Exam Flashcards
a patient presents with acute obstipation, abdominal pain and distention, nausea and vomiting and they have a sx history of a laparoscopic pelvic surgery. We decided to get a plain film xray which shows an inverted “U”. what is the diagnosis?
small bowel obstruction
what is the most common cause of small bowel obstructions?
adhesions
a patient presents with acute obstipation, abdominal pain and distention, nausea and vomiting and they have a sx history of a laparoscopic pelvic surgery. We decided to get a plain film xray which shows an inverted “U”. once the patient is admitted, what is the first treatment step for this patient?
resuscitation with NG tube
a patient presents with suspicious small bowel obstruction, what would their physical exams findings be? (4)
distention
abdominal scar
tenderness/pain on palpation
tympanic (hyperresonance) on percussion
what divides the upper and lower GI tract and is the starting point when running the bowel?
ligament of treitz
you are a PA working in gastroenterology. You have a patient who presents with multiple ulcers in the stomach and duodenum. The patient currently takes lisinopril, metformin, prilosec, zantac, and tums. We decide to order a gastrin level. Which medications should the patient discontinue before taking a serum gastrin level? (3)
H2 blocker
PPI
antacids
a patient presents with tachycardia, hypotension. On plain film xray, there is free air under the diaphragm, and the patient has a history of duodenal ulcers. We suspect a perforation of a duodenal ulcer. what is the treatment?
surgery by graham (omental) patch
an older woman comes in with abdominal distention for the last 3 days. She had her ovaries removed 4 years ago. She is mildly tachycardiac, but the rest of her vitals are normal. On upright films, we see air-fluid levels. what is the diagnosis?
what is the most likely cause of this?
small bowel obstruction
surgical adhesions
an older gentleman is having progressive dysphagia. First he was unable to eat solids and now is having difficulty swallowing liquids. On barium swallow, we see narrowing of the esophagus. On EDG biopsy, we note squamous cell carcinoma and are concerned for invasion. What is the imaging test of choice to see how deep the tumor is?
endoscopic ultrasound
a young boy is riding his bike and accidentally goes over the handle bars. He comes into the trauma bay with normal vital signs and the patient seems stable, and blood work looks good. Because of the mechanism, we are concerned so we get a CT scan which shows a grade 1 splenic laceration with no active bleed. After admitting for 24 hours and doing serial abdominal exams, the patient remains hemodynamically stable. What should we do?
a) splenectomy today
b) splenectomy in 2 weeks
c) partial splenectomy
d) call IR for embolization
e) non-operative management
e) non-operative management
a trauma patient in his mid-20s had a splenectomy. We notice he left AMA and were unable to give him post-op instructions. The patient comes to the follow-up appointment. What is the most important thing we need to do before he leaves the appointment?
vaccines against encapsulated bacteria
Strep pneumo
H. flu
Meningococcus
a patient in their late 80s with dementia and non-verbal, is brought in by his daughter because he seems like he is having painful swallowing. The patient wears dentures. He will not open his mouth but appears to be hemodynamically stable, but appears to be uncomfortable swallowing. What is the diagnosis? what is the diagnostic test of choice?
foreign body ingestion
xray
a male in his mid 40s presents with right upper quadrant pain that radiates to his back. the pain comes and goes and is worse after a big meal. what is the diagnostic test of choice?
ultrasound
a male in his mid 40s presents with right upper quadrant pain that radiates to his back. the pain comes and goes and is worse after a big meal. We are concerned for choledocholithiasis so we need an ERCP. What in the patient’s history would not allow us to perform an ERCP?
contrast allergy
a young man presents in the urgent care with a testicular mass that is getting larger. the patient denies history of trauma. There is a 2cm, firm, nontender mass that does not transilluminate. What is the concern? What test should we order?
testicular cancer
ultrasound
a middle aged woman with a history of an appendectomy 2 weeks ago, presents for a post-op appointment. After reviewing pathology, the patient has a 5ml (0.5 cm) carcinoid tumor of the appendix without involvement at the margins. what is the next step?
none needed
a middle aged woman plays pickleball and comes in a day later with abdominal pain. She c/o anorexia, nausea, and right lower quadrant pain. Her WBC count is normal. She has a bulge located on the superficial part of her abdomen. When the patient tenses her rectus muscles by raising her head, the swelling becomes more tender and distinct on palpation. The US shows a mass of the abdominal wall. What is the diagnosis?
