GI/GU

Question 1

Alimentary Tract

Answer 1

30 feet long
Includes the mouth and ends at the rectum.
Includes the pharynx, esophagus, stomach, small and large intestine.

Question 2

Accessory organs

Answer 2

Gall bladder
Liver
Appendix
Pancreas
Biliary Duct System

Question 3

If questioning liver or splenic enlargement auscultate for?

Answer 3

Friction rub (sandpaper)

Question 4

Ballottement

Answer 4

Lightly tapping fingers in a line accross the abdomen or up and down the abdomen

Question 5

Splenic Percussion

Answer 5

Just posterior to the mid axillary line in the area of the 10th rib. Shouldn’t be felt unless 3x the normal size.

Question 6

Rebound tenderness

Answer 6

If pain increases after your release your hand, + rebound tenderness

Question 7

What could a tender liver on palpation mean?

Answer 7

Inflammation
Hepatitis
Cholecystitis

Question 8

What could an inflamed spleen mean?

Answer 8

Viral illness

DO NOT palpate if suspected splenic injury

Question 9

When should you be able to palpate the kidneys?

Answer 9

Postpartum women and pediatrics.

Question 10

Where are the kidneys palpated?

Answer 10

4 cm above the right iliac crest.

5 cm above the left iliac crest.

Question 11

When should you do a rectal exam?

Answer 11

Any patient with abdominal pain.

Question 12

What diet decreases the risk of colon cancer?

Answer 12

Low fiber and high fat

Question 13

Risk factors for colon cancer

Answer 13

Inflammatory bowel disease
Adenomatous polyps/adenomas
Personal history or certain types of cancer (uterine, ovarian)
Race- high incidence in black women
Physical inactivity and obesity
Smoking
Diets high in processed meat

Increased age
Men>Women
First-degree relative
African American
Excessive ETOH

Question 14

Preventing colon cancer

Answer 14

NSAIDs and ASA
Fruits and vegetables, diets low in red meat
Surveillance
Weight loss

Question 15

Screening tests for colon cancer

Answer 15

FOBT
Colonoscopy
Sigmoidoscopy
Double contrast barium enema 
CT Colonography

Question 16

When should colonoscopies be done?

Answer 16

Age 50 and up unless you have a first degree relative , then check 10 years before that

Age 50-75 FOBT annually, sigmoidoscopy every 5 years, with FOBT every 3 years, screening colo every 10 years.

Age 76-85 No routine screening

Question 17

What causes sudden severe abdominal pain?

Answer 17

Acute perforation, inflammation, torsion of abdominal organ, ruptured fallopian tube, perforated gastric ulcer, peritonitis or acute pancreatitis

Question 18

Nausea without vomitting

Answer 18

Hepatocellular disease, pregnancy, metastatic disease

Question 19

Causes of dry skin

Answer 19

Chronic renal or hepatic diseases
Lymphoma
Hodgkin's disease
Malignancies
DRY SKIN

Question 20

Shifting dullness

Answer 20

Ascites test

Percuss the border of tympany and dullness with the patient supine, then have them roll onto their side. Percuss and mark the borders again.

Normal- the borders remain consistent.

Ascites- dullness shifts to the dependent side, tympany at the top.

Question 21

Fluid wave

Answer 21

Ascites test

If easily palpable means there is ascites.

Press hand edges down the midline and tap on one side with fingertips while feeling the opposite side.

Question 22

Rovsing’s sign

Answer 22

Pain in the RLQ during left sided pressure.

+ for pain indicates appendicitis

Question 23

Psoas sign

Answer 23

Ask patient to raise their thigh against your hand while pressing on the knee. This contracts psoas muscle. If this increases their pain it indicates an inflamed appendix.

Question 24

Obturator sign

Answer 24

Flex patients right thigh at the hip. With the knee bent rotate the leg internally. This stretches the internal obturator muscle. If + for pain in the right hypogastric area this is indicates inflamed appendix.

Question 25

Murphy's sign

Answer 25

When patient has RUQ pain/tenderness. Hook the left thumb of the right hand under the costal margin. As patient to take a deep breathe. Note the degree of tenderness. A sharp increase in tenderness with inspiratory effort is a + sign for acute cholecystitis.

