Abdominal Pathologies :)

Question 1 of 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?

Select one of the following:

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

Explanation

Question 2 of 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)?

Select one or more of the following:

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

Explanation

Question 3 of 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?

Select one of the following:

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

Explanation

Question 4 of 55

1

What are possible differential diagnoses of raised ALT?

Select one or more of the following:

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

Explanation

Question 5 of 55

1

Fill the blank spaces to complete the text.

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.

Explanation

Question 6 of 55

1

Any gynae problem, always do a pregnancy test first.

Select one of the following:

True
False

Explanation

Question 7 of 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?

Select one of the following:

Campylobacter
Cholera
E. Coli
Bacillus Cereus

Explanation

Question 8 of 55

1

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

Select one of the following:

True
False

Explanation

Question 9 of 55

1

Fill the blank spaces to complete the text.

Management of acute diarrhea and gastroenteritis:

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

Explanation

Question 10 of 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?

Select one of the following:

Hyperthyroidism
Irritable Bowel Syndrome
Endometriosis
Inflammatory Bowel Disease

Explanation

Question 11 of 55

1

Fill the blank spaces to complete the text.

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

Explanation

Question 12 of 55

1

What is NOT a potential reason for irritable bowel syndrome?

Select one of the following:

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

Explanation

Question 13 of 55

1

Fill the blank spaces to complete the text.

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

Explanation

Question 14 of 55

1

What are ways to generally investigate for irritable bowel syndrome?

Select one or more of the following:

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

Explanation

Question 15 of 55

1

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

Select one of the following:

True
False

Explanation

Question 16 of 55

1

Buscapan can be given for irritable bowel syndrome.

Select one of the following:

True
False

Explanation

Question 17 of 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?

Select one of the following:

Irritable bowel syndrome
Colorectal cancer
Crohn's disease
Ulcerative Colitis

Explanation

Question 18 of 55

1

IBD and HNPCC put you at increased risk for colorectal cancer

Select one of the following:

True
False

Explanation

Question 19 of 55

1

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

Select one of the following:

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

Explanation

Question 20 of 55

1

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

Select one of the following:

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

Explanation

Question 21 of 55

1

Fill the blank spaces to complete the text.

Most common presentation of colorectal cancer:

change in bowel habit

Explanation

Question 22 of 55

1

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

Select one of the following:

True
False

Explanation

Question 23 of 55

1

How can you NOT investigate colorectal cancer?

Select one of the following:

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

Explanation

Question 24 of 55

1

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

Select one of the following:

True
False

Explanation

Question 25 of 55

1

How can you manage colorectal cancer?

Select one or more of the following:

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

Explanation

Question 26 of 55

1

Fill the blank spaces to complete the text.

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

Explanation

Question 27 of 55

1

Click on each orange point and write the correct answer.

Fill in the chart:

Explanation

Question 28 of 55

1

Which is pelvic pain associated with?

Select one of the following:

gastrointestinal problems
gynecological problems
musculoskeletal problems
urological problems
cardiovascular problems

Explanation

Question 29 of 55

1

What is true regarding Chlamydia trachomatis?

Select one or more of the following:

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

Explanation

Question 30 of 55

1

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

Select one of the following:

True
False

Explanation

Question 31 of 55

1

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

Select one of the following:

True
False

Explanation

Question 32 of 55

1

Fill the blank spaces to complete the text.

Investigations for chlamydia:

Male: -catch
Female: swab

Both samples are sent for NAATs ( test)

Explanation

Question 33 of 55

1

Fill the blank spaces to complete the text.

Chlamydia complications:
inflammatory disease, infertility, pregnancy

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

Explanation

Question 34 of 55

1

Fill the blank spaces to complete the text.

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

Explanation

Question 35 of 55

1

Fill the blank spaces to complete the text.

