SAEM Practice 2 024/25 | quetions and answers Rated A+ Regarding rrthe rrdiagnosis rrof rracute rrappendicitis, rrall rrthe rrfollowing rrare rrtrue rrEXCEPT: rrA. rrVital rrsigns rrare rrusually rrabnormal, rreven rrearly rrin rrthe rrcourse rrof rracute rrappendicitis. rrB. rrRebound rris rrusually rrelicited rronly rrafter rrthe rrappendix rrhas rrruptured rror rrinfarcted. rrC. rrRovsing's rrsign rris rrpain rrin rrthe rrright rrlower rrquadrant rrupon rrpalpation rrof rrthe rrleft rrlower rrquadrant. rrD. rrThe rrobturator rrsign rris rrpain rrupon rrflexion rrand rrinternal rrrotation rrof rrthe rrhip. rrE. rrThe rrpsoas rrsign rris rrpain rrupon rrextension rrof rrthe rrhip. rr- rr rr rrA. rrVital rrsigns rrare rrusually rrabnormal, rreven rrearly rrin rrthe rrcourse rrof rracute rrappendicitis. The rranswer rris rrA. rrThe rrpresentation rrof rracute rrappendicitis rrvaries rrtremendously. rrEarly rrin rrits rrcourse, rrvital rrsigns rrincluding rrtemperature rrmay rrbe rrnormal. rrOnce rrperforation rrhas rroccurred, rrthe rrrate rrof rrlow-grade rrfever rr(<38 rrC) rrincreases rrto rrabout rr40%. rrOther rrvariations rrin rrpresentation rrinclude rrpain rrin rrthe rrright rrupper rrquadrant, rrtypically rrfrom rra rrretrocecal rror rrretroiliac rrappendix. rrRosving's rrsign rris rrdescribed rras: rrA. rrTenderness rrin rrthe rrright rrupper rrquadrant rrthat rris rrworse rrwith rrinspiration. rrB. rrPelvic rrpain rrupon rrflexion rrof rrthe rrthigh rrwhile rrthe rrpatient rris rrsupine. rrC. rrPelvic rrpain rrupon rrinternal rrand rrexternal rrrotation rrof rrthe rrthigh rrwith rrthe rrknee rrflexed. rrD. rrPain rrthat rrincreases rrwith rrthe rrrelease rrof rrpressure rrof rrpalpation. rrE. rrPain rrin rrthe rrright rrlower rrquadrant rrwhen rrleft rrlower rrquadrant rris rrpalpated. rr- rr rr rrE. rrPain rrin rrthe rrright rrlower rrquadrant rrwhen rrleft rrlower rrquadrant rris rrpalpated. The rranswer rris rrE. rrRosving's rrsign rris rrpain rrin rrthe rrright rrlower rrquadrant rrwhen rrthe rrleft rrlower rrquadrant rris rrpalpated. rrRebound rrtenderness rroccurs rrwith rrthe rrrelease rrof rrpressure. rrThe rriliopsoas rrsign rris rrpain rrassociated rrwith rrthigh rrflexion. rrThe rrobturator rrsign rris rrpain rrthat rroccurs rrwith rrthigh rrrotation. rrAll rrof rrthese rrsigns rrare rrassociated rrwith rrappendicitis. rrMurphy's rrsign rris rrcessation rrof rrinspiration rrduring rrpalpation rrof rrthe rrright rrupper rrquadrant rrand rris rrassociated rrwith rracute rrcholecystitis. rrIn rrestablishing rra rrdifferential rrdiagnosis rrof rrabdominal rrpain, rrwhich rrof rrthe rrfollowing rris rrtrue? A. rrRadiation rrof rrpain rrto rrthe rrscapula rris rrsuggestive rrof rracute rrhepatitis. rrB. rrCervical rrmotion rrtenderness rris rra rruseful rrphysical rrfinding rrfor rrdifferentiating rrwomen rrwith rror rrwithout rracute rrappendicitis. rrC. rrIn