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34 Cards in this Set
- Front
- Back
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Key History -
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Location
quality radiation severity (intensity) timing - relation to meals duration associated Sxs - constitutional GI cardiac pulmonary renal pelvic other exacerbating and alleviating factors prior h/o similar Sxs h/o of abdominal surgeries gallstones renal stones atherosclerotic vascular dis. meds alcohol and drug use domestic violence |
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Key PE -
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VS
heart exam lung exam abdominal exam including - guarding rebound Murphy's sign CVA palpation rectal exam pelvic exam (women) |
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45 y/o M
presents with sudden onset of colicky right-sided flank pain Pain radiates to testicles, accompanied by n/v, hematuria and CVA tenderness. What is Differential? |
Nephrolithiasis
renal cell carcinoma pyelonephritis GI etiology (appendicitis) |
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45 y/o M
presents with sudden onset of colicky right-sided flank pain Pain radiates to testicles, accompanied by n/v, hematuria and CVA tenderness. What is Workup? |
Rectal exam
UA UC and sensitivity BUN/Cr CT - abdomen US - renal IVP |
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60 y/o M
presents with dull epigastric pain that radiates to the back Weight loss, dark urine and clay-colored stool. He is a heavy drinker and smoker. What is Differential? |
Pancreatic cancer
acute viral hepatitis chronic pancreatitis cholecystitis/choledocho-lithiasis abdominal aortic aneurysm peptic ulcer disease |
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60 y/o M
presents with dull epigastric pain that radiates to the back Weight loss, dark urine and clay-colored stool. He is a heavy drinker and smoker. What is Workup? |
Rectal exam
CBC, electrolytes amylase and lipase AST/ALT/bilirubin/alk phos US - abdomen CT - abdomen |
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56 y/o M
presents with severe midepigastric abdominal pain that radiates to the back and improves when he leans forward He also reports anorexia, n/v. He is an alcoholic; has spent the past 3 days binge drinking What is Differential? |
Acute pancreatitis
PUD cholecystitis/choledocho-lithiasis gastritis AAA mesenteric ischemia alcoholic hepatitis Mallory-Weiss tear |
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56 y/o M
presents with severe midepi-gastric abdominal pain that radiates to the back and improves when he leans forward He also reports anorexia, n/v. He is an alcoholic; has spent the past 3 days binge drinking What is Workup? |
Rectal exam
CBC, electrolytes, BUN/Cr, amylase, lipase, AST/ALT/bilirubin/alk phos US - abdomen CT - abdomen upper endoscopy ECG |
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41 y/o obese F
presents with RUQ abdom pain. Pain radiates to the right scapula and is associated with n/v and a fever of 101.5F The pain started after she had eaten fatty food. She's had similar but less intense episodes that lasted a few hours. Exam reveals a positive Murphy's sign. What is Differential? |
Acute cholecystitis
hepatitis choledocholithiasis ascending cholangitis PUD Fitz-Hugh-Curtis syndrome |
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41 y/o obese F
presents with RUQ abdom pain. Pain radiates to the right scapula and is associated with n/v and a fever of 101.5F The pain started after she had eaten fatty food. She's had similar but less intense episodes that lasted a few hours. Exam reveals a positive Murphy's sign. What is Workup? |
Rectal exam
CBC AST/ALT/bilirubin/alk phos US - abdomen HIDA scan |
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43 obese F
presents with RUQ abdom pain, fever and jaundice. She was diagnosed with asymptomatic gallstones one year ago. What is Differential? |
Ascending cholangitis
acute cholecystitis hepatitis choledocholithiasis sclerosing cholangitis Fitz-Hugh-Curtis syndrome |
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43 obese F
presents with RUQ abdom pain, fever and jaundice. She was diagnosed with asymptomatic gallstones one year ago. What is Workup? |
Rectal exam
CBC AST/ALT/bilrubin/alk phos vral hepatitis serologies US - abdomen MRCP ERCP |
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25 y/o M
presents with RUQ pain, fever, anorexia, n/v. He has dark urine and clay-colored stool. What is Differential? |
Acute hepatitis
acute cholecystitis ascending cholangitis choledocholithiasis pancreatitis acute glomerulonephritis |
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25 y/o M
presents with RUQ pain, fever, anorexia, n/v. He has dark urine and clay-colored stool. What is Workup? |
Rectal exam
CBC, amylase, lipase AST/ALT/bilirubin/alk phos UA viral hepatitis serologies US - abdomen |
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35 y/o M
presents with burning epigastric pain that starts 2-3 hrs. after meals. The pain is relieved by food and antacids. What is Differential? |
PUD
gastritis GERD cholecystitis chronic pancreatitis mesenteric ischemia |
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35 y/o M
presents with burning epigastric pain that starts 2-3 hrs. after meals. The pain is relieved by food and antacids. What is Workup? |
Rectal exam
amylase, lipase, lactate AST/ALT/bilirubin/alk phos endoscopy upper GI series |
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37 y/o M
presents with severe epigastric pain, n/v and mild fever. He appears toxic. He has a h/o of intermittent epigastric pain that is relieved by food and antacids. He also smokes heavily and takes aspirin on a regular basis. What is Differential? |
Peptic ulcer perforation
acute pancreatitis hepatitis cholecystitis choledocholithiasis mesenteric ischemia |
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37 y/o M
