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Emergency Medicine > Unit 3 Lecture 4 > Flashcards

Unit 3 Lecture 4 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

dull, aching, colicky and poorly localized pain

A

visceral pain

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2
Q

sharp, well localized pain

A

parietal pain

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3
Q

referred pain to the right scapula

A

gallbladder

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4
Q

referred pain to the umbilicus

A

appendix

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5
Q

referred pain to the left scapula

A

stomach

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6
Q

condition with a rapidly worsening prognosis in the absence of surgical intervention

A

surgical abdomen/generalized peritonitis

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7
Q

signs of obstruction

A

anorexia, bloating, N/V, obstipation, high pitched or absent bowel sounds, tympany on percussion

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8
Q

extrinsic causes of SMO (3)

A

adhesions, hernia, volvulus

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9
Q

intrinsic causes of SMO (5)

A

congenital malformations, atresia/stenosis, neoplasm, inflammatory stricture, radiation enteritis

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10
Q

obstruction of normal bowel lumen causes (5)

A

intussusception, gallstones, feces, bezoar, traumatic intramural hematoma

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11
Q

signs of perintonitis

A

sick appearing, rebound tenderness, pain with light palpation, diminished BS

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12
Q

Testing for suspected bowel obstruction

A

abd. plain films or CT

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13
Q

testing for suspected peritonitis

A

US (esp in children) or CT

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14
Q

Signs of sepsis/shock

A

fever, tachycardia, hypotension, mental confusion

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15
Q

what is a “top priority” in treating acute adbominal pain while waiting for surgical intervention?

A

IV fluids

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16
Q

Causes of RUQ pain

A

hepatitis, cholecystitis, cholangitis, biliary colic, pancreatitis, budd-chiari syndrome, PNA, subdiaphargmatic abscess

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17
Q

sxs of acute cholecystitis

A

severe RUQ pain, infrascapular radiation, N/V

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18
Q

PE of acute cholecystitis

A

RUQ pain, +Murphy’s sign, low grade fever

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19
Q

Labs for acute cholecystitis

A

leukocytosis, ^ bili, ^alk phos, ^amylase

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20
Q

test of choice for acute cholecystitis

A

U/S

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21
Q

Tx of acute cholecystitis

A

IV fluids, 1st/2nd gen cephalosporins, cholecystectomy within 3 days of sx onset, percutaneous drainage for extremely high risk patients (to save surgery until pt is stable)

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22
Q

triangle of calot

A

common hepatic duct, cystic duct, and cystic artery

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23
Q

what type of choledocho is the most common? (primary or secondary)

A

secondary

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24
Q

cause of choledocho

A

gallstones

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25
Q

sxs of choledocho

A

RUQ pain

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26
Q

PE of choledocho

A

RUQ pain +jaundice**

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27
Q

DX of choledocho

A

U/S

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28
Q

labs of choledocho

A

^serum bili, ^alk phos

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29
Q

tx of choledocho

A

ERCP

30
Q

cause of cholangitis

A

ascending bacterial infection due to obstruction of the biliary ducts

31
Q

most common cause of cholangitis

A

choledocho

32
Q

charcot’s triad

A

RUQ, fever, jaundice (cholangitis)

33
Q

reynold’s pentad

A

charcot’s+ AMS and hypotension (cholangitis)

34
Q

dx of cholangitis

A

ERCP (dx and tx), ^LFTs, leukocytosis

35
Q

tx of cholangitis

A

fluid/electrolytes, abx, ERCP or PTC

36
Q

KUB showing localized ileus and bi-basilar atelectasis

A

pancreatitis

37
Q

causes of epigastric pain

A

PUD, GERD, gastritis, pancreatitis, MI, pericarditis, ruptured aortic aneurysm

38
Q

causes of pancreatitis

A

gallstones, EtOH, obstruction, hypercalcemia

39
Q

sxs of pancreatitis

A

epigastric pain with radiation to back, N/V

40
Q

PE of pancreatitis

A

fever, tachycardia, hypotension, paralytic ileus, grey turner’s sign, culen’s sign

41
Q

labs of pancreatitis

A

^amylase and lipase

amylase peaks within 12hours; lipase is better but may take a few days to peak

42
Q

tx of pancreatitis

A

ICU, NPO, IV fluids, NGT, foley cath, serial labs, pain management, surgery (ERCP with stent placement)

43
Q

sxs of pancreatic psudocyst

A

upper abd pain/asx, N/V, early satiety, jaundice

44
Q

PE of pancreatic pseudocyst

A

abd tenderness, palpable firm area

45
Q

test of choice for pancreatic pseudocyst

A

CT

46
Q

tx of pancreatic pseudocyst

A

most resolve spontaneously, cystgastrostomy

47
Q

most common type of gastric CA

A

adenocarcinoma

48
Q

risk factors for gastric CA

A

diet, H. pylori, chronic gastric inflammation, gastric polyps, EtOH, tobacco

49
Q

sxs of gastric CA

A

vague epigastric discomfort, indigestion, early satiety, abd pain with vomiting

50
Q

PE of gastric CA

A

virchow’s nodes, sister mary joseph’s, jaundice, ascites, palpable adb mass (late in ds)

51
Q

dx of gastric CA

A

upper endoscopy with bx

52
Q

complications of gastric CA

A

bleeding, obstruction, perf

53
Q

tx of gastric CA

A

surgical resection

54
Q

causes of LUQ pain

A

splenic abscess/infarct/rupture, gastritis, gastric ulcer, pancreatitis

55
Q

sxs of splenic abscess

A

fever, LUQ pain with or without splenomegaly

56
Q

cause of splenic abscess

A

endocarditis

57
Q

sxs of splenic infarct

A

LUQ pain without fever

58
Q

tx of splenic abscess

A

IV abx, eval for splenectomy

59
Q

tx of splenic infarct

A

uncomplicated-analgesia/monitor

complicated-eval for splenectomy

60
Q

causes of RLQ pain

A

appendicitis, salpingitis, ectopic pregnancy, inguinal hernia, femoral hernia, nephrolithiasis, IBD, mesenteric adenitis

61
Q

PE of abd wall hernia

A

reducible bulge/small mass (exam while supine and standing)

62
Q

dx of abd wall hernia

A

PE, U/S, or CT

63
Q

complications of abd wall hernia

A

incarceration, strangulation, recurrence, obesity

64
Q

tx of abd wall hernia

A

observation, tension free repair

65
Q

hesselbach’s triangle

A

inguinal ligament, inferior epigastric vessels, lateral margin of the rectus sheath

66
Q

evisceration

A

rupture of all layers and extrusion of abd viscera

67
Q

dehiscence

A

partial or total disruption of any or all layers of the operative wound

68
Q

most common post op day a/w dehiscence

A

between 5th-8th

69
Q

pain control for acute abd pain

A

dilaudid, morphine sulfate, demerol, toradol

70
Q

what PPI can be given IV

A

protonix

71
Q

antiemetics for acute abd pain

A

phenergan or zofran

Emergency Medicine (6 decks)

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