Tutorial 36 - Acute Abdomen I Flashcards
A 70-year-old man with a history of coronary artery disease and hypertension presents to the emergency department with sudden onset of severe abdominal pain that began two hours ago. He describes the pain as sharp and constant. He has vomited twice since the pain started but reports no prior history of gastrointestinal issues. On examination, his abdomen is tense with involuntary guarding, and his blood pressure is 85/50 mmHg with a heart rate of 110 beats per minute.
Which of the following features in this patient’s presentation are considered red flags that warrant urgent evaluation?
A. History of hypertension
B. Sudden onset of severe pain
C. Constant pain of less than two days duration
D. Vomiting before pain onset
E. Tense or rigid abdomen
F. Signs of shock
(Select all that apply.)
Correct answers: A, B, C, E, F.
Which of the following statements about abdominal imaging are correct? (Select all that apply.)
A. Abdominal x-rays are highly effective in diagnosing constipation.
B. KUB x-rays can detect approximately 90% of urinary tract stones.
C. CT scans provide more reliable detection of serious nontraumatic pathology compared to x-rays.
D. Younger patients are at higher risk of complications from radiation exposure.
Correct answers: B, C, D
What is the effective radiation dose and natural background radiation equivalent for both an abdominal x-ray and a mammogram? (Select all that apply.)
A. Effective radiation dose of 0.1 mSv
B. Effective radiation dose of 0.7 mSv
C. Natural background radiation equivalent of 8 days
D. Natural background radiation equivalent of 2 months
E. Natural background radiation equivalent of 9 months
F. Effective radiation dose of 2 mSv
Correct answers: B, D
Based on the table provided, which of the following imaging procedures have an effective radiation dose equivalent to 2.5 years of natural background radiation exposure? (Select all that apply.)
A. X-ray chest
B. X-ray abdominal
C. Mammogram
D. CT head
E. CT Chest (i.e. pulmonary embolism)
F. CT abdomen
Correct answers: E, F
Both CT Chest (e.g., for pulmonary embolism) and CT abdomen have an effective radiation dose of 10 mSv, which is equivalent to 2.5 years of natural background radiation exposure.
A 28-year-old woman presents to the emergency department with lower abdominal pain and vaginal spotting. She is unsure of her last menstrual period but mentions it was around six weeks ago. Her vital signs are stable. A urine pregnancy test is positive, and her serum β-hCG level is 1,200 mIU/mL. Transvaginal ultrasound shows an empty uterus and an adenexal mass. The patient has no significant past medical history and is not currently on any medications.
Question 1:
Which of the following are positive predictors or risk factors for the likely diagnosis in this patient? (Select all that apply.)
A. History of pelvic inflammatory disease (PID)
B. Previous ectopic pregnancy
C. Use of an intrauterine device (IUD)
D. Early pregnancy with low β-hCG levels
E. History of infertility treatments
F. Age over 35 years
Question 2:
What is the appropriate management for this patient in terms of imaging/diagnostics and treatment at this early stage? (Select all that apply.)
A. Repeat serum β-hCG levels in 48 hours
B. Laparoscopy
C. Methotrexate administration
D. Expectant management
E. Immediate surgical intervention
F. MRI pelvis
Question 1:
Correct answers: A, B, C, E.
Positive predictors and risk factors for an ectopic pregnancy, which is likely in this case, include a history of pelvic inflammatory disease (PID), previous ectopic pregnancy, use of an intrauterine device (IUD), and history of infertility treatments.
Question 2:
**Correct answers: A, C, D.*
The appropriate management at this stage involves repeating serum β-hCG levels in 48 hours to monitor the rise or fall, which helps confirm the diagnosis. If the patient is hemodynamically stable and meets the criteria, methotrexate administration or expectant management may be considered as treatment options for an early ectopic pregnancy.
A 32-year-old woman at 9 weeks of gestation presents with vaginal bleeding. She reports ongoing symptoms of pregnancy such as nausea and breast tenderness. Physical examination shows a closed cervical os, and ultrasound reveals a viable intrauterine pregnancy with a fetal heart rate of 160 bpm.
