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137 Cards in this Set
- Front
- Back
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Visceral pain in upper R quadrant can be from what? |
Liver distention in alcoholic hepatitis |
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Severe visceral pain is often associated with what other symptoms? |
N/V, sweating, pallor, restlessness |
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What kind of pain is difficult to localize? |
Visceral Pain |
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Visceral pain around the belly button can signify early what? As is progresses, it changes to parietal pain where due to inflammation of adjacent parietal peritoneum. |
Early acute appendicitis?
Right lower quadrant |
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What organs present with pain in epigastric region? |
Stomach, duodenum, pancreas |
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What organs present with pain in periumbilical region? |
Small intestine, appendix, proximal colon |
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What organs present with pain in Right upper quadrant or epigastric pain? |
Liver & biliary tree |
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What organs present with pain in suprapubic or sacral pain? |
Rectum |
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What organs present with pain in the hypogastric region? |
Colon, bladder, uterus. |
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Is parietal pain usually more severe or less severw than visceral pain? |
More severe |
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Pain that is steady, aching over involved structure and often aggravated by movement or coughing is what kind of pain? |
Parietal |
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When patients prefer to lie still, this is what kind of pain? |
Parietal |
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Back pain can refer from what organs? |
duodenal or pancreatic |
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Pain in the right shoulder or R chest refers from where? |
Biliary tree |
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Pain in the abdomen can refer from where? |
Chest, spine, pelvis |
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Pain in epigastric area can be referred pain from what 2 conditions? |
Pleurisy or acute myocardial infarction |
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Doubling over cramping colicky pain signifies what? |
Kidney stone |
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Sudden knifelike epigastric pain occurs with what disease process? |
Gallstone pancreatitis |
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Gastritis or GERD present with pain where? Cholecystitis presents with pain where? |
Epigastric RUQ |
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Patient present with indigestion that comes on with exertion and gets better when patient rests. This is likely what? |
Angina from inferior wall coronary artery disease |
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When a patient describes discomfort, this is referring to what possible feelings? |
Heartburn, bloating, nausea, abdominal fullness |
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What defines functional/non-ulcer dyspepsia? |
3 month history of nonspecific upper abdominal discomfort or nausea |
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A patient complains of chronic upper abdominal pain/discomfort of heartburn, acid reflux, or regurgitation at least once a week. This is assumed to be what until proven otherwise? |
GERD |
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A patient states he thinks he has heartburn, goes on to explain that it gets worse with exertion and better with rest. This is likely? |
Angina |
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what are some atypical respiratory symptoms of GERD? |
cough, wheezing, aspiration pneumonia |
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What are some pharyngeal symptoms of GERD? |
hoarseness and chronic sore throat |
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Patient presents with some epigastric discomfort and hoarseness when they talk, you think? Will this likely show up on endoscopy? |
GERD Only 50% chance |
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What are some pills that can cause pain on swallowing (Odynophagia)? |
ASA, NSAIDS |
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Right lower quadrant pain or pain that migrates from peri umbilical region combined with ab wall rigidity on palpation is probably what?
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Appendicitis
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Right lower quadrant pain or pain that migrates from peri umbilical region combined with ab wall rigidity on palpation is probably what?
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Appendicitis
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RLQ or peri umbilicAl pain w/ an wall rigidity could also be what in woman?
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PID, ruptured ovarian follicle, ectopic pregnancy
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Right lower quadrant pain or pain that migrates from peri umbilical region combined with ab wall rigidity on palpation is probably what?
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Appendicitis
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RLQ or peri umbilicAl pain w/ an wall rigidity could also be what in woman?
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PID, ruptured ovarian follicle, ectopic pregnancy
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Cramping pain radiating to R or L may be what?
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Renal stone
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Right lower quadrant pain or pain that migrates from peri umbilical region combined with ab wall rigidity on palpation is probably what?
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Appendicitis
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RLQ or peri umbilicAl pain w/ an wall rigidity could also be what in woman?
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PID, ruptured ovarian follicle, ectopic pregnancy
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Cramping pain radiating to R or L may be what?
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Renal stone
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Diffuse ab pain, no bowel sounds & firmness, guarding, rebound palpation is likely what?
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Small or L bowel obstruction
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Right lower quadrant pain or pain that migrates from peri umbilical region combined with ab wall rigidity on palpation is probably what?
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Appendicitis
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RLQ or peri umbilicAl pain w/ an wall rigidity could also be what in woman?
