Walden

Question 1

liver gallbladder, ascending colon, pancreas, right kidney

Answer 1

RUQ pain

Question 2

stomach, pancreas, descending colon, kidney

Answer 2

LUQ pain

Question 3

appendix, ileum, cecum, ovary

Answer 3

RLQ pain

Question 4

sigmoid colon, ovary, diverticulitis

Answer 4

LLQ

Question 5

Bladder, uterus, rectum

Answer 5

Suprapubic pain

Question 6

Midepigastric pain radiates to midback

Answer 6

Pancreatitis

Question 7

Has positive PSOAS and obturator signs,
Dx - pancreatic enzymes, liver enzymes and leukocytosis, US and/or CT
Tx - refer to ED

Answer 7

Acute appendicitis

Question 8

• Symptoms worsen with fatty meals or when supine, decreased lower esophageal sphincter tone,
• risk factors- alcohol, anticholinergic, CCB, chocolate peppermint, fatty, spicy, citrus foods, hormones, obesity, pregnancy, smoking, theophylline, exacerbated by CCB verapamil
  Tx - first line is lifestyle changes then H2 blockers first then PPI

Answer 8

GERD

Question 9

Cure ulcers faster than H2

Answer 9

PPI’s

Question 10

• metaplastic columnar epithelium replaces the stratified squamous
  epithelium that normally lines the distal esophagus [1,2]. The metaplastic epithelium is acquired as a consequence of chronic gastroesophageal reflux disease and predisposes to cancer development.
  Dx - upper endoscopy with biopsy, Refer to oncology!
  Tx - PPI omeprazole,

Answer 10

Barret’s esophagus

Question 11

• Small pouch like herniations, acute onset of fever, LLQ pain, anorexia, N/V,
  Dx - CBC, leukocytosis, shift bands to left,
  Tx - fluoroquinolone, flagyl, if severe refer to ER

Answer 11

Diverticulitis

Question 12

DESCENDING COLON CANCER caused by constipation, colorectal cancer, fecal impaction, polyps, abdominal hernias, anorectal strictures, distended or stretched colon and twisted bowel or volvulus, crohns, ulcerative colitis, IBS,
Tx - Refer to GI for colonoscopy

Answer 12

Pencil like stool

Question 13

• Narrowing of pyloric sphincter causing eventual obstruction, characterized by forceful vomiting in young infants, projectile post prandial nonbilious vomiting, olive shaped mass palpable RUQ, hunger and weight loss and dehydration, 2 weeks of age
  Dx - US,
  Tx - surgical

Answer 13

Pyloric stenosis

Question 14

Tx - fiber, avoid gas foods, antispasmodics, decrease life stress

Answer 14

IBS

Question 15

• Helicobacter pylori, pain relieved by foods and or antacids,
  Dx - gold standard upper endoscopy and biopsy gastric/duodenal tissues, detect h pylori infection,
  Dx - CBC, if positive, refer to gastro, urea breath test, stop NSAIDS, smoking,
  Tx - PPI or H2 blockers is initial, H. Pylori, ranitidine, famotidine, cimetidine, H. pylori- positive ulcers require 14-day treatment (amoxicillin, azithromycin, doxycycline) Triple - therapy is clarithomycin, amoxicillin, and omeprazole

Answer 15

PUD

Tx - CAO