GI

Question 1

52 yo female presents with yellow eyes and skin. 1. What questions to ask? 2. What important physical examination manuevers to perform? 3. DDx? 4. Test?

Answer 1

1. Fever, Chills, NVD, Constipation, Color of stool, Color of urine, Itching/Pruritus, Abdominal pain (Onset, Location, Constant, Quality, Radiation, Severity), Relation to food, previous episodes of pain, Conlonoscopy, Blood Transfusion, Travel, Immunization, Sexual Hx, Alochol/CAGE Qs. 2. Murphys sign, Eye, Palmer erythemi, Spider angiomata. 3. Extrahepatic - increase CB ( Pancreatic Cancer, Choledocholithiasis, Carcinoma of Ampulla, Sphincter of Oddi Dysfunction) Alcoholic Hepatitis, Viral Hepatitis, Acetominophen Toxicity, PBC. 4. AST/ALT/Alk phos, Albumin, PT/PTT, Hep A, Hep B Surface antibody, Hep C antibody, Acetominophen level, US Abd, CT Abd, ERCP/MRCP.

Question 2

6 month old present with diarrhea. 1. What questions to ask? 2. DDx? 3. Test?

Answer 2

1. Frequency, Description, Blood, Relationship to oral intake, previous regular bowel movements, abdominal distention, appetite changes, activities, awake and responsive, number of wet diapers, dry mouth, suncken eyes, vigorous cry, recent URI, fever, Breathing, emesis, Rash, cough, pulling on ear, daycare, sick contacts, birth hx, eating sleeping habits. 1. Rotavirus, Bacterial diarrhea, Malabsorption, UTI, Intussception, Bacteremia 3. Rotavirus enzyme immunoassay, BMP, Stool leukocytes, culture, ova and parasites and pH, UA, AXR, Blood cultures.

Question 3

Mother calls office complaining of 5 day old infant male child with yellow skin and eyes. 1. What questions to ask? 2. DDx? 3. Test?

Answer 3

OLDCARTS, Vomiting, Abdominal distention, Bowels/Frequency/Color/Consistency, Urinary frequency, Number of wet diapers, Breast feeding, Sucking well, Activities, Crying, Awake and Responsive, Recent URI, Fever, Breathing fast, Dry mouth, Cough, Shaking/Seizures, Blood group, Ill contacts, Obstetric Hx/Risks/Complications. 2. Physiologic jaundice, ABO and Rh incompatibility, Neonatal spesis, Cephalohematoma, Breast-feeding jaundice, Polycythemia, Familial neonatal hyperbilirubinemia. 3. Total and direct bilirubin, Blood typing, Direct Coombs Test, C-Reactive protein, CBC, Titers for CMV, Toxo, Rubella.

Question 4

Differential Diagnosis for GERD.

Answer 4

1. Esophagitis 2. Esophgeal spasm 3. Peptic Ulcer disease 4.Asthma 5. Postnasal Drip 6. Angina 7. MI