Rotation 1 Flashcards
McBurney’s sign
pain w palpation of RLQ
Rovsing’s sign
palpation or rebound pressure of the LLQ results in pain in RLQ
Obturator sign
pain in RLQ when flexed right thigh is internally rotated when pt is supine
psoas sign
pt is supine and attempts to raise right leg against resistance
where does pain start and end for appendicitis
begins in epigastrium –> umbilicus –> RLQ
appendicit is unlikely if
pt is hungry
common blood test findings in appendicitis
leukocytosis
on which side of the abdomen is diverticulosis/diverticulitis MC
left side
test of choice for diverticulosis
colonoscopy
test of choice for diverticulitis
CT scan
what type of diverticulitis can mimic appendicitis
cecal diverticulitis
what remains causing meckel’s diverticulus
vitelline duct
what is the MC congenital anomaly of the GI tract
Meckel’s diverticulum
Rule of 2’s for Meckel’s diverticulum
2% of population
Within 2 ft from ileocecal valve
2% symptomatic
2 inches in length
2 types of ectopic tissue (gastric MC or pancreatic)
2 years MC age
2x mc in males
Familial adenomatous polyposis is due to
mutation in APC gene
what is familial adenomatous polyposis + tx
they get hella adenomatous polyps
prophylactic colostomy best chance for survival
in which syndrome is there hamartomatous polyps and mucocutaneous hyperpigmentation
Peutz-Jehgers
what is the MC cause of occult GI bleed
Colon CA
what is the MC cause of large bowel obstruction
colon CA
Common sx in proximal/right sided colon CA
chronic occult bleeding
diarrhea
common sx in distal/left sided colon CA
bowel obstruction
changes in stool diameter
what will you see on barium enema for colon CA
apple core lesion
what is the most commonly monitored tumor marker for colon CA
CEA (carinoembryonic antigen)
characteristics of Crohn’s disease
transmural inflammation that affects any part of the GI tract (anywhere from mouth to anus)
Can lead to fistulas, bowel strictures, perianal disease, abscesses
Skip areas of involvement
what is the most commonly involved segment involved in crohns disease and on what side is it located
terminal ileum (on the right side)
cardinal sx of crohns disease
crampy abdominal pain
chronic, persistent, but intermittent diarrhea
no gross blood
what will upper GI series show for crohns disease
string sign
what will labs likely show for crohns disease
positive anti-saccharomyces cerevisiae antibodies
iron deficiency
b12 deficiency
ulcerative colitis
chronic, intermittent inflammation of the colon limited to the mucosal and submucosal layers
usually involves the rectum and may extend proximally to the colon in a continuous, circumferential pattern
who is less likely to develop ulcerative colitis
smokers
someone who had appendectomy
sx of ulcerative colitis
hematochezia
diarrhea which may be associated w blood and/or mucus (bloody diarrhea main sx)
abdominal pain (LLQ)
what will double contrast barium enema show for ulcerative colitis
stovepipe or lead pipe sign - cylindrical bowel or loss of haustral markings
labs for ulcerative colitis
P-ANCA
common signs for testicular torsion
negative prehn sign = no pain relief w elevation
negative cremasteric reflex on affected side = no elevation of the stifle after stroking inner thigh
when should you do surgical exploration for testicular torsion
within 6 hours
MC cause of epididymitis in 14-35 yo
chlamydia trachomatis (MC) and neisseria gonorrhoeae
MC cause of epididymitis in > 35 yo
E coli
sx of epididymitis
gradual onset (over a few hours to days) of localized testicular pain and swelling
exam signs for epididymitis
positive prehn sign = pain relief w elevation of scrotum
positive cremasteric reflex = elevation of testicle after stroking inner thigh
MC imaging for testicular torsion
testicular dopper ultrasound
MC imaging for epididymitis
scrotal ultrasound
in what population is multiple sclerosis more common
women in 20s-30s
MC presenting sx in multiple sclerosis
sensory disturbances followed by weakness and visual disturbances (diplopia, optic neuritis)
trigeminal neuralgia
what is uhthoff’s phenomenon and in what disease is it present
worsening of sx with heat
present in multiple sclerosis
what type of signs, UMN or LMN signs will you see in multiple sclerosis
UMN - spasticity, hyperreflexia, upward babinski, rigidity
what is Lhermitte’s sign and in what disease do you see this sign
neck flexion causing lightening-shock type pain radiating from spine down the leg
present in multiple sclerosis
what is Marcus gunn pupil and in what disease do you see this
light from unaffected eye to affected eye –> pupil dilation
present in multiple sclerosis
what is Charcot’s neurologic triad and in what disease do you see this
staccato speech, intentional tremor, nystagmus
present in multiple sclerosis
will people with multiple sclerosis have bladder, bowel, or sexual dysfunction
yes
MRI with gadolinium - MS
hyper intense white matter plaques (at least 2 areas)
lumbar puncture if negative MRI- MS
increased IgG and oligoclonal bands
acute exacerbation tx MS
IV high dose glucocorticoids
plasmapheresis if not responsive
prevention of relapse and progression tx MS
beta interferon or Glatiramer
what is myasthenia gravis
autoimmune peripheral nerve disorder of neuromuscular junction due to antibodies against acetylcholine receptor
2 main clinical manifestations with myasthenia gravis
ocular weakness (pupils spared)
generalized weakness worsened w repeated use
sensation and DTR in myasthenia gravis
usually preserved
tx for myasthenic crisis or severe
IVIG or plasmapheresis
long term tx myasthenia gravis
acetylcholinesterase inhibitors - Neostigmine or Pyridostigmine
for what disease do patients usually have a thymectomy and chest CT/MRI to view enlargement of thymus
myasthenia gravis
what do antibodies attack in Guillain barre
myelin sheath (Schwann cells)
will people w Guillain barre have UMN or LMN signs
LMN - weakness, decreased DTR, flaccid paralysis
sensation and DTRs in Guillain barre
decreased
what is the MC presenting sx of ALS
asymmetric limb weakness
what is usually spared in ALS
sensation
voluntary eye movement
sphincter function (bowel and bladder)
sexual function
tx for ALS
Riluzone
