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First Aid: Step 2 CS > Differential & Work-up: Abdominal Pain > Flashcards

Differential & Work-up: Abdominal Pain Flashcards

1
Q

45 yo M presents with sudden onset of colicky right-sided flank pain that radiates to the testicles, accompanied by nausea, vomiting, hematuria, and CVA tenderness.

A
  1. Nephrolithiasis
  2. Renal cell carcinoma
  3. Pyelonephritis
  4. GI etiology (eg, appendicitis)
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2
Q

WORK UP FOR:

  1. Nephrolithiasis
  2. Renal cell carcinoma
  3. Pyelonephritis
  4. GI etiology (eg, appendicitis)
A
  1. UA, urine culture & sensitivity, cytology
  2. BUN/Cr
  3. CT-abdomen
  4. U/S-renal
  5. KUB
  6. IVP
  7. Blood culture
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3
Q

60 yo M presents with dull epigastric pain that radiates to the back, accompanied by weight loss, dark urine, and clay colored stool. He is a heavy drinker and smoker. He appears jaundiced on exam.

A
  1. Pancreatic cancer
  2. Cholangiocarcinoma
  3. Primary sclerosing cholangitis
  4. Chronic pancreatitis
  5. Cholecystitis/choledocholithiasis
  6. Acute viral hepatitis
  7. Acute alcoholic hepatitis
  8. Abdominal aortic aneurysm
  9. Peptic ulcer disease
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4
Q

WORK UP FOR:

  1. Pancreatic cancer
  2. Cholangiocarcinoma
  3. Primary sclerosing cholangitis
  4. Chronic pancreatitis
  5. Cholecystitis/choledocholithiasis
  6. Acute viral hepatitis
  7. Acute alcoholic hepatitis
  8. Abdominal aortic aneurysm
  9. Peptic ulcer disease
A
  1. CT-abdomen
  2. CBC
  3. Electrolytes
  4. Amylase, lipase
  5. AST I ALT /bilirubin/alkaline phosphatase
  6. U/S-abdomen
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5
Q

56 yo M presents with severe mid epigastric abdominal pain that radiates to the back and improves when he leans forward. He also reports anorexia, nausea, and vomiting. He is an alcoholic and has spent the past 3 days binge drinking.

A
  1. Acute pancreatitis
  2. Peptic ulcer disease
  3. Cholecystitis/choledocholithiasis
  4. Gastritis
  5. Abdominal aortic aneurysm
  6. Mesenteric ischemia
  7. Alcoholic hepatitis
  8. Boerhaave syndrome
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6
Q

WORK UP FOR:

  1. Acute pancreatitis
  2. Peptic ulcer disease
  3. Cholecystitis/choledocholithiasis
  4. Gastritis
  5. Abdominal aortic aneurysm
  6. Mesenteric ischemia
  7. Alcoholic hepatitis
  8. Boerhaave syndrome
A
  1. CBC
  2. Electrolytes, BUN/Cr
  3. Amylase, lipase
  4. AST I ALT /bilirubin/alkaline phosphatase
  5. U/S-abdomen
  6. CT-abdomen
  7. Upper endoscopy
  8. ECG
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7
Q

41 yo obese F presents with RUQ abdominal pain that radiates to the right scapula and is associated with nausea, vomiting. and a fever of 101.5 F. The pain started after she ate fatty food. She has had similar but less intense episodes that lasted a few hours. Exam reveals a positive Murphy sign.

A
  1. Acute cholecystitis
  2. Choledocholithiasis
  3. Hepatitis
  4. Ascending cholangitis
  5. Peptic ulcer disease
  6. Fitz Hugh-Curtis syndrome
  7. Acute subhepatic appendicitis
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8
Q

WORK-UP FOR:

  1. Acute cholecystitis
  2. Choledocholithiasis
  3. Hepatitis
  4. Ascending cholangitis
  5. Peptic ulcer disease
  6. Fitz Hugh-Curtis syndrome
  7. Acute subhepatic appendicitis
A
  1. CBC
  2. AST I ALT /bilirubin/alkaline phosphatase
  3. U/S-abdomen
  4. CT-abdomen
  5. Blood culture
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9
Q

43 yo obese F presents with RUQ abdominal pain, fever, and jaundice. She was diagnosed with asymptomatic gallstones 1 year ago. She is found to be hypotensive on exam.

