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USMLE Step 2 > GI surg > Flashcards

GI surg Flashcards

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1
Q

worsening emesis one day following blunt abdominal trauma.

first line investigation?

why?

A

CT abdomen and pelvis

duodenal hematoma risk. rapid expansion of hematoma can obstruct duodenal lumen causing worsening emesis

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2
Q

ischemic colitis common complication of vascular surgery -> ct bowel wall thickening

A
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3
Q

RUQ pain and nausea 2 years after cholecystectomy. other findings. add

A

postcholycystectomy syndrome!

ERCP!!!! -> to rule out biliary causes such as retained stone, biliary stricture, SOD

or mrcp

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4
Q

management of acute diverticulitis?

A

age > 70, immunosuppression, comorbidities, Sepsis/SIRS = inpatient IV fluids and IV antibiotics

no high risk features = outpatient oral fluids oral antibiotics

abscess = IV antibiotics + drainage. if at least 4cm large!!!

perforation/obstruction/fistula = IV antibiotics + surgery

note can be diagnosed via colon wall thickening alone on CT, dont need diverticula

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5
Q

angiodysplasia can present with painless hematochezia or occult bleeding only

A
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6
Q

biggest reversible risk factor for pancreatic cancer?

A

smoking!!!

not alcohol as more in relation indirectly via chronic pancreatitis, and light drinking wont have effect

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7
Q

patient with weakness, dizziness and back pain. on warfarin. what must you rule out?

A

retroperitoneal hematoma!!! - learn how it looks on CT scan

even with a suptherapeutic iNR

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8
Q

bowel obstruction + abdominal ridgidity (a sign of peritonitis) + free air under the diaphragm on CXR.

next step in management?

A

surgical exploration!!!
NOT NG tube decompression

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9
Q

patient with gallstone pancreatitis and acute cholangitis.

gallstones visualiesed in gallbladder as well

following IV antibiotcs, first step in management?

A

ERCP!!!!

HAVE TO relieve obstruction first!!!!

can do cholycystectomy later

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10
Q

in a patient with multiple gastric ulcers and thickened folds on endoscopy, next step in management?

most likely diagnosis?

A

serum gastrin concentration!!!! -> if non diagnostic -> secretin levels!!

gastrinoma!!

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11
Q

4 days post surgery/cholycystectomy, decreased bowel sounds, abdominal distension.

key medication that compounds problem?

most likely diagnosis?

A

morphine!!!/opiates!

ileus!! -> axr may also show dilated bowel loops but no air fluid level or transition point vs MBO

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12
Q

indications for surgical evaluation of clostridium difficile?

A

signs of peritonitis = diffuse abdominal tenderness, rebound tenderness

megacolon

increased serum lactate

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13
Q

severe epigastric and right shoulder pain for 2 hours. vomited once. hadnt eaten all day and then ate a cheeseburger

mechanism causing this?

A

hollow organ contraction and outlet obstruction!!! = biliary colic!!!

NOT inflammation as well as that would be cholecystitis

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14
Q

acute left side abdominal pain, syncope, shock, anemia

history of CLL!!! (hematological malignancy), recurrent infections and on anticoagulation (risk factors)

most likely diagnosis?

A

splenic rupture!!!

spleenectomy if unstable
catheter based angioembolization if stable

peritonitis and left shoulder pain may also be present

bowel perforation would not explain the acute drop in hemoglobin

mesenteric artery occlusion eg thrombus or embolism less likely as patient on anticoagulation

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15
Q

2 months of fever, abdominal pain and intermittent bloody diarrhea. AXR shows toxic megacolon.(most likely IBD induced)

first step in management?

A

IV methylprednisolone

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16
Q

zenkers diverticulum (pouch behind oesophagus) treatment?

A

cricopharyngeal myotomy!!!

swallowing rehab is used for other causes of dysphagia eg neuro disease, trauma, surgery

NOT oesophageal balloon dilatation -> used to treat esophageal stricutres

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17
Q

vomiting bright red blood. occult blood in stool. one IV cannula in place. next step in management?

A

obtain second IV access!!

1st step in acute upper GI bleed = 2 large bore intravenous catheters

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18
Q

sepsis 10 days after admission for acute necrotizing pancreatitis.

next step in management?

A

CT abdomen!! - progression to infected pancreatic necrosis! -.positive CT give abx

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19
Q

pellet like stools. fecal incontinence
3cm erythematous mass with concentric rings!! protrudes out of anal canal when patient bears down and disappears when relaxes

treatment?
diagnosis?

