Exam + investigations

Question 1

LIF drug history?

Answer 1

Steroids dampen inflammatory response, masking symptoms

Question 2

General exam generalised peritonitis?

Answer 2

lying very still, taking shallow breaths, and looking pale.

Question 3

General exam ureteric colic?

Answer 3

writhing in pain, unable to keep still.

Question 4

General exam cachetic or jaundiced?

Answer 4

liver metastases from colon cancer.

Question 5

Abdo exam focal tenderness?

Answer 5

uncomplicated acute diverticulitis presents with local tenderness and guarding.

Question 6

Abdo exam generalised peritonitis?

Answer 6

suspect perforation of a colonic diverticulum, sigmoid carcinoma, AAA

Question 7

Abdo exam masses?

Answer 7

palpable in LIF of patients with acute diverticulitis. Sigmoid carcinoma may be a central laterally pulsatile mass is AAA.

Question 8

Abdo exam troisers sign?

Answer 8

(left supraclavicular lymphadenopathy), suggests gastrointestinal malignancy.

Question 9

Rectal exam?

Answer 9

Pelvic abscess may be detectable in patients with acute diverticulitis,

can also palpate a rectal malignancy.

Question 10

Vaginal exam?

Answer 10

Necessary in LIF pain and vaginal discharge, as cervical motion tenderness would lend weight to a diagnosis of pelvic inflammatory disease.

Question 11

LIF Investigations VBG?

Answer 11

high lactate/metabolic acidaemia = patient is acutely unwell or has ischaemic bowel.

Normal glucose can’t be DKA.

Question 12

LIF Investigations FBC?

Answer 12

WCC elevated is inflammatory (diverticulitis, pseudomembranous colitis).

Question 13

LIF Investigations U&Es?

Answer 13

establish baseline electrolyte status and check they haven’t developed acute kidney injury.

Question 14

LIF Investigations CRP?

Answer 14

useful for UC and c. difficile.

Question 15

LIF pain acute diverticulitis?

Answer 15

constant LIF pain, preceded by vague midline colicky pain, associated with nausea and fever.

Question 16

Acute diverticulitis acute phase treatment (5)?

Answer 16

analgesia, bowel rest (clear fluids), IV fluids, antibiotics, venous thromboembolism prophylaxis.

Question 17

Abdo CT with contrast?

Answer 17

diagnoses acute diverticulitis and helps plan elective surgery.

Question 18

LIF pain CXR?

Answer 18

if suspicion of perforated viscus.

Question 19

LIF pain AXR?

Answer 19

useful for ruling out bowel obstruction.

Question 20

Treatment for perforated diverticulitis?

Answer 20

fluid resuscitation, blood tests, analgesia, antibiotics, CT, emergency laparotomy.

Question 21

IBS?

Answer 21

chronic abdo pain, cramping, bloating and altered bowel habit. Do FBC for anaemia of chronic disease, and TTG for coeliac disease.

Question 22

Symptoms of pregnancy?

Answer 22

lower abdo pain, vaginal bleeding, amenorrhoea

Question 23

Pelvic inflammatory disease?

Answer 23

acute lower abdo pain, new vaginal discharge, vomiting, fever, adnexal tenderness on vaginal examination.

Question 24

Diverticulitis epidemiology?

Answer 24

5% of 40yrs, 30% of 60yrs, 65% of 85yrs. 70% are asymptomatic, 20% develop acute diverticulitis, 10% develop rectal bleeding.

Question 25

Diverticulitis complications?

Answer 25

perforation, abscess formation, fistulation into adjacent structures, chronic inflammatory strictures, haemorrhage.

Question 26

Risk factors for ectopic pregnancy?

Answer 26

previous one, PID, tubular procedures, endometriosis, pelvic surgery, IVF.