Abdominal Pathologies :)

Questão 1 de 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?

Selecione uma das seguintes:

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

Explicação

Questão 2 de 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)?

Selecione uma ou mais das seguintes:

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

Explicação

Questão 3 de 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?

Selecione uma das seguintes:

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

Explicação

Questão 4 de 55

1

What are possible differential diagnoses of raised ALT?

Selecione uma ou mais das seguintes:

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

Explicação

Questão 5 de 55

1

Preencha os espaços em branco para completar o texto.

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.

Explicação

Questão 6 de 55

1

Any gynae problem, always do a pregnancy test first.

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 7 de 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?

Selecione uma das seguintes:

Campylobacter
Cholera
E. Coli
Bacillus Cereus

Explicação

Questão 8 de 55

1

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

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 9 de 55

1

Preencha os espaços em branco para completar o texto.

Management of acute diarrhea and gastroenteritis:

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

Explicação

Questão 10 de 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?

Selecione uma das seguintes:

Hyperthyroidism
Irritable Bowel Syndrome
Endometriosis
Inflammatory Bowel Disease

Explicação

Questão 11 de 55

1

Preencha os espaços em branco para completar o texto.

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

Explicação

Questão 12 de 55

1

What is NOT a potential reason for irritable bowel syndrome?

Selecione uma das seguintes:

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

Explicação

Questão 13 de 55

1

Preencha os espaços em branco para completar o texto.

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

Explicação

Questão 14 de 55

1

What are ways to generally investigate for irritable bowel syndrome?

Selecione uma ou mais das seguintes:

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

Explicação

Questão 15 de 55

1

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

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 16 de 55

1

Buscapan can be given for irritable bowel syndrome.

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 17 de 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?

Selecione uma das seguintes:

Irritable bowel syndrome
Colorectal cancer
Crohn's disease
Ulcerative Colitis

Explicação

Questão 18 de 55

1

IBD and HNPCC put you at increased risk for colorectal cancer

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 19 de 55

1

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

Selecione uma das seguintes:

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

Explicação

Questão 20 de 55

1

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

Selecione uma das seguintes:

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

Explicação

Questão 21 de 55

1

Preencha os espaços em branco para completar o texto.

Most common presentation of colorectal cancer:

change in bowel habit

Explicação

Questão 22 de 55

1

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

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 23 de 55

1

How can you NOT investigate colorectal cancer?

Selecione uma das seguintes:

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

Explicação

Questão 24 de 55

1

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

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 25 de 55

1

How can you manage colorectal cancer?

Selecione uma ou mais das seguintes:

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

Explicação

Questão 26 de 55

1

Preencha os espaços em branco para completar o texto.

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

Explicação

Questão 27 de 55

1

Clique em cada ponto laranja e digite a resposta correta.

Fill in the chart:

Explicação

Questão 28 de 55

1

Which is pelvic pain associated with?

Selecione uma das seguintes:

gastrointestinal problems
gynecological problems
musculoskeletal problems
urological problems
cardiovascular problems

Explicação

Questão 29 de 55

1

What is true regarding Chlamydia trachomatis?

Selecione uma ou mais das seguintes:

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

Explicação

Questão 30 de 55

1

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

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 31 de 55

1

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

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 32 de 55

1

Preencha os espaços em branco para completar o texto.

Investigations for chlamydia:

Male: -catch
Female: swab

Both samples are sent for NAATs ( test)

Explicação

Questão 33 de 55

1

Preencha os espaços em branco para completar o texto.

Chlamydia complications:
inflammatory disease, infertility, pregnancy

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

Explicação

Questão 34 de 55

1

Preencha os espaços em branco para completar o texto.

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

Explicação

Questão 35 de 55

1

Preencha os espaços em branco para completar o texto.

Investigation for Gonnorhea:

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

Explicação

Questão 36 de 55

1

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

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 37 de 55

1

Which of these are complications of gonnorhea?

