Gastrointestinal

Question 1

mechanism of abdominal pain

Answer 1

Hollow viscus, capsular distention, peritoneal irritation, mucosal ulceration, vascular insufficiency, altered body motility, nerve injury, abdominal wall injury and pain referred from extra-abdominal site

Question 2

pain described as: constant achy feeling

Answer 2

abdominal wall pain

Question 3

pain described as: dull, crampy and poorly localized

Answer 3

visceral pain, arising form hollow viscus usually result of distention or spasm of a hollow organ

Question 4

pain described as: sharp well-localized pain

Answer 4

parietal pain arising from the parietal peritoneum ie acute appendicitis pain with inflammation spread to peritoneum

Question 5

pain described as aching and near surface of body

Answer 5

Referred pain; experienced away from the disease process, result of shared central pathways

Question 6

upper right abdominal quadrant pain

Answer 6

emanates from the chest cavity, liver, gallbladder, stomach, bowel, right kidney or ureter

Question 7

left upper quadrant pain associated with

Answer 7

heart, chest cavity, spleen, stomach, pancreas, acute pancreatitis, left kidney or ureter.

Question 8

Left lower quadrant pain associated with

Answer 8

bowel, left ureter, pelvis or commonly associated with diverticulitis especially when pain is protracted or severe

Question 9

right lower quadrant pain associated with

Answer 9

appendix, bowel, right ureter, pelvis most common diagnosis appendicitis

Question 10

pain in epigastrium or periumbilical area with migration to right lower quadrant and abdominal rigidity often short duration of pain

Answer 10

appendicitis

Question 11

Labs r/t appendicitis

Answer 11

CBC w diff, BMP, CRP, Serum HCG, sickeldex test, urinalysis,
CT scan, ultrasound

Question 12

nausea, vomiting, abdominal distention and pain. distended bowel on xray of abdomen

Answer 12

small bowel obstruction

Question 13

labs and imaging for small bowel obstruction

Answer 13

CBC w/ diff, CMP, lactate dehydrogenase, hcg,

Abdominal x ray upright and supine, ct scan, MRI, transabdominal ultrasound as indicated.

Question 14

pain starting in the epigastrium and spread rapidly throughout the abdomen with frequent early radiation of pain. frequent radiation to the scapular area

Answer 14

peptic ulcer disease

Question 15

common cause of peptic ulcer disease

Answer 15

repeated use of nsaid drugs and h. pylori

Question 16

labs for peptic ulcer

Answer 16

CBC w/diff, cmp, serum amylase, fobt, h. pylori. hcg (in women)
abdominal x ray upright and left lateral decubitus
endoscopy, urea breath test. `

Question 17

high fever, chills, acute abdominal pain. diffuse, localized or referred. patients with cirrhosis may not complaint of pain and may run only a low-grade fever
additional complaints: abdominal pain, tenderness, nvd or constipation

Answer 17

peritonitis

Question 18

dx of peptic ulcer suggested by

Answer 18

H & P, confirmed by detection of pneumoperitoneum on upright abdominal or chest x-ray h. pylori test and urea breath test.

Question 19

dx of peritonitis based on

Answer 19

fever, abdominal pain, tenderness and leukocytosis. decreasing bowel sounds. increasing tenderness, rebound tenderness chest and abdo x ray cbc w/diff

Question 20

asymtpomatic before rupture, may have abdominal flank or back pain several days after the rupture.

Answer 20

AA rupture.

Question 21

abdominal exam findings may include abdominal distention, flank or back pain, tenderness. pulsations over the mass

Answer 21

AAA

Question 22

who should be screened for AAA

Answer 22

men 65-75 with history of smoking at least 100 cigarettes in a lifetime

Question 23

Standard evaluation for AAA

Answer 23

CT scan

Question 24

labs for ruptured AA

Answer 24

CBC w/diff, cmp, hcg as appropriate, type and cross,

Question 25

What are hemorrhoids

Answer 25

nonpathologic venous cushions in the submucosal layer of the anal canal

Question 26

these hemorrhoids are more likely to be painful

Answer 26

external hemorrhoids

Question 27

typically present with painless bright red blood per rectum with bowel movements

Answer 27

internal hemorrhoids

Question 28

first-degree hemorrhoids cause:

Answer 28

cause bright red painless bleeding, may bulge but do not prolapse

Question 29

second-degree hemorrhoids:

