Archive Of Standardized Exam Questions: Diverticulitis

OVERVIEW

This page is dedicated to organizing various examples of standardized exam questions whose answer is diverticulitis. While this may seem a odd practice, it is useful to see multiple examples of how diverticulitis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.

KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)

When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for diverticulitis. 

Chief Complaints:

  • Fever 
  • Abdominal pain: often in the left lower quadrant
  • Diarrhea 
  • Blood in stool  may or many not be present

Patient History:

  • Older male patients are the typical

Clinical Workup:

  • Leukocytosis 
  • Presence/history of diverticula: can be seen on imaging or in the past of the patient’s history. Collections of contrast in the colon on imaging can hint at the presence of diverticula.
  • Colon inflammation on imaging: thickened/edematous colon wall, fat stranding/inflammation around the diverticula.
QUESTION EXAMPLES

Question # 1

A 75 year old male is brought to the emergency department because he has been experiencing abdominal pain and blood stools for the past 2 days. He has Alzheimer type dementia, and also has a long-standing history of constipation that is treated with laxatives. Current his temperature  is 102.1°C, pulse is 85/min, respirations are 19/min, and blood pressure is 145/80 mm Hg. An abdominal exam shows left lower quadrant tenderness and distention. A rectal exam is unremarkable. He is not oriented to the place or time. What is the likely diagnosis in this patient?

Explanation #1

Abdominal pain (left lower quadrant pain) + fever + blood in stool = diverticulitis

Question # 2

A 60 year old woman has a history of three prior episodes of left lower quadrant abdominal pain for which she was briefly hospitalized and treated with antibiotics. Now she has left lower quadrant pain, tenderness, and a vaguely palpable mass. She has fever and leukocytosis. What is the likely diagnosis in the patient?

Explanation #2

Abdominal pain (recurrent, in left lower quadrant) + treated with antibiotics +  fever + leukocytosis = diverticulitis

Question # 3

A 35 year old woman is seen in the ER for lower left abdominal pain. She firs noticed the pain a few days ago, and it has steadily gotten worse since then. She has a past medical history significant only for a tibial fracture 7 years ago. She has never had any abdominal surgeries, takes no medications, and drinks regularly on the weekends. Her temperature is 102.1°F, heart rate is 95 ppm, blood pressure is 115/60 mm Hg, and respirations are 16/min. She has voluntary guarding over the left side. When her lower right quadrant is deeply palpated, he left side of her abdomen hurts. A rectal exam reveals no gross blood, and she is guiacc negative. What is a possible diagnosis in this patient?

Explanation #3

Lower left abdominal pain + fever = diverticulitis

Question # 4

A 70 year old male is brought to the hospital because he has had a week of increasingly severe abdominal pain and diarrhea. He also has had a fever for the past few days. His temperature is currently 101.2°F, pulse is 110 ppm, and blood pressure is 115/80 mm Hg. A physical exam reveals rebound tenderness in the left lower quadrant. An abdominal CT scan is performed and reveals the presence of thickened colon wall, a collection of contrast in the region, and associated fat stranding around this area. What is the most likely diagnose sin this patient?

Explanation # 4

Lower left abdominal pain + fever + CT scan showing diverticula and inflammation = diverticulitis

Question # 5

A 73 year old male comes in with left lower abdominal pain. He also complains of nausea and fever that he has been experiencing for the past few days. His past medical history is notable for a history of chronic constipation, however he takes no medications. His temperature is 101.5°F, blood pressure is 125/75 mm Hg, and pulse is 95 bpm. He has left lower quadrant tenderness with palpation and he has no flank tenderness. Labs are collected and shown below:

  • WBC: 15,000/mm³ ***
  • Hemoglobin: 13.3 g/dL
  • BUN: 20 mg/dL
  • Creatinine: 1.0 mg/dL

What diagnosis should be considered in this patient?

Explanation # 5

Abdominal pain (in left lower quadrant)  +  fever + leukocytosis = diverticulitis

Question # 6

A 65 year old male comes to the ER because he has had abdominal pain for the past 2.5 days. His temperature is 101.2°F, blood pressure is 120/80 mm Hg, heart rate is 100 ppm, and respirations are 14/min. An abdominal exam reveals diffuse tenderness in the lower left quadrant. A rectal exam ins unremarkable and there is no occult blood in his stool. Labs are collected and the patient’s leukocyte count is 14,400/mm³. What is an important diagnosis to consider in this patient?

Explanation # 6

Abdominal pain (in left lower quadrant)  +  fever + leukocytosis = diverticulitis

TESTABLE FACTS ABOUT THIS CONDITION (BEYOND ITS IDENTIFICATION)

Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:

How To Diagnose?

  • Abdominal CT scan with both oral and IV contrast is ideal for diagnosing this condition.

Treatment:

  • Antibiotics are used for flares
  • Surgical resection is a permanent treatment option

 

 

Page Updated: 02.23.2017