Abdominal Pathologies :)

Frage 1 von 55

1

BG:
48 year old female with 2 children
Hypertension- well controlled with Amlodipine
-Irritable bowel syndrome (15 year history) on Mebeverine
-Menorrhagia- vaginal hysterectomy 2 years ago
2 month Hx worsening bowels-
Alternating diarrhoea/constipation
Associated lower abdominal pain
Exam:
alert, afebrile, BP 132/70, HR 70, reg
Abdomen: mildly distended but soft non-tender (SNT), no masses, bowel sounds present
FHx: Sister- breast cancer aged 48
Aunt- breast cancer aged 61

What is the next management step would you advise for this patient?

Wähle eine der folgenden:

Admit urgently
Pelvic Exam
Refer urgently
Reassure probably just IBS
Refer routinely and keep a close eye
Cardiorespiratory exame
Urine anaylsis
FBC

Erklärung

Frage 2 von 55

1

BG: 53 year old male, Vetenarian,
MHx – hypertension
PC: Agreed routine review to discuss blood results
Notable results:
Bili 131 (15-73)
GGT 432 (15-73)
ALP 505 (30-130)
ALT 3017 (21-72)
Eventually got hold of him 10 days later- he was on holiday!
Whilst away admitted to a couple days when urine slightly darker and stools paler but since resolved
Approx 5 units/week alcohol

Reviewed in clinic:
No abdo pain, no stigmata liver disease
Exam: obs stable, sclera slightly jaundiced, abdomen soft, nontender, no hepatosplenomegaly

What is(are) the most appropriate next step(s)?

Wähle eine oder mehr der folgenden:

Refer routinely
Refer urgently
Admit urgently
Full Liver Screen
Repeat LFTS
Caeruloplasmin Serum levels
Autoimmune profile
Hepatitis Screen
Repeat Blood tests
Gallbladder ultrasound

Erklärung

Frage 3 von 55

1

Same Patient:
blood tests repeated: Improving LFTs-except ALT still elevated
Liver Screen: all negative but Hepatits Screen:
Hep A: IgG + and IgM -
Hep E: IgG + and IgM +

What is a correct interpretation of these results?

Wähle eine der folgenden:

IgM + means that newly exposed to the pathogen
IgG+ means that newly exposed to the pathogen
IgM- that newly exposed to the pathogen

Erklärung

Frage 4 von 55

1

What are possible differential diagnoses of raised ALT?

Wähle eine oder mehr der folgenden:

Alcoholic liver disease
Wilsons
Viral hepatitis
Celiac
Alpha 1 Antitrypsin deficiency
Hemochromatosis
Certain drugs
Nonalcoholic fatty liver disease
Nelson's disease
Renal Failure

Erklärung

Frage 5 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

Abdominal Examination findings:

Pain in the foregut ( to mid-duodenum, liver, , spleen, 1/2 ) can be felt in the region.

Pain in the midgut (mid-duodenum to 2/3 transverse colon and 1/2 ) can be felt in the region.

Pain in the hindgut ( 2/3 of transverse colon to 1/2 of ) is usually in the region.

Erklärung

Frage 6 von 55

1

Any gynae problem, always do a pregnancy test first.

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 7 von 55

1

24 year old presents complaining of a 2 day history of abdominal pain, vomiting and diarrhoea. He had made some stir fried rice for dinner 3 days ago and forgot to put it in the fridge. He has had no recent travel and is otherwise fit and well. A diagnosis of gastroenteritis is made.

What is your most likely causative organism?

Wähle eine der folgenden:

Campylobacter
Cholera
E. Coli
Bacillus Cereus

Erklärung

Frage 8 von 55

1

Always seek urgent specialist advice whenever a child or elderly are reported to have has a single episode of bloody diarrhoea

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 9 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

Management of acute diarrhea and gastroenteritis:

Conservative: Fluids and
Medical: (if unwell) and whould be based off of culture results

Erklärung

Frage 10 von 55

1

A 27 year old lady presents to you with a 6 month history of abdominal pain and bloating after meals. Her pain is relieved after defecation. She is also suffering from alternating diarrhoea and constipation and feels like she hasn’t emptied her bowels properly. She is very distressed about her symptoms as it is affecting her personal and work life.

