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Step 2 CS > abdo cases > Flashcards

abdo cases Flashcards

1
Q

n and v hx

A

acuity / onset, abdo pain, pre or postprandial or food poisoning, pregnancy, gi or abdo pain, neuro (headache, stiff neck, vertigo, numb or weak), urinary, exacer/alleviate, meds, hx abdo sx

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2
Q

n and v ex

A

vitals, ent (press on sinuses), fundoscopic ex (due to increased icp), abdo ex. heart, lung, rectal, pelvic ex

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3
Q

n and v ix

A

preg: urine hCG, pelvic ex, pelvic us
ubc, euc, ca, glucose
ua, HIV Ab

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4
Q

n and v ddx

A

pregnancy, gastritis, hyperCa2++, DM, UTI, depression

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5
Q

preggers

A

morning n and v, fatigue, polyuria, LMP over a month ago, breasts full and tender, actives sans contraception

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6
Q

abdo pain hx

A

socrates/liqraa (timing; associated constitution, gi, heart, lung, renal pelvic)
abdo surgeries, trauma, gallstones, renal stones, atherosclerosis
meds (NSAIDS, steroids), etoh/drugs, needles, violence, stress/anxiety, sexual, preggers

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7
Q

abdo pain ex

A

tenderness, guarding rebound, Murphy’s (arrest of inspiration when pressing on RUQ), posas /obdurator/Rovsing signs, CVA percussion, bowel sounds, aortic bruits (AAA, carotids). rectal, pelvis (for women)

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8
Q

sudden colicky R flank pain. rads to testicles, n,v,hematuria, cva tenderness

A

nephrolithiasis, rcc, pyeloneph, GI (appendicitis)

ix: ua, urine culture and sensitivity / cytology, bun/cr, ct abdo, us renal, kub, ivp, bc (blood culture)

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9
Q

dull epigastric pain, rads to back. weight loss, dark urine, clay stools. jaundice, smoker, drinker

A

pancreatic ca, cholangioca (also jaundice and stool/urine combo). chronic pancreatitis.
acute viral or alcoholic hepatitis. cholecystitis/choledocholithais.
aaa, peptic ulcer

cbc, euc, lipase (more specific for pancreas), amylase, lfts (ast/alt/bilirubin/alp), us or ct abdo

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10
Q

midepigastric rads to back, improves with forward lean. anorexia, n,v, etoh (binge)

A

acute pancreatitis, cholecystitis/choledocholithiasis
PUD, gastritis
AAA, mesenteric ischemia, alocholic hepatitis, Boorhave’s (no vomiting blood doe)/Mallory Weiss

cbc, euc, bun/cr, lfts, amylaes/lipase, us or ct abdo, upper endoscopy, ecg

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11
Q

40s, obese, female, ruq pain rads to R scapula/back, n,v,fever,after ingesting fatty food. +Murphy’s

A

acute cholecystitis, choledocolithiasis, hepatitis, ascending cholantigis
PUD, fitx-hugh-curtis, acute subhepatic appendicitis

cbc, lfts, us or ct abdo, bc (blood culture)

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12
Q

40s obese female, ruq pain, fever, JAUNDICE. gallstones a yr ago, HYPOtensive

A

ascending cholantitis, acute gallstone cholangitis, acute cholecystitis, hepatitis, sclerosing cholangitis, fitz hugh

cbc, lfts, bc, viral hepatitis serology, us abdo, mrcp/ercp

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13
Q

25 m ruq, fever, anorexia, n,v. dark urine, clay stools

A

acute hepatitis, acute cholecystitis (but urine adn stool), asending cholantitis/choledoco, pancreatitis, acute glomerulonepth

cbc, amylase/lipase, lfts, viral hepatitis serology, ua, us abdo

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14
Q

35 m, burning epigastric pain, postprandial, relieved by food/antacids

A

PUD, gastritis, gerd
cholecystitis, chrnoic pancreatitis, mesenteric ischemia

rectal, fobt, amylase/lipase/lactate, lft’s, upper endoscopy (H pylori-also test with breath, blood or stool exam), upper gi series