Selecione uma ou mais das seguintes:

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

Explicação

Questão 38 de 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

Selecione uma das seguintes:

gonnorhea
chlaymdia
syphilis
inflammatory pelvic disease
dysmennorhea
inflammatory bowel disease

Explicação

Questão 39 de 55

1

Preencha os espaços em branco para completar o texto.

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

Explicação

Questão 40 de 55

1

How do you manage pelvic inflammatory disease?

Selecione uma ou mais das seguintes:

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

Explicação

Questão 41 de 55

1

The most common cause of a UTI is E colli

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 42 de 55

1

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

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 43 de 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.

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 44 de 55

1

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

Selecione uma ou mais das seguintes:

leukocytes
nitrates
blood
pH
concentration
glucose
ammonia

Explicação

Questão 45 de 55

1

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

Selecione uma das seguintes:

Renal abscess
Sepsis
Acute kidney injury
Pyelonephritis
Fungal Vaginal infections

Explicação

Questão 46 de 55

1

Preencha os espaços em branco para completar o texto.

Management of UTI:
(supportive)
Analgesia

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

Explicação

Questão 47 de 55

1

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

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 48 de 55

1

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

Selecione uma das seguintes:

Pelvic inflammatory disease
Fibroids
Adhesions
Endometriosis
Meniere's disease

Explicação

Questão 49 de 55

1

Preencha os espaços em branco para completar o texto.

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

Explicação

Questão 50 de 55

1

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

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 51 de 55

1

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

Selecione uma das opções:

VERDADEIRO
FALSO

Explicação

Questão 52 de 55

1

Which of these are emergency findings related to dysmenorrhea?

Selecione uma ou mais das seguintes:

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

Explicação

Questão 53 de 55

1

Preencha os espaços em branco para completar o texto.

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

Explicação

Questão 54 de 55

1

What is NOT true regarding the pill?

Selecione uma das seguintes:

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

Explicação

Questão 55 de 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.

Selecione uma das opções:

VERDADEIRO
FALSO

	Criado por Plymouth Med mais de 6 anos atrás

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

Abdominal Pathologies :)

Questão 1 de 55

Selecione uma das seguintes:

Explicação

Questão 2 de 55

Selecione uma ou mais das seguintes:

Explicação

Questão 3 de 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?

Selecione uma das seguintes:

Explicação

Questão 4 de 55

What are possible differential diagnoses of raised ALT?

Selecione uma ou mais das seguintes:

Explicação

Questão 5 de 55

Preencha os espaços em branco para completar o texto.

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.

Explicação

Questão 6 de 55

Any gynae problem, always do a pregnancy test first.

Selecione uma das opções:

Explicação

Questão 7 de 55

Selecione uma das seguintes:

Explicação

Questão 8 de 55

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

Selecione uma das opções:

Explicação

Questão 9 de 55

Preencha os espaços em branco para completar o texto.

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

Explicação

Questão 10 de 55

Selecione uma das seguintes:

Explicação

Questão 11 de 55

Preencha os espaços em branco para completar o texto.

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

Explicação

Questão 12 de 55

What is NOT a potential reason for irritable bowel syndrome?

Selecione uma das seguintes:

Explicação

Questão 13 de 55

Preencha os espaços em branco para completar o texto.

Explicação

Questão 14 de 55

What are ways to generally investigate for irritable bowel syndrome?

Selecione uma ou mais das seguintes:

Explicação

Questão 15 de 55

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

Selecione uma das opções:

Explicação

Questão 16 de 55

Buscapan can be given for irritable bowel syndrome.

Selecione uma das opções:

Explicação

Questão 17 de 55

Selecione uma das seguintes:

Explicação

Questão 18 de 55

IBD and HNPCC put you at increased risk for colorectal cancer

Selecione uma das opções:

Explicação

Questão 19 de 55

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

Selecione uma das seguintes:

Explicação

Questão 20 de 55

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

Selecione uma das seguintes:

Explicação

Questão 21 de 55

Preencha os espaços em branco para completar o texto.

Most common presentation of colorectal cancer: change in bowel habit

Explicação

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