ABDOMEN Flashcards
Mechanism of the formation of chylous ascites.
A Exudation of chyle from dilated mesenteric lymphatics
B Direct leakage of chyle
through a lymphoperitoneal fistula
C None of the choices is correct
D Obstruction of major lymphatic channels
at the base of the mesentery or the cisterna chyli
EAll of the choices are correct
E AOTA
True about acute mesenteric lymphadenitis, except:
None of the choices is correct Associated mesenteric lymph node
enlargement
Presents commonly as right lower
quadrant pain.
All of the choices are correct
The appendix is normal
AOTA
You were asked to assist in a surgical operation on a young patient to treat an ulcer in the first part of the duodenum. You would expect that the surgeon will approach the ulcer by doing an anterior abdominal wall incision in the following region:
Left lumbar
Left inguinal
Right hypochondrial
Epigastric
Hypogastric
Epigastric
The following is/are the mechanism/s of ideas causation of retroperitoneal malignancies, except:
Development of a primary malignancy of the retroperitoneal lymphatic system. Hematogenous spread from remote
cancer sites
Extracapsular growth of a primary
neoplasm of a retroperitoneal organ None of the choices is correct
All of the choices are correct
E AOTA?
What
retroperitoneal abscess?
The most common source of retroperitoneal abscesses are secondary with renal infections accounting for nearly 50% of all cases.
The posterior cul-de-sac is found between the uterus and the rectum. They are also called the excavatio recto-uterina (posterior) and excavatio vesico-uterina (anterior). Another term for cul-de-sacs is pouch of Douglas, named after the Scottish anatomist James Douglas.
Retroperitoneal Teratoma Retroperitoneal hematoma Nephrolithiasis
Ruptured appendicitis Diverticulitis
Nephrolithias
Kidney is retro
Small Bowel Mesentery extends from which vertebra
A. L4 B. T4 C. L2 D. L6
C
Left of L2
A 60-year-old woman arrived at the emergency room complaining of acute abdominal pain. She was diagnosed with ischemic bowel resulting from an obstruction of one or more branches of the inferior mesenteric artery. Which of the following is most likely NOT to be seriously affected by ischemia?
Cecum
Rectum
Splenic flexure
Sigmoid colon
Descending colon
Cecum
SMA NOT IMA
The following are the mechanisms in the causation of ascites, except
Malignant cells scattered throughout the peritoneal cavity release protein-rich fluid into the peritoneal cavity.
Multiple hepatic metastases cause portal hypotension by dilating the branches of portal venous system
Obstruction of retroperitoneal lymphatics by a tumor causes rupture of major lymphatic channels and the leakage of chyle into the peritoneal cavity.
Renal sodium retention is driven by activation of the renin-angiotensin- aldosterone and sympathetic nervous systems.
None of the choices is correct
Multiple hepatic metastases cause portal hypotension by dilating the branches of portal venous system
The Lesser Omentum
A. Extends from the liver to the greater curvature of the stomach
B. Attaches to the greater curvature of the stomach
C. Extends from the liver to the lesser curvature of
the stomach
D. Extends from the lesser curvature of the stomach to symphysis pubis
C.
Cardinal signs of peritonitis EXCEPT
A. Direct tenderness
B. Abdominal muscle guarding
C. Abdominal wall rigidity
D. Abdominal distention
E. Rebound tenderness
D Abdominal distention
A patient present to your ER with a knife wound in the 6-pack region above the arcuate line. Which of the following shows the order of layers the knife would have penetrated?
A. SKin , Campers fascia, Scarpas Fascia, Rectus sheath, Rectus Abdominis, Rectus Sheath, Extraperitoneal fascia, Peritoneum
B. Skin, Campers Fascia, Rectus Sheath, Rectus Abdominis, Scarpas Fascia, Extraperitoneal Fascia, Peritoneum
C. Skin, Campers Fascia, Scarpas Fascia, Rectus Sheath, Rectus abdominis, Extraperitoneal Fascia, Peritoneum
D. Skin, Scarpas Fascia, Campers Fascia, Rectus Sheath, Rectus abdominis, Rectus sheath, Extraperitoneal Fascia, Peritoneum
A.
