Im Gi Pain Basics Vasc Usmle 2

Front 1

type of pain:
vague, dull, poorly localized, usually midline due to bilateral innervation of organs based on embryologic origin

Back 1

Visceral Pain

(Visceral is Vague)
ex: early appendicitis

Front 2

type of Pain:
sharp, well-localized and involves the peritoneum and is associated w/ rebound and guarding

Back 2

Parietal Pain

(Parietal is Pinpoint)
ex: late appendicitis

Front 3

Referred pain:

Ureteral obstruction in man

Back 3

Ipsilateral testicle

Front 4

Dx:
45-yo obese woman complains of fever, RUQ pain and nausea that worsens when she eats fatty foods

Back 4

Cholecystitis

Front 5

Diff Dx:
Epigastric Pain
- GI (3)
- Pancreatic (2)
- Aortic (2)
- Cardiac (3)

Back 5

- Gastritis; Peptic Ulcer; GERD

- Acute/Chronic Pancreatitis

- Ruptured Aortic Aneurysm; Dissecting Aorta

- Angina, MI, Pericarditis

Front 6

Diff Dx:
RUQ Pain
- Hepatobiliary (4)
- GI (1)

Back 6

- Cholelithiasis; Cholecystitis; Cholangitis; Hepatitis

- Peptic Ulcer

Front 7

Diff Dx:
LUQ Pain
- Splenic (5)
- GI (1)

Back 7

- Spleen trauma; infarction; abscess; rupture; Mononucleosis

- Gastric Ulcer

Front 8

Diff Dx:
RLQ Pain
- GI (3)

Back 8

Small bowel obstruction;

Appendicitis;

Crohn's Dz

Front 9

Diff Dx:
LLQ Pain
- GI (2)

Back 9

Inflammatory Bowel Dz;

Diverticulitis

Front 10

Diff Dx:
Flank Pain
- GU (5)

Back 10

NET PP:
Nephrolithiasis;
Epididymitis;
Testicular Torsion;
Pyelonephritis;
Prostatitis

Front 11

Diff Dx Pain:
Adnexal (lower abdominal) Pain
(6)

Back 11

PET SOCk:
PID;
Ectopic Pregnancy;
Tubo-ovarian abscess;
Salpingitis;
Ovarian torsion;
Cystitis

Hint 11

PET SOCk

Front 12

Dx:
26-yo woman has severe LLQ pain, vaginal bleeding and light-headedness. Last menstrual period was 6 weeks ago

Back 12

Ectopic Pregnancy

Front 13

Diff Dx:
Pain Anywhere in Abdomen
(4)

Back 13

Strangulated hernia;

Large Bowel Obstruction;

Sigmoid Volvulus;

Mesenteric Ischemia

Front 14

Dx:
28-yo woman presents w/ diffuse abdominal pain, nausea, and confusion. She is not pregnant but takes a stained-glass class.

Back 14

Lead poisoning

Front 15

Diff Dx:
Abdominal wall Pain
(2)

Back 15

Hernia

Rectus sheath hematoma

Front 16

Diff Dx:
Metabolic/genetic-related Abdominal pain
(4)

Back 16

HyperC;

Acute Intermittent Porphyria;

DKA;

Sickle cell

Front 17

Diff Dx:
Viral-related Abdominal Pain
(3)

Back 17

Herpes Zoster;

Mononucleosis;

HIV

Front 18

Diff Dx:
Toxin-related Abdominal Pain
(2)

Back 18

Heavy Metal poisoning

Black Widow Spider venom

Front 19

(3) vascular causes of abdominal pain to always consider in the elderly

Back 19

MAM:

Mesenteric Ischemia;

AAA;

MI

Front 20

Diff Dx of an emergency patient w/ absent bowel sounds (3) or high-pitched sounds (1)

Back 20

Absent:
Pancreatitis;
Ischemia;
Acute Abdomen

High-pitched:
Obstruction

Front 21

63-yo obese man complains of pain in his "kidney" for 3 days. He has Hx of MI x 2 and no back tenderness.

Back 21

AAA

Front 22

Dx:
hypotension; abdominal or back pain; pulsatile mass in abdomen; Hx of vascular dz or atherosclerosis

Back 22

AAA

Front 23

(3) Dx tests for AAA

Back 23

Angiogram (gold standard)

MRI or CT w/ contrast

Front 24

Dx:
72-yo man w/ Hx of A-fib, on digoxin and complains of severe abdominal pain out of proportion to the exam

Back 24

Acute Mesenteric Ischemia

Front 25

72-yo woman w/ Hx of MI complains of gnawing abdominal pain after eating. She lost 15 pounds in the past month.

Back 25

Chronic Mesenteric Ischemia

Front 26

Cause of Acute (2) vs. Chronic Mesenteric Ischemia

Back 26

Acute:
Emboli (A-fib);
Hypercoagulability

Chronic:
Atherosclerosis

Front 27

(2) possible lab signs w/ Mesenteric Ischemia

Back 27

Increased Lactate

Metabolic Acidosis

Front 28

Gold standard test for Mesenteric Ischemia

(2) others

Back 28

Gold standard: Angiogram

others:

Spiral CT w/ contrast

MRI

Front 29

First step for Mesenteric Ischemia

Next?

Back 29

First: Maintain tissue perfusion w/ IV fluids until...

Surgical bypass