Emergency Medicine Exam #2
Questions and Answers Latest
2025 A+
Which causes acute mesenteric ischemia?
Where do most emboli originate from?
-embolic or thrombus obstruction
-the heart [A fib, valvular disease]
Symptoms/Signs of acute mesenteric ischemia?
Sx:
-severe abdominal pain out of proportion to exam
-post prandial abdominal pain
-anorexia
-nausea, vomiting, diarrhea
Signs:
-abdominal tenderness
-abdominal distention
-hypoactive or absent bowel sounds
-peritoneal signs as disease progresses [guarding, rebound]
-blood in stool
-shock signs
What is obtained in diagnosing acute mesenteric ischemia to
evaluate for hypo-perfusion?
blood gas with lactic acid
What is the gold standard for diagnosis of acute mesenteric
ischemia?
CT angiogram
How is diarrhea defined?
,more stools of lesser consistency that is typically more than 3
bowel movements per day
*Most commonly caused by VIRAL infection
What are the 4 causes of diarrhea (pathophysiology)?
1) increased intestinal secretion
2) decreased intestinal absorption
3) increased osmotic load
4) abnormal intestinal motility
T/F: In diarrhea, sodium excretion is affected while glucose
absorption remains unaffected
TRUE
*sodium channels are affected while glucose channels remain
unaffected
Which antibiotic has been shown to decrease the duration of
diarrhea by about 24 hours?
Ciprofloxacin
What has been shown to shorten duration of diarrheal
symptoms when combined with antibiotics?
Loperamide
*DO NOT use in patients with bloody or inflammatory diarrhea!
What is the most common cause of bacterial diarrhea in
hospitalized patients in Europe and North America?
C diff
Which antibiotics cause C diff?
Clindamycin, 2nd and 3rd generation Cephalosporins, Ampicillin,
Amoxicillin
*Note: any Abx can lead to C diff
Risk factors for C diff?
,-chemotherapeutics
-proton pump inhibitors
-recent bowel surgery
-malnutrition
-shock
-advanced age
-inflammatory bowel disease
-bowel ischemia
-diabetes
What is the gold standard for diagnosing C diff?
tissue-culture assay
Which GI condition is an inflammatory disease that can
involve any part of the GI tract from mouth to anus?
Crohn's
*Ileum is involved in majority of cases
Which fecal markers (2) are used in diagnosing Crohn's
disease?
calprotectin & lactoferrin
What is the gold standard for diagnosing NEW Crohn's?
colonoscopy
What is the most common complication of ulcerative colitis?
blood loss anemia from bloody diarrhea
________, should not be used in patients with toxic
megacolon from C diff?
steroids
*Start with bowel rest, NG tube, enteral feeds & contact surgery
What modality is used to confirm the diagnosis of upper GI
bleed?
endoscopy
BUN/Cr value of above what # suggest an upper GI bleed?
30
, How is upper GI bleed treated?
*PPI bolus & gtts [Omeprazole 80 mg IV bolus followed by
8mg/hour infusion]
*Octerotide gtt [50 mcg bolus followed by 25-50 mcg/hour
infusion]
*Emergent GI consultation with endoscopy
What can be used for a massive GI bleed?
Sengstaken-Blakemore tube or Minnesota tube
[significant adverse reactions]
What is the most common cause of lower GI bleeding?
diverticular disease
[2nd most common cause= colitis]
T/F: Hematochezia and melena can be due to either an upper
OR lower GI bleed
TRUE
*Hematochezia= massive UGIB, or LGIB
*Melena= likely UGIB but can be a slow LGIB
Patients with CAD having a lower GI bleed should have
which 2 things done and why?
1) EKG
2) Troponin
= to evaluate cardiac stress during blood loss
What is the most common diagnostic modality used for lower
GI bleed?
CT scan with IV contrast [because the most common cause of the
bleed is diverticular disease]
If a patient is actively bleeding (lower GI bleed) after 2L of
crystalloid given, what should be considered if vitals are still
unstable or there is hypo-perfusion?
transfusion
*Even if H/H is baseline
*Threshold for transfusion is lower in elderly
What might GERD commonly mimic?
