ToL EM GI/Nutrition

Question 1

Name 4 physical exam signs that may be seen in acute appendicitis.

Answer 1

Mcburney’s sign
Rovsing’s sign
Obturator sign
Iliopsoas sign

Question 2

What is the initial imaging for suspected appedicitis?

Answer 2

U

Question 3

What is the confirmatory imaging for acute appendicitis?

Answer 3

Contrast CT

Question 4

What bacteria is most commonly implicated in cholescystitis?

Answer 4

E. coli

Question 5

What can precipitate RUQ pain in cholecystitis?

Answer 5

Fatty foods or large meals

Question 6

What physical exam special tests would you expect to be positive in cholecystitis?

Answer 6

Murphy’s sign

Boas sign

Question 7

What is the initial diagnostic test of chouce for cholecystitis?

Answer 7

US

Question 8

What US findings are consistent with cholecystitis?

Answer 8

Thickened GB, distended GB, gal sludge, gallstones, pericholecystic fluid, sonographic murphys sign.

Question 9

What is the gold standard diagnostic test for cholecystitis?

Answer 9

HIDA( heptoiminodiacetic acid) scan

Question 10

What is concerning about a porcelain gallbladder?

Answer 10

It is a premalignant condition

Question 11

What analgesic is preferred for treatment of cholecysitis?

Answer 11

Meperidine, because morphine is associated with sphincter of oddi spasms

Question 12

What are the risk factors for cholelithiasis?

Answer 12

Fat, Fair, Female, Forty, Fertile

Question 13

What is the first line diagnostic tool for choledocolithiasis?

Answer 13

MRCP

Question 14

What is the treatment for choledocolithiasis?

Answer 14

Stone extraction via ERCP

Question 15

What is the name of the rare condition causing autoimmune progressive cholestasis with fibrosis of intrahepatic and extrahepatic ducts?

Answer 15

Primary sclerosing cholangitis

Question 16

What is the most common comorbid condition with primary schlerosing cholangitis?

Answer 16

inflammatory bowel disease.

Question 17

What is Charcot’s triad, and what is it a sign of?

Answer 17

Charcot’s triad: Fever/chills, RUQ pain, Jaundice/elevated liver enzymes
It indicates ascending cholangitis

Question 18

What is Reynold’s pentad, and what does it indicate?

Answer 18

Reynold’s pentad = Charcot’s triad + shock and AMS

It indicates severe ascending cholangitis

Question 19

What is the treatment of ascending cholangitis?

Answer 19

PCN + aminoglycoside

Decompression of biliary tree via ERCP stone extraction

Question 20

What two types of hepatitis are fecal-orally transmitted?

Answer 20

Hep A and E

Question 21

What type of hepatitis can only occur with hepatitis B coninfection?

Answer 21

Hepatitis D

Question 22

What is the most common cause of pancreatitis?

Answer 22

Cholelithiasis

Question 23

What is the second most common cause of pancreatitis?

Answer 23

Alcohol abuse

Question 24

What cause of pancreatitis might you find in routine lab work?

Answer 24

Hypertriglyceridemia

Question 25

What two physical exam findings are associated with hemorrhagic pancreatitis?

Answer 25

Grey turner sign (flank bruising) and Cullen sign (periumbilical bruising)

Question 26

What lab finding is most sensitive for pancreatitis?

Answer 26

Lipase 3x greater than upper limit of normal

Question 27

What is the diagnostic test of choice for pancreatitis?

Answer 27

CT abdomen

Question 28

What is the treatment for pancreatitis?

Answer 28

90% recover with fluid resuscitation, NPO, and supportive measures

Question 29

What is the most common location for an anal fissure?

Answer 29

Posterior midline

Question 30

What is the first line treatment for anal fissures?.

Answer 30

Analgesics, sitz bath, bulking agents and increased fluids to avoid straining

Question 31

What is the most common cause of cirrhosis?

Answer 31

Chronic hepatitis

Question 32

What is the second most common cause of chirrhosis?

Answer 32

Alcohol

Question 33

What physical exam finding in cirrhosis patients is characterized by a flapping like motion of the hands when arms are abducted?

Answer 33

Asterixis

Question 34

What diagnosis should you consider in a cirrhosis patient with fever and abdominal pain?

Answer 34

Spontaneous bacterial peritonitis

Question 35

What is the treatment spontaneous bacterial peritonitis?

Answer 35

Ceftriaxone or cefotaxime

Question 36

What is the prophylactic treatment for spontaneous bacterial peritonitis?

Answer 36

Norfloxacin or bactrim