What would be the appropriate management for this patient?
A. Expectant management with follow-up ultrasound
B. Immediate dilation and curettage (D&C)
C. Methotrexate administration
D. Administering progesterone supplements
E. MRI pelvis
Dr. Yusuf - please review questions for threatened miscarriage. I am unsure how to test.
Correct answers: A
What are the positive predictors and risk factors for a threatened miscarriage?
A. Vaginal bleeding during pregnancy
B. Closed cervical os on ultrasound
C. Absence of fetal heart rate
D. Ongoing symptoms of pregnancy
E. Suspected passage of fetal tissue
Dr. Yusuf - does this make sense? I tried to incorporate as much as i could from the illness script- CZ
Correct answers: A, B, D
A 67-year-old man presents with left lower quadrant pain that developed over three days. He has a history of similar episodes and reports a change in bowel movements, with recent constipation. His temperature is 38.1°C, and his WBC count is mildly elevated. Physical examination reveals mild focal tenderness in the LLQ, as well as a distended abdomen.
What are the positive predictors in the patients history for the most likely diagnosis?
What test would you order to confirm the most likely diagnosis?
Positive predictors for diverticulitis:
* History of similar episodes
* LLQ pain
* Change in bowel movements
* Low grade fever
* Mildly elevated WBC
Next steps: CT abdo
A 67-year-old man presents with left lower quadrant pain that developed over three days. He has a history of similar episodes and reports a change in bowel movements, with recent constipation. Physical examination reveals mild focal tenderness in the LLQ, as well as a distended abdomen. You then performed a CT scan, which did not reveal any signs of diverticulitis or other sinister pathology. What is the appropriate management for this patient?
Empiric treatment with PEG 3350 (polyethylene glycol)
A 24-year-old woman presents to the emergency department with acute lower abdominal pain that started suddenly about 6 hours ago. The pain initially began around her umbilicus but has since localized to the right lower quadrant. She describes the pain as sharp and severe, and it worsens with movement. She reports associated nausea and has vomited twice since the onset of the pain. She denies any changes in her bowel movements or urinary symptoms.
Her last menstrual period was two weeks ago, and she reports regular cycles. She is sexually active with multiple partners and does not consistently use condoms. On further questioning, she mentions that the pain also increases during intercourse. She denies any vaginal discharge or bleeding.
On physical examination, she appears in distress, holding her abdomen. She has tenderness to palpation in the right lower quadrant, with some guarding. There is also tenderness on pelvic examination, particularly with cervical motion. Her temperature is 37.8°C, and her heart rate is 90 beats per minute.
What test would help confirm the most likely diagnosis?
CT Abdo
A 24-year-old woman presents to the emergency department with acute lower abdominal pain that started suddenly about 6 hours ago. The pain initially began around her umbilicus but has since localized to the right lower quadrant. She describes the pain as sharp and severe, and it worsens with movement. She reports associated nausea and has vomited twice since the onset of the pain. She denies any changes in her bowel movements or urinary symptoms.
Her last menstrual period was two weeks ago, and she reports regular cycles. She is sexually active with multiple partners and does not consistently use condoms. On further questioning, she mentions that the pain also increases during intercourse. She denies any vaginal discharge or bleeding.
On physical examination, she appears in distress, holding her abdomen. She has tenderness to palpation in the right lower quadrant, with some guarding. There is also tenderness on pelvic examination, particularly with cervical motion. Her temperature is 37.8°C, and her heart rate is 90 beats per minute.
Lab Results:
White blood cell count: 12,500/mm³
Urinalysis: Negative for leukocytes and nitrites
Pregnancy test: Negative
Imaging:
Pelvic ultrasound: Indeterminate; shows a small, simple ovarian cyst on the right ovary.
What factor on history decreases your suspicion for ovarian torsion?
Ovarian torsion is possible, but less likely given the small size of the ovarian cyst and lack of definitive findings on ultrasound.
