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Year 3 > Surgery - Acute Abdomen > Flashcards

Surgery - Acute Abdomen Flashcards

1
Q

visceral (colic) pain is usually ..

a.deep , localised ,pain free intervals
b. generalised, constant

A

a.deep , localised

localised to the area of the organ during dvelopment

billiary colic has no pain free intervals

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2
Q

which part of the GI tract originates from the foregut

a.duodenum
b.appendix and 2/3 transverse colon
c.1/3 transverse colon - rectum

A

a.duodenum

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3
Q

which part of the GI tract originates from the midgut

a.duodenum
b.appendix and 2/3 transverse colon
c.1/3 transverse colon - rectum

A

b.appendix and 2/3 transverse colon

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4
Q

which part of the GI tract originates from the hindgut

a.duodenum
b.appendix and 2/3 transverse colon
c.1/3 transverse colon - rectum

A

c.1/3 transverse colon - rectum

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5
Q

which type of pain is eased by moving

a.colic
b.peritonitis

A

a.colic

patient cannot lie still

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6
Q

which type of pain is eased by lying still

a.colic
b.peritonitis

A

b.peritonitis

also will have guarding on examination

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7
Q

acute abdominal pain < 1 week requires

a.admission to hospital
b. urgent referal for endoscopy
c. NSAID treatment
d.Urgent CT abdo

A

a.admission to hospital

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8
Q

possible causes of abdo pain

A

non specific
acute appendicitis
acute cholycystitis
PUD
small bowel obstruction
gynaecological conditions
acute pancreatitis

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9
Q

patterns of presentation to look out for

A

abdo pain and shock

generalised peritonitis

localised peritonitis

intestinal obstruction

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10
Q

patient with acute abdo pain, pale and sweaty with hypotension and increased heart rate

which pattern of presentation does this indicate

a. abdo pain and shock

b. generalised peritonitis

c. localised peritonitis

d. intestinal obstruction

A

a. abdo pain and shock

SURGERY NOW SITUATION

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11
Q

in a patient presenting with abdo pain and shock what should be considered until proven otherwise

a. AAA
b. ruptured ectopic pregnancy
c.intestinal obstruction
d.mesenteric ischaemia
e.severe acute pancreatitis

A

a. AAA

c,d,e = third space fluid loss present similarly

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12
Q

motionless patient, tenderness, board like rigidity

are characteristic of which presentation pattern

a. abdo pain and shock

b. generalised peritonitis

c. localised peritonitis

d. intestinal obstruction

A

b. generalised peritonitis

generally caused by perforation
eg , perforated ulcer
colonic perforation
perforated appendix

SURGERY LATER

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13
Q

perforations eg of an ulcer, colon or appendix present with which pattern

a. abdo pain and shock

b. generalised peritonitis

c. localised peritonitis

d. intestinal obstruction

A

b. generalised peritonitis

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14
Q

in cases of generalised peritonitis what should be done first to check for free air under a diaphragm (perforated viscous)

a. CXR
b. amylase
c.FBC
d.CT abdo

A

a. CXR

sudden onset peritonitis + free gas = perforated viscous

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15
Q

sudden onset peritonitis and free gas under the diaphragm indicates what

A

perforated viscous

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16
Q

if there is sudden onset peritonitis and no free gas shown on chest x ray what test should be done next

a. serum amylase
b.u and e
c. fbc
d.ct abdo

A

a. serum amylase

there is no free gas in just under half of cases of perforation

if amylase is normal (diagnostic test for pancreatitis )

still indicates perforated viscous

request a CT

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17
Q

if there is sudden onset peritonitis and no free gas shown on chest x ray serum amylase is normal

a. serum amylase
b.u and e
c. fbc
d.ct abdo

A

d.ct abdo

sudden onset peritonitis + no free gas + amylase normal = perforated viscous

CT needed to confirm

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18
Q

localised peritonitis ( still patient with guarding ) in the right upper quadrant which condition is most likely

a. acute cholecystitis
b.acute appendicitis
c.acute diverticulitis

A

a. acute cholecystitis

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19
Q

localised peritonitis ( still patient with guarding ) in the left lower quadrant which condition is most likely

a. acute cholecystitis
b.acute appendicitis
c.acute diverticulitis

A

c.acute diverticulitis

20
Q

localised peritonitis ( still patient with guarding ) in the right lower quadrant which condition is most likely

a. acute cholecystitis
b.acute appendicitis
c.acute diverticulitis

A

b.acute appendicitis

21
Q

central colic pain with distention , constipation and vomiting indicates what pattern

a.abdo pain and shock
b.generalised peritonitis
c.localised periotnitis
d.intestinal obstruction

A

d.intestinal obstruction

can be a SURGERY NOW situation if there is fever, peritonitis and increased WCC/lactate

