Week 2 - Investigations Flashcards

Question

What is an acute abdomen?

Answer 1

- Strongly consider a urine pregnancy test in sexually active female patients of reproductive age, irrespective of current contraception use. - Patients with obvious signs of diffuse peritonitis or sepsis may require immediate surgical management without further diagnostic imaging.

Answer 2

**Approach** 1. The initial imaging modality should be guided by the working diagnosis, as based on the patient history, vital signs, and examination. 2. The following recommendations apply to nonpregnant adults. 3. In pregnant women with acute abdominal pain, ultrasound and/or MRI of the abdomen and/or pelvis without contrast are the preferred initial imaging modalities. 4. Maintain a low threshold for obtaining diagnostic imaging in older patients, for whom abdominal pain is associated with higher morbidity and mortality as well as lower initial diagnostic accuracy.

Answer 3

1. GI tract perforation 2. Mechanical bowel obstruction 3. Acute appendicitis (including perforated appendicitis 4. Peptic ulcer disease 5. Diverticulitis 6. Gastroenteritis 7. Neutropenic enterocolitis (typhlitis) 8. Epiploic appendagitis

Answer 4

1. Acute pancreatitis 2. Symptomatic cholelithiasis 3. Choledocholithiasis 4. Acute cholecystitis 5. Acute cholangitis

Answer 5

1. Ruptured ectopic pregnancy 2. Ovarian torsion 3. Testicular torsion 4. Acute pyelonephritis 5. Nephrolithiasis 6. Pelvic inflammatory disease 7. Acute urinary retention

Answer 6

1. Red blood cell (RBC) count 2. Hemoglobin (Hb) 3. Hematocrit (Hct) 4. Mean corpuscular volume (MCV) 5. Mean corpuscular hemoglobin (MCH) 6. Mean corpuscular hemoglobin concentration (MCHC) 7. White blood cell (WBC) count 8. Platelet count

Answer 7

1. WBC count 2. Segmented neutrophil count 3. Band neutrophil count 4. Eosinophil count 5. Basophil count 6. Lymphocyte count 7. Monocyte count

Answer 8

For causes of eosinophilia, think CHINAA: Collagen vascular disease (e.g., eosinophilic granulomatosis), Helminths, Hyper-IgE syndrome, Neoplasms, Allergies, Addison disease.

Answer 9

**Definition**: increase in immature leukocytes (e.g., band cells, metamyelocytes) in the peripheral blood **Causes** 1. Infections (especially bacterial infections) 2. Acute inflammation 3. Severe anemia 4. Bone marrow infiltration 5. Necrosis

Answer 10

**Definition**: absolute platelet count of > 400,000/mm3

Answer 11

**Definition**: a decrease in the number of cells of all cell lines (i.e., RBCs, WBCs, and platelets) in the peripheral blood 1. Aplastic anemia 2. Fanconi anemia 3. Multiple myelomas 4. Myelodysplastic syndrome 5. Acute and chronic leukemia 6. Chemotherapy 7. Autoimmune disease (e.g., SLE) 8. Infections (e.g., CMV, EBV)

Answer 12

The laboratory values that indicate that bile cannot flow from the liver to the duodenum: 1. ↑ ALP 2. ↑ GGT 3. ↑ total bilirubin 4. ↑ direct bilirubin.

Answer 13

**Reference range**: < 2.0 mmol/L **Physiology**: Lactic acid is the end product of anaerobic glycolysis, which is accomplished in the Cori cycle. The majority of lactic acid is produced by muscle cells and RBCs, especially in hypoxic states.

Answer 14

**C-reactive protein (CRP)** - Promotes the opsonization of pathogens, which leads to increased phagocytosis by macrophages - Activates the complement system - High sensitivity for detecting inflammation but not specific to any disease or organ - Increases 6–12 hours after the inflammatory process begins - Half-life is 24 hours.

