-yo obese man complains of pain in his "kidney" for 3 days. He has History of MI x 2 and no back tenderness.
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A465. AAA
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Q466. Dx: hypotension; abdominal or back pain; pulsatile mass in abdomen; History of vascular disease or atherosclerosis
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A466. AAA
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Q467. (3) Dx tests for AAA
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A467. Angiogram (gold standard); MRI or CT with contrast
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Q468. Dx: 72-yo man with History of A-fib, on digoxin and complains of severe abdominal pain out of proportion to the exam
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A468. Acute Mesenteric Ischemia
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Q469. 72-yo woman with History of MI complains of gnawing abdominal pain after eating. She lost 15 pounds in the past month.
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A469. Chronic Mesenteric Ischemia
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Q470. Cause of Acute (2) vs. Chronic Mesenteric Ischemia
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A470. Acute: Emboli (A-fib); Hypercoagulability; Chronic: Atherosclerosis
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Q471. (2) possible lab signs with Mesenteric Ischemia
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A471. Increased Lactate; Metabolic Acidosis
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Q472. Gold standard test for Mesenteric Ischemia; (2) others
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A472. Gold standard: Angiogram; others: Spiral CT with contrast, MRI
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Q473. First step for Mesenteric Ischemia; Next?
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A473. First: Maintain tissue perfusion with IV fluids until... Surgical bypass
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Q474. Cholelithiasis -; Colic results from what?; Risk factors
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A474. Colic from transient cystic duct blockage. Risk factors - female, fat, forty, fertile.
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Q475. Cholelithiasis; 3 types
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A475. 1. Cholesterol (80%) - originate from gallbladder; risk factors: obesity, rapid weight loss, Crohn's, CF, estrogens, Native Americans 2. Pigment - originate from common bile duct, calcium bilirubinate; risk factors: chronic hemolysis, biliary infections, alcohol abuse, cirrhosis 3. Mixed
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Q476. Cholelithiasis - History/PE
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A476. Postprandial abdominal pain; RUQ pain; radiates to rt. subscapular or epigastrium (can be asymptomatic); n/v; fatty food intolerance; dyspepsia; flatus; RUQ tenderness
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Q477. Cholelithiasis - Diagnosis
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A477. not XR - only 15% radiopaque; RUQ US
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Q478. Cholelithiasis - Tx
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A478. Cholecystectomy with Symptoms; ERCP - common bile duct stones; dietary modification; UDCA - if don't want surgery, effective in noncalcified cholesterol stones < 5 mm
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Q479. Cholelithasis - Complications
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A479. recurrent biliary colic; acute cholecystitis; choledocholithiasis; acute cholangitis; gallstone ileus; gallstone pancreatitis; carcinoma of the gallbladder
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Q480. Acute Cholecystitis; Results from what; Leads to what
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A480. Prolonged obstruction of cystic duct (usually stone); Distention, inflammation, infection, gangrenous, acalculous; Acalculous - in absence of cholelithiasis in TPN, trauma, burn patients.
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Q481. Acute Cholecystitis; History/PE
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A481. RUQ pain; n/v; low-grade fever; Murphy's sign
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Q482. Acute Cholecystitis; Dx
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A482. US; HIDA scan; CBC; amylase, lipase; bilirubin; LFT
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Q483. Acute Cholecystitis; Tx
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A483. IV Antibiotics; IV fluids; replete electrolytes; early cholecystectomy; preop ERCP; intraop cholangiogram
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Q484. Acute Cholecystitis; Complications
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A484. gangrene; abscess; perforation; empyema; sepsis; gallstone ileus; fistulization
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Q485. Choledocholithiasis - Results from what
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A485. gallstones in the COMMON BILIARY DUCT
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Q486. Choledocholithiasis - History/PE
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A486. biliary pain; jaundice; colic; fever; pancreatitis
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Q487. Choledocholithiasis - Dx
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A487. Increased alkaline phosphatase and total bili
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Q488. Choledocholithiasis - Tx
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A488. ERCP with stone extraction and sphincterotomy; cholecystectomy
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Q489. Acute Cholangitis; Results from what; Leads to what
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A489. Acute bacterial infection of biliary tree - from primary sclerosing cholangitis or obstruction (gallstones) as obstruction persists (usu from choledocholelith.); increased in intraluminal pressure --> reflux of bacteria to systemic circulation; Charcot's triad => Reynolds' pentad
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Q490. Acute Cholangitis; Bacteria
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A490. E Coli; Pseudomonas; Enterobacter
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Q491. Acute Cholangitis; History/PE
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A491. Charcot's triad; Reynold's pentad
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Q492. Acute Cholangitis; What is Reynold's pentad and what does it suggest
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A492. RUQ pain; jaundice; fever/chills; shock; altered mental status; suggests sepsis
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Q493. Acute Cholangitis; Dx
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A493. leukocytosis; increased alkaline phosphatase and bili; BC (to rule out sepsis); US or CT - may be useful; ERCP
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Q494. Acute Cholangitis; Tx
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A494. ICU; IV Antibiotics; IV hydration; bile duct decompression - open surgical, percutan transhepatic drain or ERCP sphincterotomy
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Q495. Diarrhea; What is it; Risk factors
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A495. > 200 gm feces/day, change in stool consistency; viral/bact. GI infection; systemic infection; sick contacts; immunosuppression; recent Antibiotics use; recent travel
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Q496. Diarrhea - What are the types (1)
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A496. Acute - < 2 wks of Symptom, infectious and self-limited, 2nd MCC - drug side effect chronic - > 2-3 wks of Symptom, disrupted secretion, malabsorption, altered motility; MCC in adults - lactase def. pediatric - usually rotavirus; can also divide as infectious, secretory, osmotic
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Q497. What are Infectious Diarrhea
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A497. - enterotoxigenic: E. coli (traveller's diarrhea); enteroinvasive: bloody diarrhea & fever; campylobacter -MC bacteria to cause diarrhea, MCC of reactive arthritis; shigella - transferred by food & water, found in daycare; salmonella - raw eggs & dairy; V. vulnificus: severe if have liver dis. Yersinia: abdominal pain, joint pain, rash, may resemble appendicitis; E. coli O157:H7, HUS; viral: MCC of infectious diarrhea
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Q498. What are secretory & osmotic diarrhea
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A498. Secretory: diarrhea > 1L; carcinoid syndrome; Zollinger-Ellison syndrome; VIPoma; phenolphthalein (laxative) osmotic - > 50 osmol/kg osmolality; lactose, fructose, sorbitol; MCC - lactase def.
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Q499. Diarrhea - Dx
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A499. - stool electrolytes - secretory vs. osmotic; fecal leukocytes – enteroinvasive, IBD; methylene blue - checks for WBC; stool Cx, O&P; giardia - string test & stool giardia Ag; cryptosporidia - modified AFB stain; NaOH - turns stool red if phenolphthalein use; colonoscopy or Biopsy
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Q500. Diarrhea - Tx
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A500. infectious - self-limited; mild - oral fluids & electrolytes; severe - IV fluids & oral Antibiotics, initial empiric- ciprofloxacin; invasive - TMP-SMX or ciprofloxacin; giardia - metro; c. diff - metro; campylobacter - erythromycin; scombroid - antihistamine; cryptosporidium - control underlying HIV with antiretrovirals
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