22
Q

patient with intestinal obstruction ( vomiting and colic) which part of bowel is most likely obstrcuted

a.small bowel
b.large bowel

A

a.small bowel

23
Q

patient with an intestinal obstruction presented with constipation and distention which part of the bowel is most likely obstructed ?

a.small bowel
b.large bowel

A

b.large bowel

24
Q

patient presented with vomiting and colic central pain indicative of a small bowel obstruction, surgery is more liekly to be performed in which case ..

a.patient has had previous surgery
b.patient has had no previous surgery

A

b.patient has had no previous surgery

can be surgery now if fever , peritonitis etc

more often surgery later or conservative management

25
Q

patient presented with vomiting and colic central pain indicative of a small bowel obstruction, conservative management is more liekly to be performed in which case ..

a.patient has had previous surgery
b.patient has had no previous surgery

A

a.patient has had previous surgery

26
Q

how is large bowel obstruction treated

a.surgery
b.conservative management

A

a.surgery

patient has central colic initially has constipation and distention

27
Q

which part of the bowel has valvulae commitantes ( transverse the whole bowel)

a.small
b.large

A

a.small

28
Q

which part of the bowel has haustrations ( transverse the bowel partly )

a.small
b.large

A

b.large

29
Q

a functional obstruction cannot be seen on x ray alone what else is required ?

a.endoscopy
b.ct
c.pet ct

A

b.ct

30
Q

senior input is needed for which groups ?

A

post op
children
elderly
pregnant
immunocompromised

31
Q

elderly with arrhythmia ( a.fib) and sudden onset abdo pain

a.acute appendicitis
b.acute mesenteric ishcaemia
c.incarcerated femoral hernia
d.caecal tumour
e.gallstone ileus

A

b.acute mesenteric ishcaemia

in the SUPERIOR MESENTERIC AA

32
Q

elderly , obese with no previous surgery and showing signs of small bowel obstruction (vomiting and central colic)

a.acute appendicitis
b.acute mesenteric ishcaemia
c.incarcerated femoral hernia
d.caecal tumour
e.gallstone ileus

A

c.incarcerated femoral hernia

part of intestine becomes intwined in hernia causing small bowel obstruction

femoral hernia is lateral and below pubic tubercle

33
Q

elderly and adhesive small bowel obstruction from previous surgery currently on conservative treatment what should be done next

a.serum amylase
b.CT for large bowel obstruction
c.CT caecal tumour
d. x ray for air in billiary tree
e.x ray for free air under the diaphragm

A

c.CT caecal tumour

34
Q

elderly with partial small bowel obstruction (vomiting and colic ) that resolves and reoccurs indicative of gallstone ileus

what investigative test should be done to confirm this

a.serum amylase
b.CT for large bowel obstruction
c.CT caecal tumour
d. x ray for air in billiary tree
e.x ray for free air under the diaphragm

A

d. x ray for air in billiary tree

35
Q

the pain from perforation (generalised peritonitis )

a.sudden high intensity

b.increases and decreases

c.gradual increase

A

a.sudden high intensity

36
Q

the pain from obstruction (colic localised and deep)

a.sudden high intensity

b.increases and decreases

c.gradual increase

A

b.increases and decreases

37
Q

the pain from inflammation (localised peritonitis )

a.sudden high intensity

b.increases and decreases

c.gradual increase

A

c.gradual increase

38
Q

what should be done prior to history taking for a patient with acute abdo pain

A

analgesia given

39
Q

dunphy sign

A

pain on coughing

40
Q

murphys sign

A

right upper quadrant tenderness

acute cholecytstitis

41
Q

rovsings sign

A

right lower quadrant pain when left lower quadrant palpated

42
Q

other exams you would like to perform ..

A

gynaecological
digital rectal

43
Q

INVESTIGATIONS in order

A

urinalysis and pregnancy test

bloods (if suspect non urgent but .. CRP>100mg/l. or WBC > 15x109 g/l) suspicion of an urgent condition rises
1. request ultrasound if not critical then CT

  1. if critical but stable do CT first

diagnostic laparoscopy is good for appendicitis

44
Q

patient with acute abdo suspected non urgent . bloods done if CRP is over ………. suspicion or urgency should rise and an ultrasound should be performed

a.30 mg/l
b.50 mg/l
c.75 mg/l
d.100 mg/l

A

d.100 mg/l

45
Q

patient with acute abdo suspected non urgent . bloods done if WCC is over ………. suspicion or urgency should rise and an ultrasound should be performed

a.5 x 10^9
b.10 x 10^9
c.15x 10^9
d.20 x 10^9

A

c.15x 10^9

46
Q

if suspicion of an urgent condition is raised which imaging test should be done first in a non critical patient

a.ct
b/laparoscopy
c.endoscopy
d.ultrasound

A

d.ultrasound

47
Q

if suspicion of an urgent condition is raised which imaging test should be done first in a critical patient

a.ct
b/laparoscopy
c.endoscopy
d.ultrasound

A

a.ct

Year 3 (25 decks)

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