Mdt Bravo Gastrointestinal Test 1

Front 1

In blunt abdominal trauma, common injuries that include splenic rupture and liver fractures are caused by what?

Back 1

Direct impact

Front 2

What type of blunt abdominal trauma is associated with high speed MVA's and falls from heights.

Back 2

Deceleration

Front 3

What type of blunt abdominal trauma is associated with being run over, and extensive soft tissue loss?

Back 3

Shear forces

Front 4

In blunt abdominal trauma what are some associated injury syndromes with insidious onset?

Back 4

Rib FX
Pelvic FX
Thoracic/ Lumbar FX
Abdominal Wall Injuries

Front 5

In blunt abdominal trauma what are 3 modes of presentation that may be difficult to DX due to insidious on set?

Back 5

Associated injury syndrome
Hypotensive shock syndrome
Peritonitis syndrome

Front 6

A pt. that presents with fever, tachycardia, diffuse abdominal px and tenderness, and ileus after blunt abdominal trauma could be DX with what?

Back 6

Peritonitis syndrome

Front 7

What are some complications of blunt abdominal trauma?

Back 7

Organ injury:

Liver
Spleen
Kidney
Pancreas
DIAPHRAGM <---- test answer

Front 8

What is the disposition of a pt. with blunt abdominal trauma with evidence of peritonitist, unstable vital signs, or questionable DX?

Back 8

MEDEVAC

Front 9

What are the 2 classifications of penetrating abdominal wounds?

Back 9

High and low velocity

Front 10

What are the S/S of shock in penetrating abdominal trauma?

Back 10

Tachycardia
Hypotension
Cold, clammy skin
Oliguria

Front 11

What signifies a serious visceral injury in penetrating abdominal trauma?

Back 11

Rigidity and guarding

Front 12

In blunt abdominal trauma what labs are done?

Back 12

CBC/DIFF

monitor HCT q6-8h

Front 13

In an abdominal eviseration what is a wound management TX?

Back 13

NS soaked sponges, apply dressing

Front 14

Hemorrhoids are painful varicosities in the superior or inferior what?

Back 14

Hemorrhoidal venous plexus

Front 15

What can happen to internal hemorrhoids that bulge into rectal lumen during defecation?

Back 15

They could prolapse

Front 16

What are the classic features of peptic ulcer dz?

Back 16

Rhythmicity and Periodicity

Front 17

What are the 3 major causes of Peptic Ulcer Dz?

Back 17

**NSAIDS**
Chronic H. Pylori Infection
Zollinger-Ellison

Front 18

What is the hallmark symptom of PUD that is present in 80-90% of pt's?

Back 18

Epigastric px

Front 19

Which type of hemorrhoids are more likely to be thrombosed?

Back 19

External hemorrhoids

Front 20

What is the probable cause of hemorrhoids?

Back 20

Increased intravenous pressure in the hemorrhoidal plexus.

Front 21

What is a predisposing factor for hemorrhoids?

Back 21

Heart Failure

Front 22

A pt with hemorrhoids may state what about defecation in their HX?

Back 22

That they have intermitten rectal bleeding after defecation.

Front 23

If external hemorrhoids are thrombosed what might the pt. c/o in the anal area?

Back 23

large subcutaneous lump

Front 24

On physical examination external hemorrhoids will appear how?

Back 24

As blue swellings at the anus.

Front 25

How are internal hemorrhoids detected?

Back 25

By digital rectal exam

Do the Dr. DRE

Front 26

What can help prevent straining during defecation?

Back 26

Stool softeners

Front 27

What procedures can be used to treat hemorrhoids?

Back 27

Cryosurgery
Hemorrhoidectomy
Ligation <--- test answer

Front 28

What is the prognosis after hemorrhoid TX?

Back 28

Hemorrhoids will resolve but have an increased incidence of recurrence.

Front 29

What is a localized infection that appears as a collection of pus due to inflammation of the soft tissue of the anus or rectum?

Back 29

Anorectal abscess

Front 30

In anorectal abscess or fistula what is the first SX a pt. will report in the HX of the illness?

Back 30

Throbbing rectal pain.

Front 31

Why might a pt with a anorectal abscess or fistula complain about sitting?

Back 31

They have a hard painful lump on one side.

Front 32

What might a DRE detect in a pt. with suspected Anorectal abscess or Fistula?

Back 32

A palpable indurated tract and a depression or ulcer in the midline anteriorly or at the dentate line posteriorly

Front 33

What is the TX for Anorectal abscess?

Back 33

Surgical I&D under caudal anesthesia.

Front 34

Pilonidal cyst incidence is highest among who?

Back 34

Hirsute white males 18-30

Front 35

What are the causes of Pilonidal cyst?

