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Emergency > Abdominal pain > Flashcards

Abdominal pain Flashcards

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1
Q

What two scores are used for acute pancreatitis?

A
  1. APACHE II

2. Ranson

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2
Q

Why is fluid resuscitation important in patients with severe pancreatitis?

A

To prevent renal dysfunction

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3
Q

What is the most common cause of SBO?

A

Adhesions

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4
Q

What is the most common cause of LBO?

A

Colorectal CA

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5
Q

Why can the presentation of SBO be misleading?

A

Initially their symptoms get worse but as the bowel continues to distend, at a certain point peristaltic activity diminishes and they might appear to improve.

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6
Q

What is a common fallacy pertaining to LBO?

A

Vomiting. This often doesn’t happen because ileocecal valve blocks backflow

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7
Q

What are two less common causes of LBO?

A
  1. Diverticular disease

2. Sigmoid volvulus

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8
Q

90% of diarrhea is

A

Infectious in nature

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9
Q

Timing of staph food poisoning

A

4-12 hours

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10
Q

Timing of cholera food poisoning

A

8-72 hours

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11
Q

Time of E Coli and giardia food poisoning

A

2-7 days

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12
Q

Timing of salmonella, campylobacter, shigella food poisoning

A

> 1 day

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13
Q

What test is often useful in diarrhea

A

Stool culture (even though it takes a few days)

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14
Q

What test is not very useful in diarrhea

A

O&P

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15
Q

Besides clindamycin, what drug is commonly implicated in C.diff development

A

Fluoroquinolones

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16
Q

For patients with diarrhea that doesn’t resolve with supportive care, what might help?

A

Antibiotics

  1. Bactrim
  2. Cipro or levo
  3. Azithro
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17
Q

Why shouldn’t pepto bismal be used in immunocompromised patients?

A

It can lead to bismuth encephalopathy

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18
Q

What is the most common kind of kidney stone?

A

Calcium oxalate (75%)

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19
Q

When do uric acid stones tend to form?

A

Low pH

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20
Q

How to MAP (struvite) stones form?

A

Thought alkalinazation via urea production by:

  1. Proteus
  2. Pseudomonas
  3. Klebsiella
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21
Q

When looking for a stone on UA, what is good to realize?

A
  1. Amount of hematuria doesn’t correlate with degree of obstruction
  2. A complete renal obstruction may present without hematuria
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22
Q

What is the imaging modality of choice for a kidney stone?

A

Helical CT without contrast

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23
Q

How should you investigate for a kidney stone in a pregnant woman or child?

A

US

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24
Q

Which patients with kidney stones need urgen urological consultation?

A
  1. Inadequate pain control
  2. Persistent N/V
  3. Associated pyelo
  4. Stone > 7 mm
  5. Complete obstruction
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25
Q

What is the most common cause of SBO in a patient without a surgical history?

A

Hernia

26
Q

During the winter, a 24 year old woman who works at a day care develops profuse watery diarrhea?

A

Rotavirus

27
Q

With kidney stones, constant pain is most likely to be located where?

A

In the kidney

28
Q

With kidney stones, colicky pain is most likely located where?

A

In the ureter

29
Q

With kidney stones located in the bladder or renal pelvis, describe the pain?

A

Typically asymptomatic

30
Q

How do you interpret a normal prostate exam in the setting of urinary retention?

A

A normal exam does not eliminate obstruction

31
Q

In a patient with a bladder obstruction, what is the most useful form of imaging?

A

A bedside ultrasound may be helpful to identify bladder distention or a clot in the bladder

32
Q

Why should a catheter not be forced into the bladder?

A

It can cause urethral trauma or create a false passage

33
Q

If a catheter can’t be inserted into the bladder, what should you do?

A

A suprapubic catheter

34
Q

What is a sequelae of relieving severe urinary retention?