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PID, ruptured ovarian follicle, ectopic pregnancy
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Cramping pain radiating to R or L may be what?
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Renal stone
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Diffuse ab pain, no bowel sounds & firmness, guarding, rebound palpation is likely what?
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Small or L bowel obstruction
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Acute LLQ pain w/ palpable mass is probably?
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Diverticulitis
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Chronic ab pain with change in bowel habits & mass lesion, suspect?
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Colon Cancer
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Anorexia, N/V accompany gastrointestinal disorders, what are some of these disorders? |
Pregnancy, DKA, adrenal sufficiency, hypercalcemia, uremia, liver disease, emotional states, adverse drug reactions |
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A patient presents with regurgitation, what are some disease states that present with this? |
GERD, esophageal stricture, and esophageal cancer |
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What are some questions you should ask about a patient's emesis? |
How much? Did it contain blood? If so, what color? Did it have an odor? |
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What are the symptoms/signs of a small bowel obstruction? |
Pain and vomiting |
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What does fecal odor suggest when it comes from vomit? |
SBO, Gastrocolic Fistula |
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what is Hematemesis? |
coffee-ground emesis |
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What do the following in emesis suggest: clear or mucoid yellowish/greenish brownish/blackish with "coffee grounds" |
gastric juice bile blood altered by gastric juice |
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An abdominal fullness after a light or moderate meal should make you think, what? |
Diabetic gastroparesis, anticholinergic meds, gastric outlet obstruction, gastric cancer, hepatitis |
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When a patient points to the sterno-clavicular notch when asked where the dysphagia occurs, this indicates what? |
Esophageal dysphagia |
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If a patient states they have dysphagia with solids and liquids, what are you thinking?
If patient states just solids, think what? |
motility disorder
structural esophageal conditions |
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If patient states pain on swallowing, what is this called?
What things are you thinking for diagnosis? |
Odynophagia
esophageal ulceration from radiation infection: candida, cytomegalovirus, herpes, HIV |
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Excessive gas may be related to what? |
Lactose deficiency, IBS |
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Chronic diarrhea is considered how long? What are likely causes of this? |
More than 4 weeks Crohn's or Colitis |
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High volume, frequent watery stools are usually from where?
Small volume stools, diarrhea with mucus, pus or blood are from what conditions? |
Small intestine
Rectal inflammatory conditions |
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What do oily residue, frothy, floating diarrhea signify? |
Malabsoroption from celiac sprue, pancreatic insufficiency, small bowel bacterial overgrowth |
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What is common with penicillins, macrolides, magnesium-based antacids, metformin, herbal and alternative medicines? |
Diarrhea |
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The following medications cause diarrhea or constipation? Anticholinergic, Fe supplements, Ca channel blockers, opiates
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Constipation |
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Does diarrhea or constipation occur with the following? Diabetes, hypothyroidism, hypercalcemia, multiple sclerosis, Parkinson's Disease, Systemic sclerosis |
Constipation |
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What is melena? Is it associated with upper or lower GI bleeding? How much blood can produce melena? |
Black tarry stools Upper GI bleeding 100 ml |
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What is hematochezia? Is it associated with upper or lower GI bleeding? How much blood can cause this? |
Red or maroon colored stools Lower More than 1000 ml |
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Jaundice can occur because of which of the following: Hepatocytes decrease uptake of bilirubin Liver not conjugating bilirubin Increased production of bilirubin Decreased excretion of bilirubin into bile, meaning
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All of them |
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Impaired excretion of conjugated or unconjugated bilirubin occurs with the following: viral hepatitis, cirrhosis, primary biliary cirrhosis & oral contraceptives |
Conjugated |
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How can dark urine be associated with jaundice? |
Dark yellowish brown or tea color urine can happen in the presence of jaundice due to increased level of conjugated bilirubin in blood and thus in the urine, that should normally be excreted in the GI tract |
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How are gallstones and pancreatic cancer related to jaundice? |
They can both obstruct the common bile duct, and cause extrahepatic jaundice |
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If urine is dark colored, would this be conjugated or unconjugated urine? |
Conjugated |
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What would you look for or ask patient about to know if bile is obstructed from being excreted in stool? What disease process can this happen with? |
Ask if stool is gray or light colored (acholic)
Viral hepatitis |
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What can itching indicate in relation to jaundice? |
Cholestatic or obstructive jaundice |
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What does pain in relation to the liver, pancrease, or gall bladder have? |
Could be distended liver capsule, biliary cholic, pancreatic cancer |
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What questions would you ask to assess for hepatitis? |
- Ask about travel or meals in areas of poor sanitation, contaminated water or food (Hep A) - Exposure to parenteral or mucous membranes from infectious body fluids (blood, serum, semen, saliva thru sex or sharing needles (Hep B) - IV drug use, blood transfusion |
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What questions might you ask to assess for BPH (benign prostatic hyperplasia)? |
Do you have trouble starting your stream? Do you have to stand close to the toilet to void? Is there a change in the force or size of your stream? Do you hesitate in middle of voiding? Is there dribbling when you are through? |
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Match the following: Sudden overdistention of bladder Chronic bladder distention Bladder Disorders Bladder infection
Agonizing pain Painless Suprapubic pain Dull/pressure like |
Agonizing Pain Painless Suprapubic Pain Dull/pressure like |
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Right lower quadrant pain or pain that migrates from peri umbilical region combined with ab wall rigidity on palpation is probably what?