rrpatients rrwith rrsickle rrcell rranemia rrwho rrpresent rrwith rrabdominal rrpain rrand rrdiarrhea, rrshigellosis rrshould rrbe rra rrtop rrconsideration. rrD. rrThe rronset rrof rrpain rrprior rrto rrthe rroccurrence rrof rrnausea rrand rrvomiting rris rrmore rroften rrsuggestive rrof rra rrsurgical rretiology. rrE. rrDiverticulitis rrtends rrto rrcause rrpain rrin rrthe rrright rrupper rrquadrant. rr- rr rr rrD. rrThe rronset rrof rrpain rrprior rrto rrthe rroccurrence rrof rrnausea rrand rrvomiting rris rrmore rroften rrsuggestive rrof rra rrsurgical rretiology. The rranswer rris rrD. rrPain rrprior rrto rrnausea rrand rrvomiting rris rroften rrsuggestive rrof rra rrsurgical rretiology rrof rrthe rrpain, rrsuch rras rrsmall rrbowel rrobstruction. rrCervical rrmotion rrtenderness rrhas rrbeen rrnoted rrin rrup rrto rr25% rrof rrwomen rrwith rracute rrappendicitis. rrPatients rrwith rrsickle rrcell rranemia rrare rrprone rrto rrSalmonella rrinfections. rrRadiation rrof rrpain rrto rrthe rrscapula rris rrclassically rrpresent rrin rracute rrcholeycystitis. rrDiverticulitis rrpain rris rrgenerally rrlocated rrin rrthe rrleft rrlower rrquadrant. rrOf rrthe rrfollowing rrpain rrpatterns, rrwhich rris rrthe rrleast rrlikely rrassociated rrwith rrdiagnosis rrof rrpeptic rrulcer rrdisease? rrA. rrnon-radiating, rrburning rrepigastric rrpain rrB. rrpain rrthat rrawakens rra rrpatient rrin rrthe rrmiddle rrof rrthe rrnight rrC. rrunrelenting rrpain rrover rra rrperiod rrof rrweeks rrD. rrrelief rrof rrabdominal rrpain rrwith rrantacids rrE. rrpain rrthat rris rrworse rrpreceding rra rrmeal rr- rr rr rrC. rrunrelenting rrpain rrover rra rrperiod rrof rrweeks The rranswer rris rrC. rrPain rrfrom rrpeptic rrulcer rrdisease rrtypically rroccurs rrin rrperiods rrof rrexacerbation rrand rrremission. rrUnrelenting rrpain rrover rrweeks rror rrmonths rrshould rrsuggest rran rralternative rrdiagnosis. rrPain rris rrclassically rrdescribed rras rrnon-radiating, rrburning rrepigastric rrpain. rrSome rrpatients rrmay rralso rrcomplain rrof rrchest rror rrback rrpain. rrPain rris rrfrequently rrsevere rrenough rrto rrawaken rrpatients rrfrom rrsleep rrin rrearly rrmorning rrhours rrbut rris rroften rrnot rrpresent rrupon rrwaking rrin rrthe rrmorning, rras rrgastric rracid rrsecretion rrpeaks rraround rr2 rra.m. rrand rrnadirs rrupon rrawakening. rrA rrmother rrbrings rrher rr6 rrweek rrold rrboy rrto rrthe rremergency rrroom. rrShe rrstates rrthe rrbaby rrhas rrbeen rrvomiting rreverything rrshe's rrtried rrto rrfeed rrhim rrfor rrthe rrpast rr12 rrhours. rrShe rrstates rrthat rrhe rrusually rreats rrreadily rrand rrcompletes rran rrentire rrfeeding, rrbut rrhe rris rrunable rrto rrkeep rranything rrdown. rrThe rremesis rris rrnon-bloody rrand rrnon-bilious, rrhowever rrit rris rrprojectile rrin rrnature. rrWhat rris rrthe rrmost rrlikely rrcondition rrin rrthis rrpatient? rrA. rrviral rrgastroenteritis