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COMLEX PE > Abdominal Pain > Flashcards

Abdominal Pain Flashcards

1
Q

What key history would you obtain from a patient who complains of abdominal pain?

A 
Location
Quality
Intensity
Duration
Radiation
Timing (relation to meals)
Associated symptoms (GI, cardiac, renal, etc)
Exacerbating and alleviating factors
Prior history of similar symptoms
History of abdominal surgeries
Gallstones
Renal stones
Atherosclerotic vascular disease
Medications
Alcohol and drug use
Domestic violence
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2
Q

What key physical exams would you perform on a patient who complains of abdominal pain?

A 
Vital signs
Heart and lung exam
Abdominal exam including guarding, rebound, Murphy's sign and CVA palpation
Rectal exam
Pelvic exam (female)
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3
Q

45 yo M presents with sudden onset of colicky right-sided flank pain that radiates to the testicles, accompanies by nausea, vomiting, hematuria and CVA tenderness. Differentials?

A

Nephrolithiasis
Renal cell carcinoma
Pyelonephritis
GI etiology (e.g., appendicitis)

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4
Q

45 yo M presents with sudden onset of colicky right-sided flank pain that radiates to the testicles, accompanies by nausea, vomiting, hematuria and CVA tenderness. Differentials: nephrolithiases, renal cell carcinoma, pyelonephritis, GI etiology (e.g., appendicitis). Work up?

A 
Rectal exam
UA
Urine culture and sensitivity
BUN/Cr
CT- abdomen
U/S - renal
IVP
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5
Q

60 yo M presents with dull epigastric pain that radiates to the back, together with weight loss, dark urine and clay-colored stool. He is a heavy drinker and smoker. Differentials?

A 
Pancreatic cancer
Acute viral hepatitis
Chronic pancreatitis
Cholecystitis/cholededocholithiasis
Abdominal aortic aneurysm
Peptic ulcer disease
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6
Q

60 yo M presents with dull epigastric pain that radiates to the back, together with weight loss, dark urine and clay-colored stool. He is a heavy drinker and smoker. Differentials: pancreatic cancer, acute viral hepatitis, chronic pancreatitis, cholecystitis/choledocholithiasis, abdominal aortic aneurysm, peptic ulcer disease. Workup?

A 
Rectal exam
CBC, electrolytes
Amylase and lipase
AST/ALT/bilirubin/alkaline phosphatase
U/S - abdomen
CT - abdomen
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7
Q

56 yo M presents with severe midepigastric abdominal pain that radiates to the back and improves when he leans forward. He also reports anorexia, nausea and vomiting. He is an alcoholic and has spent the past three days binge drinking. Differentials?

A 
Acute pancreatitis
Peptic ulcer disease
Cholecystitis/Choledocholithiasis
Gastritis
Abdominal aortic aneurysm
Mesenteric ischemia
Alcoholic hepatitis
Mallory-Weiss tear
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8
Q

56 yo M presents with severe midepigastric abdominal pain that radiates to the back and improves when he leans forward. He also reports anorexia, nausea and vomiting. He is an alcoholic and has spent the past three days binge drinking. Differentials: Acute pancreatitis, peptic ulcer disease, cholecystitis/choledocholithiasis, gastritis, abdominal aortic aneurysm, mesenteric ischemia, alcoholic hepatitis, Mallory-Weiss tear. Workup?

A 
Rectal exam
CBC, electrolytes, BUN/Cr, amylase and lipase, AST/ALT/bilirubin/alkaline phosphatase
U/S - abdomen
CT - abdomen
Upper endoscopy
ECG
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9
Q

41 yo obese F presents with RUQ abdominal pain that radiates to the right scapula and is associated with nausea, vomiting and fever of 101.5F. The pain started after she had eaten fatty food. She has had similar but less intense episodes that lasted a few hours. Exam reveals positive Murphy’s sign. Differentials?

A 
Acute cholecystitis
Hepatitis
Choledocholithiasis
Ascending cholangitis
Peptic ulcer disease
Fitz-Hugh Curtis Syndrome
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10
Q

41 yo obese F presents with RUQ abdominal pain that radiates to the right scapula and is associated with nausea, vomiting and fever of 101.5F. The pain started after she had eaten fatty food. She has had similar but less intense episodes that lasted a few hours. Exam reveals positive Murphy’s sign. Differentials: acute cholecystitis, hepatitis, choledocholithiasis, ascending cholangitis, peptic ulcer disease, Fitz-Hugh Curtis syndrome. Workup?

A 
Rectal exam
CBC
AST/ALT/bilirubin/alkaline phosphatase
U/S - abdomen
HIDA scan
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11
Q

43 yo obese F presents with RUQ abdominal pain, fever and jaundice. She was diagnosed with asymptomatic gallstones one year ago. Differentials?

