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Primary Care > PC Exam II > Flashcards

PC Exam II Flashcards

1
Q

pleuritic/MI pain can be referred to where?

A

upper abd

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2
Q

where can gallbladder pain be referred to?

A

right shoulder

right posterior chest

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3
Q

where can duodenum/pancreas pain be referred to?

A

back

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4
Q

when pain is located in the RUQ, what organs can be affected?

A 
lung
liver
gallbladder
stomach
bowel R kidney
ureter
cholecystitis/lithiasis
duodenal ulcer
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5
Q

when pain is located in the LUQ, what organs can be affected?

A 
lung
heart
spleen
pancreas
L kidney
ureter
pancreatitis
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6
Q

when pain is located in the RLQ, what organs can be affected?

A 
appendix
bowel
R ureter
ovary/tube/uterus
bladder
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7
Q

when pain is located in the LLQ, what organs can be affected?

A 
bowel
L ureter
ovary/tube/uterus
bladder
*diverticulitis most common
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8
Q

typical presentation for acute appendicitis:

A

vague initial symptoms (indigestion, anorexia)
pain: initially poorly localized, mild but constant & increasing (peaks 4-6 hrs, localizes to RLQ)
N/V/D
fever
pain w/cough
can often POINT to location of pain
tenderness at McBurney’s
peritoneal signs (guarding, rebound, obturator, psoas, Rovsing’s)

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9
Q

what is obturator sign?

A

pain with rotation of R leg w/patient supine and R hip/knee flexed

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10
Q

what is posts sign?

A

pain w/raised straight leg against resistance

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11
Q

what is Rovsing’s sign?

A

RLQ pain with palpation of LLQ

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12
Q

what are the diagnostics used to dx acute appendicitis?

A 
CBC w/dff
U/A
Hcg
pelvic exam
US (young)/CT (adult)
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13
Q

what are the risk factors for a ruptured AAA?

A 
atherosclerosis
HTN
PVD
smoking
male
advanced age
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14
Q

what does the USPSTF recommend for AAA screening?

A

one time men 65-75 who smoke or who have ever smoked

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15
Q

symptoms of a ruptured AAA?

A 
back pain
sudden onset severe abd pain
pain worse in recumbent position
syncope/shock
chest pain
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16
Q

who is at highest risk of cholelithiasis/cystitis?

A 
female
obese
rapid weight loss
pregnant/recent pregnancy
40+
comorbidities: DM, IBD, ETOH
17
Q

s/s associated with cholelithiasis

A

biliary colic (intermittent or steady RUQ and/or epigastric pain)
often radiates to R should
often follows eating (fatty foods)
mild to severe commonly associated with N/V- lasts 1-6 hrs

18
Q

s/s associated with acute cholelithiasis

A

biliary colic that doesn’t go away

fever, chills

19
Q

what is chariot’s triad?

A

RUQ pain
fever
jaundice

20
Q

what is calculus cholecystitis?

A

critically ill on presentation

21
Q

what is the PE for cholelithiasis?

A

RUQ tendernes
+ Murphy’s sign (inability to take a deep breath w/palpation at R costal margin)
fever
jaundice

22
Q

what diagnostics are used for dx of cholelithiasis?

A 
CBC
LFTs
Hcg
U/A
US
HIDA
23
Q

s/s of diverticulitis?

A 
mild to moderate aching abd pain usually LLQ
colicky or steady
fever
\+/- constipation or diarrhea
N/V
24
Q

what is the PE for diverticulitis?

A

tenderness of suprapubic area/LLQ of varying degrees
possible peritoneal signs (guarding/rebound)
+/- fever
rectal exam
pelvic exam

25
Q

what diagnostics are used for dx of diverticulitis?

A 
CBC w/diff
Hcg
U/A
stool OB
CT-WWO contrast
26
Q

management of diverticulitis?

A 
cipro + metronidazole
close f/u (24-48 hrs)
clear liquids- advance to low residue
when asymptomatic, increase fiber
GI f/u to exclude carcinoma
27
Q

when should diverticulitis pts be hospitalized?

A

more severe presentation
peritoneal signs
marked leukocytosis
fever >101

28
Q

risks of pancreatitis?

A 
ETOH
gallstones/obstruction
hypertriglyceridemia
pregnancy
HIV
blunt trauma
29
Q

presentation of pancreatitis?

A

variable
constant knife-like pain in epigastric/LUQ area or periumbilical
increasing intensity/excrutiating
may radiate to chest/back/L shoulder/flank/LLQ
pain worse supine
rocking motion
N/V

30
Q

what is the PE for pancreatitis?

A 
epigastric, LUQ tenderness
fever
hypotension
tachycardia
hemodynamic instability
CV collapse
Cullen's sign (bluish hue periumbilicus)
ecchymotic discoloration in flank area (Grey Turner's sign)
distension
decreased/absent bowel sounds
31
Q

what diagnostics are used for dx of pancreatitis?

A

CBC w/diff
hCG
U/A
serum chem (including LFTs, BS)
amylase (2-12 hrs after onset of symptoms- not always elevated (drinkers); return to normal after 2-3 days)
lipase (elevated several days AFTER attack, elevated in drinkers and non-drinkers)

32
Q

what is the ROME III criteria?

A

recurrent abd pain or discomfort at least 3 days per month in the last 3 months associated with 2 or more of the following:
improvement w/defecation
onset associated with a change in frequency of stool
onset associated with a change in appearance of stool

Primary Care (2 decks)

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