presents with severe epigastric pain, n/v and mild fever. He appears toxic. He has a h/o of intermittent epigastric pain that is relieved by food and antacids. He also smokes heavily and takes aspirin on a regular basis. What is Workup? |
Rectal exam
CBC, electrolytes, amylase, lipase, lactate AST/ALT/bilirubin/alk phos AXR upright CXR endoscopy |
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18 y/o M boxer
presents with severe LUQ abdom pain that radiates to the left scapula. He had infectious mono 3 wks. ago. What is Differential? |
Splenic rupture
kidney stone rib fracture pneumonia perforated peptic ulcer splenic infarct |
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18 y/o M boxer
presents with severe LUQ abdom pain that radiates to the left scapula. He had infectious mono 3 wks. ago. What is Workup? |
Rectal exam
CBC, electrolytes CXR CT - abdomen US - abdomen |
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40 y/o M
crampy abdominal pain, vomiting, abdominal distention and inability to pass flatus or stool. He has a h/o multiple abdominal surgeries. What is Differential? |
Intestinal obstruction
small bowel or colon cancer volvulus of the bowel gastroenteritis food poisoning ileus |
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40 y/o M
crampy abdominal pain, vomiting, abdominal distention and inability to pass flatus or stool. He has a h/o multiple abdominal surgeries. What is Workup? |
Rectal exam
CBC, electrolytes AXR CT - abdomen/pelvis CXR |
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70 y/o F
presents with acute onset of severe, crampy abdominal pain. She recently vomited and had a massive dark bowel movement. She has a h/o CHF and atrial fib, for which she has received digitalis. Her pain is out of proportion to the exam. What is the Differential? |
Mesenteric ischemia/infarction
diverticulitis PUD gastroenteritis acute pancreatitis cholecystitis/choledocholithiasis MI |
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70 y/o F
presents with acute onset of severe, crampy abdominal pain. She recently vomited and had a massive dark bowel movement. She has a h/o CHF and atrial fib, for which she has received digitalis. Her pain is out of proportion to the exam. What is the Workup? |
Rectal exam
CBC, amylase, lipase, lactate ECG, CPK-MB, troponin AXR CT - abdomen mesenteric angiography barium enema |
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21 y/o F
presents with acute onset of severe RLQ pain, n/v. She has no fever, urinary Sxs or vaginal bleeding and has never taken OCPs. Her LMP was regular. She has no h/o STDs. What is Differential? |
Ovarian torsion
appendicitis nephrolithiasis ectopic pregnancy ruptured ovarian cyst PID bowel infarct or perforation |
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21 y/o F
presents with acute onset of severe RLQ pain, n/v. She has no fever, urinary Sxs or vaginal bleeding and has never taken OCPs. Her LMP was regular. She has no h/o STDs. What is Workup? |
Pelvic exam
rectal exam urine hCG UA CBC doppler US - pelvis CT - abdomen laparoscopy |
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68 y/o M
presents with LLQ abdominal pain, fever and chills for the past 3 days. He also reports recent onset of alternating diarrhea and constipation. He consumes a low-fiber, high-fat diet. What is Differential? |
Diverticulitis
crohn's disease UC gastroenteritis abscess |
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68 y/o M
presents with LLQ abdominal pain, fever and chills for the past 3 days. He also reports recent onset of alternating diarrhea and constipation. He consumes a low-fiber, high-fat diet. What is Workup? |
Rectal exam
CBC, electrolytes CXR AXR CT - abdomen |
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20 y/o M
presents with severe RLQ abdominal pain, n/v. His discomfort started yesterday as a vague pain around the umbilicus. As the pain worsened, it became sharp and migrated to the RLQ. McBurney's and psoas signs are positive. What is Differential? |
Acute appendicitis
gastroenteritis diverticulitis crohn's disease nephrolithiasis volvulus or other intestinal obstruction/perforation |
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20 y/o M
presents with severe RLQ abdominal pain, n/v. His discomfort started yesterday as a vague pain around the umbilicus. As the pain worsened, it became sharp and migrated to the RLQ. McBurney's and psoas signs are positive. What is Workup? |
Rectal exam
CBC, electrolytes AXR CT - abdomen US - abdomen |
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30 y/o F
presents with periumbilical pain for 6 months. The pain never awakens her from sleep. It is relieved by defecation and worsens when she is upset. She has alternating constipation and diarrhea but no n/v, weight loss or anorexia. What is Differential? |
IBS
crohn's disease celiac disease chronic pancreatitis GI parasitic infection (amebiasis, giardiasis) endometriosis |
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30 y/o F
presents with periumbilical pain for 6 months. The pain never awakens her from sleep. It is relieved by defecation and worsens when she is upset. She has alternating constipation and diarrhea but no n/v, weight loss or anorexia. What is Workup? |
Rectal exam, stool for occult blood
pelvic exam urine hCG CBC electrolytes CT - abdomen/pelvis stool for O&P, E. histolytica antigen |
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24 y/o F
presents with b/l lower abdominal pain that started with the first day of her menstrual period. The pain is associated with fever and a thick, greenish-yellow vaginal discharge. She has had unprotected sex with multiple sexual partners. What is Differential? |
PID
endometriosis dysmenorrhea vaginitis spontaneous abortion pyelonephritis |
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24 y/o F
presents with b/l lower abdominal pain that started with the first day of her menstrual period. The pain is associated with fever and a thick, greenish-yellow vaginal discharge. She has had unprotected sex with multiple sexual partners. What is Workup? |
Pelvic exam
rectal exam urine hCG cervical cultures CBC/ESR UA, UC US - pelvis |
