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51 Cards in this Set
- Front
- Back
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1. What type of diverticulum is appendicitis?
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a. True
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2. What are the most common causes of appendicitis?
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a. Lymphoid hyperplasia in children
b. Fecalith in adults c. Foreign bodies, worms, tumors |
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3. What leads to appendicitis?
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a. Infection in the appendiceal wall
b. Infalmmation/edema c. Luminal/intramural obstruction d. Bacterial overgrowth e. Increased pressure f. Ischemia/necrosis |
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4. What are the two possible options in perforation of an appendix?
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a. Contained abscess
b. Generalized peritonitis |
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5. What is the risk of perforation in the first 24 hours?
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a. 25%
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6. What is the risk of perforation in the first 36 hours?
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a. 50%
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7. What is the risk of perforation in the first 48 hours?
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a. 75%
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8. What symptoms would a patient have to make you suspect appendiceal perforation?
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a. Fever >103
b. WBCs> 15 |
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9. What leads to periumbilical pain in appendicitis?
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a. Irritation stimulates visceral afferent fibers of T8-T10
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10. What causes localized RLQ pain in appendicitis?
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a. Bacterial overgrowth causes neutrophilic influx and exudative production
b. Irritation overlying the parietal peritoneum follows |
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11. What are the signs/symptoms of appendicitis?
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a. Periumbilical pain with migration to RLQ
b. Nausea/vomiting follow onset of pain c. Low grade fever d. Mild leukocytosis with left shift |
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12. What are the signs/symptoms of a retrocecal appendix?
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a. No direct contact with parietal peritoneum
b. Dull ache instead of localized tenderness c. Psoas sign d. Rectal/pelvic exam more likely to elicit symptoms |
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13. What are the signs/symptoms of a pelvic appendix?
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a. Tenderness BELOW McBurney’s point
b. Urinary frequency/dysuria c. Obturator sign |
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14. What will a CBC show in appendicitis?
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a. WBC count>10 with a left shift
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15. What secondary tests should you run in suspected appendicitis?
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a. Pregnancy test
b. UA |
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16. What is the most important/accurate aspect of a dx of appendicitis?
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a. Clinical assessment
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17. How many points is migratory pain to RLQ worth?
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a. 1 point
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18. How many points in anorexia worth?
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a. 1 point
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19. How many points in N/V worth?
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a. 1 point
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20. How many points is RLQ tenderness worth?
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a. 2 points
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21. How many points is RLQ rebound tenderness worth?
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a. 1 point
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22. How many points is a fever>37.5 C worth?
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a. 1 point
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23. How many points is leukocytosis worth?
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a. 2 points
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24. What does an Alvarado Score of 0-3 tell you?
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a. Discharge with advice to return if symptoms don’t improve
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25. What does an Alvarado Score of 4-6 tell you?
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a. Admit for observation and re-examine in 12 hours
b. Operative management if no improvement |
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26. What does an Alvarado Score of 7-9 tell you?
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a. Emergent appendectomy if not pregnant
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27. When should radiology be used to dx appendicitis? What modality?
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a. When appendicitis is suspected but dx is unclear
b. CT with IV and oral/rectal contrast |
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28. What appendiceal diameter is indicative of appendicitis?
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a. > 6mm
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29. What appendiceal wall thickening is indicative of appendicitis?
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a. > 2mm
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30. What percent of appendicitis patients present due to a fecalith?
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a. 25%
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31. What are two CT findings that indicate acute appendicitis?
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a. Periappendiceal fat stranding
b. Target sign |
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32. What should you do with patients that have had a long duration of symptoms (>5 days)?
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a. Treat with antibiotics, IV fluids, and bowel rest
b. Manage any abscess with percutaneous drainage c. May have interval appendectomy in 6-8 weeks |
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33. How can you pharmacologically manage acute appendicitis prior to surgery?
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a. Single preoperative dose for surgical wound prophylaxis
b. Postoperative antibiotics are unnecessary |
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34. How can you pharmacologically manage a perforated appendix?
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a. Broad spectrum therapy with activity against gram negative rods and anaerobes
b. Continue until leukocytosis normalizes |
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35. What are the benefits of a laproscopic appendectomy?
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a. Reduced length of hospital stay
b. Earlier return to daily activity c. Preferred in obese patients for improved visualization |
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36. What are the benefits of an open appendectomy?
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a. Decreased OR room costs
b. Fewer readmission rates c. Fewer complications→ fewer intraabdominal abscesses |
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37. What should you be sure to do in an open appendectomy?
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a. Cauterize and invert appendiceal stump to prevent a mucocele
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38. What is a 3rd option for an appendectomy?
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a. Open laprascopic
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39. What are carcinoids?
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a. Neuroendocrine tumor originating in enterochromaffin cells
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40. Where is the most common location for carcinoids?
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a. Appendix
b. 70% in tip |
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41. What would a carcinoid with ≥ 2 cm size OR found at base of appendix indicate?
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a. Right hemicolectomy
b. Due to risk of metastasis |
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42. What are the sx of carcinoid syndrome?
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a. Flushing
b. Diarrhea c. Bronchospasm/wheezing d. Right heart failure |
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43. At what point is carcinoid syndrome symptomatic?
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a. When metastatic to liver
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44. What is the tx for carcinoid syndrome?
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a. Octreotide→ symptomatic relief
b. Hepatic resection is possibly curative |
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45. Where does Meckel diverticulum traditionally present?
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a. Antimesenteric border of ileum
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46. What is the most common cause of painless lower GI bleeding in children?
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a. Meckel diverticulum
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47. What are the most common types of tissue found in Meckel diverticula?
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a. Pancreatic (#1)
b. Gastric→ most common to cause symptoms |
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48. How does Meckel diverticulum present?
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a. Diverticulitis
b. Bleeding |
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49. How do you tx Meckel diverticulum?
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a. Segmental small bowel resection
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50. What should you do if you incidentally discover a Meckel diverticulum?
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a. In children/young adults→ remove
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51. What are the contraindications for a diverticulotomy? What should you do instead?
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a. Neck is narrow
b. Base is >1/3 the diameter of the normal bowel lumen c. Do a segmental resection instead |