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15
Q

abdo pain key features

A

pancreas-epigastric, rads to back (alcohol, smoking exacerbates)

gall bladder-RUQ, fat, female, forty, tachycardio/hypotensive

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16
Q

37 m severe epigastric pain, n, v, fever, toxic. PHx relieved by food, antacids, smokes

A

perforated peptic ulcer
acute pancreatitis, hepatitis, cholecystitis, gallstone cholangitis, mesenteric ischemia

cbc, euc, amylase/lipase/lactate, lfts, bc
rectal, cxr, kub, ct abdo, upper endoscopy

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17
Q

luq abdo pain rads to L scapula, mono previously

A

splenic rupture, splenic infarct, kidney stone, rib fracture, pneumonia, perforated peptic ulcer

cbc, euc, cxr, ct or us (if hemodynamically unstable) abdo

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18
Q

crampy abdo, v, distended, can’t pass flatus/stool. abdo surgeries

A

intestinal obstruction (from adhesions, ie sbo), ileus, sb/colon ca, volvulus, gastroenteritis, food poisoning, hernia

rectal ex, cbc, euc, axr, ct abdo pelvis +/- contrast, colonoscopy

19
Q

elderly, acute onset severe, crampy pain. n,v, big dark stool. phx: chf, af

A

mesenteric ischemia/infarction, diverticulitis, PUD, gastroenteritis, acute pancreatitis, cholecystitis

rectal, cbc, euc, amylase/lipase/lactate, ecg, axr, ct abdo, mesenteric angio, barium enema

20
Q

20s F acute severe RLQ pan, n,v.cyst R ovary

A

ovarian torsion, ruptured ovarian cyst (but would be more acute), ectopic, PID
appendicitis, nephrolithiasis, bowel infarction/perforation

pelvic ex, urine hCG, doppler us pelvis, rectal
ua, cbc, NAAT chlamydia gono, vdrl/rpr
ct abdo, laparoscopy

21
Q

older M, LLQ abdo pain, fever chills 3 days. alternating diarrhea and constip. low fiber, high fat diet

A

diverticulitis, crohn’s, UC, gastroenteritis, abcess

recral ex, cbc, euc, cxr, axr, ct abdo, bc

22
Q

20s RLQ abdo,n,v. periumbilical dull to RLQ sharp. mcBurney’s, Murphey’s, psoas +

A

acute appendicitis, gastroentero, divertculitis, crohn’s, volvulus/obstruction, perforation
neprolithiasis, acute cholecystitis

23
Q

30s F perumbilical 6 mo, relieved by defecation, worsens when upset/stress, alternating constip and diarr.

A

IBS, celiac, chron’s, diverticulosis (but would be older), chronic pancreatisis, parasitic infection (amebiasis, giardiasis), endometriosis

rectal, fobt, pelvic, urine hcg
cbc, euc, stool for o and p, e histolytica antigen
colonoscopy, ct abdo pelvis

24
Q

20s F, bilat lower abdo pain, started with first day menstrual period. fever, thick green yellow discharge, unprotected sex

A

PID, endometirosis, dysmenorrhea, vaginitis, cystitis, pyelo, spontaneous abortion

pelvic, urine hcg, cervical cultures
cbc, esr, ua, u culture, pelvis us

25
Q

bloody stool hx ex

A

melena/dark vs bright red blood, in the bowl or on the tp, amount, duration, associated ssx (b sx, abdo/rectal pain, tenesmus, difficulty passing/straining, c/d), trauma,

Hx similar. hx colonoscopy, meds (esp anticoagulants), menstrual cycle

hx easy bleeds/atherosclerotic vascular dz, renal, aortic valve, liver dz. aaa repair. etoh. Fhx colon ca

ex: vitals, orthostatic bp, abdo, rectal

26
Q

elderly, weight loss, bloody stool, c, FHx colon ca

A

colorectal ca. anal fissure (brighter blood), hemorrhoids, diverticulosis, ischemic bowel dz, angiodysplasia, upper gi bleed, inflam bowel dz

ix: rectal, cbc, lfts, inr/pt, cea, colonoscopy, ct abdo

27
Q

30s F rectal bleeding, d, lower abdo pain, tenesmus for months

A

UC (rectal vs skip lesions), chron’s, proctitis, anal fissure, hemorrhoids, diverticulosis, dysentery

rectal, cbc, pt/ptt, colonoscopy, ct abdo/pelvis

28
Q

older M painless bright red blood per rectum, chronic c, low fiber

A

diverticulosis, anal fissure, hemorr, angiodysplasia, colorectal ca

rectal, cbc, blood type/cross, pt/ptt, euc, tagged rbc scan
colonoscopy, ct abdo pelv