What is your main differential?

Wähle eine der folgenden:

Hyperthyroidism
Irritable Bowel Syndrome
Endometriosis
Inflammatory Bowel Disease

Erklärung

Frage 11 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

is a common chronic functional disorder of the bowel causing abdominal cramps, bloating, constipation and/or diarrhea. Most common is in their 20-30s.

Erklärung

Frage 12 von 55

1

What is NOT a potential reason for irritable bowel syndrome?

Wähle eine der folgenden:

overactive bowel
increased visceral hypersensitivity
short chain carbohydrates in diet
post-parturition incontinecne

Erklärung

Frage 13 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

Irritable bowel syndrome is diagnosed if there is at least a month history of abdomen pain, bowel habit, and . The diagnosis is official if the abdominal pain is relieved by or linked to altered bowel habit and AT LEAST 2 OF:
passage of
altered stool passage (urgency, frequency, )
abdominal bloating
symptoms worsened by

On examination, the abdomen is usually normal with some generalized

Erklärung

Frage 14 von 55

1

What are ways to generally investigate for irritable bowel syndrome?

Wähle eine oder mehr der folgenden:

Full blood count
ESR (erythrocyte sedimentation rate)
C reactive protein
TTGA
fecal calprotetectin
CA125
CA173
imaging
Hepatitis C
hcg

Erklärung

Frage 15 von 55

1

Main managements of IBS is dietary changes, peppermint old, and (if needed) loperamide

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 16 von 55

1

Buscapan can be given for irritable bowel syndrome.

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 17 von 55

1

A 45 year old gentleman presents with 7 month history of abdominal pain and unintentional weight loss. He has been feeling more tired lately and has noticed he has become increasingly paler. He has a PMH of asthma and coeliac disease. He explains that his father and his brother also experienced similar symptoms and were subsequently diagnosed with colorectal cancer.

What is your main differential?

Wähle eine der folgenden:

Irritable bowel syndrome
Colorectal cancer
Crohn's disease
Ulcerative Colitis

Erklärung

Frage 18 von 55

1

IBD and HNPCC put you at increased risk for colorectal cancer

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 19 von 55

1

What are these symptomatic of?
Often colicky pain
Rectal bleeding
Bowel obstruction
Tenesmus
Mass in LIF
Early changes in bowel habit

Wähle eine der folgenden:

left colon cancers
right colon cancers
HPNCC
small cell colon cancers
familial colon cancers

Erklärung

Frage 20 von 55

1

What are these symptomatic of:
Weight loss
Anemia
Occult bleeding
Mass in RIF

Wähle eine der folgenden:

right colon cancers
left colon cancers
IBS
small cell colon cancer
familial colon cancers

Erklärung

Frage 21 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

Most common presentation of colorectal cancer:

change in bowel habit

Erklärung

Frage 22 von 55

1

Urgent referral for cancer pathway if the patient is aged 40 and over with unexplained weight loss and abdominal pain.

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 23 von 55

1

How can you NOT investigate colorectal cancer?

Wähle eine der folgenden:

Bedside tests
Liver function test
Urea and Electrolytes test
Thyroid function tests
CEA blood test
Colonoscopy
Biopsy
Flexible sigmoidoscopy and barium enema
MRI
Ultrasound

Erklärung

Frage 24 von 55

1

The earlier the Duke stage (for ex: stage A vs stage B), the lower 5-year survival likelihood.

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 25 von 55

1

How can you manage colorectal cancer?