Investigation for Gonnorhea:

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

Explanation

Question 36 of 55

1

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

Select one of the following:

True
False

Explanation

Question 37 of 55

1

Which of these are complications of gonnorhea?

Select one or more of the following:

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

Explanation

Question 38 of 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

Select one of the following:

gonnorhea
chlaymdia
syphilis
inflammatory pelvic disease
dysmennorhea
inflammatory bowel disease

Explanation

Question 39 of 55

1

Fill the blank spaces to complete the text.

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

Explanation

Question 40 of 55

1

How do you manage pelvic inflammatory disease?

Select one or more of the following:

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

Explanation

Question 41 of 55

1

The most common cause of a UTI is E colli

Select one of the following:

True
False

Explanation

Question 42 of 55

1

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

Select one of the following:

True
False

Explanation

Question 43 of 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.

Select one of the following:

True
False

Explanation

Question 44 of 55

1

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

Select one or more of the following:

leukocytes
nitrates
blood
pH
concentration
glucose
ammonia

Explanation

Question 45 of 55

1

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

Select one of the following:

Renal abscess
Sepsis
Acute kidney injury
Pyelonephritis
Fungal Vaginal infections

Explanation

Question 46 of 55

1

Fill the blank spaces to complete the text.

Management of UTI:
(supportive)
Analgesia

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

Explanation

Question 47 of 55

1

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

Select one of the following:

True
False

Explanation

Question 48 of 55

1

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

Select one of the following:

Pelvic inflammatory disease
Fibroids
Adhesions
Endometriosis
Meniere's disease

Explanation

Question 49 of 55

1

Fill the blank spaces to complete the text.

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

Explanation

Question 50 of 55

1

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

Select one of the following:

True
False

Explanation

Question 51 of 55

1

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

Select one of the following:

True
False

Explanation

Question 52 of 55

1

Which of these are emergency findings related to dysmenorrhea?

Select one or more of the following:

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

Explanation

Question 53 of 55

1

Fill the blank spaces to complete the text.

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

Explanation

Question 54 of 55

1

What is NOT true regarding the pill?

Select one of the following:

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

Explanation

Question 55 of 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.

Select one of the following:

True
False

	Created by Plymouth Med about 6 years ago

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

Abdominal Pathologies :)

Question 1 of 55

Select one of the following:

Explanation

Question 2 of 55

Select one or more of the following:

Explanation

Question 3 of 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?

Select one of the following:

Explanation

Question 4 of 55

What are possible differential diagnoses of raised ALT?

Select one or more of the following:

Explanation

Question 5 of 55

Fill the blank spaces to complete the text.

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.

Explanation

Question 6 of 55

Any gynae problem, always do a pregnancy test first.

Select one of the following:

Explanation

Question 7 of 55

Select one of the following:

Explanation

Question 8 of 55

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

Select one of the following:

Explanation

Question 9 of 55

Fill the blank spaces to complete the text.

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

Explanation

Question 10 of 55

Select one of the following:

Explanation

Question 11 of 55

Fill the blank spaces to complete the text.

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

Explanation

Question 12 of 55

What is NOT a potential reason for irritable bowel syndrome?

Select one of the following:

Explanation

Question 13 of 55

Fill the blank spaces to complete the text.

Explanation

Question 14 of 55

What are ways to generally investigate for irritable bowel syndrome?

Select one or more of the following:

Explanation

Question 15 of 55

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

Select one of the following:

Explanation

Question 16 of 55

Buscapan can be given for irritable bowel syndrome.

Select one of the following:

Explanation

Question 17 of 55

Select one of the following:

Explanation

Question 18 of 55

IBD and HNPCC put you at increased risk for colorectal cancer

Select one of the following:

Explanation

Question 19 of 55

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

Select one of the following:

Explanation

Question 20 of 55

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

Select one of the following:

Explanation

Question 21 of 55

Fill the blank spaces to complete the text.

Most common presentation of colorectal cancer: change in bowel habit

Explanation

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