Abdominal Pathologies :)

Description

Content credits: GP soc presentations Charlotte Bennett Tabitha and Sandra Pippa Le Page
Plymouth Med
Quiz by Plymouth Med, updated more than 1 year ago
Plymouth Med
Created by Plymouth Med over 6 years ago
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Resource summary

Question 1

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

Question 2

Question
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)?
Answer
  • Refer routinely
  • Refer urgently
  • Admit urgently
  • Full Liver Screen
  • Repeat LFTS
  • Caeruloplasmin Serum levels
  • Autoimmune profile
  • Hepatitis Screen
  • Repeat Blood tests
  • Gallbladder ultrasound

Question 3

Question
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?
Answer
  • IgM + means that newly exposed to the pathogen
  • IgG+ means that newly exposed to the pathogen
  • IgM- that newly exposed to the pathogen

Question 4

Question
What are possible differential diagnoses of raised ALT?
Answer
  • Alcoholic liver disease
  • Wilsons
  • Viral hepatitis
  • Celiac
  • Alpha 1 Antitrypsin deficiency
  • Hemochromatosis
  • Certain drugs
  • Nonalcoholic fatty liver disease
  • Nelson's disease
  • Renal Failure

Question 5

Question
Abdominal Examination findings: Pain in the foregut ( [blank_start]esophagus[blank_end] to mid-duodenum, liver, [blank_start]gallbladder[blank_end], spleen, 1/2 [blank_start]pancreas[blank_end]) can be felt in the [blank_start]epigastric[blank_end] region. Pain in the midgut (mid-duodenum to [blank_start]proximal[blank_end] 2/3 transverse colon and 1/2 [blank_start]pancreas[blank_end]) can be felt in the [blank_start]umbilical[blank_end] region. Pain in the hindgut ([blank_start]distal[blank_end] 2/3 of transverse colon to 1/2 of [blank_start]anal[blank_end] [blank_start]canal[blank_end]) is usually in the [blank_start]pubic[blank_end] region.
Answer
  • esophagus
  • gallbladder
  • pancreas
  • pancreas
  • proximal
  • distal
  • anal
  • canal
  • umbilical
  • epigastric
  • pubic

Question 6

Question
Any gynae problem, always do a pregnancy test first.
Answer
  • True
  • False

Question 7

Question
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?
Answer
  • Campylobacter
  • Cholera
  • E. Coli
  • Bacillus Cereus

Question 8

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

Question 9

Question
Management of acute diarrhea and gastroenteritis: Conservative: Fluids and [blank_start]electrolytes[blank_end] Medical: [blank_start]Antibiotics[blank_end] (if [blank_start]systematically[blank_end] unwell) and whould be based off of [blank_start]stool[blank_end] culture results
Answer
  • electrolytes
  • Antibiotics
  • systematically
  • stool

Question 10

Question
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?
Answer
  • Hyperthyroidism
  • Irritable Bowel Syndrome
  • Endometriosis
  • Inflammatory Bowel Disease

Question 11

Question
[blank_start]Irritable[blank_end] [blank_start]bowel[blank_end] [blank_start]syndrome[blank_end] is a common chronic functional disorder of the bowel causing abdominal cramps, bloating, constipation and/or diarrhea. Most common is [blank_start]women[blank_end] in their 20-30s.
Answer
  • women
  • Irritable
  • bowel
  • syndrome

Question 12

Question
What is NOT a potential reason for irritable bowel syndrome?
Answer
  • overactive bowel
  • increased visceral hypersensitivity
  • short chain carbohydrates in diet
  • post-parturition incontinecne

Question 13

Question
Irritable bowel syndrome is diagnosed if there is at least a [blank_start]6[blank_end] month history of abdomen pain, [blank_start]altered[blank_end] bowel habit, and [blank_start]bloating[blank_end]. The diagnosis is official if the abdominal pain is relieved by [blank_start]defecation[blank_end] or linked to altered bowel habit and AT LEAST 2 OF: passage of [blank_start]mucus[blank_end] altered stool passage (urgency, frequency, [blank_start]tenesmus[blank_end]) abdominal bloating symptoms worsened by [blank_start]eating[blank_end] On examination, the abdomen is usually normal with some generalized [blank_start]tenderness[blank_end]
Answer
  • tenderness
  • 6
  • altered
  • bloating
  • defecation
  • mucus
  • tenesmus
  • eating

