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Questions and Answers
What symptom is most likely associated with a lower gastrointestinal bleed?
Which of the following can cause a false-positive for upper gastrointestinal bleeding?
What is a likely presentation for a patient with a small bowel obstruction?
Which abdominal region is primarily associated with the right kidney?
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What condition commonly causes melena, indicating an upper gastrointestinal bleed?
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Which of the following is NOT one of the Rome IV Criteria for diagnosing IBS?
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What is the recommended age range to start colonoscopy screening for colorectal cancer in average-risk patients?
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Which of the following symptoms is most commonly associated with changes in bowel habits indicating potential colorectal cancer?
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Which testing method is generally recommended annually for detecting occult blood when colonoscopy is not an option?
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What is an indicator of hyperactive bowel sounds during auscultation?
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Which condition is likely indicated by the presence of bruits upon auscultation of the abdomen?
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What is the recommended testing frequency for Cologuard in older patients or those with increased risk?
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What is a common characteristic of absent bowel sounds during a clinical examination?
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Which of the following signs are associated with appendicitis?
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Which condition is identified as an emergency referral due to its risk factors?
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What characteristic is commonly associated with peritonitis?
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Which of the following conditions might result in large bowel obstruction?
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Which of the following statements is true concerning diverticulitis?
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What symptom is most characteristic of pancreatitis?
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Which of the following findings would rule out a diagnosis of ascites?
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Which condition may cause rebound tenderness in the abdomen?
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Which symptom is NOT typically associated with diverticulitis?
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What laboratory test is commonly used to identify inflammation in patients with inflammatory bowel disease?
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Which condition is least likely to cause right upper quadrant pain?
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Which statement about Crohn’s Disease is accurate?
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In patients with ulcerative colitis, which laboratory finding is commonly observed?
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Which condition is most commonly associated with H. pylori infection?
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What is a less common differential diagnosis for left upper quadrant pain?
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Which of the following is a complication associated with diverticulitis?
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What is the initial presentation of genital herpes caused by HSV?
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Which condition presents with multiple, moist, flat, round lesions?
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What is the treatment for primary syphilis?
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Which lesion is characterized by a single well-demarcated ulcer with a clean base?
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What distinguishes condylomata acuminata from other genital lesions?
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What is the appearance of a lesion caused by Chancroid?
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Which of the following dietary changes is advised for managing genital herpes?
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Which characteristic is NOT associated with molluscum contagiosum?
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Study Notes
Irritable Bowel Syndrome (IBS)
- Rome IV Criteria
- Recurrent abdominal pain, at least 1 day per week in the last 3 months
- Associated with two or more of the following:
- Related to defecation
- Associated with a change in stool frequency
- Associated with a change in stool form (appearance)
Colorectal Cancer Screening
- Recommended for those at high risk or average risk starting at ages 45-50
- Colonoscopy every 10 years
- Fecal Immunochemical Testing (FIT) for occult blood annually for those unable to have a colonoscopy
- Cologuard (Stool DNA testing) every 1-3 years for older patients or those with colonoscopy risk
- CT colonography every 5 years is an alternative
- If any of the above tests are positive, a colonoscopy is recommended
Abdominal Sounds
- Hyperactive: loud, gurgling, and rushed sounds, common with diarrhea.
- Hypoactive: soft, low, widely separated sounds, common with constipation, fasting.
- Absent: No bowel sounds present in one position after 2 minutes of auscultation, could be obstruction.
- Bruits: Due to atherosclerotic plaque build-up in an artery narrowing the lumen and turbulent blood flow. May be present with abdominal aortic aneurysm (AAA) or renal artery stenosis.
Causes of Jaundice
- Liver disease, biliary obstruction, pancreatitis, or pancreatic cancer.
- Viral Hepatitis (A, B, C)
Causes of Upper and Lower Gastrointestinal Bleeding
- Hematochezia (bright red blood)
- Lower GI bleed
- Examples: colon cancer, diverticular disease, ulcerative colitis, hemorrhoids
- Melena (black, tarry, “coffee ground” appearance)
- Upper GI bleed
- Examples: gastric or duodenal ulcer, esophageal bleed
- Note: iron supplements, Pepto-Bismol, and Maalox can also cause melena.
