2024 NR 509 ABDOMEN AND GU
FINAL EXAM WEEK 5 WITH
CORRECT ANSWERS
Extrahepatic jaundice arises from obstruction of - CORRECT-ANSWERSthe
extrahepatic bile ducts, most commonly the common bile ducts
obstruct the common bile duct cause - CORRECT-ANSWERSGallstones or
pancreatic, cholangio-, or duodenal carcinoma
Dark urine indicates - CORRECT-ANSWERSimpaired excretion of bilirubin into
the GI tract
Painless jaundice points to - CORRECT-ANSWERSmalignant obstruction of the
bile ducts, seen in duodenal or pancreatic carcinoma; painful jaundice is
commonly infectious in origin, as in hepatitis A and cholangitis
Involuntary voiding or lack of awareness suggests - CORRECT-
ANSWERScognitive/neurosensory deficits
Some patients may not actually vomit but raise esophageal or gastric
contents without nausea or retching, called - CORRECT-
ANSWERSregurgitation
Many patients with chronic upper abdominal discomfort or pain complain of
heartburn, dysphagia, or effortless ________. - CORRECT-
ANSWERSregurgitation
Painless loose or watery stools that last less than 14 days' duration:
a. persistent diarrhea
b. acute diarrhea
c. chronic diarrhea - CORRECT-ANSWERSACUTE DIARRHEA-
Stress incontinence arises from decreased.
CAUSE - CORRECT-ANSWERSintraurethral pressure.
CAUSE
1. if sudden coughing, sneezing, or laughing causes loss of urine usually in
women after they have a baby
2. These problems are common in men with partial bladder outlet
obstruction from benign prostatic hyperplasia or urethral stricture.
,In bladder infection, pain in the lower abdomen is typically - CORRECT-
ANSWERSdull and pressure-like
1. chronic bladder distention is usually painless.
Painful urination accompanies - CORRECT-ANSWERScystitis (bladder
infection), urethritis, and urinary tract infections, bladder stones, tumors,
and, in men, acute prostatitis. Women report internal burning in urethritis,
and external burning in vulvovaginitis.
Urgency suggests - CORRECT-ANSWERSurinary tract infection (UTI) or
irritation from possible urinary calculi. Frequency is common in UTI and
bladder neck obstruction.
In men, painful urination without frequency or urgency suggests - CORRECT-
ANSWERSurethritis
flank or back pain suggests - CORRECT-ANSWERSpyelonephritis
Polyuria refers to a significant increase in - CORRECT-ANSWERS24-hour urine
volume, roughly defined as exceeding 3 L.
Causes of polyuria include - CORRECT-ANSWERSthe high fluid intake of
psychogenic polydipsia and poorly controlled diabetes, the decreased
secretion of antidiuretic hormone (ADH) of central diabetes insipidus, and the
decreased renal sensitivity to ADH of nephrogenic diabetes insipidus.
Myoglobin from rhabdomyolysis can cause - CORRECT-ANSWERStinge the
urine pink in the absence of red cells.
Flank
Flank pain, fever, and chills signal - CORRECT-ANSWERSAcute pyelonephritis
Renal or ureteral colic is caused by - CORRECT-ANSWERSsudden obstruction
of a ureter, for example, from renal or urinary stones or blood clots
Firmness or hardness of the liver, bluntness or rounding of its edge, and
surface irregularity are suspicious for - CORRECT-ANSWERSLIVER DISEASE
An obstructed distended gallbladder may merge with the liver, forming a -
CORRECT-ANSWERSfirm oval mass below the liver edge and an area that is
dull to percussion
Risk factors for AAA are - CORRECT-ANSWERSage ≥65 years, history of
smoking, male gender, and a first-degree relative with a history of AAA repair
, Causes of bladder distention - CORRECT-ANSWERSoutlet obstruction from a
urethral stricture or prostatic hyperplasia, medication side effects, and
neurologic disorders such as stroke or multiple sclerosis
A sharp halting in inspiratory effort due to pain from palpation of the
gallbladder on examination is a - CORRECT-ANSWERSpositive Murphy sign
definition of "Chadwick sign". - CORRECT-ANSWERSbluish discoloration of the
cervix and vagina due to increased vascular congestion in early pregnancy
Screening for colorectal cancer - CORRECT-ANSWERSAt 50, start FOBT every
year, sigmoidoscopy every 5 years, colonoscopy every 10 years.
More often if they have personal or family history of colorectal cancer or
adenomatous polyp, or IBD.
For FOBT- send them home with three slides to do themselves, don't do it in
the office.
An overweight 26-year-old public servant presents to the Emergency
Department with 12 hours of intense abdominal pain, light-headedness, and
a fainting episode that finally prompted her to seek medical attention. She
has a strong family history of gallstones and is concerned about this
possibility. She has not had any vomiting or diarrhea. She had a normal
bowel movement this morning. Her β-human chorionic gonadotropin (β-hCG)
is positive at triage. She reports that her last period was 10 weeks ago. Her
vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate,
20/min; oxygen saturation, 99%; and temperature, 37.3ºC orally. The
clinician performs an abdominal exam prior to her pelvic exam and, on
palpation of her abdomen, finds involuntary rigidity and rebound tenderness.
What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perf - CORRECT-ANSWERSGood!
a. Ruptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive β-hCG, and findings suggestive of peritoneal
inflammation/irritation strongly suggest a ruptured ectopic pregnancy with
significant intra-abdominal bleeding leading to peritoneal signs. This case is
emergent and requires immediate treatment of her hypotension and
presumed blood loss as well as gynecological consult for emergent surgery.
Ruptured ectopic pregnancies can lead to life-threatening intra-abdominal
bleeding.
