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18 Cards in this Set
- Front
- Back
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Key History -
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Frequency
volume of stools duration of change in bowel habits associated Sxs - constitutional abdominal pain bloating sense of incomplete evacuation melena or hematochezia thyroid disease Sxs diet - esp. fiber & fluids meds - esp. recent ABx sick contacts travel camping HIV risk factors h/o abdominal surgeries diabetes pancreatitis alcohol and drug use family h/o colon cancer |
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Key PE -
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VS
relevant thyroid/endo exam abdominal exam rectal exam female pelvic exam |
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67 y/o M
presents with alternating diarrhea and constipation, decreased stool caliber and blood in the stool for the past 8 months. He also reports unintentional weight loss. He is on a low fiber diet and has a family h/o colon cancer. What is Differential? |
Colorectal cancer
IBS diverticulosis GI parasitic infection - ascariasis, giardiasis inflammatory bowel disease angiodysplasia |
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67 y/o M
presents with alternating diarrhea and constipation, decreased stool caliber and blood in the stool for the past 8 months. He also reports unintentional weight loss. He is on a low fiber diet and has a family h/o colon cancer. What is Workup? |
Rectal exam
CBC AST/ALT/bilirubin/alk phos cea colonoscopy barium enema CT - abdomen/pelvis |
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28 y/o M
presents with constipation (very hard stool) for the last 3 weeks. Since his mom died 2 mos. ago, he and his dad have only eaten junk food. What is Differential? |
Low-fiber diet
IBS substance abuse (e.g., heroin) depression hypothyroidism |
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28 y/o M
presents with constipation (very hard stool) for the last 3 weeks. Since his mom died 2 mos. ago, he and his dad have only eaten junk food. What is Workup? |
Rectal exam
TSH electrolytes urine tox |
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30 y/o F
presents with alternating constipation and diarrhea and abdominal pain that is relieved by defecation. She has no n/v, weight loss or blood in her stool. What is Differential? |
IBS
inflammatory bowel disease celiac disease chronic pancreatitis GI parasitic infection - ascariasis, giardiasis lactose intolerance |
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30 y/o F
presents with alternating constipation and diarrhea and abdominal pain that is relieved by defecation. She has no n/v, weight loss or blood in her stool. What is Workup? |
Rectal exam, stool for occult blood
CBC electrolytes stool for O&P AXR CT - abdomen/pelvis |
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33 y/o M
presents with watery diarrhea, vomiting and diffuse abdominal pain that began yesterday. He also reports feeling hot. Several of his coworkers are also ill. What is Differential? |
Gastroenteritis -
(bacterial, viral, parasitic, protozoal) food poisoning inflammatory bowel disease |
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33 y/o M
presents with watery diarrhea, vomiting and diffuse abdominal pain that began yesterday. He also reports feeling hot. Several of his coworkers are also ill. What is Workup? |
Rectal exam, stool for occult blood
stool leukocytes and culture CBC electrolytes CT - abdomen/pelvis |
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40 y/o F
presents with watery diarrhea and abdominal cramps. Last week, she was on ABx for a UTI. What is Differential? |
Pseudomembranous colitis
gastroenteritis cryptosporidiosis food poisoning inflammatory bowel disease |
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40 y/o F
presents with watery diarrhea and abdominal cramps. Last week, she was on ABx for a UTI. What is Workup? |
Rectal exam
stool leukocytes, culture, occult blood C. difficile toxin in stool electrolytes |
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25 y/o M
presents with watery diarrhea and abdominal cramps. He was recently in Mexico. What is Differential? |
Traveler's diarrhea
giardiasis amebiasis food poisoning hepatitis A |
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25 y/o M
presents with watery diarrhea and abdominal cramps. He was recently in Mexico. What is Workup? |
Rectal exam
stool leukocytes, culture, Giardia Ag, E. histolytica Ag electrolytes AST/ALT/bilirubin/alk phos viral hepatitis serology |
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30 y/o F
presents with watery diarrhea and abdominal cramping and bloating. Her Sxs are aggravated by milk ingestion and are relieved by fasting. What is Differential? |
Lactose intolerance
gastroenteritis inflammatory bowel disease IBS hyperthyroidism |
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30 y/o F
presents with watery diarrhea and abdominal cramping and bloating. Her Sxs are aggravated by milk ingestion and are relieved by fasting. What is Workup? |
Rectal exam
stool exam hydrogen breath test TSH |
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33 y/o M
presents with watery diarrhea, diffuse abdominal pain and weight loss over the past 3 weeks. He has not responded to ABx. What is Differential? |
Crohn's disease
gastroenteritis UC celiac disease pseudomembranous colitis hyperthyroidism small bowel lymphoma |
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33 y/o M
presents with watery diarrhea, diffuse abdominal pain and weight loss over the past 3 weeks. He has not responded to ABx. What is Workup? |
Rectal exam
stool exam and culture CBC, electrolytes TSH CT - abdomen colonoscopy small bowel series |
