A general approach to assessing abdominal pain should include asking about the type, location, frequency and duration of the pain, it's relation to eating, nausea, vomiting, change in bowel habits, as well as this… an important associated symptom that could imply infection.
What is fever? (or chills or rigor)
100
On PEx, patients with this diagnosis will have extreme RUQ tenderness, unable to find a comfortable position, and when asked to "breathe in deeply" may stop abruptly on palpation or during application of pressure with the sono probe.
What is Acute Cholecysytis?
100
In the workup of abdominal pain, labs to order would include CBC, BMP, LFTs, lipase (if upper abdomen), UA and this… another important urine test that can also be purchased over the counter.
What is hCG (or UPT)?
100
Preliminary management of acute cholecystitis includes hospital admission, NPO, pain control, surgical consultation, consideration of IV antibiotics (2nd/3rd gen ceph), as well THIS, particularly if they've been vomiting all day.
What is IVF?
100
Patients with Acute Cholecystitis who are poor surgical candidates/critically ill can get this temporizing procedure, which drains the gallbladder through the skin using U/S and fluoro guidance.
What is Percutaneous Cholecystostomy?
200
This diagnosis may present as an older patient with diffuse abdominal pain and syncope
What is a ruptured AAA?
200
Classic triad for diagnosis of ruptured AAA
What is pain, hypotension and pulsatile abdominal mass (NB: like all triads, only ~50% have the triad)
200
This is the best ED diagnostic study for AAA.
What is an abdominal ultrasound?
200
Although part of initial treatment of any hemorrhagic patient, this intervention can actually make hemorrhage worse, and surgery should not be delayed for this treatment.
What is fluid resuscitation?
200
When a AAA is complicated by rupture at presentation, the percent mortality is approximately this.
What is 50%? (accept 40-60%)
300
These are the classic three symptoms of an ectopic pregnancy.
What are abdominal pain, amenorrhea, and vaginal bleeding?
300
A 55 yo F presents with 3 hours of 10 out of 10 diffuse abdominal pain, nausea and vomiting, and abrupt onset of severe diarrhea. Your leading differential is THIS, and you would not be surprised to find THIS PATHOGNOMONIC FINDING on exam.
What is ACUTE MESENTERIC ISCHEMIA and PAIN OUT OF PROPORTION TO EXAM?
300
THIS lab is ordered to rule IN a diagnosis of acute mesenteric ischemia when evaluating a patient with abdominal pain. However, it is not specific and if elevated is a LATE FINDING.
What is LACTATE?
300
Most women with PID are begun on empiric antibiotics as outpatients. However, hospitalization should be considered for THESE CONDITIONS.
What is UNCERTAIN DIAGNOSIS, PREGNANCY, PELVIC ABSCESS ON US, CAN'T TOLERATE PO, TOXIC APPEARANCE, or IMMUNODEFICIENCY? (Get full points if 2 out of 6 are listed.)
300
Women with history of PID are at increased risk for infertility and THIS other important cause of acute abdominal pain.
What is ectopic pregnancy?
400
THIS would be #1 on my differential for a 65 yo male with lots of "no shows" to the INR clinic noted in Cerner who presents with sudden onset of SEVERE abdominal pain.
What is MESENTERIC ISCHEMIA?
400
The hallmark physical findings of a patient with a perforated viscus include abdominal rigidity, guarding, and tenderness, which represent this diagnosis.
What is peritonitis?
400
This finding on plain x-rays of the abdomen or chest confirms a gastrointestinal perforation.
What is free air (under the diaphragm)?
400
A patient >50 yo presents with acute abdominal pain and is hypotensive, tachycardic, ill-appearing with peritoneal signs. Yikes! You choose to start by doing THIS.
What is obtain 2 large bore IVs and initiate resuscitation? (Other priorities include immediate surgical consult and bedside US)
400
Truly surgical emergencies, these two causes of acute abdominal pain primarily affect elderly patients and have mortality rates well over 50%.
What are ACUTE MESENTERIC ISCHEMIA and RUPTURED AAA?
500
Patients with acute cholecystitis will present with acute, severe pain, intermittent --> constant, a/w nausea & vomiting, and typically presenting in this abdominal quadrant.
What is the RUQ?
500
The PEx findings in ovarian torsion can be non-specific and variable. It may present as a tender, unilateral mass, however, tenderness is absent (__%) of the time.
What is 30%?
500
A savvy EM doc suspecting acute cholecystitis will order a CBC, LFTs and perform this bedside imaging study which may show stones, wall thickening >3mm, pericholecystic fluid, and has a PPV >90%.
What is a RUQ Ultrasound?
500
Ovarian torsion can be confirmed using pelvic US to assess for an ovarian mass, twisted vascular pedicle, blood flow and/or free pelvic fluid. (CT is now being used more frequently.) If torsion is suspected, this specialty should be consulted for urgent laparoscopy.
What is Ob/Gyn?
500
There are several non-GI/HB systems that can complicate the picture by causing abdominal pain (e.g., MI causing epigastric pain). Name this non-GI/HB diagnosis which can cause pain in the LUQ.
What is LLL PNA or splenic enlargement/rupture/infarction?