Question 26

McBurney's sign

Answer 26

2 inches from the anterior superior spinous process of the ilium on a line drawn from that process to the umbilicus. Press down on this point, if having pain indicates appendicitis.

Question 27

Diagnostic tests for abdominal pain

Answer 27

Labs- cbc, urinalysis, pregnancy test, amylase/lipase, ECG Radiologic studies- plain films, ultrasound, CT

Question 28

General treatment principles for abdominal pain

Answer 28

Volume repletion Pain relief Antibiotics Surgical consult, serial evaluation, discharge

Question 29

Functions of the Genitourinary System

Answer 29

Reproduction process Removing and filtering waste products Maintaining volume states and fluid composition Assisting in the regulation of acid-base balance Regulating BP Producing erythropoietin and vitamin D

Question 30

How often should men do a self-screening?

Answer 30

Once a month in the shower

Question 31

HPV vaccine

Answer 31

Age 11-21 for males. Can prevent genital warts, anal cancer, and penile cancer. Reduce HPV transmission to female sex partners and lower risk of oropharyngeal cancers.

Question 32

Instructions for Safe Sexual Practices

Answer 32

Using a new condom with each sex act Apply before any contact occurs Add only water-based lubricants Immediately withdraw if condom breaks and hold the condom while withdrawing

Question 33

When should men seek clinical attention for genital concerns?

Answer 33

Painless lump, swelling, enlargement in either tsticle, pain or discomfort in a testicle, feeling of heaviness or a sudden fluid collection in the scrotum or a dull machine in the lower abdomen or groin.

Question 34

Diagnostic Testing for Genitourinary Disorders

Answer 34

``` Blood Test Urinalysis- culture and sensitivity 24 hour urine collection for protein and creatinine Spot urine specimen for sodium and urine osmolality Renal ultrasound IV pyelography Fractional excretion of NA+ level GFR PSA prostate-antigen test ```

Question 35

Newborn urine

Answer 35

Should occur during the first 24 hours after birth Usually colorless and odorless Persistant diaper rash can be a sign of a UTI Determine if there was use of sex hormones or birth control pills during pregnancy

Question 36

GU considerations for the peds patient

Answer 36

UTIs do not occur until 2-6 years old unless abnormal structure of the kidneys Sign of UTI- toilet trained child having accidents Increase incidence in adolescents can indicate sexual activity

Question 37

Peyronie disease

Answer 37

Palpable, non tender hard plaques found just beneath the skin usually along the dorsum of the penis. Crooked, painful erections.

Question 38

Hydrocele

Answer 38

Non tender fluid filled mass within the tunica vaginalis. Trasilluminates and the examining fingers can palpate above the mass within the scrotum.

Question 39

Hypospadias

Answer 39

Congenital displacement of the urethral meatus to the inferior surface of the penis.

Question 40

Scrotal edema

Answer 40

Pitting edema may make the scrotal skin taut as seen in CHF or renal disease.

Question 41

Scrotal hernia

Answer 41

Indirect inguinal hernia that comes through the external inguinal ring so the examining fingers cannot get above within the scrotum

Question 42

Cryptochordism

Answer 42

Testis atrophied outside the scrotum in the inguinal canal, abdomen, or near the pubic

Question 43

Small Testes

Answer 43

Kleinfelter syndrome-Testes <2cm Cirrhosis, myotonic dystrophy, use of estrogens and hypopituitarism

Question 44

Acute orchitis

Answer 44

inflamed, painful, tender, and swollen testes

Question 45

Spermatocele and cyst of the epididymis

Answer 45

A painless moveable cystic mass above the testis. Both illuminate

Question 46

Varicocele of the spermatic cord

Answer 46

Gravity mediated varicose veins of the spermatic cord, usually found on the left.

Question 47

Acute epididymitis

Answer 47

Inflamed epididymis, swollen, tender. Can be caused by neisseria gonorrhea, chlamydia, e. coli, Pseudomonas, trauma, an autoimmune disease.

Question 48

Torsion of the spermatic cord

Answer 48

twisting of the testicle. The cremasteric reflex is almost always absent on the affected side. Surgical emergency, obstructed circulation.