Week 10-GI

Question 1

When voiding is inconvenient, brain can inhibit what?

Answer 1

Detrusor muscle

Question 2

Odynophagia is:

Answer 2

Painful swallowing

Question 3

Type of pain that is gnawing, burning, cramping, or aching:

Answer 3

Visceral pain

Question 4

This occurs when hollow organs contract forcefully or are distended or stretched, or when the capsules of solid organs are stretched; can also happen with ischemia

Answer 4

Visceral pain

Question 5

This type of pain is a steady, aching, more severe than visceral type of pain that occurs from inflammation of the parietal peritoneum (peritonitis); it is aggravated by coughing or moving, patients prefer to lie still

Answer 5

Parietal pain

Question 6

This type of pain that is felt at more distant sites which are innervated at approximately the same spinal levels as the disordered structures.

Answer 6

Referred pain

Question 7

Visceral pain in the RUQ suggests:

Answer 7

Liver distention against its capsule (hepatitis)

Question 8

Visceral periumbilical pain suggests ____ then becomes ______ in the RLQ from inflammation of the parietal peritoneum

Answer 8

Early appendicitis from distention of the Inflamed appendix

Parietal pain

Question 9

Referred pain to the ___ from pancreatic or duodenal origin.

Answer 9

Back

Question 10

Referred pain from the Biliary tree to the :

Answer 10

Right scapular region or the right posterior thorax

Question 11

Referred pain from pleurisy or inferior wall myocardial infarction to the ____.

Answer 11

Epigastric area

Question 12

Sensitivity of pain increases or decreases in older adults?

Answer 12

Decreased

Question 13

Colicky acute upper abdominal pain:

Answer 13

Renal stone

Question 14

Sudden knife-like epigastric pain:

Answer 14

Pancreatitis

Question 15

Epigastric pain:

Answer 15

GERD, pancreatitis, and perforated ulcers

Question 16

RUQ/upper abdominal pain:

Answer 16

Cholecystitis and cholangitis

Question 17

Pain precipitated by exertion consider:

Answer 17

CAD

Question 18

Chronic, recurrent upper abdominal pain:

Answer 18

Dyspepsia

Question 19

Negative feeling that is not painful:

Answer 19

Discomfort

Question 20

3 month history of nonspecific upper abdominal discomfort or nausea not attributable to structural abnormalities or PUD.

Answer 20

Functional (non-ulcer) dyspepsia

Question 21

Dysphagia, odynophagia, recurrent vomiting, evidence of GI bleed, early satiety, weight loss, anemia, rial factors for GI cancer, palpable mass, painless jaundice are all

Answer 21

Alarm symptoms in chronic upper abdominal discomfort/pain

Question 22

Postprandial fullness, early satiety, epigastric pain/burning are symptoms of:

Answer 22

Dyspepsia

Question 23

RLQ pain that migrates from periumbilical area plus abdominal wall rigidity is suspicious for:

Answer 23

Appendicitis

Question 24

RLQ pain in women consider:

Answer 24

PID, ruptured ovarian cysts, ectopic pregnancy

Question 25

LLQ pain plus palpable mass:

Answer 25

Diverticulitis

Question 26

Diffuse abdominal pain, distention, hyperactive high-pitched bowel sounds and tenderness on palpation:

Answer 26

Small or large bowel obstruction

Question 27

Pain, absent bowel sounds, rigidity, percussion tenderness, and guarding:

Answer 27

Peritonitis

Question 28

Change in bowel habits with mass:

Answer 28

Colon cancer

Question 29

Pain for 12 weeks in preceding 12 months, relief with defecation, change in frequency of bowel movements, change in form of stool:

Answer 29

IBS

Question 30

Nocturnal diarrhea is usually:

Answer 30

Pathologic

Question 31

Grey or light colored stools are called __ and are caused by ___?

Answer 31

Acholic stools Obstructive jaundice

Question 32

Acholic Stools with itchy skin consider:

Answer 32

Hepatitis A, B, C, alcoholic, toxic liver damage from meds/toxins, gallbladder disease or surgery

Question 33

Melena is___

Answer 33

Black, tarry stool less than 100 ml blood from upper GI bleed

Question 34

Red or maroon colored stool greater than 100 ml of blood with lower GI bleed:

Answer 34

Hematochezia

Question 35

Feeling as if one cannot evacuate all the stool present:

Answer 35

Tenesmus

Question 36

Suprapubic pain indicates:

Answer 36

Bladder disorder

Question 37

Dysuria in women presents as:

Answer 37

Internal urethral discomfort or external across inflamed urethra

Question 38

Dysuria in men presents as:

Answer 38

Proximal to glans penis, prostatic pain- in the Perineum and across the rectum

Question 39

Increase in urine volume in 24 hour period (>3L)

Answer 39

Polyuria

Question 40

Polyuria causes:

Answer 40

Psychogenic polydipsia, poorly controlled diabetes, decreased secretion of ADH of central DI

Question 41

Increased abdominal pressure causes bladder pressure to exceed urethral resistance (usually poor sphincter tone or poor support of bladder).

Answer 41

Stress incontinence

Question 42

Urgency is followed by involuntary leakage due to uncontrolled detrusor contractions that overcome urethral resistance.

Answer 42

Urge incontinence

Question 43

Neurological disorder or anatomic obstruction from pelvic organs or the prostrate limit bladder emptying until the bladder becomes over distended.

Answer 43

Overflow incontinence

Question 44

Combined incontinence is:

Answer 44

Stress and urge

Question 45

Functional incontinence is caused by:

Answer 45

Impaired cognition, MSK problems, immobility

Question 46

Screen all patients for alcohol abuse T/F?

