Midterm

Question 1

What is the key thing that causes abdominal discomfort?

Answer 1

rapid distension of hollow organ smooth muscle

Question 2

What is the most sensitive structure in the abdomen (pain threshold)?

Answer 2

parietal peritoneum

Question 3

What is the least sensitive structure in the abdomen (pain threshold)?

Answer 3

parenchymatous organs

Question 4

Where is visceral pain often first noticed? (location on abdomen)

Answer 4

closer to midline of abdomen

Question 5

Is visceral pain made worse by palpation?

Answer 5

no

Question 6

Is visceral pain made worse by movement/coughing/breathing deeply?

Answer 6

no

Question 7

Is the underlying musculature tense/painful with visceral pain?

Answer 7

NO

Question 8

Is visceral pain easily localized?

Answer 8

No (V for visceral, V for vague)

Question 9

Three potential sources for localized abdominal pain?

Answer 9

1. peritonitis 2. nerve root/intercostal pain 3. MFTPs

Question 10

What might a pt have if they complain of pain localized to the abdominal wall, or a diffuse discomfort that mimics visceral pain?

Answer 10

MFTPs

Question 11

Why do pts not realize the area of tenderness is extremely localized and superficial with MFTPs?

Answer 11

They are preoccupied with the large area of pain spread

Question 12

Where does peritoneal pain usually manifest? (location on abdomen)

Answer 12

dermatomes T5-L2

Question 13

Is peritoneal pain easy to localize?

Answer 13

Yes

Question 14

Is peritoneal pain made worse by movement/coughing/deep respiration?

Answer 14

Yes

Question 15

Is peritoneal pain made worse by palpation?

Answer 15

yes

Question 16

What can peritoneal irritation lead to? (muscles)

Answer 16

reflexive contraction of segmental msls

Question 17

If visceral pain changes location and starts becoming parietal pain and you can’t find evidence of an NMS condition or MFTP as the source of pain, what should you start to think about?

Answer 17

peritonitis

Question 18

What is Dunphy’s sign?

Answer 18

localized pain that increases with coughing

Question 19

What is the “jar test”?

Answer 19

sudden vibration increases/localizes the pain

Question 20

What position must the pts knees be in to begin abdominal exam?

Answer 20

pt supine, hips and knees flexed

Question 21

What represents the first physical contact with the pt’s abdomen?

Answer 21

auscultation

Question 22

Do abdominal bruits assist in the Dx of AAA?

Answer 22

No

Question 23

What kind of bruits are more sensitive for renal vascular dz?

Answer 23

anterior bruits near the umbilicus

Question 24

what kind of bruits are more specific for renal vascular dz

Answer 24

flank bruits

Question 25

How deep is superficial palpation?

Answer 25

Up to 1 cm

Question 26

what is the purpose of superficial palpation?

Answer 26

compare underlying abdominal msl tone from side to side

Question 27

what is possible the most important component in assessment of suspected peritonitis?

Answer 27

superficial palpation

Question 28

how deep is deep palpation?

Answer 28

> 1 cm

Question 29

What is the best use of deep palpation?

Answer 29

evaluation of abdominal aorta (normal = 2.5-4 cm wide)

Question 30

palpation of what structure is tender in pts with IBS? (test question!)

Answer 30

sigmoid colon (can also cause pain to radiate to rectum and anus)

Question 31

what does Murphy's sign assess?

Answer 31

gall bladder

Question 32

what is considered a contraindication to spleen palpation?

Answer 32

mononucleosis

Question 33

what musculoskeletal finding may be associated with SI joint dysfunction?

Answer 33

psoas MFTPs

Question 34

what is used to assess a chronic and unremitting abdominal pain?

Answer 34

Carnett's

Question 35

when performing Carnetts, what is not included as a component/layer of the abdominal wall?

Answer 35

parietal peritoneum

Question 36

what test is not considered helpful at ruling IN peritonitis?

Answer 36

Carnett's (might be helpful at ruling OUT peritonitis)

Question 37

what are the abdominal red flags/classic signs of peritonitis?

Answer 37

abdominal tenderness, fever >105, vomiting

Question 38

what are "very bright" red flags of the abdomen?

Answer 38

abdominal distension, palpable masses, ecchymosis, hypotension/shock

Question 39

When interpreting Carnett's test, with abdominal muscles contracted, what indicates that pain does NOT originate from anterior abdominal wall?

Answer 39

pain DECREASES in intensity

Question 40

which ribs are most likely to be hypermobile?

Answer 40

"false" ribs

Question 41

what cause of costochondral pain has pain but no swelling?

Answer 41

costochondritis

Question 42

what cause of costochondral pain has pain AND swelling?

Answer 42

Tietze's syndrome

Question 43

what is a common cause of acute abdominal pain?

Answer 43

food poisoning

Question 44

What are 2 characteristics of acute abdominal pain?

Answer 44

<7 day duration of pain/tenderness

Question 45

What is the Acute Abdomen aka?

Answer 45

the surgical abdomen (urgent referral)

Question 46

what are entry level red flags for the acute abdoment?

Answer 46

abdominal tenderness, fever, vomiting

Question 47

what are the extreme red flags for the acute abdomen?

Answer 47

ascites, herniated umbilicus, jaundice, cullens/turners signs, shock

Question 48

what characteristics (of acute abdomen) favor a surgical dx?