A 
Ascending cholangitis
Acute cholecystitis
Hepatitis
Choledocholithiaisis
Sclerosising cholangitis
Fitz-Hugh Curtis syndrome
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12
Q

43 yo obese F presents with RUQ abdominal pain, fever and jaundice. She was diagnosed with asymptomatic gallstones one year ago. Differentials: ascending cholangitis, acute cholecystitis, hepatitis, choledocholithiasis, sclerosing cholangitis, Fitx-Hugh Curtis syndrome. Workup?

A 
Rectal exam
CBC
AST/ALT/bilirubin/alkaline phosphatase
Viral hepatitis serologies
U/S - abdomen
MRCP
ERCP
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13
Q

25 yo M presents with RUQ pain, fever, anorexia, nausea and vomiting. He has dark urine and clay-colored stool. Differentials?

A 
Acute hepatitis
Acute cholecystitis
Ascending cholangitis
Choledocholithiasis
Pancreatitis
Acute glomerulonephritis
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14
Q

25 yo M presents with RUQ pain, fever, anorexia, nausea and vomiting. He has dark urine and clay-colored stool. Differentials: acute hepatitis, acute cholecystitis, ascending cholangitis, choledocholithiasis, pancreatitis, acute glomerulonephritis. Workup?

A 
Rectal exam
CBC
Amylase and lipase
AST/ALT/bilirubin/alkaline phosphatase
UA
Viral hepatitis serologies
U/S abdomen
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15
Q

35 yo M presents with burning epigastric pain that starts 2-3 hours after meals. The pain is relieved by food and antacids. Differentials?

A 
Peptic ulcer disease
Gastritis
GERD
Cholecystitis
Chronic pancreatitis
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16
Q

35 yo M presents with burning epigastric pain that starts 2-3 hours after meals. The pain is relieved by food and antacids. Differentials: peptic ulcer disease, gastritis, GERD, cholecystitis, chronic pancreatitis. Workup?

A 
Rectal exam
Amylase, lipase, lactate
AST/ALT/bilirubin/alkaline phosphatase
Endoscopy (including H. pylori testing)
Upper GI series
17
Q

37 yo M presents with severe epigastric pain, nausea, vomiting and mild fever. He appears toxic. He has a history of intermittent epigastric pain that is relieved by food and antacids. He also smokes heavily and takes aspirin on a regular basis. Differentials?

A 
Peptic ulcer perforation
Acute pancreatitis
Hepatitis
Cholecystitis
Choledocholithiasis
Mesenteric ischemia
18
Q

37 yo M presents with severe epigastric pain, nausea, vomiting and mild fever. He appears toxic. He has a history of intermittent epigastric pain that is relieved by food and antacids. He also smokes heavily and takes aspirin on a regular basis. Differentials: peptic ulcer perforation, acute pancreatitis, hepatitis, cholecystitis, choledocholithiasis, mesenteric ischemia. Workup?

A 
Rectal exam
CBC, electrolytes
Amylase, lipase, lactate
AST/ALT/bilirubin/alkaline phosphatase
AXR
Upright CXR
Endoscopy (including H. pylori testing)
19
Q

18 yo M boxer presents with severe LUQ abdominal pain that radiates to the left scapula. He had infectious mononucleosis three weeks ago. Differentials?

A 
Splenic rupture
Kidney stone
Rib fracture
Pneumonia
Perforated peptic ulcer
Splenic infarct
20
Q

18 yo M boxer presents with severe LUQ abdominal pain that radiates to the left scapula. He had infectious mononucleosis three weeks ago. Differentials: splenic rupture, kidney stone, rib fracture, pneumonia, perforated peptic ulcer, splenic infarct. Workup?

A 
Rectal exam
CBC, electrolytes
CXR
CT- abdomen
U/S - abdomen
21
Q

40 yo M presents with crampy abdominal pain, vomiting, abdominal distention, and inability to pass flatus or stool. He has a history of multiple abdominal surgeries. Differentials?

A 
Intestinal obstruction
Small bowel or colon cancer
Volvulus of the bowel
Gastroenteritis
Food poisoning
Ileus
Hernia
22
Q

40 yo M presents with crampy abdominal pain, vomiting, abdominal distention, and inability to pass flatus or stool. He has a history of multiple abdominal surgeries. Differentials: intestinal obstruction, small bowel or colon cancer, volvulus of the bowel, gastroenteritis, food poisoning, ileus, hernia. Workup?

A 
Rectal exam
CBC, electrolytes
AXR
CT - abdomen/pelvis
CXR
23
Q

70 yo F presents with acute onset of severe, crampy abdominal pain. She recently vomited and had a massive dark bowel movement. She has a history of HF and atrial fibrillation, for which she has received digitalis. Her pain is out of proportion to the exam. Differentials?

A 
Mesenteric ischemia/infarction
Diverticulitis
Peptic ulcer disease
Gastroenteritis
Acute pancreatitis
Cholecystitis/choledocholithiasis
MI
24
Q

70 yo F presents with acute onset of severe, crampy abdominal pain. She recently vomited and had a massive dark bowel movement. She has a history of HF and atrial fibrillation, for which she has received digitalis. Her pain is out of proportion to the exam. Differentials: mesenteric ischemia/infarction, diverticulitis, peptic ulcer disease, gastroenteritis, acute pancreatitis, cholecystitis/choledocholithiasis, MI. Workup?