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Appendicitis
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RLQ or peri umbilicAl pain w/ an wall rigidity could also be what in woman?
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PID, ruptured ovarian follicle, ectopic pregnancy
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Cramping pain radiating to R or L may be what?
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Renal stone
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Diffuse ab pain, no bowel sounds & firmness, guarding, rebound palpation is likely what?
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Small or L bowel obstruction
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Acute LLQ pain w/ palpable mass is probably?
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Diverticulitis |
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Chronic ab pain with change in bowel habits & mass lesion, suspect?
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Colon Cancer
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Intermittent ab pain for 12 weeks of last 12 months with relief on BM, change in frequency, change in form, suspect?
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IBS
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Blood on surface or toilet paper with maybe some straining is likely what? |
Hemorrhoids
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A woman reports internal burning on urination. This is likely what?
For external burning, you would think? |
Internal - urethritis
External - vulvovaginitis |
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Where does a man feel prostate pain? |
Perineum |
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What does urgency suggest with urination? |
Bladder infection or irritation |
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Man complains of painful urination without frequency or urgency. This suggests? |
Urethritis |
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What is a significant increase in 24 hour urine output called? More than 3 liters, or abnormally high renal production of urine? |
Polyuria |
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What kind of polyuria would you see with infection? High volume or small volume frequency? |
Small volume |
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What kind of incontinence occurs with increased intra-abdominal pressure from coughing, sneezing, running, heavy lifting suggesting decreased contractility of urethral sphincter or poor support of bladder neck? |
Stress incontinence |
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What kind of incontinence occurs when unable to hold the urine due to detrusor overactivity? |
Urge incontinence |
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A man whom you know has Parkinson's states he is wetting is underwear and is having to wear a brief. He probably has what type of incontinence? What is happening? |
Overflow incontinence
He is probably not emptying his bladder |
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A patient's wife states that her husband who has dementia is having incontinence. U/A is (-), this is probably what type of incontinence? |
Functional incontinence |
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What are 2 ways you can test urine before labeling it hematuria? |
Dipstick and microscopic |
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How would pyelonephritis present differently than renal/ureteral colic? |
Pyelonephritis is upper flank pain with fever & chills Renal colic from obstruction of stone is severe and colicky |
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How is hepatitis A transmitted? Who is most at risk? Is there a vaccine? |
Fecal - oral travelers to endemic areas, male/male partners, drug users, chronic liver disease Yes |
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Which hepatitis appears asymptomatic until what develops? |
Advanced liver disease |
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At what age should you begin assessing patients for colorectal risk status? |
Age 20 |
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Which of the following are questions to ask for assessing colorectal cancer risk: Have you had colon cancer/adenomatous polyp Do you have IBS Has a family member had colon cancer or adenomatous polyp? |
Ask all 3 |
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If a person answers yes to any of previous questions, what is the next step? |
Screening for increased or high risk for colon cancer |
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How many Fecal Occult Blood Test (FOBT) samples annually are recommended?
If one sample is positive, what is the recommended follow-up? |
6 samples
colonoscopy |
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How often is a flexible sigmoidoscopy recommened for average risk?
How often is a colonscopy recommended for average risk patients? |
5 years
10 years |
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At what age is colorectal screening recommended w/ one option being the double contrast barium enema?
How often is this recommended? |
50
5 |
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Your patient has just been found to have a small adenoma, when should this patient have another colonscopy?