Wähle eine oder mehr der folgenden:

chemotherapy
palliative therapy
radiotherapy
surgery
multidisciplinary team approach
screening
drugs
bedside monitoring

Erklärung

Frage 26 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

Bowel Cancer Screening Program:

In England, men and women between the ages of -74 years take part
A bowel cancer testing kit is sent every years

2 bowel cancer screening tests:
blood testing – home testing kit
Flexi- – looking for polyps – one at age 55 years

Erklärung

Frage 27 von 55

1

Klicke auf jeden orangenen Punkt und schreibe die korrekte Antwort.

Fill in the chart:

Erklärung

Frage 28 von 55

1

Which is pelvic pain associated with?

Wähle eine der folgenden:

gastrointestinal problems
gynecological problems
musculoskeletal problems
urological problems
cardiovascular problems

Erklärung

Frage 29 von 55

1

What is true regarding Chlamydia trachomatis?

Wähle eine oder mehr der folgenden:

small gram negative
infect columnar and transitional epithelium
sexually transmitted infection
causes infertility
more common in younger adults
asymptomatic
small gram positive
febrile
affects cognitive functionality
lies dormant before manifesting later in life

Erklärung

Frage 30 von 55

1

Women with chlamydia present with dysuria and yellowish discharge and irregular bleeding

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 31 von 55

1

Males with chlamydia present with epididymitis, hematuria, dysuria, discharge, and sudden bursts of weakness

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 32 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

Investigations for chlamydia:

Male: -catch
Female: swab

Both samples are sent for NAATs ( test)

Erklärung

Frage 33 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

Chlamydia complications:
inflammatory disease, infertility, pregnancy

Treatments:
100mg (danger: ) or 1 gram stat

Erklärung

Frage 34 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

Neisseria Gonnorhea is
Gram- diplococcus
Infects mucous membranes of the urethra, , rectum, and conjunctiva
transmitted sexually or

Presentation:
Women:
Infection
Discharge

Men:
Discharge: and thick

Erklärung

Frage 35 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

Investigation for Gonnorhea:

Women: , vaginal, rectal swab
Men: Pharynx, , rectal swab

Erklärung

Frage 36 von 55

1

Ceftriaxone 500mg IM and Azithromycin 3G stat is how to treat gonnorhea.

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 37 von 55

1

Which of these are complications of gonnorhea?

Wähle eine oder mehr der folgenden:

urethral scarring
penile lymphangitis
epididymitis
prostatis
miscarriage
pre mature labor
infertility
perlvic inflammatory disease
meningtis
ischemic bladder

Erklärung

Frage 38 von 55

1

What is the differential diagnosis for these symptoms?
lower abdominal pain
Deep dyspareunia
Abnormal vaginal bleeding and/or discharge
Right upper quadrant pain
Lower abdominal tenderness
Adnexal tenderness, cervical motion tenderness, or uterine tenderness
Abnormal cervical or vaginal mucopurulent discharge
Fever greater than 38°C

Wähle eine der folgenden:

gonnorhea
chlaymdia
syphilis
inflammatory pelvic disease
dysmennorhea
inflammatory bowel disease

Erklärung

Frage 39 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

- is the development of adhesions between the liver and the peritoneum, causing right quadrant pa

Erklärung

Frage 40 von 55

1

How do you manage pelvic inflammatory disease?

Wähle eine oder mehr der folgenden:

screen for STIs
paracetamol
ibuprofen
Oral ofloxacin/levofloxacin + oral metronidazole for 14 days
Ceftriaxone as a single IM dose, followed by oral doxycycline + oral metronidazole for 14 days
Oral cefixime as a single dose (off-label use), followed by oral doxycycline + oral metronidazole for 14 days.
Aspirin
Oral ofloxacin/levofloxacin or 14 days
Ceftriaxone as a single IV dose, followed by oral doxycycline + oral metronidazole for 14 days
Ceftriaxone as a single IM dose, followed by oral doxycycline for 14 days

Erklärung

Frage 41 von 55

1

The most common cause of a UTI is E colli

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 42 von 55

1

Obesity, poor bladder emptying, diabetes, kidney stones, and Vitamin E deficiency all put you at increased risk of a UTI.