The following is/are the general mechanisms whereby developmental abnormalities result in the formation of internal hernias, EXCEPT
A. Abnormally large internal foramina or fossae
B. Incomplete mesenteric surfaces with the
presence of an abnormal opening through which the intestine herniates
C. Abdominal retroperitoneal fixation of the mesentery resulting in anomalous positioning of the intestine
D. All of the choices are correct
E. None of the choices is correct
D, AOTA
The inguinal ligament is the inferior-most part of which abdominal wall muscle? A. Transversalis
B. Internal oblique C. External oblique D. Rectus abdominis
C EXTERNAL
Which nerve root(s) supplies innervations to the skin of the umbilicus? A. C3, 4, and 5
B.T1 motor - 1-6-1-12
C.T4and5 skin edematimes) - 1-4-11 D.T10
D. T10
Treatment for diastasis recti
Primary open repair
Open repair using mesh
Laparoscopic repair using mesh
Observation
Observation
48-year-old patient presents with sudden onset of bilateral lower abdominal pain after spasmodic coughing. On examination, there is an 8-cm, tender mass in the mid lower abdomen that remains unchanged with contraction of the rectus muscles. Which of the following is the most likely diagnosis?
A.Ruptured aortic aneurysm
B. Obturator hernia
C. Spigelian hernia
D. Rectus sheath hematoma
D. Rectus sheath hematoma
The indications for surgery in a patient with a rectus sheath hematoma include
A. Persistent pain after 24 hours
B. Expanding hematoma after embolization
C. Need for transfusion
D. Need for ongoing anticoagulation
B. Expanding hematoma after embolization
Which of the following is the most important initial therapy for a patient with portal hypertension, ascites, and a tense umbilical hernia?
A. Primary repair with concurrent placement of a peritoneal venous shunt
B. Emergency primary repair to avoid hernia rupture
C.Medicaltherapytocontroltheascites
D. Transjugular intrahepatic portocaval shunt followed by umbilical hernia repair
C. Medical therapy’ to control the ascites
In a patient with a permanent ileostomy and 4-cm infraumbilical midline incisional hernia, which of the following would be the most appropriate?
A. Open primary closure
B. Open mesh closure
C. Component separation
D. Observation
C. Component separation
A 22-year-old man presents with localized peritonitis of the right lateral eating, and has a white blood cell count of 12,000. CT scan demonstrates of the following is the most appropriate treatment?
A nonsteroidal anti-inflammatory agent and observation
B. Broad spectrum antibiotics, morphine with exploration if no improvement after 24 hours
C. Laparoscopic exploration to confirm the diagnosis and resect the infarcted omentum D. Total omentectomy (open or laparoscopic)
A.NSAID ANDOBSERVE
A 55-year-old woman presents with a palpable abdominal mass and abdominal pain. CT scan and exploration show scarring of the mesentery with shortening and retraction. The base of the mesentery is fibrotic and thickened. Following biopsy confirmation of your clinical diagnosis, which of the following is the best therapy for this patient?
A. Surgical debulking of the tumor
B. Chemotherapy
C. Chemotherapy and radiation therapy
D. Observation
D
A 15-year-old girl presents with a mobile, 8-cm mid abdominal mass that moves freely from left to right but does not move superiorly or inferiorly. Which of the following is the most likely diagnosis?
Omental cyst
Ovarian cyst
Mesenteric cyst
Gastric duplication
Mesenteric cyst
Which of the following drugs is associated with retroperitoneal fibrosis?
A. Methysergide
B. Omeprazole
C.Prozac
D. Dapsone
Methysergide
Which of the following is the most appropriate treatment for retroperitoneal fibrosis?
A. Surgical débridement of potentially obstructing fibrosis
B. Prevention of obstruction with anticoagulation (for IVC thrombosis) and ureteral stenting (for
ureteralobstruction)
C. High dose corticosteroids
D. Observation
C. High dose of corticosteroids
A cutaneous malignancy of the anterior abdominal wall 2 inches above the umbilicus will drain to which lymphatic basin?