Answer 46

True

Question 47

HAV is spread by:

Answer 47

Fecal/ oral transmission prevented with hand washing and bleach

Question 48

HAV does or does not become chronic?

Answer 48

Does not

Question 49

HBV is transmitted:

Answer 49

Sexual, percutaneous, mucosal transmission

Question 50

HBV can or cannot become chronic?

Answer 50

Can

Question 51

HCV transmission:

Answer 51

Percutaneous, blood or organ transplant before 1992, clotting factors before 1987, hemodialysis, healthcare workers with needle stick injury, birth to HSV positive mother.

Question 52

Chronic Illness occurs in what present of those infected with HCV?

Answer 52

75%

Question 53

Risk factors for colorectal cancer:

Answer 53

Increasing age, personal history, polyps, long-standing IBD, family hx. Weak- male, AA, tobacco use, excessive alcohol use, red meat consumption, obesity

Question 54

When to start screening for colorectal cancer?

Answer 54

Adults 50-75

Question 55

How to screen for colorectal cancer?

Answer 55

1. ) high sensitivity FOBT annually 2. ) sigmoidoscopy every 5 years with FOBT q3yrs 3. ) screening colonoscopy every 10 years

Question 56

Normal bowel sounds:

Answer 56

Clicks and gurgles, 5-34 per minute

Question 57

Rumbling bowel sounds:

Answer 57

Borborygmi

Question 58

These bowel sounds suggest vascular occlusive diagnosis:

Answer 58

Bruits

Question 59

If patient has HTN where should one auscultate in the abdominal?

Answer 59

Epigastrum and CVAs for renal artery stenosis Aorta, iliac arteries and femoral arteries

Question 60

These bowel sounds are found over the liver and spleen and are present in hepatoma, gonococcal infection around the liver, splenic infarction, and pancreatic carcinoma.

Answer 60

Friction rubs

Question 61

These bowel sounds are a soft humming with both systolic and diastolic component and indicate collateral circulation between the portal and systemic venous systems (hepatic cirrhosis)

Answer 61

Venous hums

Question 62

Tympanic areas with percussion in the abdomen indicate:

Answer 62

Air/gas

Question 63

Dull areas with percussion of the abdomen indicate:

Answer 63

Mass or enlarged organ

Question 64

On inspiration, liver is palpable about __ below the right costal margin.

Answer 64

3cm

Question 65

If dullness is present over spleen this indicates:

Answer 65

Splenomegaly in 80% of patients

Question 66

This is when you percuss the lowest interspace- should be tympanic and should remain tympanic even with deep breath.

Answer 66

Splenic percussion sign

Question 67

Left hand behind and press forward, right hand below costal margin, press toward spleen:

Answer 67

Palapation for splenic edge

Question 68

CVA tenderness indicates:

Answer 68

Pyelonephritis/MSK

Question 69

Enlarged kidney caused by:

Answer 69

Hydronephrosis, cysts, tumors, polycystic kidney dz(bilateral)

Question 70

Aortic span should not be over:

Answer 70

3cm in adults of 50

Question 71

Ultrasound of the aorta is recommended for:

Answer 71

Men over 65 who have ever smoked

Question 72

Protuberant abdomen with bulging flanks:

Answer 72

Ascites, happens commonly with cirrhosis

Question 73

How to test for shifting dullness in abdomen?

Answer 73

Supine and then on side, without ascites border should stay the same

Question 74

How to test for a fluid wave in the abdomen?

Answer 74

Have someone push midline, tap on one flank sharply and feel opposite flank for an impulse

Question 75

Tests for appendicitis:

Answer 75

``` Mcburney point Rovsing sign Psoas sign Obturator sign Rectal exam and pelvic in women ```

Question 76

When you press deeply into LLQ and assess for withdrawal pain?

Answer 76

Rovsing sign

Question 77

When you raise thigh against resistance or turn to left side and extend the right leg at the hip?

Answer 77

Psoas sign

Question 78

When you flex right thigh at hip and internally rotate hip?

Answer 78

Obturator

Question 79

When the patient exhales and the examiner places hand below costal margin on the right side at the mid-clavicular line and then the patient inspires. If the patient stops breathing in and winces with a catch in breath this is a:

Answer 79

Positive Murphy’s sign

Question 80

A positive Murphy’s sign indicates:

Answer 80

Acute cholecystitis due to an inflamed gallbladder being palpated as it descends on inspiration

Question 81

Ventral hernia:

Answer 81

Diastasis recti: 2-3 cm gap in rectus muscles

Question 82

These are detectable by a few weeks of age and disappear by 1 year, nearly all by 5:

Answer 82

Umbilical hernias

Question 83

A midline ridge that resolves during early childhood:

Answer 83

Diastasis recti

Question 84

These are generally easily palpated in newborns/infants?

Answer 84

Spleen and liver

Question 85

In peds a silent, tympanic, distended and tender abdomen suggests:

Answer 85

Peritonitis

Question 86

Abnormal palpation findings in peds:

Answer 86

Hydronephrosis (enlarged kidney) Deep palpation in RUQ olive size firm pyloric mass (May have visible peristaltic waves followed by projectile vomiting)- pyloric stenosis

Question 87

Patient with peritonitis May present with:

Answer 87

Guarding, rigidity, rebound tenderness

Question 88

This is voluntary contraction of the abdominal wall often with grimace:

Answer 88

Guarding

Question 89

Involuntary reflex contraction of the ab wall from peritoneal inflammation:

Answer 89

Rigidity

Question 90

Kidney pain is an example of what type of pain?

Answer 90

Visceral

Question 91

Appendicitis typically presents with pain in what area?

Answer 91

Periumbilical migrating to RLQ