Abdominal Examination Findings
- Soft and non-tender to palpation, no organomegaly or masses
- Negative McBurney’s and Rovsing’s Signs (for appendicitis)
- No hepatomegaly, (-) Murphey’s Sign (for gallbladder), No splenomegaly
- Abdominal aorta is 2-4 cm in width (AAA)
- Negative Fluid Wave Test (for ascites)
- Negative CVA tenderness (for pyelonephritis)
Emergency Referrals
- Abdominal Aortic Aneurysm (AAA)
- Appendicitis
- Cholecystitis/Cholangitis
- Diverticulitis (if severe)
- Intestinal Obstruction
- Large Bowel Obstruction
- Pancreatitis
- Peritonitis
Diverticulosis vs. Diverticulitis
- Diverticulosis
- Outpouching of sacs in the colon
- Can have intermittent LLQ (sometimes RLQ), constipation, and rectal bleeding.
- Diverticulitis
- Inflammation and infection of the diverticula (sacs)
- LLQ pain, fever, chills, nausea, vomiting, constipation or diarrhea.
- Do NOT perform a colonoscopy during an active episode.
- Seek emergency care if symptoms are severe.
Inflammatory Bowel Disease (IBD)
- Structural disorder dx by labs/imaging
- CRP, ESR, and lactoferrin can help identify inflammation.
- Autoantibodies support autoimmune etiology.
Differentials for RUQ, RLQ, and LUQ pain
RUQ Pain
- Acute cholecystitis/cholelithiasis
- Pleuritic pain
- Lung/cardiac causes
- Pancreatitis
- Perforated duodenal ulcer
- Subphrenic abscess
- Pyelonephritis
- Colitis
- Hepatic carcinoma
RLQ Pain
- Appendicitis
- Perforated duodenal ulcer
- Ovarian cyst/torsion
- Ectopic pregnancy
LUQ Pain
- Spleen pain/enlargement
- Examples: Epstein-Barr Virus (EBV), mononucleosis, splenic rupture, splenic cancers.
- Abdominal Aortic Aneurysm (AAA)
- Subphrenic abscess
- Perforated gastric ulcer
- Pyelonephritis
- Colitis
- Colon cancer
Conditions Caused by H. pylori
- Gastritis
- Peptic ulcer disease (PUD)
- Positive H. pylori urea breath test
Genital Lesion Differentials
- Painful Genital Lesions
- Herpes Simplex Virus (HSV) (Genital Herpes)
- Multiple ulcers, vesicles. Initial outbreak is more severe with multiple ulcers, recurrent episodes often have single ulcers
- Chancroid
- Nonindurated, serpiginous border, friable base that bleeds
- Condylomata lata (Secondary syphilis)
- Multiple, moist, flat, round papules. Chancre is the primary lesion of syphilis.
- Molluscum contagiosum
- Usually painless but can be itchy
- Herpes Simplex Virus (HSV) (Genital Herpes)
- Painless Genital Lesions
- Chancre (Primary syphilis)
- Single, well-demarcated ulcer with a clean base and indurated border.
- Condylomata acuminata (Genital warts)
- Multiple, verrucous growths
- Molluscum contagiosum
- 1-5 mm umbilicated papules, often in clusters, can express caseous material from center
- Chancre (Primary syphilis)
Treatment for Genital Lesions
- Genital Herpes (HSV)
- Outbreak management with antivirals (acyclovir, valacyclovir/famciclovir)
- Dietary changes (low arginine, high lysine)
- L-lysine supplements (antiviral nutrients)
- Syphilis (primary)
- IM penicillin G benzathine, 2.4 million units in a single dose.
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Description
This quiz covers essential topics related to Irritable Bowel Syndrome (IBS) and colorectal cancer screening protocols. It includes the Rome IV criteria for IBS diagnosis, recommended screening methods based on risk levels, and differentiating abdominal sounds. Test your knowledge on these crucial aspects of gastrointestinal health.