A. Umbilical
B. Axillary
C. Retroperitoneal
D. Inguinal
B. Axillary
The appropriate treatment of rectus abdominis diastasis is
A. Observation
B. Resection and primary repair
C. Meshoverlay
D. Lateralcomponentseparation
Observation
Persistence of the vitelline duct can lead to which of the following?
A. Colonicdiverticulum
B. Urachalcyst
C. Umbilical cord hernia
D. Omphalomesentericductcyst
D, omphalomesenteric duct cyst
The usual presentation of a rectus sheath hematoma is A. Unexplainedanemia
B. Abdominalwallbulge
C. Suddenabdominalpain
D. Inabilitytostanderect
C. Sudden abdominal pain
A 40-year-old woman who underwent total abdominal colectomy for familial adenomatous polyposis (FAP) 5 years ago presents with a gradually expanding painless 4 cm mass of the anterior abdominal wall. A biopsy is returned as “desmoid tumor with no sign of malignancY:’ The correct management is
A. Observation
B. A course ofdoxorubicin, dacarbazine, or carboplatin
c. Enucleation
D wide local excision
D. Wide local excision
RepairofanewS-cmmidlinepostoperativeventralhernia in an otherwise healthy patient is best accomplished with
A. Primary suture repair
B. Repair with synthetic mesh
c. Repairwithtranspositionofrectusmuscle
D. Lateralcomponentseparationwithmeshoverlay
B. Repair with synthetic mesh
Repair of a new 5 cm midline postoperative ventral hernia in an otherwise healthy patient is best accomplish with
A. primary suture repair
B. Repair with synthetic mesh
C. Repair with transposition of rectus muscle
D. Lateral component separation withthe mesh overlay
B. Repair with synthetic mesh
Which is the ff statements regarding umbilical hernia is true?
A. Umbilical hernia are present in 10% of all newborns
B. Umbilical hernias should be repaired as soon as they are dx
C. Adults with small, non incarcerated umbilical hernias should undergo repair
D umbilical hernias are associated with disseminated carcinomas
A.
8.
Spigelian hernias usually occur
A. On the lateral border ofthe rectus abdominis muscle
B.In the linea alba
C. In the medial wall ofthe inguinal canal
D. n the posterior costovertebral angle
A. Lateral border of the rectus
Laparoscopic repair ofincisional hernias is associated with which ofthe following?
A. Reduced hospital cost
B. Reduced recurrence rate
C. Reduced wound infection rate
D. Reduced seroma formation
C. Reduced wound infection rate
Which of the following statements
about omental infarction are true?
A. Patientsusuallypresentwithfeverandlassitude.
B. Most cases are diagnosed on imaging studies.
C. Most cases do not require surgery.
D. Surgical resection is indicated in all cases.
C. Do not require surgery
A 60-year-old woman presents with abdominal pain, and a CT scan reveals an omental mass. The most likely diag nosis is
A. Desmoid tumor
B. Liposarcoma ofthe omentum
C. Omental infarction
D. Metastatic carcinoma
D metastatic ca
Failure offixation ofthe small intestinal and right colonic mesentery during gestation can result in
A. Chronic constipation
B. Intestinal malrotation
C. Umbilical hernia
D. Intussusception
B
Which ofthe following statements about sclerosing mes enteritis is FALSE?
A. It is always associated with diffuse abdominal pain.
B. It can appear as a mass on CT scan.
C. It can improve or resolve without surgical therapy.
D. It can be mistaken for primary or metastatic tumor
A.
The primary treatment ofretroperitoneal fibrosis is
A. Corticosteroids
B. Cyclosporine
C. Radiation therapy
D. Surgical resection
A.