Question 14

Question
What are ways to generally investigate for irritable bowel syndrome?
Answer
  • Full blood count
  • ESR (erythrocyte sedimentation rate)
  • C reactive protein
  • TTGA
  • fecal calprotetectin
  • CA125
  • CA173
  • imaging
  • Hepatitis C
  • hcg

Question 15

Question
Main managements of IBS is dietary changes, peppermint old, and (if needed) loperamide
Answer
  • True
  • False

Question 16

Question
Buscapan can be given for irritable bowel syndrome.
Answer
  • True
  • False

Question 17

Question
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?
Answer
  • Irritable bowel syndrome
  • Colorectal cancer
  • Crohn's disease
  • Ulcerative Colitis

Question 18

Question
IBD and HNPCC put you at increased risk for colorectal cancer
Answer
  • True
  • False

Question 19

Question
What are these symptomatic of? Often colicky pain Rectal bleeding Bowel obstruction Tenesmus Mass in LIF Early changes in bowel habit
Answer
  • left colon cancers
  • right colon cancers
  • HPNCC
  • small cell colon cancers
  • familial colon cancers

Question 20

Question
What are these symptomatic of: Weight loss Anemia Occult bleeding Mass in RIF
Answer
  • right colon cancers
  • left colon cancers
  • IBS
  • small cell colon cancer
  • familial colon cancers

Question 21

Question
Most common presentation of colorectal cancer: [blank_start]rectal[blank_end] [blank_start]bleeding[blank_end] [blank_start]persisting[blank_end] change in bowel habit [blank_start]anemia[blank_end]
Answer
  • anemia
  • persisting
  • rectal
  • bleeding

Question 22

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

Question 23

Question
How can you NOT investigate colorectal cancer?
Answer
  • Bedside tests
  • Liver function test
  • Urea and Electrolytes test
  • Thyroid function tests
  • CEA blood test
  • Colonoscopy​
  • Biopsy
  • Flexible sigmoidoscopy and barium enema
  • MRI
  • Ultrasound

Question 24

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

Question 25

Question
How can you manage colorectal cancer?
Answer
  • chemotherapy
  • palliative therapy
  • radiotherapy
  • surgery
  • multidisciplinary team approach
  • screening
  • drugs
  • bedside monitoring

Question 26

Question
Bowel Cancer Screening Program: In England, men and women between the ages of [blank_start]60[blank_end]-74 years take part A bowel cancer testing kit is sent every [blank_start]2[blank_end] years 2 bowel cancer screening tests: [blank_start]Fecal[blank_end] [blank_start]occult[blank_end] blood testing – home testing kit Flexi-[blank_start]sigmoidoscopy[blank_end] – looking for polyps – one at age 55 years
Answer
  • 2
  • 60
  • Fecal
  • occult
  • sigmoidoscopy

Question 27

Answer
  • 4-6
  • salmonella
  • E. coli
  • Bacillus Cereus
  • Campylobacter

Question 28

Question
Which is pelvic pain associated with?
Answer
  • gastrointestinal problems
  • gynecological problems
  • musculoskeletal problems
  • urological problems
  • cardiovascular problems

Question 29

Question
What is true regarding Chlamydia trachomatis?
Answer
  • 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

Question 30

Question
Women with chlamydia present with dysuria and yellowish discharge and irregular bleeding
Answer
  • True
  • False

Question 31

Question
Males with chlamydia present with epididymitis, hematuria, dysuria, discharge, and sudden bursts of weakness
Answer
  • True
  • False

Question 32

Question
Investigations for chlamydia: Male: [blank_start]first[blank_end]-catch [blank_start]urine[blank_end] Female: [blank_start]vulvovaginal[blank_end] swab Both samples are sent for NAATs ([blank_start]nucleic[blank_end] [blank_start]acid[blank_end] [blank_start]amplification[blank_end] test)
Answer
  • first
  • urine
  • vulvovaginal
  • nucleic
  • acid
  • amplification

Question 33

Question
Chlamydia complications: [blank_start]pelvic[blank_end] inflammatory disease, infertility, [blank_start]ectopic[blank_end] pregnancy Treatments: 100mg [blank_start]Doxycycline[blank_end] (danger: [blank_start]teratogenic[blank_end]) or 1 gram stat [blank_start]Azithromycin[blank_end]
Answer
  • teratogenic
  • Azithromycin
  • Doxycycline
  • ectopic
  • pelvic