A

Can lead to postobstructive diuresis
1. Electrolyte abnormalities
2. Profound fluid loss
3 Hypotension

35
Q

What is the dispo option for most patients with acute urinary retention?

A

Home with an indwelling catherer and outpatient urologic follow-up

36
Q

Patients diagnosed with PID should have what?

A

Imaging of the pelvis to assess for TOA (because physical findings can be subtle)

37
Q

What is the gold standard for diagnosing TOA?

A

Laparoscopy. Visual purulent discharge from the tube.

38
Q

When during an ovarian cycle is a woman most at risk for developing PID?

A

Mid-cycle because cervical mucus gets thin

39
Q

Why are fluorquinolones not used for PID any longer

A

There is FQ resistant gonorrhea now

40
Q

When a TOA is suspected, how should DOC be changed?

A

Use clinda or metronidazole (anaerobic coverage) instead of doxy

41
Q

Describe the pain associated with ovarian torsion

A
  1. Crampy
  2. Might migrate from umbilicus
  3. Typically no fever
  4. Can progress over a day
42
Q

What is the surgical treatment for an unruptured ectopic?

A

Salpingostomy (preservation of tube)

43
Q

What is the surgical treatment for a ruptured ectopic?

A

Salpingectomy (removal of tube)

44
Q

Half of episodes of ectopic pregnancy are linked to what?

A

Previous salpingitis

45
Q

97% of all ectopic pregnancies are found where?

A

Ampulla

46
Q

Lack of visualization of an IUP on transvaginal US confers up to how much risk of an ectopic?

A

85%

47
Q

In what patient population can IUP not rule out ectopic?

A

IVF

48
Q

In an asymptomatic patient with HCG

A

Repeat in 48 hours (should rise by at least 66%)

  1. Normal rise = probably viable IUP
  2. Abnormal rise=probably non-viable pregnancy
49
Q

In a patient with abnormal HCG rise that gets curettage, what are two main possible findings?

A
  1. Chorionic villi = miscarriage

2. No villi = possible ectopic and consider MTX

50
Q

What is a common symptom of MTX

A

Abdominal discomfort. If that patient is stable and not bleeding, they likely only need observation.

51
Q

How can you differentiate an incompetent cervix from an inevitable abortion?

A
  1. Incompetent: cervix opens spontaneously without uterine contractions (painless)
  2. Inevitable abortion: contractions leads to cervical dilation (cramping)
52
Q

What is PROM?

A

Rupture of membranes prior to onset of contractions

53
Q

What is PPROM?

A

Rupture of membranes before 37 weeks and prior to onset of labor

54
Q

What findings lead to confirmation that membranes have ruptured?

A
  1. Pooling of amniotic fluid
  2. Positive nitrazine test (amniotic fluid is basic)
  3. Ferning on a slide
55
Q

What is a big maternal concern for PROM and PPROM

A

Chorioamnionitis

56
Q

What is a big fetal concern for PROM and PPROM

A
  1. Fetal infection (look for tachycardia)
  2. RDS
  3. Intraventricular hemorrhage
  4. NEC
57
Q

In a pregnant patient with hyperthyroidism, when should β blockers be avoided?

A

At time of delivery because they can lead to fetal bradycardia and hypoglycemia

58
Q

What is a bad side effect of PTU and methimazole?

A

Agranulocytosis

59
Q

All pregnant patients with Pyelo need what?

A

Admission to hospital

60
Q

A patient who becomes SOB following treatment for pyelo should be assumed to have what?

A

ARDS secondary to endotoxin release

61
Q

When the hCG level exceeds 1500 and no gestational sac is seen on TVUS, the likelihood of ectopic is what?

A

> 85%

62
Q

If a patient presents with a history of PROM or PPROM, but nitrazine, ferning, and pooling are negative what should you do?

A

US to assess amniotic fluid level. If oligohydramnic, ROM is diagnosed and patient needs admitted

Emergency (23 decks)

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