Quiz

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.

3. The patient is a 27-year-old female with severe pain who is writhing around the table has symptoms most suggestive of what?

a. Peritonitis b. Abdominal aortic aneurysm c. Ruptured ectopic pregnancy d. Biliary colic e. GI obstruction

Answer: d. Patients who are writhing around in pain has a higher likelihood of having an obstructive process, such as biliary or renal colic as causes of the pain.

4. You suspect your patient has intestinal obstruction by their history and physical examination. What should your next step be in doing some type of diagnostic evaluation in this patient?

a. Noncontrast CT scan b. Barium swallow x-ray c. Ultrasound of the abdomen d. Oral and IV contrast CT scan e. Flat and lateral recumbent x-ray

Answer: e. Only with suspected intestinal obstruction should you consider a flat and lateral recumbent x-ray, which can show air-fluid levels and intestinal dilation if this is the cause of the patient’s abdominal pain.

5. What should the preferred confirmatory test be when ruling in or out an aortic dissection in the patient who has symptoms of this problem?

a. Magnetic resonance angiography b. Transesophageal echocardiography c. Contrast aortography d. Computerized tomography angiography e. Surgical confirmation

Answer: d. Of these confirmatory tests, the CTA or CT angiography is the fastest and most available test for the emergency detection of an aortic dissection.

6. You are attempting to lower the patient’s blood pressure after making the diagnosis of aortic dissection. What medication is least likely to be recommended as a single agent for this purpose?

a. Labetalol b. Nitroprusside c. Esmolol d. Diltiazem e. Metoprolol

Answer: b. Any type of beta blocker or calcium channel blocker can be used to control blood pressure in an aortic dissection as a single agent. Nitroprusside can be used but not as a single agent because it causes sympathetic overactivity that can worsen the dissection.

7. You have determined that an 80-year-old female patient has diverticulitis. What would most indicate that this has been complicated by a fistula?

a. High fever b. UTI symptoms c. Fecal vaginal discharge d. Guarding of the abdomen e. Obstipation

Answer: c. The presence of fecal vaginal discharge, air in the urine, or feces in the urine are all typical consequences of having diverticulitis complicated by an abscess.

8. You suspect that a patient has diverticulitis based on signs and symptoms. In order to make the diagnosis, you should consider what diagnostic test first?

a. Flat and upright of the abdomen b. Abdominal ultrasound c. Barium enema d. Abdominopelvic CT e. Colonoscopy

Answer: d. The patient with suspected diverticulitis should have a confirmatory test with an abdominopelvic CT scan. Only after resolution should a colonoscopy be performed.

9. For which cause of gastroenteritis would you probably give vancomycin in order to treat this?

a. Vibrio cholerae b. Clostridium difficile c. E. coli d. Salmonella e. Giardia

Answer: b. You would most likely give vancomycin for Clostridium difficile infections but you will also stop any other contributing agents.

10. What can you expect to see as the most common cause of acute pancreatitis in a woman in her third trimester of pregnancy?

a. Alcohol abuse b. Autosomal dominant pancreatitis c. Cystic fibrosis d. Hypertriglyceridemia e. Gallstones

Answer: e. Gallstones is the most common underlying cause of acute pancreatitis, particularly in pregnant women.