rrB. rrconstipation rrC. rrappendicitis rrD. rrintussusception rrE. rrpyloric rrstenosis rr- rr rr rrE. rrpyloric rrstenosis The rranswer rris rrE. rrHypertrophic rrpyloric rrstenosis rrtypically rrpresents rrin rrthe rrsecond rrto rrsixth rrweek rrof rrlife rrand rris rrfour rrtimes rrmore rrcommon rrin rrmales rrthan rrfemales. rrInfants rrwith rrhypertrophic rrpyloric rrstenosis rrtypically rrare rrvigorous rreaters rrbut rrshortly rrafterward rrregurgitate rrthe rrentire rrfeeding rrcontents rrin rra rrprojectile rrfashion. rrThe rremesis rris rrnon-
bilious. rrThe rrclassic rrfinding rron rrexam rris rran rr"olive" rrpalpable rrin rrthe rrabdomen, rrand rrdiagnosis rris rrtypically rrvia rrultrasound. rrIntussusception rrtypically rrpresents rrbetween rrthe rrages rrof rr5 rrand rr12 rrmonths. rrGastroenteritis rris rrcharacterized rrby rrdiarrhea rras rrwell rras rrvomiting. rrNeither rrconstipation rrnor rrappendicitis rrtypically rrpresent rrwith rrprotracted rrvomiting, rrthough rrthe rrlatter rrcondition rrtends rrto rrpresent rratypically rrin rryoung rrchildren rr(and rrelderly rradults). rrA rr46 rryear rrold rrwoman rrpresents rrto rrthe rremergency rrdepartment rrcomplaining rrof rrabrupt rronset rrof rrintermittent rrsevere rrpain rrin rrthe rrleft rrflank rrand rrabdomen rrthat rrwoke rrher rrfrom rrsleep. rrShe rris rrpacing rraround rrthe rrstretcher rrand rrappears rrextremely rruncomfortable. rrShe rrhas rrnever rrexperienced rrthis rrtype rrof rrpain rrpreviously rrand rrdenies rrfevers rror rrother rrsymptoms. rrRenal rrcalculus rris rrsuspected. rrWhich rrof rrthe rrfollowing rris rrtrue rrregarding rrthe rrdiagnosis rrof rrrenal rrcalculi rrin rrthis rrpatient? rrA. rrUrinalysis rrdemonstrating rrhematuria rrconfirms rrthe rrdiagnosis. rrB. rrKUB rrdetects rrless rrthan rr10% rrof rrcalculi. rrC. rrHelical rrCT rrscan rrgreater rrthan rr95% rrsensitive rrand rrspecific rrfor rrrenal rrcalculi. rrD. rrUltrasound rris rrthe rrstudy rrof rrchoice rrfor rrdetecting rrsmall rrureteral rrcalculi. rrE. rrIntravenous rrpyelogram rr(IVP) rrmay rrbe rrused rrin rrpatients rrwith rrrenal rrinsufficiency. rr- rr rr rrC. rrHelical rrCT rrscan rrgreater rrthan rr95% rrsensitive rrand rrspecific rrfor rrrenal rrcalculi. Helical rrCT rrscan rrhas rrbeen rrshown rrto rrbe rrboth rrhighly rrsensitive rrand rrspecific rrin rrthe rrdiagnosis rrof rrrenal rrcalculi. rrIt rris rrthe rrpreferred rrmodality rrfor rrevaluation rrin rrmany rrcenters. rrAlthough rrurinalysis rrtypically rrdemonstrates rrhematuria rrin rrpatients rrwith rrrenal rrcalculi, rrhematuria rris rrnot rrspecific rrenough rrto rrconfirm rrthe rrdiagnosis, rrand rrimaging rris rrwarranted rrin rrall rrfirst-time rrpresenters. rrKUB rrdetects rrapproximately rr60-70% rrof rrcalculi rr(though rrstudies rraddressing rrthis rrissue rrare rrsomewhat rrmethodologically rrflawed). rrUltrasound rris rrnot rrreliable