SP Prep

Question 1

Appendicitis

Answer 1

RLQ pain 
loss of appetite 
N/V
Fever
2nd/3rd decade of life 

labs: CBC –> leukocytosis

Imaging: CT with IV/PO contrast

Tx: NPO, admit –> surgery within the next 24 hours with close monitoring of pain and changes in pain

Question 2

Ulcerative Colitis

Answer 2

age 15-30

Bloody diarrhea

Question 3

Crohn’s Disease

Answer 3

age 15-30

RLQ pain

Question 4

Large Intestine Diarrhea

Answer 4

small mucoid amounts commonly with blood

E. choli
Shigella
Enatomoeba

Question 5

Small Intestine Diarrhea

Answer 5

LARGE amounts, watery, no blood

E. COli 
Cholerae
Toravirus 
Norwalk virus 
Giardia

Question 6

Weight loss

Answer 6

Cancer 
Malabsorption 
-vitamins
-celiac
-lactose 
Chronic Pancreatitis 
Cirrhosis 

Ask about:

• diet
• excessive brusing
• diarrhea
• steatorrhea

Get:
-CBC - anemia, leukocytosis

Question 7

GERD

Answer 7

typically older age

heartburn typically after eating that’s worse with lying down
dysphasia

be alarmed if they have:
odnyophagia
weight loss
bleeding

dx: endocsopy
tx: life style modifications (smaller meals, don’t lay down after eating, decrease fat, EtOH, loose weight, stop smoking)

Question 8

PUD

Answer 8

H. Pylori or NSAID use

dyspepsia –epigastric pain
worse at night

GI bleed (PUD is the MC cause of upper GI bleeds)

dx: endoscopy
urea breath test –H. pylori
stool antigen test for H. Pylori
CBC - anemia

tx: If H. pylori –> triple therapy = clarithromycin and amoxicllin and PPI (CAP)
ABXs for 2 weeks
PPI for two months
follow up in 2.5 months for check up on eradication of H. Pylori

Question 9

Gastric Carcinoma

Answer 9

H. pylori common cause

typically males greater than 40

FAP family hx

dyspepsia 
weight loss 
Fe anemia 
N/V 
dysphasia 

dx:
cbc - anemia
-endoscopy with biopsy

tx: chemo + surgery

Question 10

Weight loss

Answer 10

Cirrhosis 
Gastric Carcinoma 
Malabsorption (protein, vitamins, lactose, gluten) 
Chronic Pancreatitis 
Pancreatic Carcinoma

Question 11

Abdominal Pain

Answer 11

PUD (epigastric)
GERD (heartburn)
Cholelithiasis (RUQ and epigastric)
Cholangitis (RUQ pain)
Cholecystitis (RUQ/epigastric pain)
Hep A
Acute Pancreatitis (epigastric constant pain - radiating to the back)
Chronic pancreatitis (epigastric +/- back pain)
Pancreatic Carcinoma (abdominal pain radiating to the back)

Question 12

Cholelithiasis

Answer 12

gallstone (cholesterol MC type)

RUQ pain/epigastric
episodic
associated with fatty meals

dx: ultrasound
tx: cholecystectomy if symptomatic or DM or immunocompromised

Question 13

Cholangitis

Answer 13

an infection in the biliary tract secondary to gallstone

Charcot’s triad:

• fever
• RUQ pain
• Jaundice

dx:
- ultrasound
- CBC - leukocytosis
- CMP - AlkP and GGT and bilirubin elevated

tx: admit to the hospital
ABX (zosyn (pip/tazo))
blood cultures

Question 14

Cholecystitis

Answer 14

RUQ/epigastric CONTNUOUS pain
might radiate to shoulder
+ murphey’s sign
fever

dx: US
CBC - leukocytosis

tx: NPO, ABX (metronidazole and ceftriaxone)
- -> cholecystectomy within next 3 days

Question 15

Hepatitis A

Answer 15

TRAVEL

jaundice (+/-)  
fatigue 
anorexia 
N/V 
decreased smoking 
FEVER 
flu like sxs 
abdominal pain 
loss of apetite
hepatomegaly 

dark urine
pale feces

dx:
IgM HAV Ab
CMP - ALT >AST
UA - bilirubinuria

Question 16

Hep E

Answer 16

similar to hep A

dx: IgM anti-HEV

Question 17

Cirrhosis

Answer 17

EtOH hx
or chronic hepatitis

weight loss
fatigue
muscle cramps

ascites 
gynecomastia 
spider angiomas 
jaundice
palmar erythema 
hepatospelnomegaly 
PRURITIS 

dx: 
CBC - anemia, infection??
CMP - AST > ALT 
US 
liver biopsy 

Tx:
sxs treat pruritus - cholestyramide
possibly getting them on transplant list?

Question 18

Acute Pancreatitis

Answer 18

epigastric CONSTANT pain radiating to the back
relieved by leaning forward

N/V
fever

tachycardia

cullens sign
grey turner sign

dx:
Amylase blood test (will see sooner than lipase) – expecting to see 3X the normal limit
Abdominal CT

tx: supportive, bowel rest, NPO

Question 19

Chronic Pancreatitis

Answer 19

EtOH abuse
weight loss
epigastric pain +/- back pain

steatorrhea
DM

dx:
amylase and lipase probably ‘normal’ - not elevated like you’d think —leading to steatorrhea
Abdominal XRay –> calcifications

tx: pancreatic enzyme replacement
manage pain
stop EtOH
manage DM

F/U for cancer screening

Question 20

Pancreatic Carcinoma

Answer 20

smoking hx 
abdominal pain radiating to the back 
weight loss 
PAINELSS JAUNDICE 
pruritus (d/t bile salts in the blood)
lymph node involvement

dx: CT scan
tx: resection if possible? supportive? bad prognosis?

Question 21

Celiac disease

Answer 21

weight loss 
steatorrhea
abdominal pain 
diarrhea
\+/- skin rash 

dx:
endomysial IgA ab

NOT DONE HERE

Question 22

Lactose intolerance

Answer 22

abdominal pain
flatulence
loose stools

dx: hydrogen breath test

NOT DONE HERE

Question 23

Diverticulosis

Answer 23

painless bloody stool

NOT DONE HERE

Question 24

Diverticulitis

Answer 24

LLQ pain
fever

CBC - leukocytosis
NOT DONE HERE

Question 25

Colorectal Cancer

Answer 25

NOT DONE HERE

Question 26

Hemorrhoids

Answer 26

NOT DONE HERE

Question 27

Vitamin A deficiency

Answer 27

NOT DONE HERE

Question 28

All other Vitamins`

Answer 28

NOT DONE HERE

Question 29

Diarrhea from infection –food poisoning

Answer 29

NOT DONE HERE