Question 34

Question
Neisseria Gonnorhea is Gram-[blank_start]negative[blank_end] diplococcus Infects mucous membranes of the urethra, [blank_start]endocervix[blank_end], rectum, [blank_start]pharynx[blank_end] and conjunctiva transmitted sexually or [blank_start]perinatally[blank_end] Presentation: Women: [blank_start]Urinary[blank_end] [blank_start]Tract[blank_end] Infection Discharge [blank_start]Dysuria[blank_end] Men: Discharge: [blank_start]green[blank_end] and thick [blank_start]dysuria[blank_end]
Answer
  • negative
  • pharynx
  • endocervix
  • perinatally
  • Urinary
  • Tract
  • Dysuria
  • green
  • dysuria

Question 35

Question
Investigation for Gonnorhea: Women: [blank_start]Pharynx[blank_end], vaginal, rectal swab Men: Pharynx, [blank_start]urethral[blank_end], rectal swab
Answer
  • Pharynx
  • urethral

Question 36

Question
Ceftriaxone 500mg IM and Azithromycin 3G stat is how to treat gonnorhea.
Answer
  • True
  • False

Question 37

Question
Which of these are complications of gonnorhea?
Answer
  • urethral scarring
  • penile lymphangitis
  • epididymitis
  • prostatis
  • miscarriage
  • pre mature labor
  • infertility
  • perlvic inflammatory disease
  • meningtis
  • ischemic bladder

Question 38

Question
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
Answer
  • gonnorhea
  • chlaymdia
  • syphilis
  • inflammatory pelvic disease
  • dysmennorhea
  • inflammatory bowel disease

Question 39

Question
[blank_start]Peri[blank_end]-[blank_start]hepatitis[blank_end] is the development of adhesions between the liver and the peritoneum, causing right [blank_start]upper[blank_end] quadrant pa
Answer
  • hepatitis
  • Peri
  • upper

Question 40

Question
How do you manage pelvic inflammatory disease?
Answer
  • 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

Question 41

Question
The most common cause of a​ UTI is E colli
Answer
  • True
  • False

Question 42

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

Question 43

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

Question 44

Question
What do you pay special notice for in a urinalysis of a UTI?
Answer
  • leukocytes
  • nitrates
  • blood
  • pH
  • concentration
  • glucose
  • ammonia

Question 45

Question
Which of these is not a possible complication of a UTI?
Answer
  • Renal abscess
  • Sepsis
  • Acute kidney injury
  • Pyelonephritis
  • Fungal Vaginal infections

Question 46

Question
Management of UTI: [blank_start]Fluids[blank_end] (supportive) Analgesia 1. [blank_start]Trimethoprim[blank_end] 2. [blank_start]Nitrofurantoin[blank_end] for: Women - [blank_start]3[blank_end] days Men - [blank_start]7[blank_end] days
Answer
  • 3
  • 7
  • Fluids
  • Trimethoprim
  • Nitrofurantoin

Question 47

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

Question 48

Question
Which of these may NOT be the reason for secondary dysmenorrhea?
Answer
  • Pelvic inflammatory disease
  • Fibroids
  • Adhesions
  • Endometriosis
  • Meniere's disease

Question 49

Question
[blank_start]Primary[blank_end] dysmennorhea is pain which begins just before menstruation and lasts up to [blank_start]72[blank_end] hours, progressively improving
Answer
  • Primary
  • 72

Question 50

Question
NSAIDS, analgesia and contraceptive pill is how to manage dysmenorrhea.
Answer
  • True
  • False

Question 51

Question
You use ultrasounds and PAP smear tests to investigate for dysmenorrhea.
Answer
  • True
  • False

Question 52

Question
Which of these are emergency findings related to dysmenorrhea?
Answer
  • Abnormal cervix
  • persistent bleeding
  • pelvic mass
  • abdominal mass
  • ultrasound suggesting cancer
  • positive pregnancy test
  • distended abdomen

Question 53

Question
Contraception: Starting the pill on day [blank_start]5[blank_end] or before protects from pregnancy straight away. Otherwise, patients will need additional contraception until taken for [blank_start]7[blank_end] days.
Answer
  • 5
  • 7

Question 54

Question
What is NOT true regarding the pill?
Answer
  • 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

Question 55

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