Answer 29

prolapse during defecation but reduce spontaneously, pt. report bleeding and itching from the chronic moisture secreted by the anal canal mucosa

Question 30

third degree hemorrhoid

Answer 30

prolapse with defecation and require manual reduction. Patient has secondary pain related to local ischema and mucoid drainage

Question 31

fourth-degree hemorrhoid

Answer 31

permanently prolapse and not reducible, incarcerated hemorrhoids require urgent surgical intervention

Question 32

recommended tx of hemorrhoids

Answer 32

high-fiber diet and increased fluid intake reduction in constipation and straining

Question 33

painful linear crack or tears of the lining of the anal canal

Answer 33

Anal fissure

Question 34

definition of chronic vs acute anal fissure

Answer 34

less than 6 weeks acute; greater than 6 weeks in chronic

Question 35

patient experiences severe, sharp rectal pain during and after bowel movements and small amounts of bright red blood on toilet paper

Answer 35

Anal fissure

Question 36

differential dx for anal fissure

Answer 36

anal carcinoma, perianal abscess, thrombosed external hemorrhoid.

Question 37

patient experiences uncontrollable urge to scratch the anus tend to be worse at night or after a bowel movement may involve the buttocks, vulva, scrotum area

Answer 37

pruritus ani

Question 38

Tx of pruritis ani

Answer 38

1% hydrocortisone for a period of no more than two weeks to discourage skin atrophy may require antibiotics if area has become infected

Question 39

infection that occurs from the obstruction of the duct of an anal gland at the level of the denatate line. after formation may spread to adjacent pelvic tissue or the perianal skin

Answer 39

anorectal abscess

Question 40

abnormal communication between abscess and perianal skin chronic manifestation of perianal abscess

Answer 40

perianal fistula

Question 41

abscess-fistula complex appears to arise from penetrating inflammation in this disease process in up to 35% of patients

Answer 41

Crohns disease

Question 42

patient complaint of perianal pain and swelling that increases with movement sitting or bowel movements. malaise and fever , persistent purulent drainage with hx of abscess may also be present. inguinal lymphnodes may be enlarged as well

Answer 42

anorectal abscess

Question 43

tx of anorectal abscess

Answer 43

incision and drainage, cbc if systemisc symptoms or unclear diagnosis, antibiotics not generally indicated. ciprofloxacin or metronidazole may be used if abx are desired

Question 44

right upper quadrant pain, radiated to right posterior shoulder within an your of eating an type of large meal especially with high fat content. described as mild to severe accompanied by nausea and vomiting

Answer 44

cholelithiasis

Question 45

similar to systemic cholelithiasis, but lasts longer than 4 to 6 hours

Answer 45

acute cholecystitis

Question 46

recurrent mild to moderate upper quadrant pain and epigastric abdominal pain accompanied by nausea and vomiting pain may radiate to the region of the posterior right shoulder associated with eating fatty foods

Answer 46

chronic cholecystitis

Question 47

moderate distress from systemic toxicity, tachycardia and fever. The right upper quadrant abdominal pain is associated with tenderness and muscle guarding or rigidity. gallbladder distention, hypoactive bowel sounds and presence of murphy's sign

Answer 47

acute cholecystitis

Question 48

What is cirrhosis

Answer 48

end stage consequence of progressive hepatic fibrosis affecting normal liver function, serious irreversible disease

Question 49

most common cause of cirrhosis in the united states

Answer 49

hepatitis B and C virus, alcoholic liver diseases, nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (NASH)

Question 50

medication associated with liver cirrhosis

Answer 50

acetaminophen, amiodarone, methotrexate, isoniazid, varied antibiotics, carbon tetrachloride

Question 51

early symptoms include pruritis, weight loss and fatigue additionally- malaidse, dark urine or pale stools, later symptoms nausea and vomiting

Answer 51

primary biliary cirrhosis

Question 52

abnormal diagnositis in cirrhosis

Answer 52

hypoalbuminemia, elevated serum protein, elevated AST and ALT, alk phos elevation, y glutamyl elevated

Question 53

education for patient with cirrhosis

Answer 53

dietary discipline, avoidance of hepatotoxic drugs, and risk reduction.

