Acute Complaints

Question 1

First priority in evaluating abdominal pain

Answer 1

determine acute or chronic

sudden and/or sever onset of pain –> emergent evaluation

Question 2

80 y/o man p/w:

• mild, crampy, bilateral LQ abd pain
• decreased appetite
• low-grade fever for 48 hrs

Answer 2

Appendicitis

• studies estimate a 10-20% reduction in perceived intensity of abdominal pain per decade after 60
• only 22% of elderly pts with appendicitis present with classic symptoms (must have high index of suspicion)

Question 3

gold standard for dx and tx of cholodocholithiasis; performed in setting of acute cholecystitis with increased liver enzymes, amylase, or lipase

Answer 3

ERCP

NB: cholescintigraphy (HIDA) can be used and would rule out cholecystitis; in setting of increased enzymes, ERCP is the better choice

Question 4

MCC of pancreatitis

Answer 4

gallstones

NB: 
- gallstones = majority
- etoh abuse = 30%
- idiopathic = 10-30%
(less common: hypercalcemia, hyperlipidemia, trauma, meds, infx, ercp)

Question 5

Ranson criteria

Answer 5

• Assessed on admission

Poor prognosis if:

• Age >55
• WBC > 16,000
• Glucose >200
• LDH > 350
• AST > 250

Question 6

6 criteria that reflect the development of complications from pancreatitis:

Answer 6

• Assessed during first 48 hrs of admission
• decrease in hematocrit > 10
• increase in BUN > 5
• calcium 4
• fluid sequestration > 6L

Question 7

Rome Consensus Committee IBS Dx Criteria

Answer 7

symptoms present for at least 12 wks (not necessarily consecutive) in the last 12 mo w/ at least 2 of the following:

• relieved by defecation
• onset a/w change in stool frequency
• onset a/w change in form/appearance of stool

Question 8

Most likely findings (cause) after working up pt w/ 3 mo of:

• discomfort in upper abdomen
• heartburn
• frequent belching
• bloating
• occasional nausea

Answer 8

No cause is likely to be identified

Causes of dyspepsia (chronic/recurrent discomfort around the upper abdomen that can be a/w listed symptoms)

• no specific etiology for 50-60%
• ulcer disease 15-25%
• GERD 5-15%
• gastric or pancreatic cancer (rare)

Question 9

ASCUS; HPV(-)

Answer 9

repeat PAP in 1 yr

Question 10

ASCUS; HPV(+)

Answer 10

colposcopy
or
repeat PAP in 4-6 mo

• if repeat PAP = ASCUS or higher –> colpo
• if repeat PAP = normal, repeat 1 more times at 4-6 mo; if all neg, can return to normal

Question 11

stopped cards at #120

Answer 11

-