Primary compartment extending across the anterior abdomen from the diaphragm to pelvis
A. Greater omentum B. Paracolic gutters
C. Lesser sac
D. Greater sac
C. Greater Sac
Spaces between the colon and abdominal wall
A. Perinephric spaces B. Suprahepatic spaces C. Paracolic gutters
D. Intrahepatic spaces
C. Paracolic gutters
Lesser sac is the peritoneal recess anterior to the stomach
A. True
B. False
False
The following is/are mechanism/s of ideas causation of retroperitoneal malignancies, EXCEPT
A. Hematogenous spread from remote cancer sites
B. Extracapsular growth of a primary neoplasm of a
retroperitoneal organ
C. Development of a primary malignancy of the
retroperitoneal lymphatic system
D. All of the choices are correct
E. None of the choices is correct
A.
The abdominal cavity is cleaned using a variety of methods. All statements are correct, EXCEPT
• Catheters left intra-abdominally for the purpose of post-operative lavage can erode intestines
• The clear disadvantage of radical debridement is the risk of significant bleeding
• Small amounts of povidone iodine is a better lavage alternative to large volume saline
• D. An intra-operative high volume lavage will consume about 8 liters of saline
Small amounts of povidone iodine is a better lavage alternative to large volume saline
The following is/are the general mechanisms whereby developmental abnormalities result in the formation of internal hernias, EXCEPT
A. Abnormally large internal foramina or fossae
B. Incomplete mesenteric surfaces with the
presence of an abnormal opening through which the intestine herniates
C. Abdominal retroperitoneal fixation of the mesentery resulting in anomalous positioning of the intestine
D. All of the choices are correct
E. None of the choices is correct
AOTA
. The following is/are the general mechanisms whereby developmental abnormalities result in the formation of internal hernias, EXCEPT
A. Abnormally large internal foramina or fossae
B. Incomplete mesenteric surfaces with the
presence of an abnormal opening through which the intestine herniates
C. Abdominal retroperitoneal fixation of the mesentery resulting in anomalous positioning of the intestine
D. All of the choices are correct
E. None of the choices is correct
D
The following factors may mask the symptoms of an acute abdomen , except
• Chemotherapy
• Extreme of ages
• Sex of the patient
• Intake of steroids
• Diabetes
Sex of the px
In the diagnosis of a patient suspected with intestinal obstruction , which of the following principles should be upheld?
• Determine the etiology
• Distinguish between partial and complete obstruction
• None of the choices is correct
• All of the choices are correct
• E. Distinguish between mechanical obstruction and ileus
AOTA
The key points in the evaluation of patients with abdominal pain include the following, except
• All the choices are correct
• site and character of pain
• None of the choices is correct
• radiation of the pain
• E. aggravating and relieving factors
NONE
34 year old male with an abdominal gunshot wound underwent resection and anastomosis of the colon. On the 7th post op day, he presented with signs of acute abdomen and intestinal obstruction. On Ct scan there is located fluid in the pelvis with internal debris . Which of the possible mechanism of the patients condition?
• Only one answer is correct
• Both answers are correct
• local ileus in the small bowel adjacent to the abscess
• D. the small bowel can form a portion of the wall of the abscess
cavity and become obstructed by kinking of the bowel at this point
Both are correct
‘What is NOT true about spontaneous bacterial peritonitis?
• It is monobacterial
• All the choices are correct
• It is due to transmural bacterial migration
• None of the choices is correct
• E. It is secondary to decreased host defense
• All the choices are correct
Helpful laboratory studies in Acute Abdomen, except
• WBC
• Amylase
• HCG
• D. Electrolytes
All are correct but if WBC NEED UG DIFFERENTIALS
Which of the following is considered an intraluminal cause of intestinal obstruction?
• Intestinal Tuberculosis
• Carcinomatosis
• Adhesions
• Malrotation
• Gallstone
Gallstone
Extraluminal: “CHAABS”
Carcinoma Hernia Adhesion Abscess
Intraluminal: “BBEG”
foreign BODIES Bezoars Enteroliths Gallstone
Intrinsic: Primary Tumors
A patient with intestinal obstruction had a CT scan of the whole abdomen. Which CT scan findings will indicate the presence of strangulated obstruction?