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 43 von 55

1

In a UTI, there will be increased urgency and frequency of urination despite it being painful due to the feeling of incomplete urination.

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 44 von 55

1

What do you pay special notice for in a urinalysis of a UTI?

Wähle eine oder mehr der folgenden:

leukocytes
nitrates
blood
pH
concentration
glucose
ammonia

Erklärung

Frage 45 von 55

1

Which of these is not a possible complication of a UTI?

Wähle eine der folgenden:

Renal abscess
Sepsis
Acute kidney injury
Pyelonephritis
Fungal Vaginal infections

Erklärung

Frage 46 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

Management of UTI:
(supportive)
Analgesia

1.
2.
for:
Women - days
Men - days

Erklärung

Frage 47 von 55

1

While both occur shortly after menarche, there is no underlying pelvic pathology in primary dysmennorea like there is in secondary dysmenorrhea.

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 48 von 55

1

Which of these may NOT be the reason for secondary dysmenorrhea?

Wähle eine der folgenden:

Pelvic inflammatory disease
Fibroids
Adhesions
Endometriosis
Meniere's disease

Erklärung

Frage 49 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

dysmennorhea is pain which begins just before menstruation and lasts up to hours, progressively improving

Erklärung

Frage 50 von 55

1

NSAIDS, analgesia and contraceptive pill is how to manage dysmenorrhea.

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 51 von 55

1

You use ultrasounds and PAP smear tests to investigate for dysmenorrhea.

Wähle eins der folgenden:

WAHR
FALSCH

Erklärung

Frage 52 von 55

1

Which of these are emergency findings related to dysmenorrhea?

Wähle eine oder mehr der folgenden:

Abnormal cervix
persistent bleeding
pelvic mass
abdominal mass
ultrasound suggesting cancer
positive pregnancy test
distended abdomen

Erklärung

Frage 53 von 55

1

Fülle die Lücken, um den Text zu vervollständigen.

Contraception:
Starting the pill on day or before protects from pregnancy straight away. Otherwise, patients will need additional contraception until taken for days.

Erklärung

Frage 54 von 55

1

What is NOT true regarding the pill?

Wähle eine der folgenden:

not taking it at the same time everyday makes it less effective
missing a dose makes it less effective
Vomiting makes it less effective
Severe diarrhea makes it less effective
It is taken every day for 21 days, then stopped for 7 days
It is not prescribed for those over the age 40

Erklärung

Frage 55 von 55

1

If you forgot to take the pill yesterday, the missed pill should still be taken, even if it means taking two pills in today.

Wähle eins der folgenden:

WAHR
FALSCH

	Erstellt von Plymouth Med vor mehr als 6 Jahre

Content credits: GP soc presentations Charlotte Bennett Tabitha and Sandra Pippa Le Page

Abdominal Pathologies :)

Abdominal Pathologies :)

Frage 1 von 55

Wähle eine der folgenden:

Erklärung

Frage 2 von 55

Wähle eine oder mehr der folgenden:

Erklärung

Frage 3 von 55

Same Patient: blood tests repeated: Improving LFTs-except ALT still elevated Liver Screen: all negative but Hepatits Screen: Hep A: IgG + and IgM - Hep E: IgG + and IgM + What is a correct interpretation of these results?

Wähle eine der folgenden:

Erklärung

Frage 4 von 55

What are possible differential diagnoses of raised ALT?

Wähle eine oder mehr der folgenden:

Erklärung

Frage 5 von 55

Fülle die Lücken, um den Text zu vervollständigen.

Abdominal Examination findings: Pain in the foregut ( to mid-duodenum, liver, , spleen, 1/2 ) can be felt in the region. Pain in the midgut (mid-duodenum to 2/3 transverse colon and 1/2 ) can be felt in the region. Pain in the hindgut ( 2/3 of transverse colon to 1/2 of ) is usually in the region.

