CRAM SAEM Test 2 Questions And Answers Latest Updated 2024/2025 | Scored A+
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CRAM SAEM Test 2 Questions And Answers Latest Updated 2024/2025 | Scored A+. obturator sign = pain upon flexion and internal rotation of the hip#$/images/uploadflashcards/601487/854522_
what is Rovsing's sign? what diagnosis is it associated with? - Correct Answer- a/w
appendicitis
Rovsing's sig...
what is the obturator sign? what diagnosis is it associated with? - Correct Answer- a/w appendicitis obturator sign = pain upon flexion and internal rotation of the hip#$/images/upload-
flashcards/601487/854522_m.jpg what is Rovsing's sign? what diagnosis is it associated with? - Correct Answer- a/w appendicitis Rovsing's sign= pain in the RLQ upon palpation of the LLQ#$/images/upload-
flashcards/601487/854525_m.jpg Early in the course of acute appendicitis, are vital signs usually abnormal? - Correct Answer- no - early in its course, vital signs including temperature may be normal. Once perforation has occurred, the rate of low-grade fever (<38 C) increases to about 40%. what is the psoas sign? what diagnosis is it associated with? - Correct Answer- a/w appendicitis psoas sign = pain upon extension of the hip.#$/images/upload-
flashcards/601487/854528_m.jpg explain what rebound in the setting of acute appendicitis means - Correct Answer- Rebound is usually elicited only after the appendix has ruptured or infarcted. In establishing a differential diagnosis of abdominal pain, the onset of PAIN prior to the occurrence of N/V is more often suggestive of - Correct Answer- surgical etiology of the pain, such as small bowel obstruction what bug should you think of in patients with sickle cell anemia who present with abdominal pain and diarrhea? - Correct Answer- salmonella (not shigellosis) Radiation of pain to the scapula is suggestive of - Correct Answer- acute choleycystitis (NOT hepatitis) Diverticulitis pain is generally located - Correct Answer- in the LLQ CRAM SAEM Test 2 Questions And Answers With Complete Solutions Latest Updated 2024/2025 | Scored A+ Describe the pain patterns a/w with peptic ulcer disease (PUD) - Correct 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 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? - Correct 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 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? - Correct 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). 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? - Correct 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. 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.? - Correct 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. You are treating a 25yoM with the recent diagnosis of Crohn's disease in the ED. Regarding Crohn's disease, you know that: - Correct 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. 53yo obese woman presents to ED, accompanied by three of her children, c/o severe abdominal pain that began this afternoon after lunch. PE reveals marked RUQ tenderness. Likely findings on this patient would include: - Correct Answer- This woman is likely suffering from acute cholecystitis. Predisposing factors include female gender, obesity, increased age and increased parity. Inflammation of the gallbladder causes RUQ pain and sonographic Murphy's sign (inspiratory arrest, due to pain, while the ultrasound probe is positioned over the gallbladder). Pain may radiate to the right scapula. Lab studies usually show leukocytosis with or without a left shift, and aminotransferases and bilirubin are usually within normal limits. 25yo F p/w epigastric pain radiating straight through to the back. Labs are notable only for markedly elevated amylase and lipase. An abdominal X-ray is taken (see Figure).
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