• Presence of ascites
• Presence of colic gas
• Presence of air fluid levels
• Dilated intestinal bowel loops
• Presence of portal vein gas
PORTAL VEIN GAS
A patient is highly considered having a perforated viscus with peritonitis. With all available laboratory results, leukopenia, neutropenia & lymphocytosis stands out. If this is related to the perforation, it could be at the
• Duodenum
• Colon
• Ileum
• Stomach
STOMACH
An intra-abdominal abscess may be a focus of peritonitis. Percutaneous abscess drainage can be done if the abscess is
• Between the duodenum & gastric antrum
• Between segments 4-A & 4-B of the liver
• At the Morisons pouch
• D. At the pouch of Douglas
Between the duodenum and gastric antrum
A patient suspected with intestinal obstruction without signs of intestinal ischemia would benefit from which of the following initial management ?
• Insertion of nasogastric tube
• Upper GI endoscopy
• Exploratory laparotomy
• D. Rigid sigmoidoscopy and detorsion
Insertion of nasogastric tube
In the face of frank secondary peritonitis, an operative procedure that is LEAST to consider is
• A colostomy
• A drain placement
• An ileostomy
• D. An anastomosis
Anastomoses
Ceftriaxone was the antibiotic used as part of the management regimen of a patient with secondary peritonitis. This is a _____ generation cephalosporin.
• 4th
• 2nd
• 3rd
• D. 1st
3rd
Since the _____ is the most common organ involved in an adult patient with primary peritonitis they will manifest with _____.
• Spleen OPSS
• Liver Ascites
• Kidneys Renal failure
• D. Intestines Obstruction
Liver ascites
This pain is more localized and is perceived in the dermatomes and myotomes that are supplied by the same spinal cord segment as the affected viscus.
• Parietal pain
• Referred Visceral Pain
• Referred parietal Pain
• D. Visceral pain
Parietal pain- localized, more painful
Visceral pain- dull pain, poorly localized
) A 70 year old male presented with abdominal pain, vomiting and abdominal distention. He had previous surgery for ruptured appendicitis. His abdominal X-ray showed dilated bowel loops and multiple air fluid levels. What is the most probable diagnosis?
• All of the choices are correct
• Post operative ileus
• None of the choices is correct
• Carcinomatosis
• E. Complete intestinal obstruction secondary to post op adhesions
E. Complete intestinal obstruction secondary to post op adhesion
A patient with intestinal obstruction will have which of the following
findings on CT scan of the abdomen?
• Collapsed distal bowel segments
• Discrete transition zone with dilatation of proximal bowel
• Both choices are correct
• D. Neither choice is correct
Discrete transition zone with dilatation of the proximal bowel
A patient with abdominal distention was noted to have feculent vomitus. Which of the following is the most likely mechanism of this symptom?
• Complete and established obstruction with bacterial overgrowth
• Intestinal ileus
• Distal intestinal obstruction
• Proximal intestinal obstruction
• E. Partial gastrointestinal obstruction
Complete and established obstruction with bacterial overgrowth
The following are differential diagnoses for Right-sided abdominal pain, except
• Kidney Stone
• No exception
• UTI
• Ovarian cyst
• Ectopic pregnancy
No exception
A 65 year old male presented with signs of an acute abdomen in the ER with the following chest radiograph. What is the most probable etiology of the acute abdomen
• Interloop abscess
• Primary peritonitis
• Perforation of any hollow viscus
• Ruptured solid organ
• E. Deep organ space abscess
Primary peritonitis
female child with abdominal pain was clinically diagnosed with primary peritonitis. If diagnostic procedures are to be done, the specimen that would be most helpful with the diagnosis will be
• Urine
• Saliva
• Blood
• D. Feces
Blood. Primary peritonitis spreads via hematologic route
patient with intestinal obstruction will have which of the following findings in his abdominal radiograph?
• All of the choices are correct
• Dilated small bowel loops
• Air fluid levels
• Paucity of colonic gas
• E. None of the choices is correct
AOTA
Sexually-transmitted infections contribute to pelvic peritonitis. Surgery is done in addition to antibiotic treatment if there is persistent _____ abscess.
