abdominal emergencies Flashcards
An obese 52-year-old woman who presents with severe pain in the right upper quadrant of her abdomen and pain in her right shoulder is MOST likely experiencing:
A) cholecystitis.
B) acute hepatitis.
C) Crohn’s disease.
D) Mallory-Weiss syndrome.
A) cholecystitis.
A positive Murphy sign is characterized by:
A) slow, shallow breathing in an attempt to reduce the severe pain associated with cholecystitis. B) a sudden stop in inspiration due to sharp pain when pressure is applied to the right upper quadrant.
C) ecchymosis to the flank area, indicative of free blood in the retroperitoneal compartment.
D) periumbilical ecchymosis is a late, but highly suggestive sign of blood in the peritoneum.
B) a sudden stop in inspiration due to sharp pain when pressure is applied to the right upper quadrant.
Common signs of bleeding in the upper gastrointestinal tract include all of the following, EXCEPT:
A) melena.
B) hematochezia.
C) hematemesis.
D) dark, tarry stools.
B) hematochezia.
In contrast to a patient with peritonitis, a patient with hepatitis would MOST likely initially experience:
A) hematochezia.
B) diffuse abdominal pain.
C) right upper quadrant pain.
D) referred pain to the left shoulder.
C) right upper quadrant pain.
Blood that has been digested by stomach acids manifests as:
A) hematochezia.
B) bright red vomitus.
C) gray-colored stool.
D) coffee-ground emesis.
D) coffee-ground emesis.
A sudden onset of discomfort in the throat, severe dysphagia, and vomiting bright red blood are MOST indicative of:
A) ruptured esophageal varicies.
B) gastroesophageal reflux disease.
C) a malignancy in the esophagus.
D) hemorrhage from a peptic ulcer.
A) ruptured esophageal varicies.
Esophageal varices are a direct result of:
A) esophageal erosion.
B) alcohol consumption.
C) portal hypertension.
D) cirrhosis of the liver.
C) portal hypertension.
The presentation of Mallory-Weiss syndrome is linked to _________ and is caused by _________.
A) eating spicy foods, erosion of the lining of the gastrointestinal tract
B) spastic coughing, rupture of esophageal veins due to portal hypertension
C) severe vomiting, a tear at the junction between the esophagus and stomach
D) blunt trauma, rupture of hollow organs with resultant peritoneal inflammation
C) severe vomiting, a tear at the junction between the esophagus and stomach
You are caring for a middle-aged man with severe abdominal pain and dark, tarry stools. He is conscious but very restless. His blood pressure is 78/52 mm Hg, pulse rate is 130 beats/min and weak, and respirations are 24 breaths/min and shallow. Further assessment reveals that his skin is cool and clammy and his radial pulses are weakly present. You should:
A) apply a nasal cannula in case he vomits, start at least one large-bore IV line, and administer up to 3 liters of normal saline solution.
B) administer high-flow oxygen, start two large-bore IV lines, and administer 20-mL/kg normal saline boluses until his radial pulses strengthen.
C) apply supplemental oxygen, establish vascular access, and give isotonic crystalloid boluses until his systolic BP is at least 110 mm Hg.
D) administer high-flow oxygen, start a large-bore IV line, administer a 20-mL/kg normal saline bolus, and give 1 µg/kg of fentanyl for pain.
B) administer high-flow oxygen, start two large-bore IV lines, and administer 20-mL/kg normal saline boluses until his radial pulses strengthen.
A 62-year-old man presents with an acute onset of bright red vomiting. According to his wife, he ingests excessive amounts of alcohol each day. As you are assessing the patient, you note that his level of consciousness has decreased markedly. His mouth is full of blood, and his skin is pale and moist. You should:
A) assist his ventilations for 2 to 3 minutes, insert a Combitube, suction his airway for up to 15 seconds, start two large-bore IV lines with normal saline, and administer a 1-L fluid bolus.
B) perform immediate tracheal intubation, insert a nasogastric tube, establish IV or IO access, and administer 10- to 20-mL/kg normal saline or lactated Ringer’s boluses to maintain a systolic blood pressure of at least 90 mm Hg.
C) turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large-bore IV with normal saline, and administer enough fluids to maintain adequate perfusion.
D) suction his mouth for up to 20 seconds, insert a nasopharyngeal airway, ventilate him at a rate of 20 breaths/min, consider endotracheal intubation, start a large-bore IV line, and run the IV wide open until signs of improvement are noted.
C) turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large-bore IV with normal saline, and administer enough fluids to maintain adequate perfusion.
An incarcerated hernia is one that:
A) causes immediate bowel necrosis.
B) cannot be reduced and becomes trapped.
C) spontaneously returns to its normal location.
D) protrudes through an incision from a recent surgery.
B) cannot be reduced and becomes trapped.