abdominal wall (rectus sheath) hematoma
which hernia passes through the deep and superficial rings (internal inguinal ring)?
indirect inguinal hernia
which hernia goes through Hesselbach’s triangle?
direct inguinal hernia
what are the 2 disease processes that originate from a patent process vaginalis?
hydrocele
indirect inguinal hernia
a young man in high school has a recurrence of a painful mass in the midline, above his gluteal folds. on exam, we see some midline pits and some protruding hair without masses, fluctuance, tenderness, or redness. what is the diagnosis? what is the next step?
pilonidal disease
benign conservative treatment (d/t no issues)
a 30 yo female presents with bloody diarrhea, abdominal discomfort. colonoscopy shows colitis in the descending colon. the gastroenterologist takes a biopsy and diagnoses the patient with Crohn’s disease. what finding on colonoscopy + biopsy would be consistent with Crohn’s disease on pathology?
noncaseating granulomas
what is the cut off for carcinoid tumor of the appendix that separates from benign and malignant?
< 2cm is likely benign
a 23 yr old presents with a spleen injury and is unstable and bleeding in his abdomen. On xray, spleen is in pieces so they did a splenectomy. In clinic 2 weeks later, what should we make sure that he has done?
vaccines against encapsulated bacteria
Strep pneumo
H. flu
Meningococcus
a patient presents with a small bowel obstruction, most likely from adhesions. the NG tube is suctioning and patient is doing better. When he came in, he had a foley and urine output over the last 10 hours is 20cc/hour, is this appropriate, low or high? what should we provide this patient with?
low
fluid bolus
a patient rectum is biopsied and the pathology shows carcinoid tumor. what are the symptoms associated with carcinoid syndrome?
arrhythmias
bronchospasms
hot flashes
a patient presents to ER with left lower quadrant pain, fever, and vomiting. their CT scan shows a thickened sigmoid colon with inflamed diverticula that is large with a 7cm fluid collection in their pelvis. Dx? what is the treatment if the patient is stable (2)?
complicated diverticula
antibiotics
percutaneous drain
a patient presents to ER with left lower quadrant pain, fever, and vomiting. their CT scan shows a thickened sigmoid colon with inflamed diverticula that is large with a 7cm fluid collection in their pelvis. they receive antibiotics and percutaneous drain. 1 month later, he is asymptomatic. what should we do for this patient?
colonoscopy in 6 weeks
a patient presents to ER with left lower quadrant pain, fever, and vomiting. their CT scan shows a thickened sigmoid colon with inflamed diverticula that is large with a 7cm fluid collection in their pelvis. they receive antibiotics and percutaneous drain. 1 month later, he is asymptomatic so we do a colonoscopy in 6 weeks, which shows 1 large diverticula in the sigmoid colon. The patient is scared it will happen again, what should we recommend?
refer to surgery for possible sigmoid resection
a patient presents with Crohn’s disease and they ask in what situation they would need an immediate colectomy?
acute abdomen
what does imaging show to indicate an acute abdomen?
what does physical exam show to indicate acute abdomen? (3)
free air
rigidity
rebound tenderness
guarding
a patient with anal cancer; poorly differentiated squamous cell carcinoma. What is the treatment?
radiation + chemotherapy
what is the best purpose of a CEA in a patient with adenocarcinoma of the colon? treatment?
looking for reoccurrence
surgery
where does a post-pyloric feeding tube go?
duodenum
what is the 2nd most common cause of small bowel obstruction?
3rd most common?
bowel-containing hernia
cancer
if a patient has had a splenectomy, they will need clotting prophylaxis. what should we put them on?
aspirin
what disease process is an ERCP typically used for?
choledocholithiasis
what is the most likely complication of an ERCP?
pancreatitis
what other imaging can be used if we want to assess a patient’s biliary tree but they have a contrast allergy?
MRCP
in general, how long should surgery be postponed after an MI?
> 6 months
fibers located in the walls and capsules; pain is slow in onset, dull, poorly localized and protracted
visceral pain
rupture of veins in the brain
subdural hematoma
rupture of the middle meningeal artery and presents with a lucid interval
epidural hematoma