• Tubo-ovarian
• Uterine
• Fallopian
• D. Vaginal
Tubo ovarian
The following findings in plain radiographs indicate that the point of obstruction is in the small bowel , except
• No exception
• Air fluid levels in upright film
• Presence of colonic dilatation
• Absence of colonic dilatation
• Dilated loops of small bowel
Presence of colonic dilatation
SMALL INTESTINE DILATATION DAPAT
Which of the following is NOT a manifestation of strangulated intestinal obstruction?
• All of the choices are correct
• Tachycardia
• Marked leukocytosis
• None of the choices is correct
• E. Acidosis
AOTA
In patients with more proximal bowel obstruction with vomiting , which of the following is the most likely type of electrolyte imbalance present?
• Hypochloremia and hypokalemia
• Hyponatremia and hypomagnesemia
• Hypernatremia and hyperkalemia
• Hyperchloremia and hyperkalemia
• E. Hypocalcmia and hyponatremia
HypoCHLOREMIA, HypoKALEMIA
Which of the following is the primary work up adjunct needed in the diagnosis of intestinal obstruction ?\
• Angiography
• Ultrasound of the whole abdomen
• Plain abdominal radiographs
• Magnetic resonance imaging
• E. CT scan of the whole abdomen
Plain abdominal radiograph
CT -adjunct
The principle of source control is best applied to a patient with abdominal pain
• Fever, shifting dullness & jaundice
• Both answers are correct
• Neither choice is correct
• D. Nausea, vomiting & foul-smelling vaginal discharge
Both are correct
Tertiary peritonitis is described as
• A state of inflammatory response exhaustion
• A state of continuous inflammatory response
• A result of residual infectious focus
•A result of unsuccessful antibiotic therapy
Unsuccessful antibiotic therapy
A patient with high grade intestinal obstruction presents with diffuse direct and rebound abdominal tenderness. What is the most probable cause of this manifestation?
• Bowel ischemia and necrosis
• Increase in intraluminal pressure
• Gas and fluid accumulation
• D. Impaired bowel perfusion
Bowel ischemia and necrosis
If an abdominal specimen is obtained, about 70% of patients will have a monobacterial culture. The most common isolate will be
• Klebsiella
• E.coli
• Pseudomonas
• D. Pneumococci
E coli
Descending
E coli
K pneumoniae
S pneumoniae
Which of the following is not a cardinal manifestation of ìntestinal obstruction
• Vomiting
• Obstipation
• Vomiting
• Colicky abdominal pain
• Fever
Fever
V- P-O-N-D
A 20 year old patient presented with signs of intestinal obstruction. The surgeon said that the patient had closed loop obstruction. What is the most dreaded complication of this patient’s condition?
• Electrolyte imbalance
• Perforation and peritonitis
• Increased intra abdominal pressure
• Hypovolemia
• E. Dehydration
PP
Perforation and peritonitis
If a post-operative anastomotic leak occurs, the intestinal segment with the highest mortality will involve which of the following?
• Ileum
• Sigmoid
• Stomach
• Duodenum
Stomach
What is the most common and predominant presentation of an acute abdomen?
• Vomiting
• All of the choices are correct
• None of the choices is correct
• Abdominal distention
• Pain
PAIN
Parietal pain correspond to the following, except
• Involvement of the peritoneum
• More intense
• Poorly localized
• Sharper pain
Poorly localized
Visceral- poorly localized
Parietal- more painful, localized
During abdominal exploration for peritonitis, cheesy material was noted to be concentrated at the ileocecal area. With this information, post-operative treatment in this patient will include
• Aztreonam & amikacin regimen
• Metronidazole & doxycycline regimen
• Isoniazid, rifampicin, PZA & ethambutol regimen
• D. Abacavir & lamivudine regimen
RIPE
Which of the following is an indication for surgery in a patient with a presumptive diagnosis of acute appendicitis?
• Anorexia
• Alvarado score >7
• Colicky abdominal pain
• Vomiting
Abdominal pain ..?
