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Clinical Disciplines Final (Jess) > Acute abdomen case questions > Flashcards

Acute abdomen case questions Flashcards

1
Q

26 year old male presents with abdominal pain and N/V of 24 hours duration

  • Pain initially located near umbilicus but now is at RLQ
  • Pain proceeded onset of N/V
  • 90/60, 142, 30, 102.7°F, 97%RA
  • Patient lying still on bed not wanting to move or be touched
A

Appendicitis

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2
Q

44 year old female complaining of epigastric abdominal pain

  • Pain began approximately 30 minutes after eating fried chicken
  • Pain radiates to the right scapular tip
  • 110/60, 130, 36, 103.6°F, 96%RA
  • Murphy’s sign – inspiratory arrest elicited by palpating RUQ
A

Cholecystitis

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3
Q

73 year old female complains of generalized abdominal pain

  • 100/70, 135 irregular, 24, 98°F, 94%RA
  • Pain is poorly localized and is associated with nausea and vomiting
  • Abdomen is relatively soft but she complains of severe pain
A

Mesenteric ischemia

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4
Q

16 year old female with generalized abdominal pain but worse on palpation to right lower quadrant

  • 70/40, 128, 22, 100°F, 94%RA
  • FDLMP ~ 6-7 weeks ago
  • Also has vaginal bleeding
A

ectopic pregnacy

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5
Q

32 year old female complaining of generalized abdominal pain

  • 90/70, 140, 30 shallow, 101°F, 97%RA
  • Has been taking “pain medications” for pain in her knees post-arthroscopy
  • Lying still on gurney
A

perforated gastric ulcer

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6
Q

56 year old male with generalized cramping abdominal pain

  • Also with diarrhea and nausea
  • 130/80, 100, 20, 98.6°F, 99%RA
  • History of appendectomy and cholestectomy 14 years previously
A

SBO

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7
Q

87 year old male with right testicle pain

  • 80/40, 130, 22, 99°F, 94%RA
  • Dip urinalysis is positive for blood (trace)
A

AAA

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8
Q

12 year old male with abdominal pain

  • 120/70, 130, 24, 99°F, 100%RA
  • Admits to “being swollen down there” once mother leaves the room
A

Testicular torsion

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9
Q

32 year old female with sudden onset left flank pain which radiates to the left lower quadrant

  • 180/90, 130, 20, 98.6°F, 100%RA
  • Unable to find comfortable position
  • Feels need to urinate but can’t
A

Urolithiasis

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10
Q

44 year old female complaining of epigastric abdominal pain

  • Radiates to back
  • N/V
  • Onset after weekend of binge drinking
  • 100/60, 132, 22, 99.9°F, 97%RA
A

pancreatitis

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11
Q

72 year old male with LLQ pain

  • 90/60, 128, 22, 103.6°F, 95%RA
  • Also with N/V, rectal bleeding
  • Patient gives additional history of recently eating “many nuts” while watching TV at home
A

diverticulitis

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12
Q

65 year old male with generalized abdominal pain

  • 80/50, 137, 28, 97.6°F, 94%RA
  • Also with weakness, weight loss, N/V, urinary frequency
  • Accucheck - Hi
A

DKA

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13
Q

What is the difference between visceral and somatic pain? Give an example of each type.

A 
Visceral – colicky, ill defined 
Intestinal obstruction, renal colic
Early appendicitis
Somatic – sharp, well defined
Late appendicitis
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14
Q

Give some examples of common pain referral patterns.

A

Right shoulder/scapula – biliary problem
Left arm/neck/jaw – MI
Back – pancreatitis
Groin – renal colic

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15
Q

What is the clinical significance of Cullen’s and Grey Turner signs?

A

Retroperitoneal hemorrhage

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16
Q

What is the pathophysiologic process that leads to appendicitis?

A

Luminal obstruction of the appendix

17
Q

T/F – Appendicitis cannot be present if the white blood cell count is normal.

A

False

18
Q

T/F – Pain medications should be withheld from patients with abdominal pain, as this will make the physical examination less reliable.

A

False

19
Q

What are the risk factors for gallbladder disease?

A

5 F’s – fat, forty, female, flatulent, fertile

8 F’s – 5 above +, fair skinned, family, foreign

20
Q

What ultrasound findings suggest cholecystitis?

A

Thickened gallbladder wall (>3mm)
+ Pericholecystic fluid
Stones/sludge
+ Sonographic Murphy’s sign

21
Q

What are the components of Charcot’s triad of cholangitis?

A

Fever
Jaundice
RUQ abdominal pain

22
Q

Reynold’s pentad?

A

Triad plus shock and confusion

triad= Fever
Jaundice
RUQ abdominal pain

23
Q

What diagnosis should be considered in a patient with pain out of proportion to examination?

A

Mesenteric ischemia
Necrotizing fasciitis
Compartment syndrome

5 Ps - Pain, pallor, paresthesia, paralysis, pulseless

24
Q

What are the risk factors for mesenteric ischemia?

A 
Age over 60
Atrial fibrillation
CHF
MI
Hypercoagulable state
Hypotension
25
Q

What is the triad of signs/symptoms for ectopic pregnancy?

A

Abdominal/pelvic pain
Vaginal bleeding
Amenorrhea

26
Q

What is the most common cause of small bowel obstruction?

A

Adhesions from prior surgery

Incarcerated hernia

27
Q

MCC of Large bowel obstruction?

A

Malignancy

Volvulus

28
Q

What is triad of signs/symptoms for ruptured abdominal aortic aneurysm?

A

Abdominal/back/flank pain
Pulsatile abdominal mass
Hypotension

29
Q

T/F – Since testicular torsion can be reliably distinguished from epididymitis on clinical examination, an ultrasound is not indicated.

A

false

Clinical Disciplines Final (Jess) (4 decks)

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