TEST BANK; Buttaro: Primary Care Interprofessional Collaborative Practice 6TH EDITION. All Chapters

TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTARO

Chapter 111: Cholelithiasis and Cholecystitis Buttaro: Primary Care: A Collaborative Practice, 6th Edition MULTIPLE CHOICE 1. A patient has sudden onset of right upper quadrant (URQ) and epigastric abdominal pain with

fever, nausea, and vomiting. The emergency department provider notes yellowing of the sclerae. What is the probable cause of these findings? a. Acute acalculous cholecystitis b. Chronic cholelithiasis c. Common bile duct obstruction d. Infectious cholecystitis ANS: C

This patient has symptoms of cholecystitis with bile duct obstruction, which causes jaundice.

The common triad of RUQ pain, fever, and jaundice occurs when a stone is lodged in the common bile duct. Acute acalculous cholecystitis is inflammation without stones. Chronic cholelithiasis does not cause acute symptoms; jaundice occurs with obstruction. Infectious cholecystitis may occur without obstruction.

2. A patient presents with fever, nausea, vomiting, anorexia, and right upper quadrant abdominal

pain. An ultrasound is negative for gallstones. Which action is necessary to treat this patient’s symptoms? a. Empirical treatment with antibiotics b. Hospitalization for emergent treatment c. Prescribing ursodeoxycholic NUacid RSINGTB.COM d. Supportive care with close follow-up ANS: B

This patient has symptoms of acute acalculous cholecystitis and is critically ill.

Hospitalization is required. Empirical treatment with antibiotics and supportive care with follow-up do not address critical care needs. Ursodeoxycholic acid is a medication that helps with gallstone dissolution; this patient does not have gallstones.

3. Which diagnostic test will the provider safely order for a 30-year-old woman reporting right

upper quadrant abdominal pain, nausea, and vomiting? a. Abdominal computed tomography (CT) with contrast b. Abdominal ultrasound c. Magnetic resonance imaging (MRI) of the abdomen d. Plain abdominal radiographs ANS: B

Women of childbearing age may safely have ultrasound. Until pregnancy is ruled out, the other studies may be harmful to a developing fetus and should be avoided.

4. A patient with a previous history of liver disease is diagnosed with a bile duct obstruction.

Which procedure will be prescribed for this patient? a. Chemical dissolution of the gallstone b. Lithotripsy c. Open cholecystectomy

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