rrfor rrdetecting rrsmall rrcalculi, rrbut rris rr85-94% rrsensitive rrand rr100% rrspecific rrat rrdemonstrating rrhydronephrosis. rrIVP rris rrcontraindicated rrin rrpatients rrwith rrrenal rrinsufficiency rrdue rrto rrthe rrdye rrload rrnecessary rrto rrperform rrthe rrstudy. rrA rr50 rryear rrold rrman rrpresents rrwith rr1 rrday rrof rrgradually rrworsening, rrintermittent, rrleft rrlower rrquadrant rrpain rrassociated rrwith rrloose rrstools. rrHe rrhas rrhad rrno rrfevers rror rrbloody rrbowel rrmovements. rrSimilar rrsymptoms rrin rrthe rrpast rrwere rrself-limited. rrAll rrvital rrsigns rrlie rrwithin rrnormal rrlimits. rrPhysical rrexamination rrshows rrmild rrtenderness rrin rrthe rrleft rrlower rrquadrant, rrnormal rractive rrbowel rrsounds rrand rrneither rrmasses rrnor rrperitoneal rrsigns. rrHis rrprimary -
care rrphysician rrcan rrsee rrhim rrtomorrow rrin rrhis rrclinic. rrWhat rrshould rrbe rrdone rrnext rrin rrthe rrE.D.? rrA. rrDischarge rrhome rrafter rra rrsingle rrdose rrof rrIV rrantibiotics rrB. rrDischarge rrhome rron rrhigh-fiber rrdiet, rrlaxatives rrand rrstool rrsofteners rrC. rrGastroenterology rrconsult rrfor rrendoscopy rrD. rrAdmit rrfor rrobservation rrand rrserial rrexaminations rr- rr rr rrB. rrDischarge rrhome rron rrhigh-fiber rrdiet, rrlaxatives rrand rrstool rrsofteners This rrpatient rrhas rrclassic rrdiverticulosis rr(saclike rrprotrusions rrof rrcolonic rrmucosa rrthrough rrthe rrmuscularis) rrwithout rrsigns rrof rracute rrdiverticulitis rr(inflammation rrof rrdiverticula). rrUsually rrthese rrpatients rrcan rrbe rrmanaged rras rroutpatients rrwith rra rrhigh-fiber rrdiet rrand rrtreatments rrto rrdecrease rrintestinal rrspasm. rrIf rrthe rrpatient rrdevelops rrfever rror rrpain rrincreases rrhe rrmay rrneed rrfurther rrevaluation rrto rrrule rrout rrabscess rrformation. rrDiverticulitis rris rrtreated rrwith rrantibiotics, rrbowel rrrest rrand rranalgesics. rrYou rrare rrtreating rra rr25 rryear rrold rrmale rrwith rrthe rrrecent rrdiagnosis rrof rrCrohn's rrdisease rrin rrthe rrED. rrRegarding rrCrohn's rrdisease, rryou rrknow rrthat: rrA. rrLesions rrare rrtypically rrcontiguous rrB. rrSmall rrbowel rrinvolvement rris rrrare rrC. rrBleeding rris rrcommon rrdue rrto rrsuperficial rrbowel rrwall rrinflammation rrD. rrThere rris rra rrsmall rrincreased rrrisk rrof rrcolon rrcancer rr- rr rr rrD. rrThere rris rra rrsmall rrincreased rrrisk rrof rrcolon rrcancer Although rrCrohn's rrdisease rrmay rrinvolve rrthe rrentire rrbowel rrtract, rrthe rrrectum rris rrrarely rrinvolved. rrInvolved rrareas rrare rrtypically rrnon-contiguous rr(known rras rr"skip rrlesions") rrand rrthe rrinflammation rrinvolves rrall rrof rrthe rrlayers rrof rrthe rrbowel rrwall--resulting rrin rrmany rrof rrthe rrcomplications rrof rrCrohn's rrsuch rras rrabscess rrand rrfistula rrformation, rrintestinal rrobstruction, rrand rrperforation. rrThe rrrisk rrof