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OSCE 3 > Abdominal Pain > Flashcards

Abdominal Pain Flashcards

1
Q

Name some ddx for RUQ pain

A

Duodenal ulcer
Hepatitis
Hepatomegaly
Pneumonia
Cholecystitis

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2
Q

Name some ddx for RLQ pain

A

Appendicitis
Scalping it is
Ovarian cyst
Ruptured ectopic pregnancy
Renal/ureteral stone
Strangulated hernia
Meckel diverticulitis
Regional ileitis
Perforated cecum

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3
Q

Name some ddx for peri umbilical pain

A

Intestinal obstruction
Acute pancreatitis
Early appendicitis
Mesenteric thrombosis
Aortic aneurysm
Diverticulitis

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4
Q

Name some ddx for LUQ pain

A

Ruptured spleen
Gastric ulcer
Aortic aneurysm
Perforated colon
Pneumonia

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5
Q

Name some ddx for LLQ pain

A

Sigmoid diverticulitis
Salpingitis
Ovarian cyst
Ruptured ectopic pregnancy
Renal/ureteral stone
Strangulated hernia
Perforated colon
Regional ileitis
Ulcerative colitis

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6
Q

What red flag condition are you worried about with signs/sx of peritonitis?

A

Perforation or ruptured appendix

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7
Q

What are the signs/sx of peritonitis

A

P - pain - front, back, sides, shoulders
E - electrolytes fall, shock
R - rigidity/rebound
I - immobile pt
T - tenderness w guarding
O - obstruction
N - nausea/vomiting
I - inc pulse, dec BP
T - temp falls>rises, tachypnea
I - inc girth of abdomen
S - silent abdomen

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8
Q

What red flag condition are you worried about with back pain also present?

A

Ruptured abdominal aortic aneurysm

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9
Q

Describe the type of abdominal pain that may indicate emergency

A

Acute onset getting progressively worse

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10
Q

What PEs would you do for a CC of abdominal pain?

A

Note general appearance
Vitals
Abdominal - observation, bowel sounds, percussion, light + deep palpation, mcburneys and Murphys
CVA tenderness
Check Femoral pulses
state pelvic exam or DRE if indicated
Heart + lung

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11
Q

Name the abdominal pain ddx:

Sudden onset colicky pain that progresses to constant
Periumbilical > RLQ
Pain worse with movement or coughing
N/V
Guarding
RLQ tenderness
Rebound tenderness

A

Appendicitis

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12
Q

Name the abdominal pain ddx:

Sudden onset of persistent cramping in lower quadrant
Signs of shock, hemorrhage

A

Ectopic pregnancy

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13
Q

Name the abdominal pain ddx:

Sudden onset intense epigastric pain that can radiate to sides, back, or right shoulder
Burning, gnawing pain that worsens w empty stomach

A

peptic ulcer disease/perforated peptic ulcer (would also have rebound tenderness, absent bowel sounds)

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14
Q

Name the abdominal pain ddx:

Sudden onset excruciating pain that can be felt in chest or abdomen and can radiate to legs or back
Shock signs
Difference or deficit in femoral pulses

A

dissection of aortic aneurysm

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15
Q

Name the abdominal pain ddx:

Upper or diffuse abdominal pain
N/V
Dyspepsia
HTN/hypotension

A

MI

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16
Q

Appendicitis workup

A

CBC with differential, ultrasound, CT
Emergency referral

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17
Q

Ectopic pregnancy workup

A

HCG, ultrasound, immediate emergency referral

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18
Q

Peptic ulcer perforation workup

A

Radiograph, emergency referral

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19
Q

Dissecting aortic aneurysm workup

A

CT/MRI
Emergency referral

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20
Q

MI workup

A

ECGs, cardiac enzymes, emergency referral

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21
Q

Name the abdominal pain ddx:

Sudden onset of severe pain that is diffuse and worsens with movement or coughing
Guarding, rebound tenderness
Bowel sounds dec or absent

A

peritonitis

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22
Q

Peritonitis workup

A

CBC w differential
Abdominal radiographs

23
Q

Name the abdominal pain ddx:

Steady pain, same in all positions
LUQ, radiates to back
N/V, diaphoresis
Appear acutely ill
Abdominal distention
Decreased bowel sounds
Diffuse rebound tenderness

