GI 2

Question 1

diverticulitis

Answer 1

inflammation +/- infection of diverticulum or diverticula causing apin, anorexia, fever

Question 2

diverticulitis - severe cases may result in
4

Answer 2

1. intestinal abscess
2. fistula formation
3. obstruction
4. perforation/bleeding

Question 3

diverticulitis - where in pain most common
2

Answer 3

LLQ - overall
RLQ - most common in Asians

Question 4

diverticulitis - pain may be
3

Answer 4

1. intermittent or constant
2. crampy
3. associated w/ change in bowel habits - diarrhea, constipation

Question 5

diverticulitis - clinical pres
5

Answer 5

1. abd pain
2. anorexia
3. nausea
4. vomiting
5. dysuria and urinary frequency - bladder irritation

Question 6

diverticulitis - PE findings can include
7

Answer 6

1. fever
2. hypotension
3. shock
4. localized LLQ pain +/- rebound and guarding
5. +/- RLQ tenderness
6. decreased bowel sounds
7. tenderness or mass on rectal exam

Question 7

diverticulitis - img/testing
2

Answer 7

1. plain films - perf or obstruction, little role in dx diverticulitis
2. pregnancy test

Question 8

diverticulitis - DD
4

Answer 8

1. malignancy
2. PID
3. irritable bowel syndrome
4. ischemic colitis

Question 9

diverticulitis - tx if pt has prior dx, localized pain w/o s/sx of localized peritonitis and w/o evidence of systemic illness
2

Answer 9

1. amoxicllin/clavulanate 875 mg PO BID 7-10 days
2. metronidazole 500 mg PO q8H 7-10 days +
   cipro 500 mg PO BID or levofloxacin 750 mg PO daily

Question 10

diverticulitis - diet

Answer 10

NPO initially w/ slow advancement to diet

Question 11

diverticulitis - when to refer to ER
5

Answer 11

1. diverticulitis suspected, w/ no prior dx
2. unable to tolerate PO
3. peritonitis
4. persistent fever
5. increased pain or failure to improve w/ OP therapy

Question 12

appendicitis classic presentation

Answer 12

“colicky” periumbilical pain followed by vomiting, progressive pain, localizing to RLQ in approximately 24-48 hours

Question 13

appendicitis pain is exacerbated w/

Answer 13

movement

Question 14

appendicitis - fever?

Answer 14

+/-

Question 15

obturator sign

Answer 15

flex knee at 90 degrees and internally rotate - pain in lower quadrant is positive sign

Question 16

mcburney’s point

Answer 16

1/3 of the way in from umbilicus - pain w/ palpation bc this is appendix area

Question 17

psoas sign

Answer 17

lay flat, have them lift their leg while you resist then above the knee - positive then consider appendicitis

Question 18

rovsing’s sign

Answer 18

push in on LLQ and quick release, if they feel pain in RLQ then + sign

Question 19

appendicitis - what tests can you do during physical exam
4

Answer 19

1. McBurney’s point tenderness
2. obturator
3. psoas
4. rovsing’s

Question 20

appendicitis - img/testing
3

Answer 20

1. pregnancy test
2. POC urine
3. consider CBC (leukocytosis w/ CBC), BMP/LFT/lipase

Question 21

appendicitis - gyno
4

Answer 21

1. tubo ovarian abscess
2. ectopic pregnancy
3. ovarian torsion
4. ruptured ovarian cyst

Question 22

appendicitis - Uro DD
3

Answer 22

1. renal colic
2. pyelonephritis
3. UTI

Question 23

appendicitis - surgical DD
8

Answer 23

1. mesenteric adenitis
2. mesenteric ischemia
3. bowel obstruction
4. intussusception
5. Meckel’s diverticulum
6. diverticulitis
7. pancreatitis
8. cholecystitis

Question 24

appendicitis - tx and disposition
4

Answer 24

1. NPO
2. consider analgesia
3. antiemetics
4. Ed referral

Question 25

appendicitis - when to refer to ER 3

Answer 25

1. when advanced img is indicated 2. unexplained pain 3. worsening RLQ pain/tenderness, intractable vomiting, pyrexia (fever)

Question 26

GERD - patient may c/o 7

Answer 26

1. retrosternal burning 2. dyspepsia 3. CP 4. cough 5. bitter taste in mouth 6. belching 7. hoarseness

Question 27

GERD - in hx taking, ask about 2

Answer 27

1. relief with antacids 2. type of food and timing after intake (30-60 mins)

Question 28

GERD - risk factors include 5

Answer 28

1. pregnancy 2. obesity 3. cigarette smoking 4. elderly 5. stress

Question 29

GERD - hx may include 5

Answer 29

1. Sjorgren's syndrome 2. radiation 3. hiatal hernia 4. gastroparesis 5. gastric outlet obstruction

Question 30

PUD - pt may c/o 7

Answer 30

1. gnawing burning epigastric pain 2. belching/bloating 3. food intolerance 4. Nausea 5. vomiting 6. hematemesis 7. hematochezia

Question 31

PUD - classic presentation but varies Gastric vs Duodenal

Answer 31

gastric - pain during/shortly after meals duodenal - pain 2-3 hours after meal, at night

Question 32

PUD - ask about what med use 3

Answer 32

1. NSAIDs 2. steroids 3. anticogas

Question 33

PUD - sharp and severe abx pain may be concerning for

Answer 33

perforation

Question 34

GERD/PUD - vitals 2

Answer 34

usually normal hypotension/tachycardia - think perforation or anemia

Question 35

GERD/PUD - PE include 3

Answer 35

1. peritoneal signs w/ perforation 2. signs of anemia w/ blood loss 3. rectal exam for fecal blood testing

Question 36

GERD/PUD - img/testing

Answer 36

1. none usually req 2. consider cxr to r/o free air (perforation)

Question 37

GERD/PUD - foods to avoid 9

Answer 37

1. fats 2. chocolate 3. caffeine 4. mints 5. alcohol 6. citrus 7. oils 8. spicy 9. acidic

Question 38

GERD/PUD - lifestyle mods 4

Answer 38

1. smaller meals (GERD) 2. avoid laying down for three hours after eating (GERD) 3. weight loss (GERD) 4. smoking cessation

Question 39

PUD - avoid what meds 2

Answer 39

NSAIDs steroids

Question 40

persistent GERD, suspected PUD Rx and f/u 2

Answer 40

1. PPI 4-8 weeks 2. f/u with GI