rrcolon rrcancer rris rronly rrslightly rrelevated rrabove rrbaseline. rrIn rrcontrast, rrUlcerative rrcolitis rrbegins rrin rrthe rrrectum rrand rrmay rrspread rrto rrthe rrupper rrparts rrof rrthe rrcolon rrbut rrnever rrinvolves rrthe rrsmall rrintestine. rrThe rrulcerations rrare rrcontiguous rrand rrinvolve rronly rrthe rrcolonic rrmucosa. rrThe rrincidence rrof rrcolon rrcancer rrmay rrbe rrincreased rrup rrto rr30 rrtimes rrover rrbaseline. rrA rr53 rryear rrold rrobese rrwoman rrpresents rrto rrthe rremergency rrdepartment, rraccompanied rrby rrthree rrof rrher rrchildren, rrcomplaining rrof rrsevere rrabdominal rrpain rrthat rrbegan rrthis rrafternoon rrafter rrlunch. rrPhysical rrexam rrreveals rrmarked rrRUQ rrtenderness. rrLikely rrfindings rron rrthis rrpatient rrwould rrinclude rrall rrof rrthe rrfollowing rrEXCEPT: rrA. rrpositive rrsonographic rrMurphy's rrsign rrB. rrpain rrin rrthe rrright rrscapula rrC. rrleukocytosis rrwith rrleft rrshift rrD. rrmarked rringuinal rrlymphadenopathy rrE. rraminotransferases rrand rrbilirubin rrwithin rrnormal rrlimits rr- rr rr rrD. rrmarked rringuinal rrlymphadenopathy This rrwoman rris rrlikely rrsuffering rrfrom rracute rrcholecystitis. rrPredisposing rrfactors rrinclude rrfemale rrgender, rrobesity, rrincreased rrage rrand rrincreased rrparity. rrInflammation rrof rrthe rrgallbladder rrcauses rrRUQ rrpain rrand rrsonographic rrMurphy's rrsign rr(inspiratory rrarrest, rrdue rrto rrpain, rrwhile rrthe rrultrasound rrprobe rris rrpositioned rrover rrthe rrgallbladder). rrPain rrmay rrradiate rrto rrthe rrright rrscapula. rrLab rrstudies rrusually rrshow rrleukocytosis rrwith rror rrwithout rra rrleft rrshift, rrand rraminotransferases rrand rrbilirubin rrare rrusually rrwithin rrnormal rrlimits. rrA rr45 rryear rrold rrwoman rrpresents rrwith rrright rrupper rrquadrant rrpain rrand rrfever. rrThe rrpain rris rrworse rrafter rreating. rrOn rrphysical rrexam rrshe rrhas rra rrMurphy's rrsign. rrThe rrmost rrlikely rrdiagnosis rris: rrA. rrAppendicitis rrB. rrDiverticulitis rrC. rrCholelithiasis rrD. rrCholecystitis rrE. rrMesenteric rrIschemia rr- rr rr rrD. rrCholecystitis Right rrupper rrquadrant rrpain, rrfever rrand rra rrMurphy's rrsign rrsuggests rrcholecystitis. rrCholelithiasis rrpresents rrwith rrsimilar rrpain, rrbut rris rrnot rrassociated rrwith rrfever rror rra rrMurphy's rrsign rrAll rrof rrthe rrfollowing rrfactors rrpredispose rrto rrcecal rrvolvulus rrEXCEPT: rrA. rrpregnancy rrB. rrage rr25-35 rrC. rrprior rrabdominal rrsurgery rrD. rrmarathon rrrunning rrE. rrsevere rrchronic rrconstipation rr- rr rr rrE. rrsevere rrchronic rrconstipation Cecal rrvolvulus rroccurs rras rra rrresult rrof rrabnormal rrfixation rrof rrthe rrright rrcolon rrand rrincreased rrmobility rrof rrthe rrcecum. rrDepending rron rrthe rrdegree rrof rrrotation rraround rrthe rrmesenteric rraxis, rrcecal rrvolvulus rrcan rrlead rrto rrtwisting rrof rrthe rrmesentery rrand rrits rrblood rrvessels. rrCecal rrvolvulus rroccurs rrmost rrcommonly rrin rrpeople rr25-35 rryears rrold rrand rrshould rrbe rrsuspected rrin rrcases rrof rrbowel rrobstruction rrwithout rrknown rrrisk rrfactors. rrPrior rrabdominal rrsurgery rrand
