Cox & Roper: Clinical Skills

Chapter 06 - Adominal system

Instructions: Each group of extended matching questions consists of lettered options followed by a list of numbered problems/questions. For each numbered problem/question select the one lettered option that most closely answers the question. You can use the lettered options once, more than once, or not at all.

Options:

1. Heartburn
2. Biliary colic
3. Renal colic
4. Pancreatitis
5. Peritonitis
6. Intestinal obstruction
7. Peptic ulcer
8. Appendicitis
9. Diverticulitis
10. Irritable bowel syndrome
11. Acute pyelonephritis
12. Urinary tract infection
13. Diabetic ketoacidosis

Choose the diagnosis that match the following clinical scenarios.

1

Scenario 1 a) A 42 year old man presents to A&E with diffuse abdominal pain. He has had indigestion for the last 6 weeks. He looked ill, pale clammy and in extreme discomfort. Examination of the abdomen is limited because of pain and the board-like rigidity of it. Choose... Heartburn Biliary colic Renal colic Pancreatitis Peritonitis Intestinal obstruction Peptic ulcer Appendicitis Diverticulitis Irritable bowel syndrome Acute pyelonephritis Urinary tract infection Diabetic ketoacidosis Correct. This man is extremely ill and is a surgical emergency. Severe pain and board like rigidity points to peritonitis. See page 161.Incorrect. See page 161.Your answer has been saved.

2

Scenario 2 a) A 72 year old woman who had a right hemicolectomy 8 years ago presents to A&E with colicky pains coming on in intermittent waves. She has vomited foul smelling brown liquid several times. Her abdomen had swelled in size and is very resonant to percussion. She has not had her bowels open for 3 days. Choose... Heartburn Biliary colic Renal colic Pancreatitis Peritonitis Intestinal obstruction Peptic ulcer Appendicitis Diverticulitis Irritable bowel syndrome Acute pyelonephritis Urinary tract infection Diabetic ketoacidosis Correct. True colicky pain is a marker of obstruction. Foul smelling brown liquid suggests faeculent fluid and the obstruction is likely to be intestinal. Further evidence of a 'blockage' is the swelling of the abdomen which will distend proximal to the obstruction. The final clue is that she has not had her bowels opened and this may be absolute constipation when even flatus cannot be passed. As she has had a previous operation the likelihood is that she has adhesions around the previous operation site that is causing obstruction of the bowel. See pages 132-139.Incorrect. See pages 132-139.Your answer has been saved.

3

Scenario 3 a) A 68 year old man has suffered chronic urinary frequency for over a year. Over the last 2 days he has suffered bouts of severe right loin pain radiating to his groin. He has been off his food and felt nauseous, urinalysis shows blood+++ and protein++ Choose... Heartburn Biliary colic Renal colic Pancreatitis Peritonitis Intestinal obstruction Peptic ulcer Appendicitis Diverticulitis Irritable bowel syndrome Acute pyelonephritis Urinary tract infection Diabetic ketoacidosis Correct. The pain this man has experienced is typical of renal colic. The pain can be severe and lead to nausea, anorexia and sweating. Blood in the urine will be typical and an ultrasound will be useful in identifying any renal stones. See pages 127-128.Incorrect. See pages 127-128.Your answer has been saved.

4

Scenario 4 a) A 52 year old man who is a chief executive of a local hospital trust presents to his GP with a burning pain that radiates up his sternum and into the rest of his neck. He found milk of magnesia and gaviscon relieved the pain at first but now they are only partially effective. He has found hot tea aggravates the pain Choose... Heartburn Biliary colic Renal colic Pancreatitis Peritonitis Intestinal obstruction Peptic ulcer Appendicitis Diverticulitis Irritable bowel syndrome Acute pyelonephritis Urinary tract infection Diabetic ketoacidosis Correct. The pain described is classical of heartburn with retrosternal pain radiating up to the neck. The fact that antacids are becoming less effective suggests that his pathology is advancing. Hot tea is known to aggravate oesophagitis. It may also be possible that he could be developing a peptic ulcer. The other condition to consider that can mimic indigestion/heartburn is myocardial ischaemia and a middle aged man should also be investigated for possible coronary artery disease. See page 130.Incorrect. See page 130.Your answer has been saved.

5

Scenario 5 a) A semi-conscious 24 year old is admitted to the medical admissions unit. He had been complaining of vague central abdomen pain. He has been thirsty and has had urinary frequency and nocturia up to 3-4x per night. He has had no dysuria. For the last 2 months he has lost 6 kg in weight. His urine dipstick shows protein+, a trace of blood, glucose+++, Ketones+++ Choose... Heartburn Biliary colic Renal colic Pancreatitis Peritonitis Intestinal obstruction Peptic ulcer Appendicitis Diverticulitis Irritable bowel syndrome Acute pyelonephritis Urinary tract infection Diabetic ketoacidosis Correct. This is an unusual presentation for diabetic ketoacidosis but does occur. The clues are found in the other systems ie thirst, urinary frequency and weight loss. The diagnosis is even trickier if the patient is not known to be a diabetic. The clues are in the urinalysis with glucose and ketones. See page 181.Incorrect. See page 181.Your answer has been saved.

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