RUQ Pain

Question 1

How are symptomatic gallstones managed?

Answer 1

Anaelgesia
Low fat diet
Laparoscopic cholecystectomy

Question 2

Risk factors for gallstones

Answer 2

Older age
Female
Pregnancy
Obesity
Rapid weight loss
Drugs
Genetics

Question 3

What type are most gallstones?

Answer 3

Cholesterol stones

Question 4

Symptoms of cholecystitis

Answer 4

RUQ pain
Murphy a sign
Inflammatory picture
Possible guarding
History of biliary colic?

Question 5

Do you get jaundice in cholecystitis?

Answer 5

No!

Question 6

What does Murphy sign indicate?

Answer 6

Cholecystitis

Question 7

Investigations for RUQ pain

Answer 7

FBC UE LFT CRP
Lipase
VBG
Urinalysis
CXR
ECG
USS
CT AP
MRCP

Question 8

What proportion of cholecystitis is secondary to gallstones?

Answer 8

90%

Question 9

What is the management of cholecystitis

Answer 9

Fluids
Antibiotics
Anaelgesia
Laparoscopic cholecystectomy

Question 10

What is acute cholecystitis?

Answer 10

Acute inflammation of the gall bladder due to obstruction of the cystic duct (usually by dislodged gallstone)

Question 11

Symptoms of hepatitis A

Answer 11

Fever
RUQ pain
Malaise
Jaundice
Nausea and vomiting
Itch

Question 12

Severe symptoms of new Hep B infection

Answer 12

RUQ pain
Malaise
Jaundice
Nausea
Encephalopathy
Vomiting

Question 13

What proportion of patients are symptomatic with hep C?

Answer 13

1/3rd get:
Fatigue
Myalgia
Jaundice

Question 14

Which hepatitis viruses cause HCC?

Answer 14

Chronic B and C

Question 15

How is viral hepatitis transmitted?

Answer 15

A and E - faecal oral
B, C and D - blood and fluids

Question 16

Symptoms of renal colic

Answer 16

Sudden onset unilateral flank pain
Radiation to groin and scrotum
Vomiting
Frank haematuria
Patient pacing as can’t get comfortable

Question 17

Investigations for renal colic

Answer 17

FBC UE LFT CRP
VBG
Urinalysis
CT-KUB

Question 18

What is the largest size of kidney stone that will likely pass naturally?

Answer 18

10mm

Question 19

How to prevent kidney stones

Answer 19

Hydrate
Reduce protein intake
Targeted salt urine chelation therapy

Question 20

Where are the most common sites for kidney stones to get stuck?

Answer 20

Pelviuteric junction
Pelvic brim
Vesicouteric junction

Question 21

What is MRCP

Answer 21

MRI scan of the upper abdomen that visualises the biliary tree and pancreatic ducts
Non invasive

Question 22

What is cholangitis

Answer 22

Infection of the biliary tree

Question 23

What is Charcots triad?

Answer 23

Fever
RUQ pain
Jaundice

Question 24

Reynauds pentad

Answer 24

Fever
RUQ pain
Jaundice
Shock (hypotension and tachycardia)
Altered mental status

Question 25

Symptoms of a perforated peptic ulcer

Answer 25

Sudden onset severe continuous epigastric pain Guarding and peritonitis

Question 26

Investigations for perforated peptic ulcer

Answer 26

FBC UE LFT CRP VBG Urinalysis ECG CXR CT AP

Question 27

Management of perforation

Answer 27

Emergency surgical intervention to repair defect and washout

Question 28

Symptoms of acute pancreatitis

Answer 28

Sudden onset epigastric and LUQ pain Radiation to the back Pain worse on movement Nausea and vomiting

Question 29

Investigations for acute pancreatitis

Answer 29

FBC UE LFT CRP Renal profile Serum amylase and lipase USS OR CT OR MRCP

Question 30

Diagnosis of acute pancreatitis

Answer 30

Serum lipase 3x greater than normal

Question 31

Risk factors for gallstones

Answer 31

Middle aged women Younger men Alcohol excess Gallstones

Question 32

Causes of pancreatitis

Answer 32

Ideopathic Gallstones Ethanol Trauma S Mumps and Malignancy Autoimmune Scorpion venom Hyperlipidaemia/Hypercalcaemia ERCP Drugs - azathioprine, thiazides, septrin and tetracyclines

Question 33

Symptoms of DKA

Answer 33

Polyuria Polydipsia Weight loss Nausea and vomiting Abdominal pain Malaise

Question 34

When do you get kids mail breathing?

Answer 34

In DKA

Question 35

Examination findings in DKA

Answer 35

Kussmaul breathing Tachycardia Hypotension Dry Pear drop breath Abdo tenderness

Question 36

Scary complications of DKA

Answer 36

Hypokalaemia Cerebral oedema AKI ARDS

Question 37

Management of DKA

Answer 37

Give isotonic saline IV insulin Correct electrolytes Assess for trigger - ?infection

Question 38

Symptoms of gastric cancer

Answer 38

Abdo pain Weight loss Dysphasia sometimes Lymphadenopathy - SMJ and Virchows node Nausea Melaena

Question 39

Symptoms of acute mesenteric ischaemia

Answer 39

Moderate to severe colicky or constant abdo pain Poorly localised pain Melaena Diarrhoea Peritonism

Question 40

Management of ischaemic bowel

Answer 40

Fluids Anaelgesia Oxygen Antibiotics Laparotomy to reestablish blood supply and resect non viable tissue

Question 41

Causes of ischaemic bowel

Answer 41

Thrombus Embolus Non-occlusive (inadequate supply, eg hypotension)