Erklärung

Frage 6 von 55

Any gynae problem, always do a pregnancy test first.

Wähle eins der folgenden:

Erklärung

Frage 7 von 55

Wähle eine der folgenden:

Erklärung

Frage 8 von 55

Always seek urgent specialist advice whenever a child or elderly are reported to have has a single episode of bloody diarrhoea

Wähle eins der folgenden:

Erklärung

Frage 9 von 55

Fülle die Lücken, um den Text zu vervollständigen.

Management of acute diarrhea and gastroenteritis: Conservative: Fluids and Medical: (if unwell) and whould be based off of culture results

Erklärung

Frage 10 von 55

Wähle eine der folgenden:

Erklärung

Frage 11 von 55

Fülle die Lücken, um den Text zu vervollständigen.

is a common chronic functional disorder of the bowel causing abdominal cramps, bloating, constipation and/or diarrhea. Most common is in their 20-30s.

Erklärung

Frage 12 von 55

What is NOT a potential reason for irritable bowel syndrome?

Wähle eine der folgenden:

Erklärung

Frage 13 von 55

Fülle die Lücken, um den Text zu vervollständigen.

Erklärung

Frage 14 von 55

What are ways to generally investigate for irritable bowel syndrome?

Wähle eine oder mehr der folgenden:

Erklärung

Frage 15 von 55

Main managements of IBS is dietary changes, peppermint old, and (if needed) loperamide

Wähle eins der folgenden:

Erklärung

Frage 16 von 55

Buscapan can be given for irritable bowel syndrome.

Wähle eins der folgenden:

Erklärung

Frage 17 von 55

Wähle eine der folgenden:

Erklärung

Frage 18 von 55

IBD and HNPCC put you at increased risk for colorectal cancer

Wähle eins der folgenden:

Erklärung

Frage 19 von 55

What are these symptomatic of? Often colicky pain Rectal bleeding Bowel obstruction Tenesmus Mass in LIF Early changes in bowel habit

Wähle eine der folgenden:

Erklärung

Frage 20 von 55

What are these symptomatic of: Weight loss Anemia Occult bleeding Mass in RIF

Wähle eine der folgenden:

Erklärung

Frage 21 von 55

Fülle die Lücken, um den Text zu vervollständigen.

Most common presentation of colorectal cancer: change in bowel habit

Same Patient:
blood tests repeated: Improving LFTs-except ALT still elevated
Liver Screen: all negative but Hepatits Screen:
Hep A: IgG + and IgM -
Hep E: IgG + and IgM +

What is a correct interpretation of these results?

Management of acute diarrhea and gastroenteritis:

Conservative: Fluids and
Medical: (if unwell) and whould be based off of culture results

What are these symptomatic of?
Often colicky pain
Rectal bleeding
Bowel obstruction
Tenesmus
Mass in LIF
Early changes in bowel habit

What are these symptomatic of:
Weight loss
Anemia
Occult bleeding
Mass in RIF

Most common presentation of colorectal cancer:

change in bowel habit

Bowel Cancer Screening Program:

In England, men and women between the ages of -74 years take part
A bowel cancer testing kit is sent every years

2 bowel cancer screening tests:
blood testing – home testing kit
Flexi- – looking for polyps – one at age 55 years

Investigations for chlamydia:

Male: -catch
Female: swab

Both samples are sent for NAATs ( test)

Chlamydia complications:
inflammatory disease, infertility, pregnancy

Treatments:
100mg (danger: ) or 1 gram stat

Neisseria Gonnorhea is
Gram- diplococcus
Infects mucous membranes of the urethra, , rectum, and conjunctiva
transmitted sexually or

Presentation:
Women:
Infection
Discharge

Men:
Discharge: and thick

Investigation for Gonnorhea:

Women: , vaginal, rectal swab
Men: Pharynx, , rectal swab