A
  1. Ascending cholangitis
  2. Acute gallstone cholangitis
  3. Acute cholecystitis
  4. Hepatitis
  5. Primary sclerosing cholangitis
  6. Fitz Hugh-Curtis syndrome
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10
Q

WORK UP FOR:

  1. Ascending cholangitis
  2. Acute gallstone cholangitis
  3. Acute cholecystitis
  4. Hepatitis
  5. Primary sclerosing cholangitis
  6. Fitz Hugh-Curtis syndrome
A
  1. CBC
  2. AST I ALT /bilirubin/alkaline phosphatase
  3. Blood culture
  4. Viral hepatitis serologies
  5. U/S-abdomen
  6. MRCP
  7. ERCP
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11
Q

25 yo M presents with RUQ pain, fever, anorexia, nausea, and vomiting. He has dark urine and clay-colored stool.

A
  1. Acute hepatitis
  2. Acute cholecystitis
  3. Ascending cholangitis
  4. Choledocholithiasis
  5. Pancreatitis
  6. Primary sclerosing cholangitis
  7. Primary biliary cirrhosis
  8. Acute glomerulonephritis
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12
Q

WORK UP FOR:

  1. Acute hepatitis
  2. Acute cholecystitis
  3. Ascending cholangitis
  4. Choledocholithiasis
  5. Pancreatitis
  6. Primary sclerosing cholangitis
  7. Primary biliary cirrhosis
  8. Acute glomerulonephritis
A
  1. CBC
  2. Amylase, lipase
  3. AST I ALT /bilirubin/alkaline phosphatase
  4. Viral hepatitis serologies
  5. UA
  6. U/S-abdomen
  7. ERCP
  8. MRCP
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13
Q

35 yo M presents with burning epigastric pain that starts 2 to 3 hours after meals. The pain is relieved by food and antacids.

A
  1. Peptic ulcer disease
  2. Gastritis
  3. GERD
  4. Cholecystitis
  5. Chronic pancreatitis
  6. Mesenteric ischemia
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14
Q

WORK UP FOR:

  1. Peptic ulcer disease
  2. Gastritis
  3. GERD
  4. Cholecystitis
  5. Chronic pancreatitis
  6. Mesenteric ischemia
A
  1. Rectal exam, stool for occult blood
  2. Amylase, lipase, lactate
  3. AST I ALT /bilirubin/alkaline phosphatase
  4. Upper endoscopy(including H pylori testing)
  5. Upper GI series
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15
Q

37 yo M presents with severe epigastric pain, nausea, vomiting. and mild fever. He appears toxic. He has a history of intermittent epigastric pain that is relieved by food and antacids. He also smokes heavily and takes aspirin on a daily basis.

A
  1. Perforated peptic ulcer
  2. Acute pancreatitis
  3. Hepatitis
  4. Cholecystitis
  5. Gallstone cholangitis
  6. Mesenteric ischemia
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16
Q

WORK UP FOR:

  1. Perforated peptic ulcer
  2. Acute pancreatitis
  3. Hepatitis
  4. Cholecystitis
  5. Gallstone cholangitis
  6. Mesenteric ischemia
A
  1. Rectal exam
  2. CBC
  3. Electrolytes
  4. Amylase, lipase, lactate
  5. AST/ALT /bilirubin/alkaline phosphatase
  6. CXR
  7. KUB
  8. CT-abdomen
  9. Upper endoscopy (including H pylori testing)
  10. Blood culture
17
Q

18 yo M boxer presents with severe LUQ abdominal pain that radiates to the left scapula. He had infectious mononucleosis 3 weeks ago.

A
  1. Splenic rupture
  2. Kidney stone
  3. Rib fracture
  4. Pneumonia
  5. Perforated peptic ulcer
  6. Splenic infarct
18
Q

WORK UP FOR:

  1. Splenic rupture
  2. Kidney stone
  3. Rib fracture
  4. Pneumonia
  5. Perforated peptic ulcer
  6. Splenic infarct
A
  1. CBC
  2. Electrolytes
  3. CXR
  4. CT-abdomen
  5. U/S-abdomen (if hemodynamically unstable)
19
Q

40 yo M presents with crampy abdominal pain, vomiting, abdominal distention, and inability to pass flatus or stool. He has a history of multiple abdominal cancer surgeries.

A
  1. Intestinal obstruction
  2. Small bowel or colon cancer
  3. Volvulus
  4. Gastroenteritis
  5. Food poisoning
  6. Ileus
  7. Hernia
20
Q

WORK UP FOR:

  1. Intestinal obstruction
  2. Small bowel or colon cancer
  3. Volvulus
  4. Gastroenteritis
  5. Food poisoning
  6. Ileus
  7. Hernia
A
  1. Rectal exam
  2. CBC
  3. Electrolytes
  4. AXR
  5. CT-abdomen pelvis with contrast
  6. Colonoscopy
21
Q

70 yo F presents with acute onset of severe, crampy abdominal pain. She recently vomited and had a massive dark bowel movement. She has a history of CHF and atrial fibrillation, for which she has received digitalis. Her pain is out of proportion to the exam.

