Rapid Review

Question 1

Patient presents with sudden onset of severe, diffuse abdominal pain. Exam shows peritoneal signs and AXR shows free air under diaphragm. Management?

Answer 1

Emergent laparotomy to repair a perforated viscus

Question 2

Most likely cause of acute lower GI bleed in patients older than 40?

Answer 2

Diverticulosis

Question 3

Diagnostic modality used when US is equivocal for cholecystitis?

Answer 3

HIDA scan

Question 4

Risk factors for cholelithiasis

Answer 4

Fat, female, fertile, forty, flatulent

Question 5

Inspiratory arrest during palpation of the RUQ

Answer 5

Murphy’s sign, seen in acute cholecystitis

Question 6

The most common cause of SBO in patients with no history of abdominal surgery?

Answer 6

Hernia

Question 7

Most common cause of SBO in patients with a history of abdominal surgery?

Answer 7

Adhesions

Question 8

11 scenarios involving organisms causing diarrhea

Answer 8

1) Most common organism - campylobacter
2) Recent antibiotic use - C. Dif
3) Cramping - Giardia
4) Traveler’s diarrhea - ETEC
5) Church picnics/mayo - S aureus
6) Uncooked hamburgers - E Coli O157:H7
7) Fried rice - B cereus
8) Poultry/eggs - Salmonella
9) Raw seafood - vibrio, HAV
10) AIDS - Isospora, Cryptosporidium, M avium complex (MAC)
11) Pseudoappendicitis - Yersinia

Question 9

25 year old jewish man presents with pain and watery diarrhea after meals. Exam shows fistulas btw bowel and skin and nodular lesions on his tibias

Answer 9

Crohn’s disease

Question 10

Inflammatory disease of the colon with an increased risk of colon cancer

Answer 10

UC (greater risk than Crohn’s)

Question 11

Extraintestinal manifestations of IBD

Answer 11

Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis

Question 12

Medical treatment of IBD

Answer 12

5-ASA agents and steroids during acute exacerbations

Question 13

Difference between Mallory-Weiss and Boerhaave tears

Answer 13

MW - superficial tear in esophageal mucosa

BH - full thickness esophageal rupture

Question 14

Charcot’s triad

Answer 14

RUQ pain

Jaundice

Fever/chills

Signs of ascending cholangitis

Question 15

Reynold’s pentad

Answer 15

Charcot’s triad plus shock and AMS - signs of suppurative ascending cholangitis

Question 16

Medical treatment for hepatic encephalopathy

Answer 16

Lower protein intake

Lactulose

Rifaximin

Question 17

First step in the management of a patient with an acute GI bleed

Answer 17

Manage ABCs

Question 18

A 4 year old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?

Answer 18

HUS due to E Coli O157H7

Question 19

Post-HBV exposure tx

Answer 19

HBV immunoglobulin

Question 20

Classic causes of drug-induced hepatitis

Answer 20

TB meds (INH, rifampin, pyrazinamide)

Acetaminophen

Tetracycline

Question 21

40 year old obese woman with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.

Answer 21

Biliary tract obstruction

Question 22

Hernia with highest risk of incarceration - indirect, direct or femoral?

Answer 22

Femoral

Question 23

50 year old man with history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

Answer 23

Confirm dx of pancreatitis with elevated amylase and lipase. Make the patient NPO and give IVFs, O2, analgesia, and “tincture of time”