CRAM SAEM EXAM 2023 WITH 100% CORRECT ANSWERS

what is the obturator sign? what diagnosis is it associated with? a/w appendicitis obturator sign = pain upon flexion and internal rotation of the hip#$/images/upload-flashcards//_ what is Rovsing's sign? what diagnosis is it associated with? a/w appendicitis Rovsing's sign= pain in the RLQ upon palpation of the LLQ#$/images/upload-flashcards//_ Early in the course of acute appendicitis, are vital signs usually abnormal? 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? a/w appendicitis psoas sign = pain upon extension of the hip.#$/images/upload-flashcards//_ explain what rebound in the setting of acute appendicitis means Rebound is usually elicited only after the appendix has ruptured or infarcted. In establishing a differential diagnosis of abdominal pain, the onset of PAIN prior to the occurrence of N/V is more often suggestive of surgical etiology of the pain, such as small bowel obstruction what bug should you think of in patients with sickle cell anemia who present with abdominal pain and diarrhea? salmonella (not shigellosis) Radiation of pain to the scapula is suggestive of acute choleycystitis (NOT hepatitis) Diverticulitis pain is generally located in the LLQ Describe the pain patterns a/w with peptic ulcer disease (PUD) pain that is worse preceding a meal non-radiating, burning epigastric pain pain that awakens a patient in the middle of the night relief of abdominal pain with antacids note: unrelenting pain over a period of weeks should suggest an alternative diagnosis A 78 year old female presents to the E.D. with a sensation of LLQ abdominal pain, accompanied by some irregular bowel movements and loss of appetite. Her abdominal CT (two images) is shown in the Figure. What is the most likely diagnosis? /images/upload-flashcards//_#$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//_ 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? 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).