GI Exam

Question 1

visceral pain

Answer 1

hollow organs
-distension or stretching

comes and goes - crescendo decrescendo

not well localized

Question 2

parietal pain

Answer 2

inflammation of peritoneum

steady aching pain well localized

Question 3

right shoulder

Answer 3

gallbladder

Question 4

left shoulder

Answer 4

spleen

Question 5

back

Answer 5

pancreas/aorta

Question 6

renal colic

Answer 6

renal system pain

flank pain

Question 7

epigastric pain

Answer 7

MI**
peptic ulcer
acute cholecystitis
perforated esophagus

Question 8

LLQ pain

Answer 8

sigmoid diverticulitis

Question 9

melena

Answer 9

black tarry stool

above ligament of treitz

Question 10

hematochezia

Answer 10

blood bright red

at level of colon or lower

Question 11

cathartic

Answer 11

blood in stool

-makes you go to bathroom

Question 12

blood outside stool

Answer 12

suggests anus

Question 13

DDx for GI bleeding

Answer 13

congenital - meckel
immune - UC, crohns, PUD
trauma - mallory weiss
neoplastic - zollinger-ellison
infectious 
metabolic - NSAID

Question 14

red currant jelly stool

Answer 14

intussusception

Question 15

jaundice

Answer 15

staining with bilirubin

pruritis - itching
dark colored urine
acholic feces

Question 16

acholic feces

Answer 16

malodorous, gray to light colored stool

Question 17

unconjugated hyperbilirubinemia

Answer 17

hemolysis
RBC defect
ineffective erythropoiesis
deficient hepatic uptake
deficient hepatic conjugation

Question 18

conjugated hyperbilirubinemia

Answer 18

impaired bilirubin excretion

serum alk phos elevated out of proportion to transaminases

intrahepatic - liver disease, drugs, sepsis, biliary cirrhosis

extrahepatic - gallstones, sclerosing cholangitis, parasites, pancreatic cancer, pancreatitis

Question 19

painless jaundice

Answer 19

pancreatic cancer unless proven otherwise

Question 20

ascites

Answer 20

accumulation of peritoneal fluid

most common - cirrhosis of liver - portal HTN

also lymph obstruction, hypoalbuminemia, peritonitis

Question 21

bulging flank, tympany of abdomen, fluid wave, shift dullness

Answer 21

four signs of free fluid in abdomen

Question 22

DDx for ascites

Answer 22

cirrhosis**
malignancy
CHF
tuberculosis peritonitis
dialysis
nephrotic syndrome

Question 23

percussion of fluid in abdomen

Answer 23

dullness

normal abdomen - tympany

Question 24

exposure of abdomen

Answer 24

xiphoid to pubis

Question 25

caput medusa

Answer 25

portal HTN

Question 26

auscultation of abdomen

Answer 26

before palpation all 4 quadrants RLQ - best to listen normal - high pitched tinkle every 3-5 seconds no bowel sounds 2 minutes - absent

Question 27

borborygmi

Answer 27

hyperactive sounds low pitched rumbling hyperperistalsis

Question 28

abdominal bruits

Answer 28

aortic renal - lateral to aorta femoral - inguinal ligament

Question 29

liver percussion

Answer 29

dull

Question 30

lung percussion

Answer 30

resonant

Question 31

normal liver size

Answer 31

10cm

Question 32

percussion of liver

Answer 32

right MCL

Question 33

rebound tenderness

Answer 33

peritonitis

Question 34

rovsings

Answer 34

referred rebound tenderness

Question 35

DDx for peritonitis

Answer 35

bacterial - spontaneuous or secondary (appendicitis, diverticulitis, perforated PUD, cholecystitis) pancreatic ascites PID ectopic pregnancy fitz-hugh-curtis syndrome

Question 36

palpation of liver

Answer 36

left hand under right 11th and 12th rib or hooking method

Question 37

DDx for hepatomegaly

Answer 37

``` hepatitis fatty liver cirrhosis CHF cancer leukemia/lymphoma ```

Question 38

liver function test

Answer 38

enzymes - ALT, AST, alk phos - tissue damage or obstruction bilirubin, albumin, PT - function of liver

Question 39

generalized edema

Answer 39

anasarca

Question 40

alk phos much larger than AST and ALT

Answer 40

extrahepatic problem

Question 41

AST and ALT elevated much larger than alk phos

Answer 41

hepatic problem

Question 42

DDx for splenomegaly

Answer 42

infection EBV, CMV, HIV, malaria ``` EMH CHF polycythemia vera SLE RA - feltys metastatic disease amyloidosis ```

Question 43

DDx for CVA tenderness

Answer 43

nephrolithiasis pyelonephritis renal cell cancer DJD - arthritis pneumonia

Question 44

lloyds sign

Answer 44

CVA tenderness

Question 45

DRE

Answer 45

get 360 degrees around also check prostate

Question 46

condyloma acuminata

Answer 46

HPV | anal warts

Question 47

condyloma lata

Answer 47

syphilis looks like anal warts lots of spirochetes

Question 48

procidentia

Answer 48

complete rectal prolapse

Question 49

pain periumbilical then to RLQ

Answer 49

appendicitis nausea and vomiting, anorexia**, fever

Question 50

psoas sign

Answer 50

psoas muscle inflammation

Question 51

obturator sign

Answer 51

right leg figure 4

Question 52

appendicitis work up

Answer 52

``` CBC urine xray ultrasound CT - best** female - pregnancy test BMP ```

Question 53

female, fat, fertile, fair, flatulent

Answer 53

gallbladder disease

Question 54

RUQ pain, fever, leukocytitis

Answer 54

diagnostic triad for acute cholecystitis

Question 55

murphys sign

Answer 55

RUQ pain and arrest of inspiration when palpate liver and gallbladder

Question 56

alcohol abuse

Answer 56

most common cause of pancreatitis obstruction drugs, meds infection

Question 57

pain radiates to back and constant

Answer 57

pancreatitis

Question 58

turners sign

Answer 58

discoloration of flanks

Question 59

cullens sign

Answer 59

discoloration around umbilicus

Question 60

turners and cullens positive

Answer 60

hemorrhagic pancreatitis