15- abdominal pain

Question 1

psoas sign

Answer 1

Passive extension of patient’s thigh as s/he lies on his/her side with knees extended, or asking the patient to actively flex his/her thigh and hip causes abdominal pain, often indicative of appendicitis.

Question 2

obturator sign

Answer 2

Examiner has patient supine with right hip flexed to 90 degrees; takes patient’s right ankle in his right hand as he uses his left hand to externally/internally rotate patient’s hip by moving the knee back and forth. Elicitation of pain in the abdomen implies acute appendicitis.

Question 3

biliary colic

Answer 3

right upper quadrant pain, epigastric pain or chest pain that is constant typically lasts 4-6 hours or less, and often radiates to the back (classically under the right shoulder blade).

It is often accompanied by nausea or vomiting and often follows a heavy, fatty meal.

These symptoms are a result of a stimulated gallbladder (e.g., from a fatty meal) contracting when a gallstone obstructs the outlet of the cystic duct.

The hallmark of biliary colic is that the stone is mobile and eventually moves away from the outlet allowing resumption of normal gallbladder function and resolution of symptoms.

Question 4

cholecystitis

Answer 4

right upper quadrant pain with associated nausea and vomiting and also classically occurs following a large, fatty meal.

The pathophysiology of cholecystitis is similar to biliary colic but is caused by a stone that is not dislodged from the cystic duct outlet. In contrast to biliary colic, the symptoms of cholecystitis typically persist, are more severe, and are often associated with fever. An elevated white blood cell count is often present from inflammation of the distended gallbladder wall. It should be noted that these inflammatory changes found with cholecystitis can be acute or chronic.

Question 5

murphy sign indicates

Answer 5

cholecystitis

Question 6

duodenal ulcer

Answer 6

typically causes epigastric pain (possibly right or left upper quadrant pain) that is relieved rather than worsened by food and is relieved by antacids.

nausea common

Question 7

hepatitis

Answer 7

While RUQ pain, nausea, and vomiting are frequently encountered, there is often associated malaise, anorexia, itching, and icterus/jaundice. Hepatomegaly is often present.

Question 8

acute pancreatitis

Answer 8

Nausea, vomiting and epigastric pain

abdominal tenderness on exam and there is unlikely to be resolution of symptoms without prolonged bowel rest, and jaundice may be seen if there is obstruction of the common bile duct.

Question 9

Grey Turner sign

Answer 9

ecchymotic discoloration in the flank

seen in acute pancreatitis

Question 10

Cullen sign

Answer 10

ecchymotic discoloration in the periumbilical region

seen in acute pancreatitis

Question 11

simple KUB (kidney, ureter, bladder) film would indeed be helpful in ruling in or ruling out

Answer 11

kidney or ureter stone

Question 12

BNP (Brain natriuetic peptide) (J) is primarily useful in distinguishing

Answer 12

chronic obstructive pulmonary disease from congestive heart failure, especially in the evaluation of shortness of breath

Question 13

the preferred study to evaluate the right upper quadrant is

Answer 13

abdominal US

Question 14

management of biliary colic

Answer 14

Surgical consultation for cholecystectomy (non-emergent)

Question 15

ursodiol

Answer 15

an agent that is sometimes effective in dissolving gallstones and preventing future gallstone

If the patient is having more atypical symptoms with visible stones, which may or may not account for the symptoms, then such a medical trial might be warranted.

Question 16

If there was jaundice and/or gallstone pancreatitis suggestive of a common duct stone (choledocholelithiasis), what might be warranted

Answer 16

ERCP

Question 17

Moderate Drinking means

Answer 17

patient’s alcohol consumption is up to one drink per day for women and up to two drinks per day for men.

Question 18

Binge Drinking is defined by

Answer 18

consumption of five or more alcoholic beverages on one occasion on one or more days in a 30-day period.

Question 19

Heavy Drinking is defined by

Answer 19

consuming five or more alcoholic drinks on a single occasion, five or more days in a 30-day period.

Question 20

Alcohol Use Disorder

Answer 20

2 of following: More than once wanted to cut down or stop drinking, or tried to, but couldn’t.
Spent a lot of time drinking, being sick from drinking, or getting over the after-effects of drinking.
Experienced craving - a strong need, or urge, to drink.
Found that drinking - or being sick from drinking - often interfered with taking care of his/her home or family; has caused job troubles or school problems.
Continued to drink even though it was causing trouble with family or friends.
Given up or cut back on activities that were important or interesting to the patient or gave him/her pleasure, in order to drink.
More than once gotten into situations while or after drinking that increased the patient’s chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex).
Continued to drink even though it was making the patient feel depressed or anxious or adding to another health problem, or after having had a memory blackout.
Had to drink much more than he/she once did to get the effect he/she wanted, or found that his/her usual number of drinks had much less effect than before.
Found that when the effects of alcohol were wearing off, the patient had withdrawal symptoms, such as trouble sleeping; shakiness; irritability; anxiety; depression; restlessness; nausea; or sweating, or r sensed things that were not there.