Eval of abd pain in PC

Question 1

What is the TOC for eval of RUQ pain?

Answer 1

u/s

Question 2

+ murphy’s sign is in what disease?

Answer 2

cholecystitis

Question 3

A patient with cholecystits has +u/s and nl labs. What is the tx?

Answer 3

watch and wait

Question 4

A patient with cholecystits has +u/s and abnl labs. What is the tx?

Answer 4

ER or gen surg for chole

Question 5

You should keep _______ on the ddx for epigastric pain

Answer 5

cardiopulmonary

Question 6

melena is a PE clue for what disease?

Answer 6

PUD

Question 7

These are alarming sxs and need what?

Alarming sxs: age >50, dysphagia, weight loss/f/c/night sweats, gi bleeding, prolonged vomiting

Answer 7

endoscopy/GI referral

Question 8

What is the GS test for h.pylori?

Answer 8

breath test

Question 9

It is important to know what with H.pylori antibody testing?

Answer 9

Once patients are positive, they will remain positive for the rest of their lives

Question 10

How long should you do a trial of empiric therapy with H2 blockers or PPIs?

Answer 10

2-4 wks

Question 11

What is the TOC for a perf?

Answer 11

Xray (shows air under the diaphragm)

Question 12

What is the mc cause of PUD?

Answer 12

H.pylori

Question 13

What is the tx for PUD from H. pylori infection?

Answer 13

QUAD THERAPY: bismuth, tetracycline, flagyl, prilosec

Question 14

A patient with PUD should avoid ______

Answer 14

NSAIDS

Question 15

What is the TOC for pancreatitis?

Answer 15

CT abd pelvis with contrast

Question 16

What is the TOC for pancreatitis if you suspect stone disease?

Answer 16

u/s

Question 17

What is the tx for pancreatitis?

Answer 17

outpatient tx, fluids, clear liquid diet, pain control

Question 18

_______ should be considered in all patients with RLQ pain

Answer 18

appendicitis

Question 19

TOC for appendicitis?

Answer 19

CT or U/S in women

Question 20

_________ should be considered and highest on your differential in patients with LLQ pain

Answer 20

diverticulitis

Question 21

In patients that have never had sxs of diverticulitis before, what is the TOC?

Answer 21

CT with con

Question 22

Treatment for diverticulitis?

Answer 22

clear liquid and high fiber diet, flagyl and cipro

Question 23

A patient with bowel alterations and sensation of incomplete emptying most likely has what condition?

Answer 23

IBS

Question 24

Treatment for IBS?

Answer 24

diet, stress reduction, symptom directed

Question 25

Unilateral flank pain and hematuria are classic findings in what disease?

Answer 25

nephrolithiasis

Question 26

What is the gold standard imaging for a first time or uncertain dx of nephrolithiasis?

Answer 26

CT without contrast

Can do u/s if concern for hydronephrosis

Question 27

A stone < _____ mm will usually pass on its own

Answer 27

5

Question 28

Tx for nephrolithiasis if it cannot pass on its own?

Answer 28

tordol IM, alpha blocker x 14 days

Question 29

If you have a high suspicion for SBO, what toc is it?

Answer 29

CT abd/pelvis with contrast

Question 30

MC site of ectopic?

Answer 30

fallopian tube

Question 31

TOC for ectopic?

Answer 31

Transvaginal u/s should be performed regardless of bHCG level when ectopic is considered

Question 32

These are findings in what disease?

+bhcg, + pelvic pain +/- vaginal bleeding

Answer 32

ectopic –> send to ER

Question 33

Imaging that should be done in elderly patients since they have a diminished sense of abd pain?

Answer 33

CT

Question 34

Consider ________ in all patients who have abd pain and an appendix, esp in patients with the presumed dx of gastroenteritis, PID or UTI

Answer 34

appendicitis

Question 35

Any women with childbearing potential and abd pain has an ________ until preg test comes back negative

Answer 35

ectopic

Question 36

An elderly pt with abdominal pain has what?

Answer 36

A high liklihood of surgical disease

Question 37

Obtain an _______ in elderly patients and those with cardiac risk factors presenting with pain

Answer 37

ECG