Questions and Answers Latest
2025 A+
Which causes acute mesenteric ischemia?
Where do most emboli originate from?
-embolic or thrombus obstruction
-the heart [A fib, valvular disease]
Symptoms/Signs of acute mesenteric ischemia?
Sx:
-severe abdominal pain out of proportion to exam
-post prandial abdominal pain
-anorexia
-nausea, vomiting, diarrhea
Signs:
-abdominal tenderness
-abdominal distention
-hypoactive or absent bowel sounds
-peritoneal signs as disease progresses [guarding, rebound]
-blood in stool
-shock signs
What is obtained in diagnosing acute mesenteric ischemia to
evaluate for hypo-perfusion?
blood gas with lactic acid
What is the gold standard for diagnosis of acute mesenteric
ischemia?
CT angiogram
How is diarrhea defined?
,more stools of lesser consistency that is typically more than 3
bowel movements per day
*Most commonly caused by VIRAL infection
What are the 4 causes of diarrhea (pathophysiology)?
1) increased intestinal secretion
2) decreased intestinal absorption
3) increased osmotic load
4) abnormal intestinal motility
T/F: In diarrhea, sodium excretion is affected while glucose
absorption remains unaffected
TRUE
*sodium channels are affected while glucose channels remain
unaffected
Which antibiotic has been shown to decrease the duration of
diarrhea by about 24 hours?
Ciprofloxacin
What has been shown to shorten duration of diarrheal
symptoms when combined with antibiotics?
Loperamide
*DO NOT use in patients with bloody or inflammatory diarrhea!
What is the most common cause of bacterial diarrhea in
hospitalized patients in Europe and North America?
C diff
Which antibiotics cause C diff?
Clindamycin, 2nd and 3rd generation Cephalosporins, Ampicillin,
Amoxicillin
*Note: any Abx can lead to C diff
Risk factors for C diff?
,-chemotherapeutics
-proton pump inhibitors
-recent bowel surgery
-malnutrition
-shock
-advanced age
-inflammatory bowel disease
-bowel ischemia
-diabetes
What is the gold standard for diagnosing C diff?
tissue-culture assay
Which GI condition is an inflammatory disease that can
involve any part of the GI tract from mouth to anus?
Crohn's
*Ileum is involved in majority of cases
Which fecal markers (2) are used in diagnosing Crohn's
disease?
calprotectin & lactoferrin
What is the gold standard for diagnosing NEW Crohn's?
colonoscopy
What is the most common complication of ulcerative colitis?
blood loss anemia from bloody diarrhea
________, should not be used in patients with toxic
megacolon from C diff?
steroids
*Start with bowel rest, NG tube, enteral feeds & contact surgery
What modality is used to confirm the diagnosis of upper GI
bleed?
endoscopy
BUN/Cr value of above what # suggest an upper GI bleed?
30
, How is upper GI bleed treated?
*PPI bolus & gtts [Omeprazole 80 mg IV bolus followed by
8mg/hour infusion]
*Octerotide gtt [50 mcg bolus followed by 25-50 mcg/hour
infusion]
*Emergent GI consultation with endoscopy
What can be used for a massive GI bleed?
Sengstaken-Blakemore tube or Minnesota tube
[significant adverse reactions]
What is the most common cause of lower GI bleeding?
diverticular disease
[2nd most common cause= colitis]
T/F: Hematochezia and melena can be due to either an upper
OR lower GI bleed
TRUE
*Hematochezia= massive UGIB, or LGIB
*Melena= likely UGIB but can be a slow LGIB
Patients with CAD having a lower GI bleed should have
which 2 things done and why?
1) EKG
2) Troponin
= to evaluate cardiac stress during blood loss
What is the most common diagnostic modality used for lower
GI bleed?
CT scan with IV contrast [because the most common cause of the
bleed is diverticular disease]
If a patient is actively bleeding (lower GI bleed) after 2L of
crystalloid given, what should be considered if vitals are still
unstable or there is hypo-perfusion?
transfusion
*Even if H/H is baseline
*Threshold for transfusion is lower in elderly
What might GERD commonly mimic?