Answer 15

1. Total cholesterol 2. Triglycerides 3. LDL = Bad - A lipoprotein that transports cholesterol from the liver to extrahepatic tissue. 4. HDL = Good - A lipoprotein that transports cholesterol from extrahepatic tissue to the liver. 5. LDL/HDL ratio 6. Total cholesterol/HDL ratio

Answer 16

- Mammography is a medical imaging technique that uses low-dose X-rays to visualize the breast tissue. It is primarily used for breast cancer screening and diagnosis. - Two low-dose x-rays of the breast are obtained (mediolateral oblique and craniocaudal) to screen for breast abnormalities. - Used for early detection of breast abnormalities: Mammography detects the majority of cancers and can detect lesions ∼ 2 years before they are clinically evident. - In postmenopausal women and women ≥ 30 years of age with a suspicious breast mass, mammography is preferred over ultrasound. In premenopausal women < 30 years of age, ultrasound is preferred, because the higher density of breast tissue decreases the diagnostic power of mammography. - Mammography has greatly improved the rate of early detection of noninvasive carcinomas.

Answer 17

An inspection of the upper gastrointestinal tract (up to the duodenal papilla) with an endoscope.

Answer 18

Capsule endoscopy is a valuable tool for the evaluation of small intestinal pathologies, especially in cases where conventional endoscopic methods are limited.

Answer 19

Enteroscopy is a procedure used to examine the small intestine (small bowel).

Answer 20

Proctoscopy is a common medical procedure in which an instrument called a proctoscope is used to examine the anal cavity, rectum, or sigmoid colon. A proctoscope is a short, straight, rigid, hollow metal tube, and usually has a small light bulb mounted at the end.

Answer 21

Sigmoidoscopy is the minimally invasive medical examination of the large intestine from the rectum through to the nearest part of the colon, the sigmoid colon. There are two types of sigmoidoscopy: flexible sigmoidoscopy, which uses a flexible endoscope, and rigid sigmoidoscopy, which uses a rigid device.

Answer 22

Sigmoidoscopy is a valuable diagnostic tool for evaluating lower gastrointestinal conditions, including rectal bleeding, colorectal cancer screening, anorectal disorders, and inflammatory bowel disease. However, its limitations in terms of reach and inability to perform interventions beyond the sigmoid colon should be considered, and further evaluation with a complete colonoscopy may be required in certain cases.

Answer 23

A diagnostic and/or therapeutic procedure in which a side-viewing endoscope is inserted into the duodenum and contrast is injected via the ampulla of Vater into the bile ducts. Different instruments can then be introduced via the endoscope to cannulate the common bile duct. If necessary, a sphincterotomy of the ampulla of Vater or removal of gallstones from the common bile duct can also be performed.

Answer 24

Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope. The urethra is the tube that carries urine from the bladder to the outside of the body. The cystoscope has lenses like a telescope or microscope.

Answer 25

Cystoscopy is a valuable diagnostic and therapeutic tool for evaluating various urinary tract conditions. While it has limitations in terms of reach and potential discomfort, it offers the ability to directly visualize the bladder and urethra, perform biopsies, remove tumors or polyps, and manage urinary stone-related issues.

Answer 26

**Most common causes** 1. Biliary pancreatitis (∼ 40% of cases; mostly caused by gallstones) 2. Alcohol-induced (∼ 20% of cases) 3. Idiopathic (∼ 25% of cases)

Answer 27

**Sequence of events** 1. Intrapancreatic activation of pancreatic enzymes: secondary to pancreatic ductal outflow obstruction (e.g., gallstones, cystic fibrosis) or direct injury to pancreatic acinar cells (e.g., alcohol, drugs) 2. Increased proteolytic and lipolytic enzyme activity → destruction of pancreatic parenchyma 3. Attraction of inflammatory cells (neutrophils, macrophages) → release of inflammatory cytokines → pancreatic inflammation (pancreatitis)

Answer 28

**Symptoms of Acute Pancreatitis** - Constant, severe epigastric pain. - Classically radiating towards the back - Worse after meals and when supine - Improves on leaning forwards - Nausea, vomiting - Fever - If pulmonary complications are present: chest pain, dyspnea

Answer 29

**= Cullen Sign** Periumbilical ecchymosis as a result of retroperitoneal hemorrhage, commonly seen in acute pancreatitis.

Answer 30

**Grey Turner sign** = Right-sided flank ecchymosis suggestive of retroperitoneal hemorrhage, commonly seen in acute pancreatitis.