Question 54

primary causes of constipation

Answer 54

irritable bowel syndrome, disordered colonic transit, evacuation disorders, dyssynergic defecation

Question 55

inability of abdominal and pelvic floor muscles to coordinate correctly and empty stool, may affect half of patients with chronic constipation

Answer 55

dyssynergic defecation

Question 56

secondary causes of constipation

Answer 56

medical and psychogenic condition, medications, structural abnormalities and lifestyle

Question 57

c/o nausea, vloating, straining, cramping, and difficulty passing stools

Answer 57

constipation

Question 58

Diagnostics related to constipation

Answer 58

abdominal xray, ct scan, CBC w/diff to rule out obstruction, ileus, megacolon and volvulus

Question 59

constipation management

Answer 59

lifestyle changes, increase exercise, increase dietary fiber | bulk forming laxatives, stool softeners, osmotic laxatives, stimulant laxatives in this order.

Question 60

what is diarrhea

Answer 60

increase in stool frequency of more than three unformed stools per day loose or liquid characterized by urgency and consistent

Question 61

chronic diarrhea characterized as

Answer 61

diarrhea for a month without improvement

Question 62

acute diarrhea characterized as

Answer 62

diarrhea lasting less than 2 weeks

Question 63

malabsorptive disorders from ingesting solute rich molecules (sugar free gum, alha glucosidase, ampicillin, clindamycin, miralax, methyldopa, qunidines, hydralaien ace inhibitors

Answer 63

osmotic diarrhea

Question 64

Most common type of diarrhea, more likely to result in watery stools as absorption in gut is compromised

Answer 64

secretory diarrhea

Question 65

steatorrhea

Answer 65

known as fatty diarrhea a type of secretory diarrhea i.e. bile acid malabsorption post gallbladder removal

Question 66

brief episodes of acute diarrhea typically caused by :

Answer 66

viral or food-borne illness

Question 67

diarrhea diagnostics

Answer 67

x-ray KUB, flat and upright if small bowel obstruction or stool impaction with overflow incontinence is suspected

Question 68

outpouching of mucosa through the colon wall

Answer 68

Diverticular disease

Question 69

mild to moderate aching abdominal pain present in the left lower quadrant

Answer 69

diverticulitis

Question 70

Diagnostics for diverticulitis

Answer 70

cbc w/diff, crp, ua, bun, colonoscopy 4-6 weeks later

Question 71

most common cause of lower GI bleeding

Answer 71

diverticular bleeding

Question 72

swallowing disorder that involves dysfunction of one or more stages in the sequence of swallowing

Answer 72

oropharyngeal dysphagia

Question 73

causes of oropharyngeal dysphagia

Answer 73

medication side effects, postsurgical muscular or neurogenic disorder, radiation therapy causes of Iatrogenic oropharyngeal dysphagia

Question 74

Botulism, diphtheria, lyme disease, syphilis

Answer 74

infectious cause of oropharyngeal dysphagia

Question 75

Amyloidosis, Cushing syndrome, Thyrotxicosis, Wilson disease

Answer 75

Causes of metabolic oropharyngeal dysphagia

Question 76

Connective tissue disease, myasthenia gravis, myotonic dystrophy, polymyositis, sarcoidosis, paraneoplastic syndromes

Answer 76

Myopathic causes of oropharyngeal dysphagia

Question 77

amyotrophic lateral sclerosis, brain-stem tumors, cerebral palsy, dementia, guillain-barre syndrome

Answer 77

neurologic causes of oropharyngeal dysphagia

Question 78

chewing (mastication) involves which cranial nerves

Answer 78

V ( trigeminal, VII Facial, IX glossopharyngeal and XII hypoglossal

Question 79

diagnostics for oropharyngeal dysphagia

Answer 79

modified barium swallow, CT or MRI, fiberoptic endoscopic examination of swallow

Question 80

first factor causing acid reflux

Answer 80

TLESR- transient lower esophageal sphincter relaxations

Question 81

second cause of acid reflux

Answer 81

hiatal hernia

Question 82

third factor of acid reflux

Answer 82

intensity of acid exposure

Question 83

fourth cause of acid reflux

Answer 83

pathogenic factor affecting the ability of the esophagus to clear itself of reflux material resulting in longer exposure to gastric contents

Question 84

fifth factor of acid reflux

Answer 84

integrity of the protective barrier of the mucosal lining

Question 85

abdominal pain that occurred a minimum of once each week for the previous 3 months in combination with two or more of following defecation related pain pain related to change in stool frequency pain associated with change in appearance of stoll

Answer 85

Irritable bowel syndrome IBS