GI MY favorite

Question 1

What are some meds that can cause dyspepsia?
You want to make sure ask pt if they take these meds

Answer 1

Aspirin
Antibiotics
DM drugs such as metformin
steroid meds
thyroid meds
psych meds
anti-hypertensives
oral contraceptives/estrogen replacement
Parkinson’s meds
painkillers
iron

Question 2

What would be a key question to ask when taking history who comes with dyspepsia?

Answer 2

Do you go camping? Do you go hiking?
Here you thinking about causative agent of dyspepsia like Giardia

Question 3

What kind of questions do you want you make sure to ask when taking social history of someone coming with dyspepsia?

Answer 3

Domestic violence
anxiety
home/school problems
prior psych problems?

Question 4

Pt comes to you and states “ I have upper abdominal pain occurs with an empty stomach , but when I eat symptoms go away”
What is your one diagnosis?

Answer 4

PUD….. for definitive diagnosis you need to send this pt for EGD

Question 5

What is one test you do not forget to order for a female of reproductive age coming with abdominal pain?

Answer 5

Urine HCG……… NO EXCUSE FOR NOT ORDERING IT…. definitely test question

Question 6

What are some tests you will order for someone with dyspepsia?

Answer 6

H Pylori testing
Fecal occult blood
CBC
CT or US or gastric emptying studies if pt has recurrent vomiting

Question 7

What is the treatment for H Pylori?

Answer 7

Clarithromycin 500 mg PO BID
Amoxicillin 1 gm PO BID
PPI PO BID 14 DAYS

Question 8

What are the medications that constitute Prevpac( is prescribed for H.Pylori)

Answer 8

Lansoprazole
Clarithromycin
Amoxicillin

Question 9

If allergic to penicillin what are your options for abx for H. pylori?

Answer 9

Flagyl
Tetracycline

Question 10

What is the black box warning for Reglan if used over 3 months ?

Answer 10

Tardive dyskinesia especially with elderly

Question 11

What physical exam ( tests) will you perform on pt presenting with sudden localized abd pain? think of physical exam not CT

Answer 11

Iliopsoas test
Obturator sign

Question 12

What teaching would you give to someone with diverticulitis?

Answer 12

Avoid laxatives
enemas
opiates

Question 13

What is the treatment plan for diverticulitis?

Answer 13

Flagyl with levaquin or ciprofloxacin
or alternative Augmentine 875/125 po TID 7-10 days or Septra DS along with Flagyl

Question 14

What questions would you ask to get more history or ROS for someone with RLQ pain?

Answer 14

Is your pain aggravated by cough and walking?
Do you have n/v?
Do you have indigestion, flatulence, irregular BMs?
Fatigue /malaise?
Any dysuria?
Any rectal pain or pressure?
Pt may feel rectal pain and pressure if appendix located lower in the pelvis

Question 15

What physical exam test will you perform for someone with RLQ pain or in general abd pain?

Answer 15

Deep palpation—— if appendicitis will be rebound tenderness
Abd pain gets worse with release of palpation

Question 16

List all the possible tests you will perform for physical exam for someone suspecting appendicitis?

Answer 16

Positive psoas test— pain while extending psoas muscle
Positive obturator sign. pain on passive internal rotation of right thigh
positive McBurney’s tenderness 1.5-2 inches from anterior iliac spine aka rebound tenderness
Positive Rovsing’s test— pain elcited in RLQ with palpation pressure in the LLQ
Positive Markle test— pain in RLQ when dropping from standing on toes to heels with jarring landing
Positive Dunphy test—– a sharp pain in the RLQ elicited by cough
Positive Blumberg test— abd palpation reveals rebound tenderness

Question 17

What are some differential diagnosis for a male patient with lower abd pain ?

Answer 17

Cecal diverticulitis
Meckel’s diverticulitis
Acute ileitis
Crohn’s disease
Renal colic
Testicular torsion—- big one

Question 18

What are some differential diagnosis for a female patient coming to your clinic with lower abd pain?

Answer 18

Pelvic Inflammatory disease
Ectopic pregnancy—-big one
Ruptured ovarian cyst
Renal colic
Cecal diverticulitis
Meckel’s diverticulitis
Acute ileitis
Crohn’s disease
Tuboovarian abcess

Question 19

What are some differential diagnosis for pt coming with epigastric pain?

Answer 19

GERD
Dyspepsia
AMI
Pancreatitis
Hiatal hernia

Question 20

What are your differential diagnosis for someone coming with RUQ pain?

Answer 20

Hepatitis
Portal Vein Rupture
Splenic abcess/ rupture LUQ

Question 21

What is a MUrphy’s sign and what is the condition associated with it?

Answer 21

Murphy’s sign—-pain on deep palpation of gallbladder in RUQ —- ask patient to take deep breath and pain causes them to stop breathing

Cholecystitis

Question 22

What are your differential diagnosis for generalized abdominal pain?

Answer 22

Mesenteric ischemia
Bowel perforation
Bowel obstruction
Malignancy
Abdominal aortic aneurism

Question 23

An infant presents with forceful vomiting after feeding and persistent hunger.. What is the diagnosis?

Answer 23

Pyloric Stenosis —-classic sign olive shaped mass

Question 24

Who is at risk for intussusception?

Answer 24

MosT common abd medical emergency in first 2 years of life
Males> females
5-10 months most common’

Question 25

What are signs and symptoms of intussusception?

Answer 25

intense abd pain
intermittent extremely sharp pain
loud cry is writhing in pain
child is inconsolable
child draws knees up
Current jelly stool
fever
bile colored vomit
bloody BM, n/v

Question 26

How is Hemolytic Uremic Syndrome (HUS) defined in children?

Answer 26

Microangiopathic hemolytic anemia
Thrombocytopenia
Acute kidneyinjury