A

surgical repair!!!

rectal prolapse!!!

NOT hemorrhoids as these appear as blue or purple bulges and treated with rubber band ligation

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20
Q

chest pain, back pain, fever, CXR shows left sided pleural effusion

dysphagia due to achalasia so frequently induces himself to vomit

5kg weight loss

significant smoking history

most likely diagnosis?
next step in management?

A

esophageal perforation!! -> inflammation/fever -> pleural effusion due to leaked gastric contents. plural fluid may show high amylase

eosophagography or CT with water soluble contrast!!!

lung cancer unlikely as fever not present in pleural effusion and weight loss can be explained by vomiting

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21
Q

elderly patient with small bowel obstruction. tenderness and fullness of right groin. no history of surgeries. most likely aetiology of SBO?

A

small bowel herniation!!!!!! = femoral hernia

FH common in elderly women

NOT small bowel intussuception as more common in children and can cause hematochezia

NOT small bowel stricuture as unlikely without surgeries or chrons disease

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22
Q

findings in mesenteric ischemia?

describe a typical case

A

leukocytosis
elevated hemoglobin
elevated amylase!!!
metabolic acidosis - suggested by low bicarb!!!!!

recent MI 4 weeks ago. now has vomiting and abdominal pain, diffuse abdominal tenderness but more pronounded over RLQ.

note mi caused a thrombus

infective endocarditis also risk factor

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23
Q

IBD symptoms + abdominal distention and tenderness + fever and hypotension (toxicity signs)

most likely diagnosis?

first step in management?

A

Toxic megacolon

CT abdomen!!!!!
colonoscopy contraindicated due to risk of perforation

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24
Q

how to supply nutrition to a patient with moderate to severe burn injuries?

