Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3rd year core conditions > Abdominal Core Conditions > Flashcards

Abdominal Core Conditions Flashcards

1
Q

Which of these patients are most likely to develop cholelithiasis?

A) 25 year old male of Chinese ethnicity
B) 55 year old white female (normal BMI)
C) 40 year old black male
D) 70 year old white female (BMI > 30)

A

Ans: D. F>M (2/3 times more likely), obesity increases risk, incidence peaks 70-79 YO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common type of gallstone?

A) cholesterol stones,
B) black pigment stones,
C) brown pigment stones,
D) red pigment stones

A

Ans: A. Occurs 90% of the time. Black pigment stones occur 2% of the time. Red pigment stones don’t exist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which of these is/are not factor(s) contributing to cholesterol stone deposition?

A) cholesterol supersaturation of bile (relative to solubising agents
B) crystallisation-promoting factors within bile
C) chronic haemolytic anaemia causing Hb to spill into blood (more haem > more unconjugated bilirubin)
D) gallbladder hypomobility

A

Ans: C. This is the cause of black pigment stones forming, not cholesterol stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are black pigment stones made of?

A

Calcium bilirubinate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A 55 y.o. female patient comes in with RUQ/epigastric pain lasting over 30 min after having cheese fondue for dinner. No N/V, no guarding or rigidity, Murphy’s sign is negative. What do you suspect she has?

A) Cholangitis
B) Cholecystitis
C) Biliary colic due to cholelithiasis
D) Appendicitis

A

C.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which of these would you expect to see on the LFTs of a pt with cholecystitis?

A) raised ALP
B) normal serum bilirubin
C) low AST
D) low ALT

A

A.

ALP + bilirubin produced by cells lining the bile canaliculi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which of these are not a typical symptom of biliary colic?

A) RUQ/epigastric pain
B) Pain comes on after consuming fatty foods
C) RUQ tenderness with guarding + rigidity
D) Pain radiates to right shoulder & subscapular region

A

C. This usually only occurs in cholecystitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where is recurrent pyogenic cholangitis endemic to?

A) East Asia
B) South Asia
C) Southeast Asia
D) Middle East

A

C.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which of the following are not a risk factor for developing acute cholangitis?

A) Cholelithiasis
B) Strictures
C) Female
D) Age > 50

A

C. Unlike cholelithiasis, cholangitis has an equal male:female ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 most common causes of acute cholangitis in order?

A

1) Choledocholithiasis (i.e. stone in the common bile duct), 2) ERCP
3) tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Charcot’s triad and what is it indicative of?

A

RUQ pain, fever, jaundice, classical symptoms of ascending cholangitis although all 3 are only present in a minority of patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Reynold’s pentad?

A

Charcot’s triad + mental status change + sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is ascending cholangitis important to distinguish from in pregnant women?

A

HELLP syndrome. Haemolysis, Elevated Liver enzymes, Low Platelet count.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which of these are a 1st line investigation for suspected acute cholangitis?

A) transabdominal USS
B) MRCP 
C) abdominal x-ray
D) abdominal CT scan
E) ERCP
F) coagulation screen
A

A, E and F. You may see a prolonged PT time if obstruction has occurred over several days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which of these treatments are suitable for a patient with diagnosed ascending cholangitis secondary to choledocholithasis who is severely ill

A) ERCP with stone removal
B) ERCP with stent insertion without stone removal
C) Cholecystectomy with CBD exploration

A

B. stone and stent removal should follow in a few days after the acute episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which of these is the most common cause of small bowel obstruction in adults?

A) appendicitis
B) hernia
C) malignancy
D) adhesions

A

D. It causes 80% of SBOs in adults this is followed by hernia then malignancy. In children, appendicitis is most common.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What percentage of patients who have undergone previous abdominal surgery is at risk of small bowel obstruction?

A) 20%
B) 40%
C) 60%
D) 80%

A

C. It is a major risk factor for developing SBO.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which of these are not risk factors for developing a small bowel obstruction?

A) H.pylori infection
B) Crohn’s
C) Foreign body ingestion
D) Intussusception

A

A. Incidence of SBO in Crohn’s patients is 25%.

19
Q

What causes colicky pain associated with small bowel obstruction?

A

Combination of proximal dilatation of the intestine and peristalsis results in pain.

20
Q

What does a pneumoperitoneum on an erect CXR indicate in a patient with small bowel obstruction?

A

Pneumoperitoneum = air under diaphragm. Indicates rupture of the intestine… not good outcome.

21
Q

Which of these is the treatment of choice for a complete small bowel obstruction?

A) emergency laparoscopy
B) emergency laparotomy
C) emergency OGD
D) emergency ERCP

A

B.

22
Q

What is the normal diameter of small intestine lumen?

A

< 3cm

23
Q

What is the most common cause of large bowel obstruction?

