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Abdominal pain Flashcards

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1
Q

What two scores are used for acute pancreatitis?

A
  1. APACHE II

2. Ranson

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2
Q

Why is fluid resuscitation important in patients with severe pancreatitis?

A

To prevent renal dysfunction

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3
Q

What is the most common cause of SBO?

A

Adhesions

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4
Q

What is the most common cause of LBO?

A

Colorectal CA

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5
Q

Why can the presentation of SBO be misleading?

A

Initially their symptoms get worse but as the bowel continues to distend, at a certain point peristaltic activity diminishes and they might appear to improve.

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6
Q

What is a common fallacy pertaining to LBO?

A

Vomiting. This often doesn’t happen because ileocecal valve blocks backflow

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7
Q

What are two less common causes of LBO?

A
  1. Diverticular disease

2. Sigmoid volvulus

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8
Q

90% of diarrhea is

A

Infectious in nature

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9
Q

Timing of staph food poisoning

A

4-12 hours

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10
Q

Timing of cholera food poisoning

A

8-72 hours

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11
Q

Time of E Coli and giardia food poisoning

A

2-7 days

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12
Q

Timing of salmonella, campylobacter, shigella food poisoning

A

> 1 day

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13
Q

What test is often useful in diarrhea

A

Stool culture (even though it takes a few days)

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14
Q

What test is not very useful in diarrhea

A

O&P

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15
Q

Besides clindamycin, what drug is commonly implicated in C.diff development

A

Fluoroquinolones

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16
Q

For patients with diarrhea that doesn’t resolve with supportive care, what might help?

A

Antibiotics

  1. Bactrim
  2. Cipro or levo
  3. Azithro
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17
Q

Why shouldn’t pepto bismal be used in immunocompromised patients?

A

It can lead to bismuth encephalopathy

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18
Q

What is the most common kind of kidney stone?

A

Calcium oxalate (75%)

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19
Q

When do uric acid stones tend to form?

A

Low pH

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20
Q

How to MAP (struvite) stones form?

A

Thought alkalinazation via urea production by:

  1. Proteus
  2. Pseudomonas
  3. Klebsiella
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21
Q

When looking for a stone on UA, what is good to realize?

A
  1. Amount of hematuria doesn’t correlate with degree of obstruction
  2. A complete renal obstruction may present without hematuria
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22
Q

What is the imaging modality of choice for a kidney stone?

A

Helical CT without contrast

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23
Q

How should you investigate for a kidney stone in a pregnant woman or child?

A

US

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24
Q

Which patients with kidney stones need urgen urological consultation?

A
  1. Inadequate pain control
  2. Persistent N/V
  3. Associated pyelo
  4. Stone > 7 mm
  5. Complete obstruction
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25
What is the most common cause of SBO in a patient without a surgical history?
Hernia
26
During the winter, a 24 year old woman who works at a day care develops profuse watery diarrhea?
Rotavirus
27
With kidney stones, constant pain is most likely to be located where?
In the kidney
28
With kidney stones, colicky pain is most likely located where?
In the ureter
29
With kidney stones located in the bladder or renal pelvis, describe the pain?
Typically asymptomatic
30
How do you interpret a normal prostate exam in the setting of urinary retention?
A normal exam does not eliminate obstruction
31
In a patient with a bladder obstruction, what is the most useful form of imaging?
A bedside ultrasound may be helpful to identify bladder distention or a clot in the bladder
32
Why should a catheter not be forced into the bladder?
It can cause urethral trauma or create a false passage
33
If a catheter can't be inserted into the bladder, what should you do?
A suprapubic catheter
34
What is a sequelae of relieving severe urinary retention?
Can lead to postobstructive diuresis 1. Electrolyte abnormalities 2. Profound fluid loss 3 Hypotension
35
What is the dispo option for most patients with acute urinary retention?
Home with an indwelling catherer and outpatient urologic follow-up
36
Patients diagnosed with PID should have what?
Imaging of the pelvis to assess for TOA (because physical findings can be subtle)
37
What is the gold standard for diagnosing TOA?
Laparoscopy. Visual purulent discharge from the tube.
38
When during an ovarian cycle is a woman most at risk for developing PID?
Mid-cycle because cervical mucus gets thin
39
Why are fluorquinolones not used for PID any longer
There is FQ resistant gonorrhea now
40
When a TOA is suspected, how should DOC be changed?
Use clinda or metronidazole (anaerobic coverage) instead of doxy
41
Describe the pain associated with ovarian torsion
1. Crampy 2. Might migrate from umbilicus 3. Typically no fever 4. Can progress over a day
42
What is the surgical treatment for an unruptured ectopic?
Salpingostomy (preservation of tube)
43
What is the surgical treatment for a ruptured ectopic?
Salpingectomy (removal of tube)
44
Half of episodes of ectopic pregnancy are linked to what?
Previous salpingitis
45
97% of all ectopic pregnancies are found where?
Ampulla
46
Lack of visualization of an IUP on transvaginal US confers up to how much risk of an ectopic?
85%
47
In what patient population can IUP not rule out ectopic?
IVF
48
In an asymptomatic patient with HCG
Repeat in 48 hours (should rise by at least 66%) 1. Normal rise = probably viable IUP 2. Abnormal rise=probably non-viable pregnancy
49
In a patient with abnormal HCG rise that gets curettage, what are two main possible findings?
1. Chorionic villi = miscarriage | 2. No villi = possible ectopic and consider MTX
50
What is a common symptom of MTX
Abdominal discomfort. If that patient is stable and not bleeding, they likely only need observation.
51
How can you differentiate an incompetent cervix from an inevitable abortion?
1. Incompetent: cervix opens spontaneously without uterine contractions (painless) 2. Inevitable abortion: contractions leads to cervical dilation (cramping)
52
What is PROM?
Rupture of membranes prior to onset of contractions
53
What is PPROM?
Rupture of membranes before 37 weeks and prior to onset of labor
54
What findings lead to confirmation that membranes have ruptured?
1. Pooling of amniotic fluid 2. Positive nitrazine test (amniotic fluid is basic) 3. Ferning on a slide
55
What is a big maternal concern for PROM and PPROM
Chorioamnionitis
56
What is a big fetal concern for PROM and PPROM
1. Fetal infection (look for tachycardia) 2. RDS 3. Intraventricular hemorrhage 4. NEC
57
In a pregnant patient with hyperthyroidism, when should β blockers be avoided?
At time of delivery because they can lead to fetal bradycardia and hypoglycemia
58
What is a bad side effect of PTU and methimazole?
Agranulocytosis
59
All pregnant patients with Pyelo need what?
Admission to hospital
60
A patient who becomes SOB following treatment for pyelo should be assumed to have what?
ARDS secondary to endotoxin release
61
When the hCG level exceeds 1500 and no gestational sac is seen on TVUS, the likelihood of ectopic is what?
>85%
62
If a patient presents with a history of PROM or PPROM, but nitrazine, ferning, and pooling are negative what should you do?
US to assess amniotic fluid level. If oligohydramnic, ROM is diagnosed and patient needs admitted

Emergency (23 decks)

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