bilious. rrThe rrclassic rrfinding rron rrexam rris rran rr"olive" rrpalpable rrin rrthe rrabdomen, rrand rrdiagnosis rris rrtypically rrvia rrultrasound. rrIntussusception rrtypically rrpresents rrbetween rrthe rrages rrof rr5 rrand rr12 rrmonths. rrGastroenteritis rris rrcharacterized rrby rrdiarrhea rras rrwell rras rrvomiting. rrNeither rrconstipation rrnor rrappendicitis rrtypically rrpresent rrwith rrprotracted rrvomiting, rrthough rrthe rrlatter rrcondition rrtends rrto rrpresent rratypically rrin rryoung rrchildren rr(and rrelderly rradults). rrA rr46 rryear rrold rrwoman rrpresents rrto rrthe rremergency rrdepartment rrcomplaining rrof rrabrupt rronset rrof rrintermittent rrsevere rrpain rrin rrthe rrleft rrflank rrand rrabdomen rrthat rrwoke rrher rrfrom rrsleep. rrShe rris rrpacing rraround rrthe rrstretcher rrand rrappears rrextremely rruncomfortable. rrShe rrhas rrnever rrexperienced rrthis rrtype rrof rrpain rrpreviously rrand rrdenies rrfevers rror rrother rrsymptoms. rrRenal rrcalculus rris rrsuspected. rrWhich rrof rrthe rrfollowing rris rrtrue rrregarding rrthe rrdiagnosis rrof rrrenal rrcalculi rrin rrthis rrpatient? rrA. rrUrinalysis rrdemonstrating rrhematuria rrconfirms rrthe rrdiagnosis. rrB. rrKUB rrdetects rrless rrthan rr10% rrof rrcalculi. rrC. rrHelical rrCT rrscan rrgreater rrthan rr95% rrsensitive rrand rrspecific rrfor rrrenal rrcalculi. rrD. rrUltrasound rris rrthe rrstudy rrof rrchoice rrfor rrdetecting rrsmall rrureteral rrcalculi. rrE. rrIntravenous rrpyelogram rr(IVP) rrmay rrbe rrused rrin rrpatients rrwith rrrenal rrinsufficiency. rr- rr rr rrC. rrHelical rrCT rrscan rrgreater rrthan rr95% rrsensitive rrand rrspecific rrfor rrrenal rrcalculi. Helical rrCT rrscan rrhas rrbeen rrshown rrto rrbe rrboth rrhighly rrsensitive rrand rrspecific rrin rrthe rrdiagnosis rrof rrrenal rrcalculi. rrIt rris rrthe rrpreferred rrmodality rrfor rrevaluation rrin rrmany rrcenters. rrAlthough rrurinalysis rrtypically rrdemonstrates rrhematuria rrin rrpatients rrwith rrrenal rrcalculi, rrhematuria rris rrnot rrspecific rrenough rrto rrconfirm rrthe rrdiagnosis, rrand rrimaging rris rrwarranted rrin rrall rrfirst-time rrpresenters. rrKUB rrdetects rrapproximately rr60-70% rrof rrcalculi rr(though rrstudies rraddressing rrthis rrissue rrare rrsomewhat rrmethodologically rrflawed). rrUltrasound rris rrnot rrreliable rrfor rrdetecting rrsmall rrcalculi, rrbut rris rr85-94% rrsensitive rrand rr100% rrspecific rrat rrdemonstrating rrhydronephrosis. rrIVP rris rrcontraindicated rrin rrpatients rrwith rrrenal rrinsufficiency rrdue rrto rrthe rrdye rrload rrnecessary rrto rrperform rrthe