GI Quiz 1 - Approach to Pt

Question 1

List GI symptoms that require further evaluation (10)?

Answer 1

Anorexia
Abdominal mass/Organomegaly
Blood in stool/urine
Dysphagia
Edema
Fever
Pain (awakens pt)
Persistent N/V
Skin changes (jaundice)
Wt. loss

Question 2

For an CC that is abdominal in nature what systems do you NEED to do PE for (6-8)?

Answer 2

Vitals
Skin
Extremities
HEENT
Chest (Respiratory/Cardio)
Abdominal
M/b Pelvic in W or genitalia exam in M
Rectal exam for occult blood (DRE)

Question 3

What vitals are necessary for GI CC?

Answer 3

Weight, BMI, Pulse Ox

Question 4

What skin exams are necessary for GI CC?

Answer 4

Rash, Erythema, Jaundice, Pallor

Question 5

What extremity exams are necessary for GI CC?

Answer 5

Nail clubbing, contractures, liver flap

Question 6

What HEENT exams are necessary for GI CC?

Answer 6

Eyes: jaundice in sclera, conjunctival pallor
Mouth: lesions
Lymph: upper cervical/virchow’s node

Question 7

What resp/cardio exams are necessary for GI CC?

Answer 7

Spider nervi, purpura, gynecomastia

Full auscultation of heart/lungs

Question 8

What are the 4 components of a GI exam (in order)?

Answer 8

Inspection
Auscultation
Percussion
Palpation

Question 9

What are you looking for during the inspection portion of GI PE?

Answer 9

Lesions, masses, distention (7Fs), scars, vessels, pertistalsis

Question 10

What are the 7 Fs of distention

Answer 10

Fat, Flatus, Fetus, Fluid, Feces, Fatal growth, Fibroids

Question 11

What are you listening for during GI auscultation?

Answer 11

Bowel sounds, bruits over abdominal arteries

Question 12

What are you listening for during percussion of GI?

Answer 12

Normal: mixed resonant/dull
Tympanic: gas in stomach/intestines
Dull: solid organs, feces, fluids, tumors
Liver span in cm at MCL

Question 13

What could percussion that includes shifting dullness indicate?

Answer 13

Ascites

Question 14

What are you feeling for during palpation of GI?

Answer 14

4 quadrants: superficial/deep, tenderness/mass/gaurding

Liver, spleen, kidneys (tenderness, organomegaly, masses, enlarged AA)

Question 15

A positive Murphy’s sign would indicate what pathology?

Answer 15

Gallbladder

Question 16

What are 4 tests that would indicate appendicitis?

Answer 16

McBurney’s point tenderness, Rovsing’s sign, Psoas sign, Obturator sign

Question 17

What are some serum tests that can check Liver function (bonus if you can name the acronyms)?

Answer 17

LFT: ALP, AST, ALT, LDH, GGT, 5 Nucleotidase, PT, INR, Bilirubin, Albumin
CMP: Bilirubin, Total Protein, Albumin
Serum Immunoglobulins: Anti-mitochondrial Abs, a-Fetoprotein

Question 18

What are some serum test that check general health or pancreatic function?

Answer 18

ESR, CBC

Amylase, Lipase

Question 19

What test checks urine function & more?

Answer 19

UA!

Question 20

What are upper GI specific tests & procedures?!

Answer 20

Acid Related: ambulatory pH monitoring, gastric analysis
Endo/Ano/Sigmoido-scopy
Laparoscopy
Manometry
Nuclear scans
X-ray & other imaging contrast
Nasogastric/Intestinal intubation
Abdominal paracentesis
Others: electrogastrography, electrical impedance test