ABDOMINAL PAIN

Question 1

Nephrolithiasis DDx:

3

Answer 1

1. RCC.
2. Pyelonephritis.
3. GI etiology (eg appendicitis).

Question 2

Nephrolithiasis workup:

7

Answer 2

1. UA, urine culture and sensitivity, urine cytology.
2. BUN/Cr.
3. CT abdomen.
4. US renal.
5. KUB.
6. IVP.
7. Blood culture.

Question 3

Pancreatic cancer DDx:

7

Answer 3

1. Cholangiocarcinoma.
2. Acute viral hep.
3. Acute alcoholic hep.
4. Chronic pancreatitis.
5. Cholecystitis/choledocholithiasis.
6. AAA.
7. PUD.

Question 4

Pancreatic cancer workup:

6

Answer 4

1. CBC.
2. Electrolytes.
3. Amylase, lipase.
4. AST/ALT/Bil/ALP.
5. CT abdo.
6. US abdo.

Question 5

Acute pancreatitis DDx:

7

Answer 5

1. PUD.
2. Cholecystitis/choledocholithiasis.
3. Gastritis.
4. AAA.
5. Mesenteric ischemia.
6. Alcoholic hepatitis.
7. Boerhaave syndrome.

Question 6

Acute pancreatitis workup:

8

Answer 6

1. CBC.
2. Electrolytes, BUN/Cr.
3. Amylase, lipase.
4. AST/ALT/Bil/ALP.
5. US abdo.
6. CT abdo.
7. Upper endoscopy.
8. ECG.

Question 7

Acute cholecystitis DDx:

6

Answer 7

1. Choledocholithiasis.
2. Hepatitis.
3. Ascending cholangitis.
4. PUD.
5. Fitz-Hugh-Curtis.
6. Acute subhepatic appendicitis.

Question 8

Acute cholecystitis workup:

5

Answer 8

1. CBC.
2. AST/ALT/bil/ALP.
3. US abdo.
4. CT abdo.
5. Blood culture.

Question 9

Ascending cholangitis DDx:

5

Answer 9

1. Acute gallstone cholangitis.
2. Acute cholecystitis.
3. Hepatitis.
4. Sclerosing cholangitis.
5. Fitz-Hugh-Curtis.

Question 10

Ascending cholangitis workup:

7

Answer 10

1. CBC.
2. AST/ALT/bil/ALP.
3. Blood culture.
4. Viral hep serologies.
5. US abdo.
6. MRCP.
7. ERCP.

Question 11

Acute hep DDx:

5

Answer 11

1. Acute cholecystitis.
2. Ascending cholangitis.
3. Choledocholithiasis.
4. Pancreatitis.
5. Acute glomerulonephritis.

Question 12

Acute hepatitis workup:

6

Answer 12

1. CBC.
2. Amylase, lipase.
3. AST/ALT/bil/ALP.
4. Viral hep serologies.
5. UA.
6. US abdo.

Question 13

PUD DDx:

5

Answer 13

1. Gastritis.
2. GERD.
3. Cholecystitis.
4. Chronic pancreatitis.
5. Mesenteric ischemia.

Question 14

PUD workup:

5

Answer 14

1. Rectal exam, stool for occult blood.
2. Amylase, lipase, lactate.
3. ALT/AST/bil/ALP.
4. Upper endoscopy (including H.pylori testing).
5. Upper GI series.

Question 15

Perforated peptic ulcer DDx:

5

Answer 15

1. Acute pancreatitis.
2. Hepatitis.
3. Cholecystitis.
4. Gallstone cholangitis.
5. Mesenteric ischemia.

Question 16

Perforated peptic ulcer workup:

10

Answer 16

1. Rectal exam.
2. CBC.
3. Electrolytes.
4. Amylase, lipase, lactate.
5. AST/ALT/bil/ALP.
6. CXR.
7. KUB.
8. CT abdo.
9. Upper endoscopy (including H.pylori testing).
10. Blood culture.

Question 17

Splenic rupture DDx:

5

Answer 17

1. Kidney stone.
2. Rib fracture.
3. Pneumonia.
4. Perforated peptic ulcer.
5. Splenic infarct.

Question 18

Splenic rupture workup:

5

Answer 18

1. CBC.
2. Electrolytes.
3. CXR.
4. CT abdo.
5. US abdo (if hemodynamically unstable).

Question 19

Intestinal obstruction DDx:

6

Answer 19

1. Small bowel or colon cancer.
2. Volvulus.
3. Gastroenteritis.
4. Food poisoning.
5. Ileus.
6. Hernia.

Question 20

Mesenteric ischemia/infarction DDx:

5

Answer 20

1. Diverticulitis.
2. PUD.
3. Gastroenteritis.
4. Acute pancreatitis.
5. Cholecystitis.

Question 21

Mesenteric ischemia/infarction workup:

8

Answer 21

1. Rectal exam.
2. CBC.
3. Amylase, lipase, lactate.
4. ECG.
5. AXR.
6. CT abdo.
7. Mesenteric angio.
8. Barium enema.

Question 22

Ovarian torsion DDx:

6

Answer 22

1. Appendicitis.
2. Nephrolithiasis.
3. Ectopic pregnancy.
4. Ruptured ovarian cyst.
5. PID.
6. Bowel infarction or perforation.

Question 23

Ovarian torsion workup:

9

Answer 23

1. Pelvic exam.
2. Urine hCG.
3. Doppler US pelvis.
4. Rectal exam.
5. UA.
6. CBC.
7. CT abdo.
8. Laparoscopy.
9. Chlamydia and gonorrhea testing, VDRL/RPR.

Question 24

Diverticulitis DDx:

4

Answer 24

1. Crohn.
2. UC.
3. Gastroenteritis.
4. Abscess.

Question 25

Diverticulitis workup: | 7

Answer 25

1. Rectal exam. 2. CBC. 3. Electrolytes. 4. CXR. 5. AXR. 6. CT abdo. 7. Blood culture.

Question 26

Acute appendicitis DDx: | 7

Answer 26

1. Gastroenteritis. 2. Diverticulitis. 3. Crohn. 4. Nephrolithiasis. 5. Volvulus or other intestinal obstruction. 6. Perforation. 7. Acute cholecystitis.

Question 27

Acute appendicitis workup: | 6

Answer 27

1. CBC. 2. Electrolytes. 3. CT abdo. 4. AXR. 5. US abdo. 6. Blood culture.

Question 28

IBS DDx: | 5

Answer 28

1. CD. 2. Celiac disease. 3. Chronic pancreatitis. 4. GI parasitic infection (amebiasis, giardiasis). 5. Endometriosis.

Question 29

IBS workup: | 8

Answer 29

1. Rectal exam, stool for occult blood. 2. Pelvic exam. 3. Urine hCG. 4. CBC. 5. Electrolytes. 6. Colonoscopy. 7. CT abdo/pelvis. 8. Stool for ova and parasitology, Entamoeba histolytica antigen.

Question 30

PID DDx: | 6

Answer 30

1. Endometriosis. 2. Dysmenorrhea. 3. Vaginitis. 4. Cystitis. 5. Spontaneous abortion. 6. Pyelonephritis.

Question 31

PID workup: | 7

Answer 31

1. Pelvic exam. 2. Urine hCG. 3. Cervical cultures. 4. CBC. 5. ESR. 6. UA, urine culture. 7. US pelvis.

Question 32

**plus** Intestinal obstruction workup: (6)

Answer 32

1. Rectal exam. 2. CBC. 3. Electrolytes. 4. AXR. 5. CT abdo/pelvis with contrast. 6. Colonoscopy.