Abdominal Pain Fatigue Weight Loss DSA

Question 1

The risk of an aortic aneurysm rupture increases at around what size?

Answer 1

Greater than 5 cm in diameter

Question 2

How does an abdominal aortic aneurysm present?

How is it usually detected?

Answer 2

1) Commonly asymptomatic

2) On routine examination as a palpable, pulsatile, and nontender mass

Question 3

What occurs with rupture of AAA which requires an emergency operation?

What is the prior warning sign of AAA rupture?

Answer 3

1) Acute pain and hypotension

2) Occurs without any prior warning

Question 4

What specific population is recommended for screening of AAA by abdominal ultrasound?

Answer 4

Men age 65–75 years who have ever smoked

Question 5

Aortic dissection is caused by a circumferential or, less frequently, transverse tear of?

The pulsatile aortic flow then dissects along the elastic lamellar plates of the aorta and creates?

Answer 5

1) The intima

2) False lumen

Question 6

How do aortic dissections present?

Answer 6

1) Atypical chest pain
2) Widened mediastinum
3) VS abnormalities

Question 7

Appendicitis is initiated by obstruction of the appendix by?

Answer 7

Fecalith, inflammation, foreign body, or neoplasm

Question 8

How does appendicitis present?

Answer 8

Begins with periumbilical or epigastric pain and within 12 hours the pain shifts to the right lower quadrant

Question 9

How does appendicitis present on labs?

Answer 9

Moderate leukocytosis (10,000–20,000/mcL) with neutrophilia

Question 10

After the appendectomy what should be given to reduce the incidence of postoperative infections?

Answer 10

Give broad-spectrum antibiotics with gram-negative and anaerobic coverage

Question 11

What is the most common causes of maternal death during the first trimester?

Answer 11

Undetected ectopic pregnancy

Question 12

How does ectopic pregnancy present?

Answer 12

Sudden onset of severe lower quadrant pain

Question 13

Along with serum beta-hCG greater than 2000 milliunits/mL, how is ectopic pregnancy diagnosed?

Answer 13

No intrauterine pregnancy on transvaginal ultrasound

Question 14

What presents acutely and may be due to rupture, bleeding or torsion of cysts, or, much less commonly, neoplasms of the ovary, fallopian tubes, or paraovarian areas?

Answer 14

Ovarian torsion

Question 15

Nearly 70% of ovarian torsions occur on what side?

This is due to?

Answer 15

1) Right side
2) Increased length of the utero-ovarian ligament on the right and the sigmoid on the left which limits space for movement

Question 16

How do ovarian torsions present?

Answer 16

Sudden-onset, unilateral, lower abdominal pain that may develop after episodes of exertion

Question 17

An ovary greater than what size due to cyst, tumor, or edema is the most common
ultrasonographic finding associated with torsion?

Answer 17

4 cm

Question 18

Acute colonic pseudo-obstruction (Ogilvie Syndrome) is due to?

Answer 18

Spontaneous massive dilation of cecum or right colon without mechanical obstruction

Question 19

What is found on plain film radiograph for acute colonic pseudo-obstruction?

Answer 19

Colonic dilation

Question 20

A cecal diameter greater than what size is associated with an increased risk of
colonic perforation?

Answer 20

10–12 cm

Question 21

Meckel’s diverticulitis is a remnant of?

What is the most useful method of diagnosis for it?

Answer 21

1) Vitelline duct

2) Technetium-99m scan

Question 22

What is diverticulitis?

How does it present?

What may be found on PE?

Why is endoscopy (sigmoidoscopy or colonoscopy) contraindicated during the initial stages of an acute attack?

Answer 22

1) Macroscopic inflammation of a diverticulum
2) LLQ pain
3) Thickened, palpable sigmoid and descending colon
4) Risk of perforation

Question 23

What presents as periumbilical pain out of proportion to tenderness?

Answer 23

Acute mesenteric ischemia

Question 24

What sign is present on abdominal XR for acute mesenteric ischemia?

Answer 24

Thumbprinting (submucosal edema)

Question 25

What presents as abdominal angina: dull, crampy periumbilical pain 15–30 min after a meal and lasting for several hours (patient’s will have a food fear)?

Answer 25

Chronic mesenteric ischemia

Question 26

What is the test of choice for mesenteric ischemia?

Answer 26

CT angiography with IV contrast

Question 27

What is the most common cause of intestinal obstruction?

Answer 27

Peritoneal adhesions

Question 28

What is seen on plain radiographs or CT scan for intestinal obstruction?

Answer 28

Dilated bowel and air-fluid levels

Question 29

How are intestinal obstruction treated?

Answer 29

1) NG tube decompression and fluid resuscitation

2) Urgent laparotomy for lysis of adhesions (LOA) performed before bowel ischemia develops

Question 30

What type of inflammation is a life-threatening event that is often accompanied by bacteremia and sepsis?

Answer 30

Peritonitis

Question 31

Which form of peritonitis is most common among patients with cirrhosis?

Answer 31

Primary bacterial peritonitis

Question 32

What are the most common etiologic agents seen with primary bacterial peritonitis?

Answer 32

1) Gram-negative bacilli such as Escherichia coli

OR

2) Gram-positive organisms such as streptococci, enterococci, and pneumococci

Question 33

Primary bacterial peritonitis is confirmed if the peritoneal fluid is sampled and contains a PMNs/μL level of?

Answer 33

> 250

Question 34

How does secondary peritonitis occur?

Answer 34

Bacteria contaminate the peritoneum as a result of spillage from an intra abdominal viscus

Question 35

What does the microbiology look like in secondary peritonitis?

Answer 35

Mixed flora of gram-negative bacilli and anaerobes

Question 36

How does the patient present with secondary peritonitis?

Answer 36

They lie motionless, often with knees drawn up to avoid stretching the nerve fibers of the peritoneal cavity

Question 37

What is a potentially lethal complication of ulcerative colitis or C. Diff colitis?

Answer 37

Toxic megacolon

Question 38

When should we prompt further evaluation for unintentional weight loss in a previous healthy individual?

Answer 38

Loss of 5-10% of body weight over 6 months

Question 39

What PEs should be done on men due to unintentional weight loss?

For women?

For both?

Answer 39

1) Rectal examination, including the prostate
2) Pelvic examination
3) Test stool for occult blood

Question 40

What should be taken into consideration for unintentional weight loss?

Answer 40

Poor dentition