Answer 48

lasts >6 hrs, sudden onset

Question 49

what is the most valuable single test for the acute abdomen?

Answer 49

periodic repetition of physical exam (let them sit) done by the same doctor

Question 50

what are the signs of peritonitis?

Answer 50

abdominal tenderness, fever >100.5, vomiting

Question 51

what kind of peritonitis is the most common?

Answer 51

infectious

Question 52

what causes inflammatory peritonitis?

Answer 52

inflammation of an adjacent structure (no direct infection of the peritoneum)

Question 53

what is the best indicator of peritonitis?

Answer 53

rigidity/"true guarding"

Question 54

what is "true guarding"?

Answer 54

guarding that doesnt diminish with reassurance and continued palpation

Question 55

What is the unofficial gold standard for peritonitis?

Answer 55

Rovsing's sign

Question 56

What is Rovsings sign aka?

Answer 56

contralateral tenderness or indirect rebound tenderness (classically used for acute appendicitis, may be more accurate than direct rebound tenderness)

Question 57

what are the 2 big functional esophageal disorders?

Answer 57

functional heartburn, functional chest pain

Question 58

what can gross aspiration lead to?

Answer 58

pneumonia

Question 59

what does peppermint leaf/oil do?

Answer 59

smooth muscle relaxant

Question 60

what is the side effect of peppermint leaf/oil?

Answer 60

heartburn

Question 61

what should you avoid when on statin therapy?

Answer 61

peppermint or grapefruit juice (competes for R/C sites)

Question 62

T/F: upper esophageal sphincter is not a true sphincter

Answer 62

true

Question 63

T/F: lower esophageal sphincter is not a true sphincter

Answer 63

false

Question 64

what are the most common structural abnormalities in the esophagus?

Answer 64

rings and webs

Question 65

After the upper esophageal sphincter, what is the last place in the GI tract that has well localized symptoms?

Answer 65

anal sphincter

Question 66

what kind of obstruction does trouble swallowing solids indicate?

Answer 66

intrinsic

Question 67

what are two examples of intrinsic obstruction?

Answer 67

Plummer-Vinson syndrome and Zenker diverticulum

Question 68

What is the classic triad for zenker diverticulum?

Answer 68

dysphagia, halitosis, and regurgitation

Question 69

where does a Mallorie-Weiss tear occur?

Answer 69

gastroesophageal junction

Question 70

what does the E in CREST syndrome stand for?

Answer 70

esophageal dysmotility

Question 71

T/F: when an infant is choking, abdominal thrusts are recommended

Answer 71

false

Question 72

what does decreased LES tonus lead to?

Answer 72

increased risk of heartburn

Question 73

what is the only thing that has shown to be consistently effective for GERD?

Answer 73

weight loss and elevating the head of the bed

Question 74

how often does heartburn refer pain to the spine?

Answer 74

40% (left arm/shoulder = 5%)

Question 75

T/F: severeness of heartburn symptoms doesn't always correlate with degree of damage

Answer 75

true

Question 76

what kind of population usually presents with atypical GERD?

Answer 76

older

Question 77

what are the heartburn alarm symptoms?

Answer 77

angina pectoris mimic, dysphagia, odynophagia, weight loss, blood loss

Question 78

what are oral osteoporosis meds notorious for damaging?

Answer 78

esophagus

Question 79

where does H. Pylori tend to colonize?

Answer 79

gastric antrum (beneath mucous layer)

Question 80

how do most people with hiatal hernias present?

Answer 80

asymptomatic

Question 81

what are the dyspepsia alarm symptoms?

Answer 81

anorexia/dysphagia/wt. loss, bleeding/melena/anemia, age/family Hx of gastric cancer, personal Hx of PUD, jaundice/masses

Question 82

which layer of the stomach produces the most bleeding with erosion?

Answer 82

submucosa

Question 83

what layer of the stomach produces the least amount of bleeding with erosion?

Answer 83

mucosa

Question 84

what does chronic alcohol ingestion decrease the delivery of?

Answer 84

mucus glycoproteins

Question 85

what does cigarette smoking significantly reduce?

Answer 85

mucus synthesis

Question 86

what is known to dissipate surface active phospholipids?

Answer 86

bile acids/some NSAIDs/aspirin

Question 87

what is the possible turnover time of human gastric epithelium?

Answer 87

2-4 days

Question 88

what do non-selective OTC NSAIDs inhibit?

Answer 88

COX 1 and COX 2

Question 89

what is considered to be the most ulcerogenic OTC NSAID?

Answer 89

aspirin

Question 90

what does alcohol stimulate?

Answer 90

gastric secretions (and also, bad decisions)

Question 91

what has bile reflux been linked to?

Answer 91

long term use of proton pump inhibitors (PPIs)

Question 92

what conditions are H. pylori infection often assoc. with? (4)

Answer 92

1. GERD and dyspepsia 2. PUD 3. chronic antral gastritis 4. increased risk of gastric cancer

Question 93

how do you differentiate the initial clinical presentations of acute gastritis, chronic gastritis, and PUD?

Answer 93

they are indistinguishable

Question 94

how often is acute GI hemorrhage due to acute gastritis?

Answer 94

30% of cases (most common cause of blood in large quantities in GI tract)

Question 95

what are the physical characteristics of a peptic ulcer?

Answer 95

extend through muscularis mucosa and are greater than 5 mm in diameter