rrstudy. rrA rr50 rryear rrold rrman rrpresents rrwith rr1 rrday rrof rrgradually rrworsening, rrintermittent, rrleft rrlower rrquadrant rrpain rrassociated rrwith rrloose rrstools. rrHe rrhas rrhad rrno rrfevers rror rrbloody rrbowel rrmovements. rrSimilar rrsymptoms rrin rrthe rrpast rrwere rrself-limited. rrAll rrvital rrsigns rrlie rrwithin rrnormal rrlimits. rrPhysical rrexamination rrshows rrmild rrtenderness rrin rrthe rrleft rrlower rrquadrant, rrnormal rractive rrbowel rrsounds rrand rrneither rrmasses rrnor rrperitoneal rrsigns. rrHis rrprimary -
care rrphysician rrcan rrsee rrhim rrtomorrow rrin rrhis rrclinic. rrWhat rrshould rrbe rrdone rrnext rrin rrthe rrE.D.? rrA. rrDischarge rrhome rrafter rra rrsingle rrdose rrof rrIV rrantibiotics rrB. rrDischarge rrhome rron rrhigh-fiber rrdiet, rrlaxatives rrand rrstool rrsofteners rrC. rrGastroenterology rrconsult rrfor rrendoscopy rrD. rrAdmit rrfor rrobservation rrand rrserial rrexaminations rr- rr rr rrB. rrDischarge rrhome rron rrhigh-fiber rrdiet, rrlaxatives rrand rrstool rrsofteners This rrpatient rrhas rrclassic rrdiverticulosis rr(saclike rrprotrusions rrof rrcolonic rrmucosa rrthrough rrthe rrmuscularis) rrwithout rrsigns rrof rracute rrdiverticulitis rr(inflammation rrof rrdiverticula). rrUsually rrthese rrpatients rrcan rrbe rrmanaged rras rroutpatients rrwith rra rrhigh-fiber rrdiet rrand rrtreatments rrto rrdecrease rrintestinal rrspasm. rrIf rrthe rrpatient rrdevelops rrfever rror rrpain rrincreases rrhe rrmay rrneed rrfurther rrevaluation rrto rrrule rrout rrabscess rrformation. rrDiverticulitis rris rrtreated rrwith rrantibiotics, rrbowel rrrest rrand rranalgesics. rrYou rrare rrtreating rra rr25 rryear rrold rrmale rrwith rrthe rrrecent rrdiagnosis rrof rrCrohn's rrdisease rrin rrthe rrED. rrRegarding rrCrohn's rrdisease, rryou rrknow rrthat: rrA. rrLesions rrare rrtypically rrcontiguous rrB. rrSmall rrbowel rrinvolvement rris rrrare rrC. rrBleeding rris rrcommon rrdue rrto rrsuperficial rrbowel rrwall rrinflammation rrD. rrThere rris rra rrsmall rrincreased rrrisk rrof rrcolon rrcancer rr- rr rr rrD. rrThere rris rra rrsmall rrincreased rrrisk rrof rrcolon rrcancer Although rrCrohn's rrdisease rrmay rrinvolve rrthe rrentire rrbowel rrtract, rrthe rrrectum rris rrrarely rrinvolved. rrInvolved rrareas rrare rrtypically rrnon-contiguous rr(known rras rr"skip rrlesions") rrand rrthe rrinflammation rrinvolves rrall rrof rrthe rrlayers rrof rrthe rrbowel rrwall--resulting rrin rrmany rrof rrthe rrcomplications rrof rrCrohn's rrsuch rras rrabscess rrand rrfistula rrformation, rrintestinal rrobstruction, rrand rrperforation. rrThe rrrisk rrof rrcolon rrcancer rris rronly rrslightly rrelevated rrabove rrbaseline. rrIn rrcontrast, rrUlcerative rrcolitis rrbegins rrin rrthe rrrectum rrand rrmay rrspread rrto rrthe rrupper rrparts rrof rrthe rrcolon rrbut rrnever rrinvolves rrthe rrsmall rrintestine. rrThe rrulcerations rrare