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37 Cards in this Set
- Front
- Back
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Where does Visceral pain tend to localize?
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Midline
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where does Somatic pain tend to localize?
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Dermatomal distributions
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5 diagnoses that localize to the RUQ:
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-Biliary colic
-Hepatitis -Peptic ulcer disease -Pancreatitis -Perforated viscus |
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3 diagnoses that localize to the LUQ:
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-Pancreatitis
-Mesenteric ischemia -Small bowel obstruction |
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Where does renal enteritis tend to localize?
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RLQ
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Where does diverticulitis localize?
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LLQ
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What does pain that is steadily worsening and localizing make you suspect?
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Peritonitis
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What does pain that is abrupt onset and severe make you suspect?
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Perforation, dissection, torsion, mesenteric ischemia
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What is writhing, cresc/decrec pain make you suspect?
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Colic - biliary, renal, or intenstinal obstruction
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What pain radiates to the back?
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Pancreas
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What pain radiates to the flank?
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Renal colic
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What pain radiates to the tip of the scapula?
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Gallbladder
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What pain radiates to the Left Shoulder?
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-Splenic
-IPFA |
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What are 2 things a QUIET abdomen might point to?
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-peritonitis
-ileus |
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Best way to elicit rebound tenderness:
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PERCUSSION
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2 things to consider in a tympanitic abdomen:
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ileus
obstruction |
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Is the rectal exam helpful for appendicitis?
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NO
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What is Carnett's sign?
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Focal tenderness with flexion of the abdominal wall muscles
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For what 3 suspected diagnoses or patient groups should you always do an abdominal ultrasound?
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-Biliary disease
-AAA -reproductive age women |
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For what patients is an abdominal CT withOUT contrast sufficient?
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-Stone protocol for urolithiasis
-Obese patients |
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What is IV contrast good for?
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Infectious, inflammatory, and vascular disorders
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What test should you order if concerned about mesenteric ischemia?
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Angiography
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What is the perf rate for appendicitis in the elderly?
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50% - 5X higher
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What is the mortality rate in elderly with abdominal pain compared to younger pts?
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6-8x higher
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What is an atypical way that peritonitis often presents in elderly?
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Hypothermia rather than fever
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Why should you beware normal vital signs in an elderly with abdominal pain?
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They may be chronic hypertensives and their 'normal' is actually low
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What test can you NOT go wrong with in working up abdominal pain in elderly?
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ECG
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When is the wbc count rendered useless in elderly?
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If they're on glucocorticoids
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3 extra-abdominal causes of abdominal pain in pediatrics:
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-Strep pneumo
-Pharyngitis -DKA |
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What is the rule of 3's for colic?
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-3 hrs/day
-3 days/week -Lasts 3 hrs |
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When does most Malrotation with midgut volvulus occur in infants?
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60% in first month
Most within first year (newborns/infants) |
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What is the key symptom of malrotation with volvulus? How is it diagnosed?
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Sx: bilious emesis
Dx: upper GI |
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What is the classic triad for intussuseption?
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-Currant jelly stools
-Abdominal pain w/ emesis -Palpable mass |
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What is the more typical presentation of intussusception?
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AMS, lethargy, unresponsiveness
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What is the most common cause of surgical-related abdominal pain in children? Why?
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Appendicitis - perforation is more commin in kids bc of atypical presentations
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What type of incarcerated hernias are much more common in kids?
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inguinal >>> umbilical
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Why do pregnant patients have more GERD?
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LES pressure decreases
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