Pearson: Clinical Case Flashcards

1
Q
McBurney's point tenderness
Rovsing's sign (referred pain from left side)
Obturator sign (Leg maneuvers)
A

Appendicitis

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2
Q

Cholecystitis

A

+ Murphy’s sign (illiciting pain while try to palpate gallbladder below the costal margin on an inspiration)

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3
Q

Protuberant abdomen w/ bulging flanks, positive fluid wave or shifting dullness

A

Ascites

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4
Q

Ventral hernias

A

Valsalva

abdominal pressure/sit-up to produce

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5
Q

AAA

A

pulsating mass

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6
Q

Tense protuberant abdomen tympanitic to percussion

A

Perforated viscera

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7
Q

All women who present w/ abdominal pain should receive this unless they are post-hysterectomy.

A

Serum quantitative bHCG (VERY sensitive, picks up almost all pregnancies)

*Urine pregnancy test may miss early ectopics

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8
Q

Lab ordered on most cases of abdominal pain to rule out infection

A

CBC w/ UA

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9
Q

Labs ordered to evaluate abdominal pain w/ vomiting and diarrhea

A

Electrolytes
BUN
creatinine

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10
Q

BMP (I think this is equivalent to chem 7)

A

Glucose, Calcium
Electrolytes
Kidney function (BUN, Cr)

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11
Q

CMP (chem 21?)

A

Glucose, Calcium
Electrolytes
Kidney function +

Protein
Liver tests

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12
Q

Lab to rule out DKA and hyperglycemia

A

Glucose and Ca

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13
Q

Labs for upper abdominal pain

A

Liver function tests
LIver enzymes
amylase
lipiase

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14
Q

Imaging for appendicitis

A

CT of abdomen and pelvis w/ contrast

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15
Q

Female w/ R or L LQ abdominal pain imaging

A

abdominal or transvaginal ultrasound of pelvis to evaluate pregnancy, complications w/ pregnancy and rule out reproductive tract pathology

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16
Q

suspected in women w/ vaginal bleeding and lower abdominal pain

A

Ectopic pregnancy

17
Q

location of most ectopic pregnancies

A

97% in FT (55% in ampulla)

18
Q

Do most pts presenting w/ an ectopic pregnancy have an indentifiable RF?

A

NO!

19
Q

What may be some RF associated w/ ectopic pregnancy?

A
PID
prior hx of ectopic pregnancy
tubal surgery
fertility drugs
older
smoker
endometriosis
20
Q

First steps to evaluate a pt w/ suspected ectopic pregnancy

A
  1. quantitative serum HCG
  2. CBC
  3. transvaginal US (can be used to visualize an intrauterine pregnancy 24 days post ovulation–about 1 week earlier than transabdominal)
21
Q

how do you proceed w/ a pt who’s bHCG <1500 and US is negative

A

US may not show a gestational sac. If pt is stable and US is negative follow up with them at later date. DO NOT assume benign course w/ low bHCG. It is still possible to rupture an ectopic if one is present

22
Q

how do you proceed w an bHCG > 1500?

A

an intrauterine pregnancy should be detectable by transvaginal US in 95% of cases.

If an intrauterine sac is NOT visible, than suspicion of ectopic is increased.

23
Q

how should you proceed w/ a stable, reliable pt is US is unable to exclude ectopic pregnancy

A

Obtain serial quantitative b-HCG ever 48 hrs>
bHCG should DOUBLE in 48 hours (and continue to do this until it reaches its peak in the first 8-11 weeks of pregnancy)

If bHCG rises by 66% in 48 hrs, pregnancy is CONTINUING, repeat US when bHCG is >1500 to differentiate between ectopic and intrauterine.

If still indeterminate, follow up w/ repeat quantitative bHCG and US in another 48 hrs.

24
Q

how should you proceed w an unreliable pt and an US unable to exclude ectopic pregnancy

A

presume ectopic

25
Q

what should you do if bHCG levels are not rising or falling?

A

pregnancy is NON viable and D&C should be done to look for chorionic villi

26
Q

primary tx for ectopic pregnancy?

A

Surgical

-tube sparing technique (laparoscopic salpingostomy)

27
Q

Methotrexate injection

A

effective for small ectopics
no fetal heart motion
hCG levels <5000

28
Q

What should you remember to give Rh- women w/ ectopic or spontaneous abortion?

A

Rhogam