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CRAM SAEM Test 2 /72 Questions And Answers (A+)
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CRAM SAEM Test 2 /72 Questions And Answers(A+)
Quiz :what is the obturator sign? what diagnosis is it associated with? -
√Answer :a/w appendicitis
obturator sign = pain upon flexion and internal rotation of the
hip#$/images/upload-flashcards/601487/854522_m.jpg
Quiz :what is Rovsing's sign? what diagnosis is it associated with? -
√Answer :a/w appendicitis
Rovsing's sign= pain in the RLQ upon palpation of the LLQ#$/images/upload-
flashcards/601487/854525_m.jpg
Quiz :Early in the course of acute appendicitis, are vital signs usually abnormal?
- √Answer :no - early in its course, vital signs including temperature may be
normal. Once perforation has occurred, the rate of low-grade fever (<38 C)
increases to about 40%.
Quiz :what is the psoas sign? what diagnosis is it associated with? -
√Answer :a/w appendicitis
psoas sign = pain upon extension of the
hip.#$/images/upload-flashcards/601487/854528_m.jpg
Quiz :explain what rebound in the setting of acute appendicitis means -
√Answer :Rebound is usually elicited only after the appendix has ruptured or
infarcted.
Quiz :In establishing a differential diagnosis of abdominal pain, the onset of
PAIN prior to the occurrence of N/V is more often suggestive of -
√Answer :surgical etiology of the pain, such as small bowel obstruction
Quiz :what bug should you think of in patients with sickle cell anemia who
present with abdominal pain and diarrhea? - √Answer :salmonella (not
shigellosis)
Quiz :Radiation of pain to the scapula is suggestive of - √Answer :acute
choleycystitis (NOT hepatitis)
Quiz :Diverticulitis pain is generally located - √Answer :in the LLQ
,Quiz :Describe the pain patterns a/w with peptic ulcer disease (PUD) - √Answer
:pain that is worse preceding a meal
non-radiating, burning epigastric pain
pain that awakens a patient in the middle of the night
relief of abdominal pain with antacids
note: unrelenting pain over a period of weeks should suggest an alternative
diagnosis
Quiz :A 78 year old female presents to the E.D. with a sensation of LLQ
abdominal pain, accompanied by some irregular bowel movements and loss of
appetite. Her abdominal CT (two images) is shown in the Figure. What is the
most likely diagnosis? - √Answer
:/images/upload-flashcards/601487/854531_m.jpg#$A patient with this general
picture is most likely to have diverticulitis, which is revealed on the CT scan as
diverticular disease with inflammation (wall thickening and
stranding).#$/images/upload-flashcards/601487/854534_m.jpg
Quiz :A mother brings her 6 week old boy to the emergency room. She states
the baby has been vomiting everything she's tried to feed him for the past 12
hours. She states that he usually eats readily and completes an entire feeding,
but he is unable to keep anything down. The emesis is non-bloody and non-
bilious, however it is projectile in nature. What is the most likely condition in
this patient? - √Answer :pyloric stenosis
The answer is C. Hypertrophic pyloric stenosis typically presents in the second
to sixth week of life and is four times more common in males than females.
Infants with hypertrophic pyloric stenosis typically are vigorous eaters but
shortly afterward regurgitate the entire feeding contents in a projectile fashion.
The emesis is non-bilious. The classic finding on exam is an "olive" palpable in
the abdomen, and diagnosis is typically via ultrasound. Intussusception typically
presents between the ages of 5 and 12 months. Gastroenteritis is characterized
by diarrhea as well as vomiting. Neither constipation nor appendicitis typically
present with protracted vomiting, though the latter condition tends to present
atypically in young children (and elderly adults).
Quiz :46yo F c/o abrupt onset of intermittent severe pain in L flank & abdomen
that woke her from sleep. She is pacing & appears extremely uncomfortable.
She has never experienced this type of pain previously and denies fevers or
other symptoms. Renal calculus is suspected. Some questions -
What is the best diagnostic test (KUB, IVP, Helical CT, U/S)?
, How helpful is a Urinalysis? - √Answer :Helical CT scan is greater than 95%
sensitive and specific for renal calculi
Helical CT scan has been shown to be both highly sensitive and specific in the
diagnosis of renal calculi. It is the preferred modality for evaluation in many
centers. Although urinalysis typically demonstrates hematuria in patients with
renal calculi, hematuria is not specific enough to confirm the diagnosis, and
imaging is warranted in all first-time presenters. KUB detects approximately
60-70% of calculi (though studies addressing this issue are somewhat
methodologically flawed). Ultrasound is not reliable for detecting small calculi,
but is 85-94% sensitive and 100% specific at demonstrating hydronephrosis.
IVP is contraindicated in patients with renal insufficiency due to the dye load
necessary to perform the study.
Quiz :50 yo M p/w 1 day of gradually worsening, intermittent, LLQ pain a/w
loose stools. No fevers or bloody bowel movements. Similar sxs in the past
were self-limited. Vital signs wnl. PE shows mild tenderness in LLQ, +BS and
no masses or peritoneal signs. His PCP can see him tomorrow in his clinic.
What should be done next in the E.D.? - √Answer :Discharge home on high-
fiber diet, laxatives and stool softeners
This patient has classic diverticulosis (saclike protrusions of colonic mucosa
through the muscularis) without signs of acute diverticulitis (inflammation of
diverticula). Usually these patients can be managed as outpatients with a high-
fiber diet and treatments to decrease intestinal spasm. If the patient develops
fever or pain increases he may need further evaluation to rule out abscess
formation. Diverticulitis is treated with antibiotics, bowel rest and analgesics.
Quiz :You are treating a 25yoM with the recent diagnosis of Crohn's disease in
the ED. Regarding Crohn's disease, you know that: - √Answer :There is a small
increased risk of colon cancer
Although Crohn's disease may involve the entire bowel tract, the rectum is
rarely involved. Involved areas are typically non-contiguous (known as "skip
lesions") and the inflammation involves all of the layers of the bowel wall--
resulting in many of the complications of Crohn's such as abscess and fistula
formation, intestinal obstruction, and perforation. The risk of colon cancer is
only slightly elevated above baseline. In contrast, Ulcerative colitis begins in
the rectum and may spread to the upper parts of the colon but never involves the
small intestine. The ulcerations are contiguous and involve only the colonic
mucosa. The incidence of colon cancer may be increased up to 30 times over
baseline.
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