Back 35

Hirsutism
Stretching or irritation of sacrococcygela area
Poor hygiene
Excessive sweat
Tight clothes
Sedentary life style
Obesity

Front 36

Discharge in a Pilonidal cyst usually doesn't contain what?

Back 36

Bowel bacteria

Front 37

What is a conservative TX for a Pilonidal cyst?

Back 37

I&D
Extraction of hair
Sitz baths

Front 38

Anal fissures are also known as what?

Back 38

Fissura in ano

Front 39

What is a laceration or crack in the lining of the anus that extends to the circular muscle?

Back 39

Anal Fissure (fissura in ano)

Front 40

Which type of anal fissure is the rarer type and is 10 times more common in females?

Back 40

Anterior anal fissure

Front 41

What are the 2 possible causes of an anterior anal fisssure?

Back 41

Child birth or rarely from stricture caused by scar tissue.

Front 42

What is the TX for an acute anal fissure?

Back 42

Local pain relief with analgesics
Sitz bath
Bulk producing agents

Front 43

What is the key symptoms of peritonitis?

Back 43

Sudden, severe diffuse ab px that localizes in the area of underlying disorder.

Front 44

How do you decompress a bowel in a pt. with peritonitis?

Back 44

By Nasogastric intubation

Front 45

What disease associated with chronic gastritis causes chronic reflux of pancreatic secretions, bile, and bile acids from the duodenum into the stomach?

Back 45

Peptic ulcer disease (PUD)

Front 46

What is the TX for a pt. with gastritis and massive bleeding?

Back 46

Blood replacement
Iced saline lavage
Sometimes surgery

Front 47

What is the last resort in gastritis if conservative TX fails?

Back 47

Surgery

Front 48

What is an inflammation of the stomach and small intestine that is a self limiting disorder. Can be referred to as travelers diarhhea.

Back 48

Gastroenteritis

Front 49

In Gastroenteritis what would be a sign of poor hydration?

Back 49

Poor skin tugor.

Front 50

Regional enteritis is also known as what?

Back 50

Crohn's disease

Front 51

What inflammatory bowel disease may affect any part of the GI tract but usually involves the terminal ileum?

Back 51

Crohn's disease (regional enteritis)

Front 52

When would diarrhea be worse in a pt. with suspected Crohn's disease?

Back 52

Emotional upset

Ingestion of poorly tolerated foods

Front 53

In Crohn's disease what might a Barium enema show that would confirm the DX?

Back 53

Fissures and narrowing of the intestines

Front 54

What is the most common site for diverticula?

Back 54

Sigmoid colon

Front 55

Diverticular disease in the stomach may be a precursor to what 2 diseases?

Back 55

1. Peptic disease
2. Neoplastic disease

Front 56

Diverticular disease is most common in adults of what age?

Back 56

45 and older

Front 57

Diverticular disease affects what percentage of adults over age 60?

Back 57

30%

Front 58

When food mixed with bacteria hardens in the diverticulum what is formed?

Back 58

A fecalith

Front 59

When food mixed with bacteria hardens in the diverticulum what occurs?

Back 59

Diverticulitis

Front 60

What might a pt. HX reveal in a person with possible diverticulitis?

Back 60

Intermitten dull/ steady pain in LLQ

Front 61

In appendicitis where does the pt. complain of pain?

Back 61

McBurneys point (RLQ)

Front 62

In the HX of appendicitis what might be found about a pt's sleeping position?

Back 62

They may sleep with right knee bent to decrease pain.

Front 63

Name 3 recommened antibiotics for preoperative administration in appendicitis?

Back 63

Ampicillin
Gentamycin
Metronidazole

Front 64

What is the disease caused by gallstones partially or completely obstructing bile duct?

Back 64

Choledocholithiasis

Front 65

In a pt. with possible gallbladder disease when is an attack likely to occur?

Back 65

After fatty meals or a large meal after fasting.

Front 66

What disease is associated with, alcholism, trauma, and peptic ulcer disease in men?

Back 66

Pancreatitis

Front 67

What disease is associated Pancreatitis disease in women?

Back 67

Biliary tract disease

Front 68

What may be seen on Physical exam of a pt. with suspected Pancreatitis?

Back 68

Generalized jaundice

Cullens sign (bluish periumbilical)

Turners sign (bluish flank discoloration)

Front 69

What is the aim of therapy in a pt. with IBS?

Back 69

Control SX with changes in diet, stress, and life style.

Front 70

Ulcerative colitis occurs primarily in who?

Back 70

Young adults, especially women.

Front 71

Ulcerative colitis is more prevalent among who?

Back 71

Jews and higher socioeconomic groups.

Front 72

A pt with Ulcerative colitis may expeirence what during sleep?

Back 72

Nocturnal diarrhea