29
Q

upper gi bleeds hx ex

A

amt, duration, context/tiing (after vomiting, etoh, nosebleeds), associated sx (b, n,abdo pain, dyspepsia), meds (anticoag, nsaids, steroids). hx PUD, liver dz, AAA repair, easy bleeding

ex: vitals/orthostatic, *ent, heart,lung,abdo,rectal

30
Q

40s F coffee ground emesis, dark tarry stools, intermittent epigastric pain relieved by food/antacids

A

bleeding peptic ulcer, gastritis, gastric ca, esophageal varices

31
Q

40s F epigastric pain coffee ground vomit, RA treated with NSAIDS, etoh

A

gastritis, bleeding peptic ulcer, gastric ca, varicess, mallory weiss tear

32
Q

upper gi bleeds ix

A

rectal, cbc, blood typing, euc, lfts, inr, upper endoscopy (H pylori tests if ulcer)

33
Q

constip / diarrhea hx

A

freq / duration of change, color, oder, volume, mucus, flatulence, flating stools.

associated sx (b, abdo pain, bloating, tenesmus, straining, melena, hematochezia)
thyroid dz (palpitations, hot, weight loss)

diet (fiber, fluids), meds (antibiotics/cdiff), sick contacts, travel, camping. HIV rfs, abdo sx (adhesions obstructing), diabetes, pancreatitis, etoh and drug use, FHx colon Sx

34
Q

constip / diarrhea ex

A

vitals, thyroid, endo, abdo, rectal, pelvic for females

35
Q

constip / diarrhea ix

A

rectal, fobt, cdiff toxin, stool leukocytes and culture,stool o and p, giardia antigen, entamoeba histolytica antigen

cbc, euc, lfts, tsh/t4, utox, viral hep serology, hydrogen/urea breath test, 5-hiaa (carcinoid)

colonoscopy, barium enema, ct abdo pelvis, small bowel series

36
Q

33 M water diarrhea, diffuse abdo pain, weight loss 3 w. hx apthous ulcers

A

crohn’s, uc, gastroentero, celiac, hperthyroidism, pseudomembrane colitis, small bowel lymphoma, carcinoid

37
Q

watery diarr, abdo cramps, bloating, post milk relieved by fasts

A

lactose intolerance, gastroenero, inflam or irritiable bowel dz, hyperthy

38
Q

watter diarrhea, cramps, Mexico

A

traveler’s d (e coli), giardiasis, emebiasis, food poisoning, hep a

39
Q

40s F, watery diarrhea, abdo cramps, UTI antibiotics recently

A

pseudomembranous colitis, gastroentero, cryptosporidiosis, food poisoning, inflam bowel dz

40
Q

watery dia, v, diffuse abdo pain (vs cramps-more infectious etiology), fever, sick contacts

A

gastroenter (infecious via bacteria, virus, parasites, protozoa), food poisoning

41
Q

alternating c and d, abdo pain, relieved by defecation.

A

irritable bowel, inflam, celiac, chronic pancreatitis, lactose intolderance, gi parasite (ascariasis, giardiasis)

42
Q

c (hard stool), poor diet

A

low fiber diet, depression, irritibal bowel, hypothyroid, substance abuse

43
Q

elderly alternating d and c, decreased stool caliber (obstructing lesion on left, look for anemia on right), blood in stool, unintentional weight loss. FHx

A

colon/colorectal ca, diverticulosis, irritable bowel, inflam bowel, gi parasite

Step 2 CS (8 decks)

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