GI 1

Question 1

RUQ pain DD
5

Answer 1

1. biliary colic -type of gallbladder pain caused by a gallstone blocking the cystic duct or common bile duct
2. cholecystitis
3. cholangitis -condition that causes inflammation of the bile ducts
4. hepatitis
5. renal colic - severe pain in the kidney area that’s usually caused by a kidney stone blocking the ureter

Question 2

epigastric pain DD
6

Answer 2

1. pancreatitis
2. gastritis - condition that causes inflammation of the stomach lining
3. peptic ulcer - sore in the lining of the stomach or duodenum, the first part of the small intestine
4. biliary colic
5. ACS
6. dissection/AAA

Question 3

LUQ pain DD
4

Answer 3

1. splenic infarction or rupture
2. gastritis
3. peptic ulcer
4. renal colic

Question 4

RLQ pain DD
5

Answer 4

1. appendicitis
2. ectopic pregnancy
3. ovarian torsion
4. ovarian cyst
5. PID

Question 5

suprapubic pian DD
4

Answer 5

1. cystitis - common inflammation of the bladder that’s usually caused by a bacterial infection, also known as a lower urinary tract infection (UTI)
2. early appendicitis
3. PID
4. endometriosis

Question 6

LLQ pain DD
5

Answer 6

1. diverticulitis - can occur anywhere in colon but most common in sigmoid colon
2. ectopic pregnancy
3. ovarian torsion
4. ovarian cyst
5. PID

Question 7

flank pain DD

Answer 7

1. kidney stone
2. pyelonephritis
3. AAA

Question 8

abd diffuse or variable pain DD
10

Answer 8

1. SBO
2. mesenteric ischemia
3. IBS
4. infectious colitis
5. hernia
6. AAA
7. IBD
8. C. difficile
9. gastroenteritis - inflammation of the stomach and intestines that causes diarrhea and vomiting
10. malignancy

Question 9

abd pain - ask about the context of what in the history taking portion
3

Answer 9

1. onset and duration
2. association w/ meals
3. hx of trauma

Question 10

abd pain - when asking about sx include questions about
3

Answer 10

1. description and severity - constant vs intermittent
2. location and radiation
3. associated s/sx - fever, NV, diarrhea/constipation, hematuria, dysuria, vaginal discharge

Question 11

abd pain - hx questions include
5

Answer 11

1. prior episodes of similar pain
2. abd surgeries
3. alcohol use
4. travel
5. recent abx and/or nsaid use

Question 12

Peritonitis

Answer 12

a serious condition that occurs when the peritoneum, the tissue lining the abdomen, becomes inflamed or infected

Question 13

abd pain - appears diaphoretic, think
3

Answer 13

1. peritonitis
2. MI
3. AAA

Question 14

abd pain - appears w/ scleral icterus or jaundice, think

Answer 14

hepatobiliary disease

Question 15

peritoneal signs
2

Answer 15

1. rigidity
2. rebound tenderness

Question 16

abd pain - consider EKG for pain where
2

Answer 16

epigastric
upper abd pain

Question 17

abd pain - consider what for img/testing
5

Answer 17

1. ekg - epi, upper quadrants
2. urine sample
3. pregnancy test
4. POC glucose
5. abd x ray - dilated loops of bowel, foreign body, stool, free air

Question 18

abd pain - disposition if well appearing, benign exam, tolerating PO

Answer 18

d/c

Question 19

abd pain - if referring to ER, keep what

Answer 19

NPO, consider appropriate analgesia

Question 20

abd pain - when to refer to ER
4

Answer 20

1. acute/surgical abd warranting advanced imaging
2. intractable vomiting or coffee ground emesis
3. jaundice, lethargy, dehydration
4. special considerations - advanced age, pregnancy/ectopic pregnancy, ovarian torsion, significant comorbidities

Question 21

vomiting/diarrhea - hx taking, asking about
6

Answer 21

1. recent travel
2. sick contacts
3. dietary hx
4. hx of chronic GI disorders or eating disorders
5. medications (abx, NSAIDs etc)
6. substance use

Question 22

vomiting/diarrhea - may present w/
3

Answer 22

1. abd pain
2. fever
3. blood in vomitus or diarrhea

Question 23

vomiting/diarrhea - PE findings might include
5

Answer 23

1. fever
2. tachycardia
3. hypotension
4. sx of dehydration
5. tender abx

Question 24

vomiting/diarrhea - img/testing
2

Answer 24

none usually required
consider obstruction series

Question 25

vomiting/diarrhea - DD 9

Answer 25

1. acute intestinal obstruction 2. mesenteric ischemia - when blood flow to the intestines in reduced or blocked 3. medication w/d syndromes 4. metabolic causes - DKA, hyperthyroid 5. pregnancy - hyperemesis gravidarum 6. infectious diarrhea/food poisoning 7. inflammatory diarrhea - diverticulitis, IBD 8. IBS 9. eating disorders

Question 26

vomiting/diarrhea - overall tx #1

Answer 26

rehydration

Question 27

tx for vomiting w/o evidence of systemic disease or dehydration - tx as outpatient 2

Answer 27

1. ondansetron 4 mg ODT 1 tab PO/SL q4-6 2. promethazine 25 mg PO q6h

Question 28

vomiting in pregnancy rx 4

Answer 28

1. pyridoxine 25 mg PO w/ doxylamine 12.5 mg PO 2. metoclopramide 5-10 mg PO q4-6h 3. promethazine 12.5-25 mg PO/PR q4-6h 4. ondansetron 4-8 mg q4-6h ODT (avoid prior to 10 weeks)

Question 29

diarrhea w/o evidence of systemic disease or dehydration - tx as OP, was it typically not recommended

Answer 29

antimotility agents and abx

Question 30

vomiting/diarrhea - when to refer to ER 4

Answer 30

1. dehydration 2. intractable vomiting 3. VS abnormalities 4. concerning abd pain