A

early ENTERAL! nutrition
helps offset hypermetabolic response

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25
post colon cancer: colonoscopy in 1 year, then every 3-5 years after
26
cholecystectomy typically done within 72 hours !!!! and prior to discharge however, emergency one is done if it is emphysematous cholecystitis (has air within gallbladder wall) unstable medical conditions eg unstable angina causing high mortality -> delayed surgery
27
jaundice 24 hours after surgery for appendix labs showed normal ast alt and alk phos, increased bilirubin most likely mechanism causing this?
deficiency in hepatic gluconosyltransferase activity!!! = gilberts other differentials would have causes widespread elevation of lfts
28
history of A fib undergoes transesophageal ecocardiography to rule out mural thrombus that evening, severe chest and back pain ECG sinus tachy CXR widened mediastinum fever next step to diagnose condition? most likely condition?
water soluble contrast esogagography!!!! esophageal perforation!! Not CT angiogram as not aortic dissection - murmur, asymmetric blood pressure more likely
29
splenic abscess cause presentation treatment
bacteremia from distant infection fever, left upper quadrant pain +/-spleenomegaly CT scan of the abdomen antibiotics + spleenectomy
30
first line for diagnosis of pancreatic cancer is CT abdomen!!! not CA19-9 Which can be used to monitor progression
31
recent appendectomy now has abdominal pain, RUQ pain, fever, leukocytosis, pleural efffusion, abdominal distension most likely diagnosis?
intra-abdominal abscess!!! suphrenic abcess!!! suspect this with fever + pain/vomiting few days after ABDOMINAL surgery. Can also occur with perforated ulcer or appendicitis
32
HCC causes raised alkphos!!! and other lfts and raised afp!! vs cholangiocarcinoma which causes raised CEA and CA19-9!!!!!!
33
young woman on prolonged OCP acute RUQ pain and syncope. fever, low bp. cold extremities and long cap refill. US solid liver mass and free fluid in abdomen. diagnosis?
hepatic ADENOMA!!! -> IT ruptured!!! another complication is malignant transformation may cause slight changes in lfts
34
BAT, Fever, abdominal and right flank pain, imaging reveals free air in the retroperitoneum must likely organ injured?
duodenal tear!!! - esentially a perforated viscus Renal pelvis laceration would have caused free FLUID not free air transverse colon is intrraperitoneal not retro
35
34 yo woman. liver mass with central scar. most likely diagnosis?
Focal nodular hyperplasia!!! NOT hepatic angioma as doesnt have a scar but has centripetal enhancement
36
dumping syndrome is a common postgastrectomy complication and can be managed with dietary modification
37
Predictors of developing severe acute pancreatitis from pancreatitis?
sirs = raised temp and leukocytes ELEVATED BUN!!! ELEVATED HEMATOCRIT!! third spacing of fluids = pulmonary infiltrates and pleural effusions
38
sigmoid volvulus management?
flexible sigmoidoscopy NOT nasogastric decompression and small bowel rest as that is used for SBO only!!
39
in critically ill patients eg spleen surgery to abdomen optimum form of nutrition to provide?
ENTERAL nutrition via feeding tube!!! reduces infections, maintains gut integrity TPN only used when contraindications to enteral due to risk of central line infections
40
nausea abdominal pain for 6 months severe abdominal pain today and signs of small bowel obstruction no history of surgeries recent travel to indonesia most likely diagnosis? treatment?
ascariasis!!!! mebendazole! albendazole may cause pulmonary = cough, pneumonitis or intestinal symptoms as described complications = SBO or hepatobiliary tree obstruction (cholangitis, pancreatitis)
41
management of congenital umbilical hernia?
observation!! close spontaneously by age 5
42
alcoholic with impaired healing of leg laceration. receeded gums with easy bleeding (gingivitis) most likely cause of impaired wound healing?
Nutritional deficiency!!! scurvyyy occurs in malnourishment due to alcohol or substance use disorders or psychiatric illness
43
bariatric surgery hit knee - non healing brusie with hemarthrosis and xanthochromia smaller echymoisis and petechiae on other extremities most likely cause?
vitamin C deficiency!!
44
appendicitis = CT scan ultrasound in children and pregnant women
45
anal pain, chronic discharge. pustule like lesion close to anal verge next step in management?
surgical evaluation!!! -> anorectal fistula fistula likely stemmed from perianal abscess NOT empirical antibiotics which would be treatment choice in fistula in patient with history of IBD
46
patient just had CABG was critically ill and required ventilation now has fever, RUQ pain most likely diagnosis?
acute acalculous cholecystitis!!! acute inflammation of gallbladder in abscence of gallstones seen in hospitalized critically ill patients these conditions can also cause ileus, with decreased bowel signs and distended bowels
47
Hemobilia is rare cause of Upper GI bleed occuring as a complication of hepatic or biliopancreatic procedures. eg liver biopsy!! RUQ pain, jaundice, Upper GI bleed
48
obesity and T2DM increase risk of colon cancer likely due to hyperinsulinemia
49
abdominal trauma FAST scan shows free intraperitoneal fluid. fracture of right 8 and 9th rib!!! and left fourth rib still severe hypotension after 2l fluids most likely cause of persistent hypotension?