rrcontiguous rrand rrinvolve rronly rrthe rrcolonic rrmucosa. rrThe rrincidence rrof rrcolon rrcancer rrmay rrbe rrincreased rrup rrto rr30 rrtimes rrover rrbaseline. rrA rr53 rryear rrold rrobese rrwoman rrpresents rrto rrthe rremergency rrdepartment, rraccompanied rrby rrthree rrof rrher rrchildren, rrcomplaining rrof rrsevere rrabdominal rrpain rrthat rrbegan rrthis rrafternoon rrafter rrlunch. rrPhysical rrexam rrreveals rrmarked rrRUQ rrtenderness. rrLikely rrfindings rron rrthis rrpatient rrwould rrinclude rrall rrof rrthe rrfollowing rrEXCEPT: rrA. rrpositive rrsonographic rrMurphy's rrsign rrB. rrpain rrin rrthe rrright rrscapula rrC. rrleukocytosis rrwith rrleft rrshift rrD. rrmarked rringuinal rrlymphadenopathy rrE. rraminotransferases rrand rrbilirubin rrwithin rrnormal rrlimits rr- rr rr rrD. rrmarked rringuinal rrlymphadenopathy This rrwoman rris rrlikely rrsuffering rrfrom rracute rrcholecystitis. rrPredisposing rrfactors rrinclude rrfemale rrgender, rrobesity, rrincreased rrage rrand rrincreased rrparity. rrInflammation rrof rrthe rrgallbladder rrcauses rrRUQ rrpain rrand rrsonographic rrMurphy's rrsign rr(inspiratory rrarrest, rrdue rrto rrpain, rrwhile rrthe rrultrasound rrprobe rris rrpositioned rrover rrthe rrgallbladder). rrPain rrmay rrradiate rrto rrthe rrright rrscapula. rrLab rrstudies rrusually rrshow rrleukocytosis rrwith rror rrwithout rra rrleft rrshift, rrand rraminotransferases rrand rrbilirubin rrare rrusually rrwithin rrnormal rrlimits. rrA rr45 rryear rrold rrwoman rrpresents rrwith rrright rrupper rrquadrant rrpain rrand rrfever. rrThe rrpain rris rrworse rrafter rreating. rrOn rrphysical rrexam rrshe rrhas rra rrMurphy's rrsign. rrThe rrmost rrlikely rrdiagnosis rris: rrA. rrAppendicitis rrB. rrDiverticulitis rrC. rrCholelithiasis rrD. rrCholecystitis rrE. rrMesenteric rrIschemia rr- rr rr rrD. rrCholecystitis Right rrupper rrquadrant rrpain, rrfever rrand rra rrMurphy's rrsign rrsuggests rrcholecystitis. rrCholelithiasis rrpresents rrwith rrsimilar rrpain, rrbut rris rrnot rrassociated rrwith rrfever rror rra rrMurphy's rrsign rrAll rrof rrthe rrfollowing rrfactors rrpredispose rrto rrcecal rrvolvulus rrEXCEPT: rrA. rrpregnancy rrB. rrage rr25-35 rrC. rrprior rrabdominal rrsurgery rrD. rrmarathon rrrunning rrE. rrsevere rrchronic rrconstipation rr- rr rr rrE. rrsevere rrchronic rrconstipation Cecal rrvolvulus rroccurs rras rra rrresult rrof rrabnormal rrfixation rrof rrthe rrright rrcolon rrand rrincreased rrmobility rrof rrthe rrcecum. rrDepending rron rrthe rrdegree rrof rrrotation rraround rrthe rrmesenteric rraxis, rrcecal rrvolvulus rrcan rrlead rrto rrtwisting rrof rrthe rrmesentery rrand rrits rrblood rrvessels. rrCecal rrvolvulus rroccurs rrmost rrcommonly rrin rrpeople rr25-35 rryears rrold rrand rrshould rrbe rrsuspected rrin rrcases rrof rrbowel rrobstruction rrwithout rrknown rrrisk rrfactors. rrPrior rrabdominal rrsurgery rrand
