Lab Medicine Stuff

Question 1

dx for abdominal pain before vomiting or abdominal pain with nausea or vomiting

Answer 1

Appendicitis

Question 2

Dx for abdominal pain with nausea or abdominal pain with vomiting

Answer 2

Acute cholecysitis

Question 3

Dx for dyspepsia with vomiting or dyspepsia with water brush (regur of sour or tasteless fluid)

Answer 3

Peptic ulcer dz

Question 4

Dx for N/V associated with diarrhea, headache and myalgias

Answer 4

viral gastroenteritis

Question 5

Dx for bilious vomiting and study you should get

Answer 5

Small bowel obstruction

gastric emptying study

Question 6

Dx for continuous vomiting and study to get

Answer 6

Conversion disorders

get electrolyte levels

Question 7

Dx for delayed vomiting (more than one hour after meals)

Answer 7

gastric obstruction

gastroparesis

Question 8

Study to get for suspected obstruction

Answer 8

abdominal x-ray

Question 9

study to get for potential gastroparesis

Answer 9

gastric emptying study

Question 10

dx for feculent or foul odor to vomitus

Answer 10

intestinal obstruction

Question 11

dx for habitual postprandial, irregular vomiting

Answer 11

major depression

Question 12

Dx for insidious onset N/V

Answer 12

GERD
gastroparesis
medication related effect
metabolic disorder
pregnancy

Question 13

Labs to get for metabolic disorder

Answer 13

pulse ox
ABGs
serum chemistries
chest x-ray

Question 14

Dx for projectile vomiting, may not be preceded by nausea

Answer 14

intracranial disorders, increased intracranial pressure (or could be normal emesis)

Question 15

dx for regurgitation of undigested food

Answer 15

Achalasia
esophageal stricture
zenker diverticulum

Question 16

Dx for vomiting before breakfast

Answer 16

alcohol ingestion
increased ICP
pregnancy
uremia

Question 17

Studies for uremia

Answer 17

Renal function testing

electrolyte levels

Question 18

Dx for vomiting during or soon after meals

Answer 18

anorexia

bulimia

Question 19

Dx for vomiting partly digested food or chyme several hours after meals

Answer 19

Gastric outlet obstruction, gastroparesis

Question 20

man with stage 4 colon cancer and metastasis, AAA repair. Hx of HTN, hyperlipidemia. Has been constipated x 2 weeks.
elevated urea nitrogen, glucose, WBC
low calcium, RBC, hemoglobin, crit
CT- AAA had gas in it

Answer 20

aortic-enteric fistula

Question 21

most common cause of periaortic ectopic gas in a patient with repaiared AAA

Answer 21

stent graph infection

aortic-enteric fistula

Question 22

common complication of AAA. Gas is uncommon

Answer 22

endoleak

Question 23

CT can see this. Infection from staph aureus.

Answer 23

stent graph infection

Question 24

often due to exaggerated local inflammatory infection due to aortic arteriosclerosis. Usually no gas on CT, has more symptoms than the patient did

Answer 24

retroperitoneal fibrosis

Question 25

CT sign is gas, common complication AAA | Gi bleeding, abdominal pain, pulsatile abdominal mass

Answer 25

aortic-enteric fistula

Question 26

most common sign/ symptom of aortic-enteric fistula in order of occurrence

Answer 26

GI bleeding sepsis (predominant clinical manifestations) abdominal pain back pain

Question 27

tests for aortic-enteric fisultas

Answer 27

upper GI endoscopy | CT

Question 28

where do aortic-enteric fistulas occur most commonly

Answer 28

duodenum

Question 29

how do you treat an aortic enteric fistula?

Answer 29

surgery

Question 30

35 year old male with fever and abdominal pain crampy, intermittent, not associated with BMs in RLQ. Has loose, non-bloody stools. Acute promyelocytic leukemia and last chemo was 10 days ago. PE shows 38.4 C 108/56 BP R-20. Port doesn't appear infected. Moderate tenderness to RLQ palpation. No lesions in perianal area. Low hemoglobin, platelets slightly low extremely low leukocyte (0.1), low neutrophils. low alkaline phosphatase.

Answer 30

typhlitis (neutropenic entercolitis)

Question 31

most important initial medical therapy in patient with fever and neutropenia?

Answer 31

antipseudomonal beta lactam+ vanco (skin/ catheter)+ metronidazole (c. Diff) within 60 minutes of presentation

Question 32

persist with neutropenic fever after 4-7 day of antimicrobial therapy what should you ad?

Answer 32

Anti-fungal therapy

Question 33

least appropriate test for evaluating symptoms in the 35 year old male.

Answer 33

colonoscopy

Question 34

what labs should you get on the 35 year old male

Answer 34

blood cultures from peripheral and port stool sample for C. Diff CBC Ultrasound

Question 35

why should the 35 year old male not get a colonoscopy or barium enema?

Answer 35

Bacteremia or perf

Question 36

most appropriate management of typhlitis

Answer 36

broad spectrum antibiotics, bowel rest, G-CSF (granulocyte site stimulating colony therapy) surgery indicated with ileus consider floroquinolone prophlaxis in future

Question 37

what is the Nadir

Answer 37

after 7-14 days of chemo | lowest neutrophil count