Rotation 1

Question 1

McBurney’s sign

Answer 1

pain w palpation of RLQ

Question 2

Rovsing’s sign

Answer 2

palpation or rebound pressure of the LLQ results in pain in RLQ

Question 3

Obturator sign

Answer 3

pain in RLQ when flexed right thigh is internally rotated when pt is supine

Question 4

psoas sign

Answer 4

pt is supine and attempts to raise right leg against resistance

Question 5

where does pain start and end for appendicitis

Answer 5

begins in epigastrium –> umbilicus –> RLQ

Question 6

appendicit is unlikely if

Answer 6

pt is hungry

Question 7

common blood test findings in appendicitis

Answer 7

leukocytosis

Question 8

on which side of the abdomen is diverticulosis/diverticulitis MC

Answer 8

left side

Question 9

test of choice for diverticulosis

Answer 9

colonoscopy

Question 10

test of choice for diverticulitis

Answer 10

CT scan

Question 11

what type of diverticulitis can mimic appendicitis

Answer 11

cecal diverticulitis

Question 12

what remains causing meckel’s diverticulus

Answer 12

vitelline duct

Question 13

what is the MC congenital anomaly of the GI tract

Answer 13

Meckel’s diverticulum

Question 14

Rule of 2’s for Meckel’s diverticulum

Answer 14

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

Question 15

Familial adenomatous polyposis is due to

Answer 15

mutation in APC gene

Question 16

what is familial adenomatous polyposis + tx

Answer 16

they get hella adenomatous polyps
prophylactic colostomy best chance for survival

Question 17

in which syndrome is there hamartomatous polyps and mucocutaneous hyperpigmentation

Answer 17

Peutz-Jehgers

Question 18

what is the MC cause of occult GI bleed

Answer 18

Colon CA

Question 19

what is the MC cause of large bowel obstruction

Answer 19

colon CA

Question 20

Common sx in proximal/right sided colon CA

Answer 20

chronic occult bleeding
diarrhea

Question 21

common sx in distal/left sided colon CA

Answer 21

bowel obstruction
changes in stool diameter

Question 22

what will you see on barium enema for colon CA

Answer 22

apple core lesion

Question 23

what is the most commonly monitored tumor marker for colon CA

Answer 23

CEA (carinoembryonic antigen)

Question 24

characteristics of Crohn’s disease

Answer 24

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

Question 25

what is the most commonly involved segment involved in crohns disease and on what side is it located

Answer 25

terminal ileum (on the right side)

Question 26

cardinal sx of crohns disease

Answer 26

crampy abdominal pain chronic, persistent, but intermittent diarrhea no gross blood

Question 27

what will upper GI series show for crohns disease

Answer 27

string sign

Question 28

what will labs likely show for crohns disease

Answer 28

positive anti-saccharomyces cerevisiae antibodies iron deficiency b12 deficiency

Question 29

ulcerative colitis

Answer 29

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

Question 30

who is less likely to develop ulcerative colitis

Answer 30

smokers someone who had appendectomy

Question 31

sx of ulcerative colitis

Answer 31

hematochezia diarrhea which may be associated w blood and/or mucus (bloody diarrhea main sx) abdominal pain (LLQ)

Question 32

what will double contrast barium enema show for ulcerative colitis

Answer 32

stovepipe or lead pipe sign - cylindrical bowel or loss of haustral markings

Question 33

labs for ulcerative colitis

Answer 33

P-ANCA

Question 34

common signs for testicular torsion

Answer 34

negative prehn sign = no pain relief w elevation negative cremasteric reflex on affected side = no elevation of the stifle after stroking inner thigh

Question 35

when should you do surgical exploration for testicular torsion

Answer 35

within 6 hours

Question 36

MC cause of epididymitis in 14-35 yo

Answer 36

chlamydia trachomatis (MC) and neisseria gonorrhoeae

Question 37

MC cause of epididymitis in > 35 yo

Answer 37

E coli

Question 38

sx of epididymitis

Answer 38

gradual onset (over a few hours to days) of localized testicular pain and swelling

Question 39

exam signs for epididymitis

Answer 39

positive prehn sign = pain relief w elevation of scrotum positive cremasteric reflex = elevation of testicle after stroking inner thigh

Question 40

MC imaging for testicular torsion

Answer 40

testicular dopper ultrasound

Question 41

MC imaging for epididymitis

Answer 41

scrotal ultrasound

Question 42

in what population is multiple sclerosis more common

Answer 42

women in 20s-30s

Question 43

MC presenting sx in multiple sclerosis

Answer 43

sensory disturbances followed by weakness and visual disturbances (diplopia, optic neuritis) trigeminal neuralgia

Question 44

what is uhthoff's phenomenon and in what disease is it present

Answer 44

worsening of sx with heat present in multiple sclerosis

Question 45

what type of signs, UMN or LMN signs will you see in multiple sclerosis

Answer 45

UMN - spasticity, hyperreflexia, upward babinski, rigidity

Question 46

what is Lhermitte's sign and in what disease do you see this sign

Answer 46

neck flexion causing lightening-shock type pain radiating from spine down the leg present in multiple sclerosis

Question 47

what is Marcus gunn pupil and in what disease do you see this

Answer 47

light from unaffected eye to affected eye --> pupil dilation present in multiple sclerosis

Question 48

what is Charcot's neurologic triad and in what disease do you see this

Answer 48

staccato speech, intentional tremor, nystagmus present in multiple sclerosis

Question 49

will people with multiple sclerosis have bladder, bowel, or sexual dysfunction

Answer 49

yes

Question 50

MRI with gadolinium - MS

Answer 50

hyper intense white matter plaques (at least 2 areas)

Question 51

lumbar puncture if negative MRI- MS

Answer 51

increased IgG and oligoclonal bands

Question 52

acute exacerbation tx MS

Answer 52

IV high dose glucocorticoids plasmapheresis if not responsive

Question 53

prevention of relapse and progression tx MS

Answer 53

beta interferon or Glatiramer

Question 54

what is myasthenia gravis

Answer 54

autoimmune peripheral nerve disorder of neuromuscular junction due to antibodies against acetylcholine receptor

Question 55

2 main clinical manifestations with myasthenia gravis

Answer 55

ocular weakness (pupils spared) generalized weakness worsened w repeated use

Question 56

sensation and DTR in myasthenia gravis

Answer 56

usually preserved

Question 57

tx for myasthenic crisis or severe

Answer 57

IVIG or plasmapheresis

Question 58

long term tx myasthenia gravis

Answer 58

acetylcholinesterase inhibitors - Neostigmine or Pyridostigmine

Question 59

for what disease do patients usually have a thymectomy and chest CT/MRI to view enlargement of thymus

Answer 59

myasthenia gravis

Question 60

what do antibodies attack in Guillain barre

Answer 60

myelin sheath (Schwann cells)

Question 61

will people w Guillain barre have UMN or LMN signs

Answer 61

LMN - weakness, decreased DTR, flaccid paralysis

Question 62

sensation and DTRs in Guillain barre

Answer 62

decreased

Question 63

what is the MC presenting sx of ALS

Answer 63

asymmetric limb weakness

Question 64

what is usually spared in ALS

Answer 64

sensation voluntary eye movement sphincter function (bowel and bladder) sexual function

Question 65

tx for ALS

Answer 65

Riluzone