Which of the following is an indication for surgery in a patient with intestinal obstruction?
• Strangulation
• Established presence of mechanical obstruction
• Failure of conservative management
• All of the choices are correct
• None of the choices is correct
Strangulation
An anastomotic leak usually presents
• After 1 week
• Between the 3rd and 5th post-operative days
• After 2 weeks
• Between the 5th and 7th post-operative days
5th-7th post op
6 syllables
In the algorithm for the treatment of left lower quadrant abdominal pain, the patient who has signs of peritonitis would need the following
• Abdominal xray
• MRI
• Ultrasound of the abdomen
• CT scan of the abdomen with bowel contrast
• UGI series
CT SCAN
Which of the following is a nonsurgical cause of an acute abdomen?
• Ruptured spleen
• Appendicitis
• Lead poisoning
• Solid organ trauma
• Meckles Diverticulitis
Lead poisoning
Which of the following is/are the consequence/s of bowel dilatation in intestinal obstruction?
• Third space loss of fluids and electrolytes
• Increased intra-luminal pressure
• Dehydration and hypovolemia
• Impaired venous and arterial circulation in the bowel wall
• All of the answers are correct
AOTA
Pneumoperitoneum is appreciated in the following cases, EXCEPT
• Pancreatitis
• Perforated typhoid ileitis
• Complicated Diverticulitis Hinchy 4
• PPUD
Pancreatitis
With regards to primary peritonitis, evidence points out that from its source, the spread is
• Via the lymphatics
• Introduced by the surgeon
• By direct seeding
• Via the blood stream
Blood!
If primary peritonitis is considered in an adult and an abdominal specimen is collected, the most common expected report will be _____ & the most common isolate will be _____
• Monobacterial E. coli
• Monobacterial S. aureus
• Polybacterial P. aeruginosa
• Polybacterial K. pneumoniae
Monobacteria E. Coli
A patient with intestinal obstruction will have which of the following findings on CT scan of the abdomen?
• Collapsed distal bowel segments
• Discrete transition zone with dilatation of proximal bowel
• Both choices are correct
• Neither choice is correct
Discrete transitional zone with dilatation of proximal bowel
In the pathophysiology of a strangulated obstruction, which of the following occurs immediately after the increase of intra luminal pressure?
• Bowel gangrene
• Obstruction of arterial blood flow
• Obstruction of venous blood flow
• Leakage of endotoxins
Obstruction of ARTERIAL flow (duh o2 is here)
Pressure> obstruction > ischemia> perforation
Which of the following is/are sign/s of early intestinal obstruction?
• Hypoactive bowel sounds
• Obstipation
• Diarrhea
• Erythema of the abdominal wall
• Tenderness on all quadrants of the abdomen
Obstipation
Classical presentation of bowel obstruction: intermittent or colicky abdominal pain, distention, acute obstipation, nausea, and vomiting.
In a fluid specimen collected after a major surgical procedure for a perforated cecum, anaerobic coverage was added to the empiric antibiotic given. This coverage will be useful for all, EXCEPT
• Fusobacterium sp.
• Enterococcus sp.
• Bacteroides sp.
• Proteus sp.
Proteus daw
The stimuli causing visceral pain include the following, EXCEPT
• Stretching of capsules of solid viscera (e.g., subcapsular liver hematoma)
• Changes in diameter of a hollow viscus perceived as cramping
• Ischemia
• Chemicals (acids, alkalis, hypertonic solutions)
• Peristalsis
Aotaaaaa
What is the most common cause of small bowel obstruction?
• Adhesions from previous surgery
• Congenital adhesive bands
• Intestinal tumors
• Adhesions from previous upper abdominal surgery
• E. Incarcerated hernias
Adhesion
Pathology in the following organs can cause shoulder pain, EXCEPT
• Gallbladder
• Liver
• Ureter
• Tail of pancreas
Ureter
(Scrotum and testis)
Left shoulder- Heart
Left hemidiaphragm
Spleen
Tail of pancreas
Right shoulder
-Gallbladder
Liver
Right hemidiaphragm
