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EMED EOR Practice Questions - Gastrointestinal
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Which is the term used for blue discoloration around the umbilicus? A. Cullen sign B. Murphy sign C. Roxving sign D. Turner sign - โโA. Cullen sign - blue discoloration around umbilicus - hemorrhagic pancreatitis A 65 year-old homeless male with a history of pancreatitis is seen in the emergency department for vomiting, upper abdominal pain, back pain and weakness. He is cachetic, pale and jaundiced. A 4-5 cm mass is palpable in the mid to right hypochondrium. What is the most likely diagnosis? A. Chronic cholecystitis B. Carcinoma of head of pancreas C. Fibrolipoma D. Primary biliary cirrhosis - โโB. Carcinoma of head of pancreas - 75 % of pancreatic cancers found in the head - RF = age, tocacco use, obesity, chronic pancreatitis, fam hx and previous abdominal radiation A patient presents with abdominal pain in the RLQ examination reveals increased pain in the RLQ on deep palpation on the LLQ. This is known as which of the following? A. Psoas sign B. Murphys sign C. Rovsings sign D. Obturator sign - โโC. Rovsings sign - increased pain occurs in the right lower quadrant in the LLQ Which of the following pathophysiological procresses is believed to intitiate acute appendicitis? A. Obstruction B. Perforation C. Hemorrhage D. Vascular compromise - โโA. Obstruction - obstruction of the appendiceal lumen by lymphoid hyperplasia, a fecalith or foreign body inititates most cases of appendicitis
which of the following clinical findings would be seen in a ptatient with food poisoning caused by staphylococcus aureus? A. Ingestion of mayonnaise-based salads 48 hrs earlier B. Bloody diarrhea with mucous for 1 week C. Abdominal cramps and vomiting for 48 hrs D. High fever for 1 week - โโC. Abdominal cramps and vomiting for 48 hrs - abdominal cramps, nausea, vomiting and watery diarrhea last 1-2 days A 32 year-old presents with a 3-day history of diarrhea. The patient denies blood, mucus, or night awakening with diarrhea. He recently returned from a business trip to Canada. On physical examination, the patient is afebrile and vital signs reveal BP 115/80, pulse is 76, and respirations are 14. The abdominal examination reveals hyperactive bowel sounds, but is otherwise unremarkable. Which of the following is the most appropriate initial intervention? A. Stool for culture, ova, and parasites B. Proctosigmoidoscopy C. Metronidazole (Flagyl) D. Supportive treatment - โโD. Supportive treatment - dietary management and OTC antidiarrheals for afebrile pts. with watery diarrhea of less than 5 day duration The initial sign or symptom of iron poisoning in a 3 yr old is? A. Vomiting and bloody diarrhea B. Convulsions and tetany C. Somnolence and coma D. Ataxia and colicky abdominal pain - โโA. Vomiting and bloody diarrhea - iron causes localized necrosis and hemorrhage at the point of contact in the GI system An 8 year-old patient presents with fever, nausea, vomiting, and diarrhea, 12 hours after playing with a turtle. The stools are watery, non-bloody and of moderate volumes. Which of the following laboratory tests will be most helpful in making the diagnosis? A. Stool for ova and parasites B. Scotch tape test C. Widal test
A. Giemsa stain, thick blood smear B. Blood cultures with gram stain C. India ink preparation of CSF D. RAST testing of serum - โโA. Giemsa stain, thick blood smear - malaria is typically diagnosed with thick or think Giemsa-stained blood smears - other testing = ELISA or PCR which has similar or greater sensitivity but takes longer, is more expensive and not easily done in the field A middle aged person is being treated for recurrent diarrhea and PUD that is refractory to adequate standard therapy. Which of the following is the most likely diagnosis? A. Achlorhydria B. Drug resistant h pylori infection C. Zollinger Ellison syndrome D. Giardiasis - โโC. Zollinger Ellison syndrome - result of unregulated gastrin release resulting in gastric acid hypersecretion - 50 % of pts. have diarrhea with PUD The drug of choice in an adult for empirical treatment of an ill=appearing adult pt with infectious diarrhea who recently returned from mexico is? A. Amoxicillin B. Ceftriaxone (Rocephin) C. Ciprofloxacin (Cipro) D. Doxycycline - โโC. Ciprofloxacin (Cipro) - fluoroquinolone - class of drugs used in the empirical treatment of infectious diarrhea - alternative = trimethoprim/sulfamethoxazole or erythromycin A 3 year-old presents with profuse watery diarrhea for the past three days. The child vomited twice yesterday, but not today. On examination, the child is febrile, with pulse of 142, respiratory rate of 18, and blood pressure of 60/40 mmHg. The child is alert and responsive, with no focal findings. Which of the following is the most appropriate intervention? A. Antibiotic therapy B. Loperamide (Imodium) C. 3% normal saline IV infusion D. Oral rehydration - โโD. Oral rehydration - goal of therapy for a child with severe gastroenteritis and dehydration = restore fluid loss - oral rehydration with appropriate electrolyte solution is best option if the child is not actively vomiting and can tolerate oral fluids