A

Acute pancreatitis

24
Q

Acute pancreatitis workup

A

CBC with differential
Serum amylase and lipase
Ultrasound

25
Q

Name the abdominal pain ddx:

RLQ pain, mimics appendicitis
Fever
Elevated WBC

A

Mesenteric adenitis

26
Q

Name the abdominal pain ddx:

RUQ colicky pain progressing to contact
Can radiate to right scapula
Constant, rises to plateau, falls
N/V
Dark urine, light stools
Tender to palpation RUQ
Murphy sign

A

Cholecystitis/cholelithiasis

27
Q

Cholecystitis/Lithiasis workup

A

CBC w diff
Ultrasound
Serum amylase and lipase

28
Q

Name the abdominal pain ddx:

Sudden onset of excruciating colicky pain > constant
Lower abdomen and flank, radiates to groin
N/V, distention, chills, fever
CVA tendernesss
Hematuria
Frequency

A

Ureterolithiasis

29
Q

Ureterolithiasis workup

A

UA
CT

30
Q

Name the abdominal pain ddx:

Sexually active women
Progressive lower abdominal pain
Abdominal tenderness, CMT, adnexal tenderness
Fever, irregular bleeding/dc, vomiting

A

PID/salpingitis

31
Q

PID wrkup

A

CBC, ESR, DNA probes, cultures, gram staining

32
Q

Name the abdominal pain ddx:

Sudden onset raspy pain in umbilical area
Vomiting (early small, late large)
Obstipation or diarrhea
Hyperactive, high pitched bowel sounds
Palpable mass
Abdominal distention

A

Bowel obstruction

33
Q

Bowel obstruction workup

A

DRE
Abdominal radiographs

34
Q

Cholecystitis/lithiasis treatment

A

Referral

35
Q

Ureterolithiasis treatment

A

Alpha blockers
Chanca piedra (stone breaker)

36
Q

UTI/pyelo tx

A

Antibiotics
D-mannose
Corn silk tea

37
Q

PID tx

A

Antibiotics

38
Q

Name the abdominal pain ddx:

Crampy hypogastric pain variable duration
Gas, bloating, distention
Relief with feces/flatulence
Normal abdominal exam

A

IBS

39
Q

IBS workup

A

Fecal occult blood

40
Q

IBS treatment

A

Peppermint
Antispasmodic drugs
Digestive enzymes

41
Q

Name the abdominal pain ddx:

Abdominal pain/cramping
Abdominal tenderness
Diarrhea
Possible blood in diarrhea

A

Crohns

42
Q

Crohns tx

A

Anti-inflammatory meds
Immunomodulating meds
Ginger, turmeric

43
Q

Name the abdominal pain ddx:

Intermittent localized pain worse with exertion or lifting

A

Hernia

44
Q

Hernia workup

A

Valsalva
CT/MRI to rule out strangulation/obstruction

45
Q

Hernia tx

A

Surgery referral

46
Q

Name the abdominal pain ddx:

Hx trauma
Ecchymosis or swelling
Pain with muscle wall stress

A

Abdominal wall disorder

47
Q

Name the abdominal pain ddx:

Epigastric burning, gnawing pain
Worse empty stomach, stress, alcohol intake
Soreness, hunger
Steady
Epigastric tenderness to palpation

A

Peptic ulcer

48
Q

Peptic ulcer workup

A

Endoscopy, h pylori testing

49
Q

Peptic ulcer tx

A

proton pump inhibitors
Antibiotics if h pylori present
Licorice root

50
Q

Name the abdominal pain ddx:

Diffuse, crampy pain
N/V, diarrhea, fever
Hyperactive bowel sounds

A

Gastroenteritis

51
Q

Gastroenteritis tx

A

Electrolytes
Bland diet

ER if signs of severe dehydration (tachycardia, altered mental status, skin tenting, dry mucous membranes), or no improvement in 48 hours

52
Q

Name the abdominal pain ddx:

Episodic periumbilical pain
Nausea/vomiting
Photophobia
Headache
Fhx migraine

A

Abdominal migraine

53
Q

Name the abdominal pain ddx:

GI sx with no pathological condition

A

Functional dyspepsia

OSCE 3 (13 decks)

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