Abdominal Pain

Question 1

REBOUND TENDERNESS is key finding of ____

Answer 1

acute peritonitis (appendicitis, pancreatitis, cholecystitis)

Question 2

1 on the differential diagnosis of RUQ pain is ____

Answer 2

Acute cholecystitis

Question 3

1 on the differential diagnosis of RLQ pain is ____

Answer 3

Appendicitis

Question 4

Which of the following is NOT on the differential diagnosis of RUQ pain?
A. Biliary Colic 
B. Hepatomegaly 
C. Peptic ulcer disease (duodenal ulcer)
D. Pancreatitis
E. Lower right lobe pneumonia

Answer 4

D. Pancreatitis is epigastric pain

Question 5

Which of the following is NOT on the differential diagnosis of epigastric pain?
A. Peptic ulcer disease
B. Acute cholecystitis 
C. Appendicitis
D. Cardiac pain - ischemia  
E. Abdominal aortic aneurysm

Answer 5

C. Appendicitis is periumbilical pain

Question 6

Which of the following is NOT on the differential diagnosis of LUQ pain?
A. Acute Pancreatitis
B. Diverticulitis
C. Peptic ulcer disease- gastric ulcer
D. Splenic enlargement
E. Lower left lobe pneumonia

Answer 6

B. Diverticulitis is #1 on differential of LLQ pain

Question 7

Which of the following is NOT on the differential diagnosis of LLQ pain?
A. Ectopic pregnancy
B. Pelvic Inflammatory Disease
C. Ureteral Calculi
D. Hernia
E. Ovarian disease

Answer 7

ALL are on differential diagnosis of LLQ pain

Question 8

Which of the following is NOT on the differential diagnosis when eating makes the pain worse?
A. Pancreatitis
B. Gastric ulcer
C. Duodenal ulcer
D. Mesenteric ischemia

Answer 8

C. Duodenal ulcer gets better with eating.

Question 9

Which of the following is on the differential diagnosis when eating makes the pain better?
A.  Pancreatitis
B. Duodenal ulcer
C. Bowel obstruction
D. Biliary colic

Answer 9

B

A. Pancreatitis: worse w/ eating and associated w/ nausea and vomiting
C, D. Bowel obstruction, biliary colic: associated w/ nausea and vomiting

Question 10

Which of the following is NOT on the differential diagnosis when pain radiates to back?
A.  Pancreatitis
B. Duodenal ulcer
C. Biliary colic
D. Gastric ulcer

Answer 10

C. Biliary colic radiates to the shoulder

Question 11

Name the 2 possible causes of pain radiating to the right shoulder

Answer 11

Biliary colic

Cholecystitis

Question 12

Name the possible cause of pain radiating to the left arm or neck

Answer 12

Myocardial ischemia

Question 13

Ureteral obstruction may have referred pain to ____

Answer 13

testicular pain

Question 14

Biliary disease may have referred pain to ____

Answer 14

right infrascapular pain

Question 15

Acute coronary syndrome may have referred pain to ____

Answer 15

epigastric, jaw or upper extremity pain

Question 16

When you suspected bowel obstruction or free air, you should order ____

Answer 16

abdominal xray (limited utility)

Question 17

Abdominal aortic aneurysm can be diagnosed with ___

Answer 17

ultrasound

Question 18

Acute cholecystitis can be visualized with _____

Answer 18

ultrasound

Question 19

Which one of the following is NOT CT abdomen/pelvis WITHOUT contrast used for?
A. Kidney stones
B. Abscess
C. Free air
D. Bowel obstruction

Answer 19

B. Abscess should use WITH contrast

KIDNEY STONES definitely use CT WITHOUT contrast

Question 20

T/F: Infection and inflammation is best visualized with CT abdomen/pelvis WITH contrast.

Answer 20

True

Also to exclude malignancy

Question 21

Most common causes of elderly abdominal pain (2)

Answer 21

Cholecystitis

Diverticulitis

Question 22

Which of the following is NOT a feature of mesenteric ischemia?
A. Severe pain alleviated by medication
B. Abdominal exams are usually normal
C. Diagnosis by mesenteric angiography or CT angiography
D. Consider in patients w/ afib, atherosclerosis, hypercoagulable

Answer 22

A. Pain is refractory to meds

Question 23

What's the diagnosis? What next?
24 yo male
RLQ pain for 1 day
Radiates to groin
Hypoactive bowel sounds
Tender to palpation with mild guarding

Answer 23

Appendicitis

Confirmed on CT

Question 24

What’s the diagnosis? What next?
66 y/o woman with two days of LLQ pain
Diarrhea, fever and chills, nausea, vomiting
Tender to palpation in LLQ

Answer 24

Diverticulitis

Confirmed with contrast CT

Question 25

1 on the differential diagnosis of LLQ pain is ____

Answer 25

Diverticulitis

Question 26

What’s the diagnosis? What next?
46 y/o man present with a 3-day history of severe upper abdominal pain
Nausea and vomiting.
Drinks 4-6 shots of rum per night + beer over weekends.
He smokes 2 packs/day.
PE: Obviously sick, tender to palpation in the epigastric area.

Answer 26

Acute pancreatitis—- can be deadly, lead to volume depletion, needs to be admitted

Question 27

What’s the diagnosis? What next?
45 y/o woman presents with a 24-hour history of nausea and vomiting along with generalized abdominal pain.
History positive for hysterectomy.
No fevers/chills, +anorexia.
Last stool 2 days ago.
Diffusely tender and distended abdomen, hypoactive bowel sounds, rebound tenderness.

Answer 27

Small bowel obstruction due to adhesions from previous surgery

abdominal Xray

Question 28

What’s the diagnosis? What next?
48 y/o woman with one day history of RUQ pain after eating.
Intermittent and cramping pain, 6/10 intensity.
She also has nausea and vomiting. No diarrhea.
Had a similar episode 6 months ago after eating.
Positive Murphy’s

Answer 28

Cholecystitis
Start with an Ultrasound.
Always check for pancreatitis too because stone could block both

Question 29

What’s the diagnosis? What next?
34 y/o man presents with a 4-hour history of sudden onset left flank pain, nausea and vomiting.
No prior hx of similar symptoms. No fevers/chills.
Reports difficulty urinating, no hematuria. Feels like he has to urinate but cannot.

Answer 29

Kidney stone

NON contrast CT scan