liver laceration!! retroperitoneal organs like pancreas less likely to cause intraperitoneal free fluid NOT bladder rupture as unlikely to cause significant hemodynamic instability, it usually occurs with pelvic fractures and gross hematuria typically present
50
what is mild UC and how do you manage it?
<4 bowel movements per day 5-asa eg mesalazine. if limited to rectosigmoid, enema preferred to oral
51
succession splash when abdomen is palpated = gastric outlet obstruction -> presents with early satiety, post prandial vomiting and abdominal distention. common cause of this is pancreatic cancer. also pyloric stricture
52
epigastric pain + floating stools weight loss two duodenal ulcers and jejunal ulcer best explanation for impaired fat absorption?
reduced bile acid absorption!!!! in zollinger ellison syndrome pancreatic enzymes are inactivated by increased production of stomach acid
53
how does dumping syndrome present?
tachycardia diaphoresis and flushing within 30 mins of meals history of gastric bypass surgery
54
4-5 non bloody loose stools a day, including at night. abdominal bloating, excessive flatulence and diarrhea over the last 3 months history of gastric bypass surgery most likely diagnosis?
bacterial overgrowth!!! = small intestinal bacterial overgrowth or SIBO common complication of gastric bypass!! in severe cases malabsorption -> B12 and other deficiencies, anemia not irritable bowel syndrome as you dont get nocturnal symptoms. there will be chronic abdominal pain, altered bowel habits and symptom relief with defecation
55
prostate cancer, had radiation. now has constipation, straining to defecate, fecal leakage. hematochezia colonoscopy = rectal pallor with areas of hemorrhage and telangiectasias most likely mechanism causing symptoms? diagnosis?
progressive rectal fibrosis!!! (pathogenesis) radiation proctitis chronic radiation proctitis > 3months = bleeding! + strictures with constipation, fecal incontinence. telangiectasia and pallor on colonoscopy acute radiation proctitis
56
essentially question described a patient with acute cholangitis. and history of occasional bloody stools. what condition most likley caused this?
primary SCLEROSING!! Cholangitis!!! fibrosis of ducts promotes cholestasis and acute cholangitis increased alkphos, bilirubin GGT as although no obstruction, cholestasis!!! other complications = cholangicarcinoma, colon cancer, fat soluble vitamins deficiencies
57
it sounded like ruptured AAA but patient had signs of peritonism which is not in keeping with this vague left lower abdominal discomfort, anorexia, constipation (most likely diverticulitis) then sudden severe abdominal pain and vomiting. pain spreads across abdomen and signs of peritonism (most likely divertiula perforation). imaging in this patient would most likely reveal?
free air in the peritoneal cavity
58
patient is obese but has only lost 3% of body weight with exercises and lifestyle changes over 6 months. frustrated. BMI is now 38. next step in management? indications for this?
BMI of at least 35 BMI of at least 30 with T2DM or unsuccessful attempt at weight loss or uncontrolled comorbidities medication failure not required for weight loss surgery and both interventions can be pursued concurrently
59
post prandial epigastric pain + chronic alcohol misuse. now developed ascites with high amylase and total protein. serosanguinous fluid. most likely diagnosis?
chronic pancreatitis!!! patient has developed a RARE complication called pancreatic ascites!! damage to pancreatic duct with leakage of juice low saag also seen asicites from HCC= malignant ascites = bloody, normal amylase, high protein, low saag ascities from cirrhosis is straw yelllow, normal amylase, low protein, high saag ascites due to intestinal perforation have high neutrophil counts. severe pain with fever lymphomas can cause lymphatic obstruction with chylous ascites which is milky ascities from portal vein thrombosis = abdominal PAIN from SBP = fever, abdominal tenderness tuberculous ascities = abdominal pain, fever, night sweats, straw coloured nephrotic syndrome = non bloodly + PROFOUND peripheral edema
60
57 YO man constant middle and low thoracic back pain worse when lying supine 4.5 kg weight loss and fatigue spine and imaging and neuor ecam is normal cbc is normal smoking history next step in management?
CT abdomen!!! likely pancreatic cancer in tail/body!!!. contrast pancreatic head cancer -> obstructive jaundice, steatorrhea, epigastric pain NOT endoscopy!! as used to identify gastric cancer which causes epigastric pain not back pain. and often associated with anemia
61
dysphagia + epigastric or chest pain + retrocardiac air fluid level -> hiatus hernia
62
recent severe gastroenteritis and history of diuretic use now presents with abdominal distention and colonic dilation on CT scan with no obstruction likely cause? diagnosis? management?
electrolyte imbalance!!! -- hypokelamia, hypomagnesemia olgilvie syndrome!! bowel rest = NPO + decompression with nasogastric and rectal tubes +/- Neostigmine not entamoeba = hematochezia and liver abscess, rare in US
63
23 YO episodic sensations of dysphagia -> solids! burning discomfort in retrosternal area ( heartburn/epigastric pain) no weight loss intermittent asthma treated with beta agonists as needed most likely diagnosis?
