pain

Question 1

causes of painful lips, tongue or buccal mucosa

Answer 1

• deficiencies (iron, folate, vitamin B12, vitamin C)
• dermatological disorders
• chemotherapy
• ulcers

Question 2

causes of mouth ulcers

Answer 2

IBD

gluten enteropathy

Question 3

what is heartburn

Answer 3

hot, burning retrosternal discomfort which radiates upwards

Question 4

likeliest cause of heartburn

Answer 4

GORD

Question 5

what is reflux

Answer 5

sour taste in the mouth from regurgitating gastric acid

Question 6

how can you differentiate heartburn from cardiac chest pain?

Answer 6

• burning quality
• upward radiation
• association with acid reflux
• occurence on long flat or bending forward

Question 7

what is waterbrash

Answer 7

sudden appearance of fluid in the mouth due to reflex salivation as a result of GORD or rarely peptic ulcer disease

Question 8

what is dyspepsia?

Answer 8

pain or discomfort centred in the upper abdomen

Question 9

what is the classical symptom of peptic ulceration?

Answer 9

• worse on an empty stomach

- eased by eating

Question 10

what is fat intolerance classical in?

Answer 10

common in all causes of dyspepsia including gallbladder disease

Question 11

what is odynophagia?

Answer 11

pain on swallowing often precipitated by drinking hot liquids

Question 12

what does odynophagia indicate?

Answer 12

active oesophageal ulceration from peptic oesophagitis or oesophageal candidiasis

Question 13

what are the foregut structures and where is the pain from these structures localised?

Answer 13

• stomach, pancreas, liver and biliary system

- localised above the umbilicus

Question 14

what are the midgut structures and where is the pain from these structures localised?

Answer 14

• small bowel and appendix

- central abdominal pain

Question 15

what are the hindgut structures and where is the pain from these structures from?

Answer 15

• colon

- lower abdomen

Question 16

where is the pain from unpaired structures localised?

Answer 16

midline and radiates to the back

Question 17

where is the pain from paired structures?

Answer 17

radiates to the affected side

Question 18

what does sudden onset of severe abdominal pain suggest?

Answer 18

hollow viscus perforation
ruptured AAA
mesenteric infarction

Question 19

what does pain precipitated by constipation suggest?

Answer 19

colorectal cancer or diveritucular disease as the cause of perforation

Question 20

what does pain precipitated by dyspepsia suggest?

Answer 20

peptic ulceration

Question 21

what does abdo pain in someone with co-exitsting peripheral vascular disease, hypertension, or AF suggest?

Answer 21

AAA

mesenteric ischaemia

Question 22

what does the development of circulatory pain following the onset of pain suggest?

Answer 22

intra-abdo sepsis or bleeding e.g. ruptured AAA

Question 23

what symptoms does torsion of the testis or ovaries produce?

Answer 23

severe acute abdo pain and nausea

Question 24

what kind of pain does inflammation produce?

Answer 24

constant pain exacerbated by movement or coughing

Question 25

what kind of pain does billiard and renal colic produce?

Answer 25

pain rapidly increases to a peak intensity and persists over several hours before gradually resolving.

Question 26

pain radiating from the loin to the groin and genitalia is typical of what?

Answer 26

renal colic

Question 27

central upper abdo pain radiating through to the back relieved by sitting forward is typical of what?

Answer 27

pancreatitis

Question 28

central abdo pain which shifts into the right iliac fossa is typical of what?

Answer 28

acute appendicitis

Question 29

combination of severe back and abdo pain is typical of what?

Answer 29

ruptured or dissecting AAA

Question 30

severe vomiting without significant pain is typical of what?

Answer 30

gastric outlet or proximal small bowel obstruction

Question 31

faeculent vomiting of small bowel contents is a feature of what?

Answer 31

late feature of distal small bowel or colonic obstruction

Question 32

pain exacerbating by movement or coughing suggests what?

Answer 32

inflammation

Question 33

excruciating pain poorly relieved by opioids suggest what?

Answer 33

ischaemic vascular event e.g. bowel infarction or ruptured AAA