DDx, conditions, etc.

Question 1

Prolonged exposure of esophagus to gastric acid due to impaired esophageal motility or lower esophageal sphincter.

Answer 1

GERD

Question 2

Describe the location and quality of GERD pain.

Answer 2

Burning chest/epigastric pain

Question 3

Describe the provocative/palliative factors affecting GERD.

Answer 3

physical activity, lying down, alcohol, fatty meals, chocolate make worse BUT antacids and avoiding Ca Channel blockers make better.

Question 4

Associated symptoms of GERD

Answer 4

chronic cough, SOB, hoarseness, halitosis, sore throat

Question 5

Describe the location and quality of pain associated with a peptic ulcer.

Answer 5

gnawing, burning, boring, aching or hunger like epigastric pain/discomfort that may radiate to the back

Question 6

Patient complains of pain that wakes her at night and is intermittent over a few weeks.. even disappears for months

Answer 6

Duodenal ulcer should be considered.

Question 7

Describe the location and quality of pain associated with acute appendicitis.

Answer 7

Initially mild, poorly localized periumbilical pain that becomes more steady, severe and moves to RLQ

Question 8

Associated symptoms for acute appendicitis

Answer 8

anorexia, nausea/vomiting, low fever

Question 9

Gallbladder inflammation due to cystic or common bile duct obstruction (gallstone)

Answer 9

acute cholecystitis

Question 10

Pt. complains of steady, aching RUQ pain than radiates to the rt. scapular area.

Answer 10

Acute cholecystitis

Question 11

A steady epigastric pain that radiates to the back… it seems to get better when leaning forward with trunk flexed.. Which organ will you focus on?

Answer 11

Pancreas.. Acute/chronic pancreatitis? cancer?

Question 12

Pt. complains of steatorrhea and DM… Part of Ddx should include:

Answer 12

chronic pancreatitis

Question 13

A cramping LLQ pain comes on gradually, but becomes steady… Pt. has fever, constipation, and brief initial diarrhea. What you think?

Answer 13

Acute diverticulitis

Question 14

Cramping, paroxysmal pain… Obstipation and possible vomiting… What you think?

Answer 14

Bowel obstruction… location of pain and composition of vomit may help decide between SBO and colon..

Question 15

Three reasons for a bowel lumen obstruction?

Answer 15

adhesions, hernias, cancer, diverticulitis

Question 16

When might you consider mesenteric ischemia as part of your Ddx?

Answer 16

abrupt periumbilical cramping pain at first that becomes diffuse and persistent.. older pt. possibly prone to thrombi or emboli

Question 17

What causes oropharyngeal dysphagia?

Answer 17

motor disorders affecting the pharyngeal muscles (stroke, bulbar palsy, neuromuscular conditions)

Question 18

AS with oropharyngeal dysphagia:

Answer 18

aspiration, regurgitation into nose with attempts to swallow

Question 19

Various reasons for esophageal dysphagia:

Answer 19

mucosal rings, esophageal stricture, or cancer causing a mechanical narrowing

Question 20

P/P factors associated with esophageal dysphagia

Answer 20

Solid foods provocate… regurgitation of the bolus relieves

Question 21

Uncoordinated spasms of esophagus that fail to propel food to stomach… shows a characteristic corkscrew barium swallow x-ray… What is condition and possible triggers?

Answer 21

DES (diffuse esophageal spasm). Uncontrolled gastroesophageal reflux, really hot/cold beverages

Question 22

Provide 3 life activities/habits that suggest constipation

Answer 22

ignoring defecation reflex, false expectations, low-fiber diet

Question 23

Functional change in frequency/form of BM w/o known pathology…possible change in intestinal bacteria.. What’s the problem?

Answer 23

Irritable Bowel Syndrome

Question 24

3 reasons for a mechanical obstruction resulting in constipation

Answer 24

narrowed lumen from adenocarcinoma, fecal impaction, diverticulitis, volvulus, intussusception, hernia..

Question 25

Acute diarrhea can be secretory or inflammatory infection. Give possible causative agents.

Answer 25

S.aureus, B. cereus, C. perfringens, cholerae, cryptosporidium, Giardia, rotavirus

Question 26

List several causative agents of inflammatory infection resulting in acute diarrhea

Answer 26

Salmonella, Shigella, Yersinia, Campylobacter, E. coli, C. difficile

Question 27

Name several drugs that can induce diarrhea

Answer 27

Mg containing antacids, antibiotics, antineoplastic agents, laxatives

Question 28

Causes of chronic diarrhea include:

Answer 28

IBS, cancer, ulcerative colitis, Crohn’s, malabsorption syndrome, lactose intolerance

Question 29

What are several causes for melena

Answer 29

Gastritis, GERD, peptic ulcer, esophageal/gastric varices, reflux esophagitis Mallory-Weiss tear

Question 30

Black stools but a negative occult test and asymptomatic.. reason?

Answer 30

ingestion of iron, bismuth salts, licorice, chocolate cookies

Question 31

Causes for hematochezia

Answer 31

cancer, adenomatous polyps, diverticula, inflammatory conditions, hemorrhoids, fissures, proctitis