eosinophillic esophagitis!!! risk factor = atopic conditions eg eczema asthma complications -> strictures and food impaction treat by avoiding food allergens. PPI, topical glucocorticoids NOT achalasia as dyphagia is progressive not episodic and involves solids and liquids NOT esophageal cancer = slow progressive not intermittent dysphagia. + weight loss NOT peptic stricture as it causes slow progressive not intermittend dysphagia in people with long history of reflux
64
6-7 watery brown stools a day nocturnal episodes cholycestectomy 5 weeks ago everything else negative first step in treatment?
cholestyramine!! or colestipol, colsevelam!!! (bile acid resins) patient is experiencing bile acid diarrohea!! release of bile into intestine from surgery
65
mallory weiss tear from vomiting causes mucosal tear at gastroesophageal junction nasogastric suction may return stomach contents mixed with blood. alcohol risk factor. heal normally but endoscopic therpay for prolonged bleeding contrast stress gastritis where GI bleeding from stress ulcers -> seen in patients in intensive care or burn unit setting
66
sliding hiatal hernia management?
asymptomatic = observation reflux symptoms = PPI refractory to GERD treatment = nissen fundoplication
67
postcholycystectomy RUQ pain 2 years later elevated alkphos and lfts. US shows midly dilated common bile ducts but no stones most likely diagnosis?
sphincter of ODDI dysfunction!!! causes intermittent obstruction of flow of bile and or pancreatic juice recurrent episodes pain in RUQ or epigastric region, similar to biliary colic two parts to sphincter -> amylase elevated if pancreatic sphincter affected opiod analgesics can increase sphincter contraction and worsen pain!!! CONTRAST TO POST CHOLECYSTECTOMY SYNDROME where you do ERCP TO rule out> to rule out biliary causes such as retained stone, biliary stricture, SOD
68
post bariatric surgery, fever abdominal pain epigastric tahcycardia tachypnea within a week of bariatric surgery leukocytosis most likely diagnosis? management?
anastamotic leak!!! CT abdomen with contrast!!! surgical repair!!
69
GI bleed with no identifable source on upper and lower endoscopy (suggests bleeding in distal duodenum, jejujunum or ileum which are not well visualised with endoscopy = small bowel bleeding) dizziness and severe fatigue and decreased levels of VWF
Aortic stenosis!!! trigers low levels of VWF as valve shears it.. predisposes patient to bleeding from angiodysplasias!!!
70
epigastric pain and weight loss hepatomegaly on exam and raised alk phos and transaminases microcytic anemia most likely diagnosis?
gastric cancer!!! additional findings due to mets to liver!! NOT pancreatic cancer as with obstruction you would also expect elevated bilirubin and jaundice. microcytic anemia not typical
71
vomiting green vomit. Last bowel movement 3 days ago. no diarrhea. abdomen distended with hyperactive bowel sounds. diffusely tender to palpation. what finding will most likely be seen in patient? -> appendectomy 6 months ago!!!!! patient has mechanical SBO!!
72
esophageal rupture may cause unsual pleural effusion colours eg green
73
post operative ileus management?
bowel rest and serial examinations!!
74
suspected IBD. next best step in management?
colonoscopy with biopsies!!! - can distinguish type of iBD NOT fecal calprotectin as not specific or diagnostic. used in patients with established diagnosis to who have symptoms of a flare
75
thrombosed external hemorhhoid treatment?
hemorrhoidectomy!!! rubberband ligation and sclerotherapy are used for INTERNAL hemorrhoids only. when conservative management eg fibre and topical glucocorticoid fail. hemorrhoidectomy only if thrombosed hemorrhoids cause itchiness, only external or thrombed ones painful. internal may prolapse and cause fecal incontinence
76
pancreaticopleural fistula can occur and result in amylase rich pleural effusion in lungs most likely from acute or chronic pancreatitis (history of heavy alcohol use and attacks of epigastric pain is a clue) management is bowel rest to allow fistula closure ERCP may be needed less likely to be esophageal rupture as chest pain expected! and pleural fluid <6
77
GI bleed. everyone gets endoscopy and colonoscopy. if source is not found -> technetium scan child vs capsule endoscopy in adults to look for angiodysplasias, neoplasia, ulcers and second line in child
78
epigastric pain and weight loss but CBC was normal (pointing away from gastric cancer) patient also had a recent diagnosis of T2DM 6 months ago. first step in management?
CT Abdomen -> pancreatic cancer !! 25% of cases occur in setting of new onset T2DM in previous 2 years pancreatic cancer is sometimes worse with eating or lying down
79
a HIDA scan is used to diagnose acute cholecystitis in patients with equivocal ultrasounds. not used first line
80
psoas absess signs? investigation?
fever lower abdominal or flank pain radiating to groin abdominal pain with hip extension!! = psoas sign CT scan!!
81
on colonoscopy, patient found to have 2 hyperplastic polyps. next step in management?
repeat colonoscopy in 10 years!!! = normal interval repeat colonoscopy in 5 years if 1st degree relative with colon cancer at <60 years!!! hyperplastic polyps are common benign
82
antibiotic of choice for acute cholecystitis?
pip taz
83
ischemic colitis is most likely to have affected what region?