A) colonic volvulus
B) mega colon
C) benign strictures
D) colorectal cancer

A

D. causes 90% of large bowel obstructions.

24
Q

Being institutionalised confers a higher risk of

A) small bowel obstruction
B) appendicitis
C) cholecystitis
D) large bowel obstruction

A

D. Institutionalised patients have a higher chance of colonic volvulus, which is a cause of LBO.

25
Q

Regarding the pathophysiology of large bowel obstruction, put these in the correct order:

A) full thickness necrosis
B) dilatation of the proximal colon and increased colonic pressure
C) progresses to arterial compromise
D) decreased mesenteric blood flow
E) perforation
F) dehydration & electrolyte imbalance
G) mucosal oedema with transudation of fluid + electrolytes into the colon

A

B - D - G - F

C - A - E

26
Q

What is the likely diagnosis of a middle aged male patient who has not passed stools or flatus in 24h, has severe abdominal pain worse on movement with rebound tenderness, gross abdominal distension with a history of changes in bowel habit and recent weight loss?

A) small bowel obstruction with perforation
B) large bowel obstruction with perforation
C) small bowel obstruction without perforation
D) large bowel obstruction without perforation

A

B. history suggest colorectal cancer, the most common cause of LBO. pain worse on movement with rebound tenderness suggests peritonitis, which occurs after rupture.

27
Q

Which of these are first line investigations you would order for someone with suspected large bowel obstruction?

A) Flexi sigmoidoscopy 
B) CT abdo/pelvis
C) Erect CXR
D) Plain AXR
E) Coagulation
A

C, D and E. You’d order a coagulation screen if you suspected sepsis as this can lead to DIC which would consume multiple clotting factors.

28
Q

A middle aged male patient who has not passed stools or flatus in 24h, has severe abdominal pain worse on movement with rebound tenderness, gross abdominal distension with a history of changes in bowel habit and recent weight loss?

How would you treat him?

A) flexi sigmoidoscopy
B) emergency laparoscopy
C) emergency laparotomy
D) enema

A

C.

29
Q

True or false, appendicitis affects young adults more than other age groups?

A

False. Appendicitis affects all age groups.

30
Q

Which of these does not commonly cause appendicitis?

A) faecolith obstructing of the lumen of the appendix
B) normal stool obstructing the lumen of the appendix
C) lymphoid hyperplasia obstructing the lumen of the appendix
D) appendix volvulus obstructing the lumen of the appendix

A

D.

31
Q

What is Rovsing’s sign

A) localised pain 1/3 of the way from the ASIS to the navel
B) while lying on the left side, patient feels pain when they slowly extend the left thigh
C) internal rotation of flexed right thigh causes pain
D) pressure on the LLQ causes pain in the RLQ

A

D.

A is Mcburney’s sign
B is Psoas sign as this action stretches the iliopsoas muscles
C is the obturator sign

32
Q

In suspected appendicitis of a female of child-bearing age, which of these investigations must be undertaken?

A) USS
B) MRI
C) urine pregnancy test
D) U&Es

A

C. ectopic pregnancy MUST be ruled out

33
Q

What is the treatment for uncomplicated appendicitis?

A

Appendectomy

34
Q

Which of these are not a risk factor for developing an inguinal hernia?

A) old age
B) smoking
C) female sex
D) Ehlers-Danlos syndrome

A

C. males are more at risk.

35
Q

Answer each question with A) direct hernia or B) indirect hernia

1) These types of hernias are always acquired
2) These types of hernias occur due to a persistent vaginalis
3) In men, these types of hernias can extend to the scrotum
4) Most hernias in women are this type of hernia
5) Strangulation occurs more in this type of hernia

A

1) A
2) B
3) A
4) B
5) B

36
Q

Where does a inguinal hernia vs femoral present

A

Inguinal hernia would be superomedial to the pubic tubercle whereas femoral would be inferolateral. However, if the hernia is particularly large, this may be difficult to differentiate

37
Q

What is the 1st line investigation of a suspected inguinal hernia?

A) USS
B) AXR
C) CT
D) Clinical diagnosis

A

D

38
Q

How would you manage a small, asymptomatic inguinal hernia?

A) open-mesh repair
B) watchful waiting
C) laparoscopic repair
D) open repair

A

B

39
Q

Femoral hernias make up what percentage of all abdominal hernias?

A) 1%
B) 5%
C) 10%
D) 40%

A

B.

40
Q

Which of these patients are at highest risk of developing a femoral hernia?

A) female in her mid 20s
B) male in his mid 20s
C) female in her late 50s
D) male in his lates 50s

A

C. Middle-aged and elderly women most commonly develop femoral hernias - esp if parous

41
Q

Is strangulation common in femoral hernias?

A

Yes. Femoral canal is a very tight space so strangulation is common.

42
Q

Where would the mass of a femoral hernia be located on the abdominal wall in relation to the pubic tubercle?

A) superior and medial to the pubic tubercle
B) inferior and medial to the pubic tubercle
C) superior and lateral to the pubic tubercle
D) inferior and lateral to the pubic tubercle

A

D. Just think about where the femoral canal or where the femoral artery is in relation to the pubic tubercle.

43
Q

How would you distinguish between a femoral and inguinal hernia other than location as location may not be be an accurate measure

A

1) Place finger over the femoral canal – you can locate this by palpating for the femoral artery and moving 1 finger breadth medially.
2) Ask patient to cough
3) Hernia should remain reduced if femoral hernia
4) if inguinal hernia, bump will reappear as an obvious swelling

3rd year core conditions (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions