Topics In Medicine

Front 1

pain in RUQ. Differential:

Back 1

Acute cholecystitis and biliary colic
Acute hepatitis
Hepatic abscess
Hepatomegaly secondary to CHF
Perforated duodenal ulcer
Acute pancreatitis (bilateral pain)
Retrocecal appy.
Herpes zoster
Myocardial ischemia
RLL pneumonia

Front 2

Diffuse abdominal pain

Back 2

Peritonitis
Acute pancreatitis
Sickle cell crisis
Early appendicitis
Mesenteric thrombosis
AGE
Dissecting or rupturing aneurysm
Intestinal obstruction
Diabetes mellitus

Front 3

pain in LUQ. Differential:

Back 3

Gastritis
Acute pancreatitis
Spleen: rupture, infarction, aneurysm, enlargement
Myocardial ischemia
LLL pneumonia

Front 4

pain in RLQ. Differential:

Back 4

Appendicitis
Regional enteritis
Meckel’s diverticulitis
Cecal diverticulitis
Leaking aneurysm
Abd. wall hematoma
Ruptured ectopic pregnancy
Twisted ovarian cyst
PID
Mittelschmerz
Endometriosis
Ureteral calculi
Seminal vesiculitis
Psoas abscess
Mesenteric adenitis
Groin hernia (incarcerated/strangulated)

Front 5

pain in LLQ. Differential:

Back 5

Sigmoid diverticulitis
Leaking aneurysm
Ruptured ectopic pregnancy
Mittelschmerz
Twisted ovarian cyst
PID
Endometriosis
Ureteral calculi
Seminal vesiculitis
Psoas abscess
Groin hernia (incarcerated/
strangulated)
Regional enteritis

Front 6

systemic (Etraabdominal etiology)

Back 6

DKA SLE
AKA vasculitis
uremia glaucoma
SCD porphyria
hyperthyroidism

Front 7

toxic (Etraabdominal etiology)

Back 7

methanol poisoning
heavy metal toxicity
scorpion bite
black widow spider bite

Front 8

infectious (Extraabdominal etiology)

Back 8

strep pharyngitis (mostly in kids)
Rocky Mountain Spotted fever
mono!

Front 9

other Extraabdominal causes of abdominal wall pain:

Back 9

herpes zoster
muscle spasm
muscle hematoma

Front 10

more ominous (reasons for concern) if pain is:

Back 10

<48 hrs, no prior Hx, constant (vs intermittent)

Front 11

auscultation of abdomen. Silent?

Back 11

ileus (blockage)

Front 12

auscultation of abdomen. High pitched?

Back 12

obstruction

Front 13

auscultation of abdomen. Bruits?

Back 13

vascular

Front 14

if pain rebound? pnt 'guarding' when doc's palpating?

Back 14

peritoneal irritation present
have pnt take a deep breath then palpate (guarding not relieved? then it is involuntary guarding)

Front 15

apin increased upon contracting abdominal wall

Back 15

abdominal wall is the origin of pain

Front 16

rebound tenderness/pain?

Back 16

HALLMARK of peritoneum being irritated

Front 17

MURPHY's sign

Back 17

pnt takes a deep breath and suddenly stops while doc is resisting pnt's liver descend. May be a sign of GB and liver probs

Front 18

OBTURATOR

Back 18

hip flexed and rotated internally and externally

Front 19

ROVSING's sign

Back 19

left exam for rebound shows right tenderness

Front 20

Lipase or Amylase? which is more specific for pancreas?

Back 20

LIPASE must be x2 to x3 to be indicative of pancreatic involvement.

Front 21

Alkaline phosphatase elevated?

Back 21

biliary tract dx

Front 22

transaminases up? ALT AST

Back 22

Hepatitis

Front 23

urinalysis is helpful in diagnosing UTI and kidney stones

Back 23

not very helpful in diagnosing AAA or appendicitis (only 30% pos for hematuria)

Front 24

pregnancy test is a vital sign!

Back 24

serum hCG and uCG

Front 25

when inorganic phosphate and lactate levels are elevated

Back 25

mesenteric ischemia... if labs SHOW elevation - > too late for pnt... surgical resection is a must

Front 26

what do dilated loops of bowel mean?

Back 26

obstruction or volvulus

Front 27

best way to determine pulmonary causes of abdominal pain

Back 27

CXR upright view

Front 28

ultrasound is the best test (test of choice) for what conditions?

Back 28

biliary problem or ectopic pregnancy

Front 29

helical CT is best for:

Back 29

appendicitis and AAA (abdominal aortic aneurysm)

Front 30

in case of ectopic pregnancy cannot rely on WBC

Back 30

nota bene

Front 31

elderly? obscure presentation of abdominal pain..look for reasons to admit

Back 31

in HIV: obstruction? -> portal lymphadenopathy.

Front 32

in HIV: esophagitis?

Back 32

Candida and HSV

Front 33

functional cause of abdominal pain

Back 33

idiopathyc..pain is likely real but psychiatric disorders may be present, abuse too. Pain management and psych consult necessary.

Front 34

peak of appendix is adolescence/young adulthood

Back 34

younger than 6 y.o. appendix is difficult to diagnose

Front 35

epigastric periumbilical pain that migrates after 8-10hrs to RLQ. feverish. Dx?

Back 35

appendicitis

Front 36

pain in RUQ with possible radiation to R shoulder, often a steady pain

Back 36

biliary tract dx-> cholelithiasis 80% cholesterol stones! (pigmented? black?->hemolytic disorder; brown?->infection)

Front 37

cholelithiasis management?

Back 37

antiemetics and analgesics, IV fluids, admit pnt

Front 38

on Ultrusound with cholelithiasis what do we see?

Back 38

wall thickening and stones

Front 39

oral bile acids in treatment of cholelithiasis take long long time to be effective

Back 39

cholecystitis - inflammation of gall bladder

Front 40

cholangitis - inflammation of a bile duct of the entire biliary tree. A non-diagnostic Charcot's triad is:

Back 40

1) RUQ pain
2) fever
3) jaundice
nota bene: high mortality rate

Front 41

most causes of acute pancreatitis are?

Back 41

EtOH or gallstones

Front 42

what is the name of criteria that is a mortality predictor for pancreatitis?

Back 42

Ranson's criteria
0-3 -- 1%
3-4 -- 15%
5-6 -- 40%
>7 -- 100%

Front 43

pancreatitis is difficult to diagnose. most at autopsy. if 2 Ranson's criteria- ICU admission is necessary

Back 43

see calcifications of pancreas on CT! see enlarged pancretic duct on Ultrasound

Front 44

Acute Gastroenteritis A.G.E.) is the most common misdiagnose of appendicitis unless present in several family members

Back 44

Gastroenteritis is usually viral (fever common, diarrhea-key!)

Front 45

Mesenteric adenitis - RLQ pain is similar to appendicitis.

Back 45

Mesenteric adenitis (inflammation of mesenteric lymph nodes) usu follows viral disease.

Front 46

two main causes of Peptic Ulcer Disease PUD are?

Back 46

H. pylori and NSAIDs

Front 47

treatment of H. pylori

Back 47

macrolides, amoxicillin, PPI

Front 48

Gastritis is used synonymously with what term?

Back 48

Dispepsia

Front 49

prostaglandins are used as Upper GI meds. what's the mechanism?

Back 49

Inhibits gastric acid secretion
Mucus and bicarbonate production increased
Stimulation of mucosal blood flow

Front 50

most common location for viscus perforations is duodenum (duodenal ulcer)

Back 50

free air - obvious on film, and WBC elevated

Front 51

diverticulitis (mostly left sided presentation)

Back 51

herniation of colonic mucosa and submucosa

Front 52

diverticulitis s&s

Back 52

change in stool frequency and consistency, rectal bleeding. on CT see soft tissue thickening and pericolonic edema

Front 53

high pitched bowel sounds?

Back 53

bowel obstruction

Front 54

functional obstruction

Back 54

decreased gut motility. Ogilivie's Syndrome- all s&s of obstruction without an identifiable leision

Front 55

intussusception - rare in adults but mostly in children. what's on AXR?

Back 55

soft tissue mass in RUQ

Front 56

large bowel obstruction is less common than small b.o.

Back 56

sigmoid large bowel obstruction-mostly in elderly or disabled, immobile

Front 57

for LBO surgical interference is likely

Back 57

AAA - atherosclerosis is in 95% cases of AAA (pain radiates to back , testes, perineum -tearing)

Front 58

more s&s of AAA? (risk of ruptures begin at 3cm..most ruptures are at 5cm)

Back 58

distal pulses are absent or unequal. abdominal bruits

Front 59

AAA ruptured? management:

Back 59

two bore I.V.s.....hold 6 units of PRBC's....surgery (hypotention

Front 60

with Mesenteric Ischemia... what's pain like?

Back 60

sever pain

Front 61

with Mesenteric Ischemia bowel sounds are present

Back 61

Mesenteric Ischmia- WBC high, Lactate is high too

Front 62

Ureteal colic (mostly men)

Back 62

common problem ages 20-50

Front 63

Ureteal colic due to

Back 63

Ca oxalate, Ca oxalate phosphate (75%)
struvite (15%) Mg/NH4/PO4
uric acid stones are radiolucent

Front 64

Ureteal colic - sudden onset of flank pain

Back 64

80% of ureteal colic has hematuria

Front 65

abd pain with fever and chills?

Back 65

TRUE EMERGENCY

Front 66

kidney stones

Back 66

if <5mm 90% pass within 4 wks
if >8mm - surgery

Front 67

presence of cremasteric reflex

Back 67

excludes diagnosis of testicular torsion

Front 68

Bell Clapper deformity

Back 68

loose hanging testicle and redundant spermatic cord which twists on itself. Operative exploration is best, not nuclear scan, etc.

Front 69

Meckel's diverticulum (usu male child; massive generally painless)

Back 69

most common congenital malformation of small intestine

Front 70

Rule of 2’s:
2% of population
2% of affected become symptomatic
½ symptomatic by age 2
Majority symptomatic by 2nd decade
2 cm. wide, 2 cm. long
Usually located within 2 feet of ileocecal valve

Back 70

nota bene

Front 71

ruptured ectopic pregnancy

Back 71

third leading cause of maternal death

Front 72

s&s of ectopic pregnancy

Back 72

50% vaginal bleeding and abd pain

Front 73

predisposing factors

Back 73

infertility treatment, prior PID, prior ectopic pregnancy, smoking

Front 74

what kind of acid-base blood chemistry hypoxemia(deficiency of dissolved O2 in bld), pain and pulmonary emboli will cause?

Back 74

respiratory alkalosis

Front 75

what kind of acid-base blood chemistry does diarrhea cause?

Back 75

metabolic acidosis

Front 76

what kind of acid-base blood chemistry does vomiting cause?

Back 76

metabolic alkalosis

Front 77

what kind of acid-base blood chemistry do opioids cause?

Back 77

respiratory acidosis

Front 78

FRC (functional residual capacity) is increased in?

Back 78

obstructive pulmonary dx

Front 79

Asthma, Bronchiectasis, Emphysema, Chronic Bronchitis, Bronchiolitis, Cystic fibrosis
-----------these are examples of?

Back 79

obstructive pulmonary dx

Front 80

Smooth muscle surrounds airways, with beta-2 receptors; with Adrenergic stimulation what happens?

Back 80

bronchodilation

Front 81

with obstructive dx: Vital Capacity?
Functional Residual Capacity?
Residual Volume?
Total Lung Capacity? UP or DOWN

Back 81

Vital Capacity: down
Functional Residual Capacity: up
Residual Volume: up
Total Lung Capacity: NML or up

Front 82

what is the mainstay asthma management that decreases frequency of the attacks?

Back 82

inhaled corticosteroids (Nota bene: pnts only go for albuterol -short-acting β2-adrenergic receptor agonist forgoing corticosteroids, thus frequency is not addressed)

Front 83

management of acute asthma attack

Back 83

Monitor
IV
Fluids
Oxygen
B-agonists (nebulizer)
Systemic steroids
ABG
CXR?
Mg, heliox

Front 84

Slowly progressive (years)
Irreversible obstruction
Decreased or absent response
to bronchodilators

Back 84

COPD

Front 85

Decreased FEV1 & FEV1/FVC ratio is a hallmark for?

Back 85

obstructive dx (pulmonary flow test, cxr are gold standards in evaluation)

Front 86

what three findings do we see with emphysema "pink puffer" (vs"blue bloater" in chronic bronchitis)?

Back 86

arterial deficiency, bullous dx and hyperinflation

Front 87

foul smelling cough, "tram tracks" on CXR

Back 87

bronchiectasis (thickened bronchial walls yet easily collapsible)

Front 88

what is the most common genetic disorder in white population? (autosomal recessive)

Back 88

cystic fibrosis -Disease of defective chloride transport and sodium reabsorption in airway and ductal endothelial cells

Front 89

mechanism of cystic fibrosis

Back 89

Formation of abnormally thick and viscous secretions. Luminal obstructions develop in respiratory, hepatobiliary, GI, and reproductive tracts develop

Front 90

colonization of mucus in CF

Back 90

S. aureus, then H. influenzae, then Pseudomonas aeruginosa.. then bronchiectasis develops

Front 91

what is #1 test for CF?

Back 91

sweat chloride test

Front 92

one of the modalities for treatment for CF?

Back 92

pancreatic enzymes

Front 93

for severe persistent asthma, a monoclonal Ab that binds IgE. what's the drug?

Back 93

Omalizumab

Front 94

cremasteric muscle is a derivative/continuation of which abdominal muscle group?

Back 94

internus abdominis muscle (middle layer of adb muscles)

Front 95

the weakest area of the abdominal wall. The majority of the hernias occur along this line

Back 95

linea Alba

Front 96

incarcerated hernias can not be placed back into the proper place for one or another reason.

Back 96

b/c the contents of the hernia sac is trapped or imprisoned in the abnormal position