If it has been a large adenoma or multiple adenomas? |
3-6 yrs
within 3 years |
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In a person who had a colon resection for cancer, when should they have another colonoscopy? |
Within 1 year |
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The US Prevention Services Task Force recommends for the use of or against the use of ASA and NSAIDS in average risk patients to prevent colorectal cancer? |
Against it because of the incidence of GI bleed and renal impairment |
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Upon inspection, a bulge noted above the umbilicus is probably what? |
Hernia |
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An assymetric abdomen would alert you to assess for what? |
Enlarged organ or mass |
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You notice an pulsation in the epigastric region. This is what?
An increased pulsation in this region suggests what? |
normal aortic pulsation
aortic aneurysm or increased pulse pressure |
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What is the order of assessment for the abdomen and why? |
Inspect, Auscultate, Percuss, Palpate Because percussing or palpating the abdomen may alter the bowel sounds/frequency |
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Where do you auscultate on the abdomen for bruits if patient has HTN? |
epigastrium and each upper quadrant |
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A bruit in the epigastrium or RUQ suggests what? |
Renal artery stenosis |
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A patient has a bruit that can be auscultated with systole. This is likely what? |
normal and not concerning. Bruits with both systole and dystole suggest turbulent blood flow or partial arterial occlusion or arterial insufficiency |
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Why do we percuss the abdomen? |
To assess amount and distribution of gas and i.d. masses |
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The sound of tympany from percussing the abdomen is from what? What about dullness? |
Tympany is from gas Dullness is from solid or fluid filled areas |
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A protuberant tympanic abdomen suggests what? |
Intestinal obstruction |
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What would you think if there is dullness in the flanks? |
ascites |
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What does abdominal pain with coughing or light percussion suggest? |
Peritoneal inflammation |
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How is rebound tenderness assessed?
What does it suggest? |
Press down firmly and slowly and withdraw quickly
Peritoneal inflammation |
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Why is liver dullness displaced downward with COPD? |
Low diaphragm |
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Tympany in the RUQ could obscure liver dullness and falsely decrease estimate of liver size. What is this from? |
Gas in the colon |
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If you can percuss the liver at the right costal margin, what is the likelyhood of hepatomegaly? |
Double what it usually is |
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Tenderness on palpation over the liver suggests what? |
Inflammation |
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All of the following are true about diverticula except: A) they are located in colon B) Low fiber diet is associated with it C) Most are gram (-) bacteria D) Supplementing w/ fiber such as psyllium (metamucil) recommended |
C) Most are not gram (-), they are both (-) and (+) |
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All of the following are false statements regarding acute gastritis except: A) chronic intake of NSAIDS can cause this B) Chronic lack of fiber is main cause C) Screening test is barium swallow test D) Gold standard to evaluate is colonoscopy |
C) Screening test is barium swallow test |
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What is a positive splenic percussion sign? |
Change in percussion note from tympany to dullness on inspiration suggests splenic enlargement |
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What 2 organs if enlarged could you palpate in the LUQ |
Spleen and kidney |
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A pain that begins near the umbilical and shifts to RLQ is often what?
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Appendicitis
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A pain that begins near the umbilical and shifts to RLQ is often what?
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Appendicitis
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What is a positive Rovsing's sign?
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Pressing deeply in left lower quadrant that produces pain in RLQ
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What is a psoas sign?
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Increased abdominal pain when patient raises R knee against your hand that is on their thigh OR when patient lying on L and R leg extends
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What is a psoas sign?
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Increased abdominal pain when patient raises R knee against your hand that is on their thigh OR when patient lying on L and R leg extends
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Why does a positive psoas sign suggest appendicitis?
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Because inflamed appendix irritates the psoas muscle
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Where is pain experienced on a positive obturator sign?
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Right hypogastric area
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Cutaneous Hyperesthesia tests for what?
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Appendicitis
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What does a Murphy's sign mean?
What happens during a positive Murphy's sign? |
Acute choleycystitis
When hooking your fingers under costal margin, a sharp increase in tenderness with sudden stop in inspiratory effort |
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Which of these elicits a Murphy's sign? A) upon deep inspiration by pt, palpate firmly in RUQ below costovertebral angle B) bend patient's hip and knees at 90 degrees, then passively rotate hip externally, then internally C) Ask pt to squat, then place stethoscope on apical area D) Press into abdomen deeply, then release suddenly |
A) |