FINAL EXAM WEEK 5 WITH
CORRECT ANSWERS
Extrahepatic jaundice arises from obstruction of - CORRECT-ANSWERSthe
extrahepatic bile ducts, most commonly the common bile ducts
obstruct the common bile duct cause - CORRECT-ANSWERSGallstones or
pancreatic, cholangio-, or duodenal carcinoma
Dark urine indicates - CORRECT-ANSWERSimpaired excretion of bilirubin into
the GI tract
Painless jaundice points to - CORRECT-ANSWERSmalignant obstruction of the
bile ducts, seen in duodenal or pancreatic carcinoma; painful jaundice is
commonly infectious in origin, as in hepatitis A and cholangitis
Involuntary voiding or lack of awareness suggests - CORRECT-
ANSWERScognitive/neurosensory deficits
Some patients may not actually vomit but raise esophageal or gastric
contents without nausea or retching, called - CORRECT-
ANSWERSregurgitation
Many patients with chronic upper abdominal discomfort or pain complain of
heartburn, dysphagia, or effortless ________. - CORRECT-
ANSWERSregurgitation
Painless loose or watery stools that last less than 14 days' duration:
a. persistent diarrhea
b. acute diarrhea
c. chronic diarrhea - CORRECT-ANSWERSACUTE DIARRHEA-
Stress incontinence arises from decreased.
CAUSE - CORRECT-ANSWERSintraurethral pressure.
CAUSE
1. if sudden coughing, sneezing, or laughing causes loss of urine usually in
women after they have a baby
2. These problems are common in men with partial bladder outlet
obstruction from benign prostatic hyperplasia or urethral stricture.
,In bladder infection, pain in the lower abdomen is typically - CORRECT-
ANSWERSdull and pressure-like
1. chronic bladder distention is usually painless.
Painful urination accompanies - CORRECT-ANSWERScystitis (bladder
infection), urethritis, and urinary tract infections, bladder stones, tumors,
and, in men, acute prostatitis. Women report internal burning in urethritis,
and external burning in vulvovaginitis.
Urgency suggests - CORRECT-ANSWERSurinary tract infection (UTI) or
irritation from possible urinary calculi. Frequency is common in UTI and
bladder neck obstruction.
In men, painful urination without frequency or urgency suggests - CORRECT-
ANSWERSurethritis
flank or back pain suggests - CORRECT-ANSWERSpyelonephritis
Polyuria refers to a significant increase in - CORRECT-ANSWERS24-hour urine
volume, roughly defined as exceeding 3 L.
Causes of polyuria include - CORRECT-ANSWERSthe high fluid intake of
psychogenic polydipsia and poorly controlled diabetes, the decreased
secretion of antidiuretic hormone (ADH) of central diabetes insipidus, and the
decreased renal sensitivity to ADH of nephrogenic diabetes insipidus.
Myoglobin from rhabdomyolysis can cause - CORRECT-ANSWERStinge the
urine pink in the absence of red cells.
Flank
Flank pain, fever, and chills signal - CORRECT-ANSWERSAcute pyelonephritis
Renal or ureteral colic is caused by - CORRECT-ANSWERSsudden obstruction
of a ureter, for example, from renal or urinary stones or blood clots
Firmness or hardness of the liver, bluntness or rounding of its edge, and
surface irregularity are suspicious for - CORRECT-ANSWERSLIVER DISEASE
An obstructed distended gallbladder may merge with the liver, forming a -
CORRECT-ANSWERSfirm oval mass below the liver edge and an area that is
dull to percussion
Risk factors for AAA are - CORRECT-ANSWERSage ≥65 years, history of
smoking, male gender, and a first-degree relative with a history of AAA repair
, Causes of bladder distention - CORRECT-ANSWERSoutlet obstruction from a
urethral stricture or prostatic hyperplasia, medication side effects, and
neurologic disorders such as stroke or multiple sclerosis
A sharp halting in inspiratory effort due to pain from palpation of the
gallbladder on examination is a - CORRECT-ANSWERSpositive Murphy sign
definition of "Chadwick sign". - CORRECT-ANSWERSbluish discoloration of the
cervix and vagina due to increased vascular congestion in early pregnancy
Screening for colorectal cancer - CORRECT-ANSWERSAt 50, start FOBT every
year, sigmoidoscopy every 5 years, colonoscopy every 10 years.
More often if they have personal or family history of colorectal cancer or
adenomatous polyp, or IBD.
For FOBT- send them home with three slides to do themselves, don't do it in
the office.
An overweight 26-year-old public servant presents to the Emergency
Department with 12 hours of intense abdominal pain, light-headedness, and
a fainting episode that finally prompted her to seek medical attention. She
has a strong family history of gallstones and is concerned about this
possibility. She has not had any vomiting or diarrhea. She had a normal
bowel movement this morning. Her β-human chorionic gonadotropin (β-hCG)
is positive at triage. She reports that her last period was 10 weeks ago. Her
vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate,
20/min; oxygen saturation, 99%; and temperature, 37.3ºC orally. The
clinician performs an abdominal exam prior to her pelvic exam and, on
palpation of her abdomen, finds involuntary rigidity and rebound tenderness.
What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perf - CORRECT-ANSWERSGood!
a. Ruptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive β-hCG, and findings suggestive of peritoneal
inflammation/irritation strongly suggest a ruptured ectopic pregnancy with
significant intra-abdominal bleeding leading to peritoneal signs. This case is
emergent and requires immediate treatment of her hypotension and
presumed blood loss as well as gynecological consult for emergent surgery.
Ruptured ectopic pregnancies can lead to life-threatening intra-abdominal
bleeding.