A 
Rectal exam
CBC, amylase, lipase, lactate
ECG, CPK-MP, troponin
AXR
CT - abdomen
Mesenteric angiography
Barium enema
25
Q

21 yo F presents with acute onset of severe RLQ pain, nausea, and vomiting. She has no fever, urinary symptoms or vaginal bleeding and has never taken OCPs. Her last menstrual period was regular and she has no history of STDs. Differentials?

A 
Ovarian torsion
Appendicitis
Nephrolithiases
Ectopic pregnancy
Ruptured ovarian cyst
PID
Bowel infarction or perforation
26
Q

21 yo F presents with acute onset of severe RLQ pain, nausea, and vomiting. She has no fever, urinary symptoms or vaginal bleeding and has never taken OCPs. Her last menstrual period was regular and she has no history of STDs. Differentials: ovarian torsion, appendicitis, nephrolithiasis, ectopic pregnancy, ruptured ovarian cyst, PID, bowel infarction or perforation. Workup?

A 
Pelvic exam
Rectal exam
Urine hCG
UA
CBC
Doppler U/S - pelvis
CT - abdomen
Laproscopy
27
Q

68 yo M presents with LLQ abdominal pain, fever, and chills for the past three days. He also reports recent onset of alternating diarrhea and constipation. He consumed a low-fiber, high-fat diet. Differentials?

A 
Diverticulitis
Crohn's disease
Ulcerative colitis
Gastroenteritis
Abscess
28
Q

68 yo M presents with LLQ abdominal pain, fever, and chills for the past three days. He also reports recent onset of alternating diarrhea and constipation. He consumed a low-fiber, high-fat diet. Differentials: diverticulitis, Crohn’s disease, ulcerative colitis, gastroenteritis, abscess. Workup?

A 
Rectal exam
CBC, electrolytes
CXR
AXR
CT- abdomen
29
Q

20 yo M presents with severe RLQ abdominal pain, nausea, and vomiting. His discomfort started yesterday as a vague pain around the umbilicus. As the pain worsened, it became sharp and migrated to the RLQ. McBurney’s and psoas signs are positive. Differentials?

A 
Appendicitis
Gastroenteritis
Diverticulitis
Crohn's disease
Nephrolithiasis
Volvulus or other intestinal obstruction/perforation
30
Q

20 yo M presents with severe RLQ abdominal pain, nausea, and vomiting. His discomfort started yesterday as a vague pain around the umbilicus. As the pain worsened, it became sharp and migrated to the RLQ. McBurney’s and psoas signs are positive. Differentials: appendicitis, gastroenteritis, diverticulitis, Crohn’s disease, nephrolithiasis, volvulus or other intestinal obstruction/perforation. Workup?

A 
Rectal exam
CBC, electrolytes
AXR
CT- abdomen
U/S - abdomen
31
Q

30 yo F presents with periumbilical pain for six months. The pain never awakens her from sleep. It is relieved by defecation and worsens when she is upset. She has alternating constipation and diarrhea but no nausea, vomiting, weight loss or anorexia. Differentials?

A 
Irritable bowel syndrome
Crohn's disease
Celiac disease
Chronic pancreatitis
GI parasitic infection (amebiasis, giardiasis)
Endometriosis
32
Q

30 yo F presents with periumbilical pain for six months. The pain never awakens her from sleep. It is relieved by defecation and worsens when she is upset. She has alternating constipation and diarrhea but no nausea, vomiting, weight loss or anorexia. Differentials: irritable bowel syndrome, Crohn’s disease, Celiac disease, chronic pancreatitis, GI parasitic infection (amebiasis, giardiasis), endometriosis. Workup?

A 
Rectal exam, stool for occult blood
Pelvic exam 
Urine hCG
CBC
Electrolytes
CT - abdomen/pelvis
Stool for ova and parasitology, Entamoeba histolytica antigen
33
Q

24 yo F presents with bilateral lower abdominal pain that started with the first day of her menstrual period. The pain is associated with fever and a thick, greenish yellow vaginal discharge. She has had unprotected sex with multiple sexual partners. Differentials?

A 
PID
Endometriosis
Dysmenorrhea
Vaginitis
Cystitis
Spontaneous abortion
Pyelonephritis
34
Q

24 yo F presents with bilateral lower abdominal pain that started with the first day of her menstrual period. The pain is associated with fever and a thick, greenish yellow vaginal discharge. She has had unprotected sex with multiple sexual partners. Differentials: PID, endometriosis, dysmenorrhea, vaginitis, cystitis, spontaneous abortion, pyelonephritis. Workup?

A 
Pelvis exam
Rectal exam
Urine hCG
Cervical cultures
CBC/ESR
UA, urine culture
U/S - pelvis

COMLEX PE (34 decks)

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