An otherwise healthy 23 year old female presents with 3 days of frequent, watery, non-bloody stools. She denies significant abdominal pain, vomiting, fever, or dark urine. Others on campus have been seen with same presentation. Initial treatment is? A. Fluid intake and bowel rest B. Ciprofloxacin C. Hospital admission with IV fluids D. Atropine - โโA. Fluid intake and bowel rest - mild diarrhea will not lead to dehydration with adequate fluids and comfort with bowel rest A 30 yr old pt presents with weight loss, diarrhea, and steattorhea. Labs revel the antiendomysial antibody (AEA) is positive. What is the most likely diagnosis? A. Celiac sprue B. Ulcerative colitis C. Whipples disease D. Zollinger-ellison syndrome - โโA. Celiac sprue - classic symptoms and AEA = 90-95% sensitivity and specifity Which of the following is the most effective prophylaxis of travelers diarrhea? A. Metronidazole B. Ciprofloxacin C. Tetracycline D. Ampicillin - โโB. Ciprofloxacin - norfloxacin, ciprofloxacin, olfloxacin, or Bactrim A 30 year-old female presents with a one to two year history of daily bouts of mid-abdominal crampy pain and bloating that are briefly relieved with defecation. Loose to watery bowel movements occur four to five times daily. She denies any nocturnal symptoms. Previous laboratory studies, abdominal CT scans and a colonoscopy have all been normal. Attempted dietary changes, exercise and probiotics have provided no relief. What is the next step in treatment for this patient? A. Nortriptyline (Pamelor)s B. Omeprazole (Prilosec) C. Polyethylene Glycol (Miralax)
A is incorrect because staph has an incubation of 1-8hrs A 26-year-old male patient presents with complaints of diarrhea with marked flatulence and weight loss for the past 6-8 months. In addition, he states that his stools are loose and soft with an oily appearance and foul smelling. The patient has not traveled out of the country. Which of the following laboratory tests would be most helpful based upon this history? A. Stool for leukocytes B. Stool for ova and parasites C. Stool for 72 hr fecal fat D. Stool for culture and sensitivity - โโC. Stool for 72 hr fecal fat - steatorrhea usually present - may be absent in mild disease of celiac sprue - a quantitiative 72 hr stool collection taken while the patient consumes 100gm fat diet is more sensitive in means of detecting fat malabsorption A 24 year old female presents with complaints of abdominal pain, bloating and chronic diarrhea. She says she felt worse last month while on vacation in itialy. Despite eating well she lost weight. What would be the most appropriate treatment for this patient? A. Gluten free diet B. Small bowel resection C. Ciprofloxacin (Cipro) D. Pancreatic enzymes - โโA. Gluten free diet - celiac disease is a diffuse disease of the small bowel that is caused by immunologic malfunction; this disease is active only in the presence of gluten, a constituent of wheat - avoidance of gluten containing foods is the treatment of choice A 31 year old female complains of diarrhea. She admits to associated weight loss and steattorhea, but denies melena or hematochezia. Which of the following is the most likely diagnosis? A. Celiac disease B. Lactose intolerance C. Shory bowel syndrome D. Irritable bowel syndrome - โโA. Celiac disease - greater than 10g of fecal fat in 24 hrs is most consistent with malabsorption syndrome A 25 year old female with hx of diarrhea presents to the ED with guillian-barre syndrome. What is the most likely diagnosis? A. Shigella dysenteriae
B. Yersinia enterocolitica C. Entamoeba histolytica D. Campylobacter jejuni - โโD. Campylobacter jejuni - gram negative bacteria that has been links to GBS - GBS develops 2-3 weeks after initial illness Which of the following is used to screen for malabsorption disorders of the intestines? A. Serum gastrin level B. Urea breath test C. Fecal eosinophils D. Stool fecal fat - โโD. Stool fecal fat - GOLD STANDARD for evaluation of pts. with malabsorption of the intestine A 3 year old presents with 24 hr history or diarrhea, the pt is afebrile and the stool is noted to be loose and watery. No blood is noted in the stool. Fecal WBC is negative. Which of the following is the most likely diagnosis? A. Viral gastroenteritis B. Toxic megacolon C. Ulcerative colitis D. Intussception - โโA. Viral gastroenteritis - afebrile with loose, watery, no-bloody diarrhea - fecal WBC negative Which of the following is the most helpful serological test in primary biliary cirrhosis? A. Anti-smooth muscle antibodies B. Anti-mitochondrial antibodies C. Anti-hepatitis B antibodies D. Anti-nuclear antibodies - โโB. Anti-mitochondrial antibodies - over 90% of cases of primary biliary cirrhosis and rare in other forms of liver dz A patient presents uncertain as to wheter he has complete the Hep B vaccination series. What lab tests would be most useful in determining his immunization status? A. Anti-Hbs B. HbeAg