splenic flexure!!! and rectosigmoid junction !!
84
pain itching and red streaks on left arm palpable cord like veins on left arm and upper chest mild epigastric pain for months and heartburn only partially releived by antacids. next step in management?
CT abdomen has migratory superficial thrombophlebitis or trouseaus syndrome seen in pancreatic and lung cancer
85
porcelain gallbladder increases risk of gallbladder cancer so cholecystectomy required
86
BAT, upper abdominal discomfort and vomiting ecchymosis there, large amounts of free fluid in the upper abdomen importantly CT scan was negative!! most likely cause?
pancreatic duct injury!! compression of pancreas against vertebral column persistent nausea!! abdominal pain, peripancreatic fluid collection!! all signs. may have raised amylase NOT splenic rupture of liver laceration as the big injuries would show up on CT scan!!
87
acute pancreatitis + ALT level > 150 / elevated LFTS!! next step in evaluation?
RUQ ultrasound!! = Gallstone pancreatitis!!! NOT ct scan!!
87
dilated loops of small bowel and air in the intrahepatic ducts. most likely diagnosis?
mechanical bowel obstruction!! -> gallstone ileus!!, gallstone has passed into small bowel before final obstruction causes tumbling obstruction = episodic abdominal pain
87
duodenal hematoma = post prandial abdominal pain, emesis + SBO signs
87
new onset ascities in a patient diagnosed with cirrhoisis on previous ultrasound requires new US to rule out HCC regular USS screening for HCC in patients with cirhossis but asymptomatic = every 6 months
87
causes of ileus
abdominal surgery abdominal hemorrhage!! pancreatitis intestinal ischemia electrolyte abnormalities
88
abdominal compartment syndrome causes? presentation?
massive fluid resusitation eg for pancreatitis, major abdominal surgery 1. tense distended abdomen 2. diaphragmatic elevation causing lung compression - difficulty breathing, atelectasis 3. decreased urine output hypotension tachycardia, venous compression with increased central venous pressure, decreased venous return to the heart and decreased cardiac output
89
with pancreatic cancer imaging can show dilatation of both intra and extra hepatic bile ducts as well as the pancreatic duct. what is this known as?
double duct sign
90
complications of nissen fundoplication and how to diagnose?
gastroparesis due to damage to vagal nerve= bloating, early satiety, postprandial emesis, food aversion, weight loss = gastric scintigraphy to diagnose!!!!! + OGD to rule out obstruction. -> small low fat low fibre meals bloating and inability to belch = resolves on its own dysphagia = self resolving
91
severe epigastric pain radiating to back turners syndrome and HTN elevated amylase CT scan shows dilated bowel loops and normal pancreas next step in management?
CT angiography of chest and abdomen!!!! -> aortic dissection dilated bowel loops due to extenstion into mesenteric artery causing intestinal ischemia raised amylase due to intestinal ischemia
92
signs of obstruction if patient has chrons disease with ileal involvement = stricture most likely. not toxic megacolon as it affects colon and typically in history of c difficile
93
ERCP for sphincter of oddi dysfunction 24 hours ago. now signs of acute pancreatitis. next step in management?
serum lipase!!! pancreatitis is complication of ERCP not CT abdomen as can be normal for first 48 hours.
94
medication used for anal fissures?
topical lidocane and nifedipine surgical manageemnt only indicated if refractory to treatment
95
tracheosesphageal fistula with eosphageal atresia suspected in a baby. next step in management?
nasogastric tube insertion!!! -> inability to insert tube helps diagnose which is then confirmed with CXR showing tip of catheter in eosophagus not a lateral neck radiograph as this is used for epiglottitis
96
bilateral renal infarcts and several abdominal arteries with microaneurysms progressive abdominal pain fatigue, joint pain weight loss most likely diagnosis?
polyarteritis nodosa!!!! mesenteric angiography often diagnostic and biopsy gold standard NOT Thromboangiitis obliterans = distal extremties eg finger ulcers, gangrene seen in young smokers
97
gallstone pancreatitis management? note can be diagnosed with pancreatitis and raised ALT alone
supportive care + cholecystectomy!!! ERCP only if acute cholangitis or common bile duct obstruction seen on US
98
mild urinary irrtiative sympotms eg urinary urgency, dysuria, frequency as well as sterlile pyuria (positive leukocyte esterase, negative nitrite) is common in diverticulitis!! LLQ pain rather than suprapubic or abdominal pain helps point away from cystitis
99
gunshot owund 5 years ago with resection of cecum and terminal ileum abdominal bloating and 4-5 watery stools daily next step in management?
carbohydrate breath test!!! or endoscopy with jejunal aspirate patient has SIBO!!! -> Ileoceacal valve resection so colonic bacteria entering Small bowel/ chronic pancreatitis also RF treat with oral antibiotics NOT fecal elastase as levels linked with chronic pancreatitis NOT PPIs as they worsen SIBO.
100
colovesical fistula (air bubbles in urine). ecoli uti, next step in management?
CT scan with rectal contrast!!!
101
liver mets, most likely to establish diagnosis? if CXR unremarkable
colonoscopy!

USMLE Step 2 (32 decks)

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