A
  1. Mesenteric ischemia/infarction
  2. Diverticulitis
  3. Peptic ulcer disease
  4. Gastroenteritis
  5. Acute pancreatitis
  6. Cholecystitis
22
Q

WORK UP FOR:

  1. Mesenteric ischemia/infarction
  2. Diverticulitis
  3. Peptic ulcer disease
  4. Gastroenteritis
  5. Acute pancreatitis
  6. Cholecystitis
A
  1. Rectal exam
  2. CBC
  3. Amylase, lipase, lactate
  4. ECG
  5. AXR
  6. CT-abdomen
  7. Mesenteric angiography
  8. Barium enema
23
Q

21 yo F presents with acute onset of severe RLQ pain, nausea, and vomiting. She has no fever, urinary symptoms, or vaginal bleeding and has never taken OCPs. Her last menstrual period was regular, and she has no history of STDs. She has been told that she had a cyst on her right ovary.

A
  1. Ovarian torsion
  2. Appendicitis
  3. Nephrolithiasis
  4. Ectopic pregnancy
  5. Ruptured ovarian cyst
  6. Pelvic inflammatory disease
  7. Bowel infarction or perforation
24
Q

WORK UP FOR:

  1. Ovarian torsion
  2. Appendicitis
  3. Nephrolithiasis
  4. Ectopic pregnancy
  5. Ruptured ovarian cyst
  6. Pelvic inflammatory disease
  7. Bowel infarction or perforation
A
  1. Pelvic exam
  2. Urine hCG
  3. Doppler U/S-pelvis/transvaginal
  4. Rectal exam
  5. UA
  6. CBC
  7. CT-abdomen
  8. Laparoscopy
  9. Chlamydia and gonorrhea testing, VDRL/RPR
25
Q

68 yo 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.

A
  1. Diverticulitis
  2. Crohn disease
  3. Ulcerative colitis
  4. Gastroenteritis
  5. Abscess
26
Q

WORK UP FOR:

  1. Diverticulitis
  2. Crohn disease
  3. Ulcerative colitis
  4. Gastroenteritis
  5. Abscess
A
  1. Rectal exam
  2. CBC
  3. Electrolytes
  4. CXR
  5. AXR
  6. CT-abdomen
  7. Blood culture
27
Q

20 yo M presents with severe RLQ abdominal pain, nausea, and vomiting. His discomfort started yesterday as a vague pain around the umbilicus. As the pain worsened, it became sharp and migrated to the RLQ. McBurney and psoas signs are positive.

A
  1. Acute appendicitis
  2. Gastroenteritis
  3. Diverticulitis
  4. Crohn disease
  5. Nephrolithiasis
  6. Volvulus or other intestinal obstruction
  7. Perforation
  8. Acute cholecystitis
28
Q

WORK UP FOR:

  1. Acute appendicitis
  2. Gastroenteritis
  3. Diverticulitis
  4. Crohn disease
  5. Nephrolithiasis
  6. Volvulus or other intestinal obstruction
  7. Perforation
  8. Acute cholecystitis
A
  1. CBC
  2. Electrolytes
  3. CT-abdomen
  4. AXR
  5. U/S-abdomen
  6. Blood culture
29
Q

30 yo 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 nausea, vomiting, weight loss, or anorexia.

A
  1. Irritable bowel syndrome
  2. Crohn disease
  3. Celiac disease
  4. Chronic pancreatitis
  5. GI parasitic infection (amebiasis, giardiasis)
  6. Endometriosis
30
Q

WORK UP FOR:

  1. Irritable bowel syndrome
  2. Crohn disease
  3. Celiac disease
  4. Chronic pancreatitis
  5. GI parasitic infection (amebiasis, giardiasis)
  6. Endometriosis
A
  1. Rectal exam, stool for occult blood
  2. Pelvic exam
  3. Urine hCG
  4. CBC
  5. Electrolytes
  6. Colonoscopy
  7. CT -abdomen/pelvis
  8. Stool for ova and parasitology, Entamoeba histolytica antigen
31
Q

24 yo F presents with bilateral 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.

A
  1. Pelvic inflammatory disease
  2. Endometriosis
  3. Dysmenorrhea
  4. Vaginitis
  5. Cystitis
  6. Spontaneous abortion
  7. Pyelonephritis
32
Q

WORK UP FOR:

  1. Pelvic inflammatory disease
  2. Endometriosis
  3. Dysmenorrhea
  4. Vaginitis
  5. Cystitis
  6. Spontaneous abortion
  7. Pyelonephritis
A
  1. Pelvic exam
  2. UrinehCG
  3. Cervical cultures
  4. CBC
  5. ESR
  6. UA, urine culture
  7. U/S-pelvis

First Aid: Step 2 CS (23 decks)

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