QUIZ 1. You have seen several patients with abdominal pain as part of your day. Which patient is most likely to require an urgent surgical consult? a. The five-year old with crampy abdominal pain and diarrhea b. The twenty-five-year-old male with vomiting and epigastric pain c. The sixty-five-year old with the complaint of lower abdominal pain and constipation d. The nineteen-year-old female with lower abdominal pain of acute onset and a positive pregnancy test e. The forty-five-year-old female with vaginal bleeding and cramping in the lower abdomen Answer: d. The patient with abdominal pain may or may not have an actual gastrointestinal process happening. The sudden onset of lower abdominal pain in a woman of reproductive age represents an emergency situation, especially with a known positive pregnancy test so an OB/GYN surgical consultation is indicated. 2. You suspect that a young patient has early appendicitis. Based on what you know about the innervation of the abdomen, where would you expect to see the pain and what kind of pain would you expect? a. Vague epigastric pain b. Vague periumbilical pain c. Sharp lower abdominal pain d. Sharp epigastric pain e. Crampy lower abdominal pain Answer: b. The patient with early appendicitis would be expected to complain of vague pain that centers most in the periumbilical area. This would represent visceral pain from one of the midgut structures.
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