Chapter 19 - Gastrointestinal & Urologic Emergencies

Question 1

A 29-year-old pregnant woman has had severe vomiting for the last 2 days. Today, she is vomiting large amounts of blood. Her skin is cool and pale and she is tachycardic. The EMT should suspect:

Select one:

A. esophagitis.
B. Mallory–Weiss tear.
C. esophageal varices.
D. acute pancreatitis.

Answer 1

B. Mallory–Weiss tear.

Explanation

• Tear between the esophagus & stomach.
• Excessive vomiting (can’t stop) due to bleeding into the stomach

A. Incorrect - esophagitis.
Vomiting is associated with this but not necessarily large amounts. Also, the hematemesis is missing.

C. esophageal varices (Capillary network leaking in the esophagus)
Excessive vomiting is a key indicator lacking in acute pancreatitis. S/S Fatigue, weight loss, jaundice, anorexia, edema, abdominal pain

D. Incorrect - acute pancreatitis
Excessive vomiting is a key indicator lacking in acute pancreatitis. S/S Pain Upper Left & Right Quadrants, Nausea, & Abdominal Distention

Question 2

A 30-year-old woman with a history of alcoholism presents with severe upper abdominal pain and is vomiting large amounts of bright red blood.

Her skin is cool, pale, and clammy; her heart rate is 120 beats/min and weak, and her blood pressure is 70/50 mm Hg. Your MOST immediate action should be to:

Select one:

A. give her high-flow supplemental oxygen.
B. protect her airway from aspiration.
C. keep her supine and keep her warm.
D. rapidly transport her to the hospital.

Answer 2

B. protect her airway from aspiration.

Question 3

A 47-year-old male presents with severe abdominal pain of 3 hours’ duration. His abdomen is distended and guarded. Your MOST important consideration for this patient should be to:

Select one:

A. be alert for signs and symptoms of shock.
B. determine the exact location and cause of his pain.
C. transport him in a supine position.
D. assess his blood pressure to determine perfusion adequacy.

Answer 3

A. be alert for signs and symptoms of shock.

Question 4

A 59-year-old male presents with sudden-onset severe lower back pain. He is conscious and alert, but very restless and diaphoretic. Your assessment reveals a pulsating mass to the left of his umbilicus. You should:

Select one:

A. vigorously palpate the abdomen to establish pain severity.
B. administer oxygen and prepare for immediate transport.
C. request a paramedic unit to give the patient pain medication.
D. place the patient in a sitting position and transport at once.

Answer 4

B. administer oxygen and prepare for immediate transport.

Question 5

A young female presents with costovertebral angle tenderness. She is conscious and alert with stable vital signs. Which of the following organs is MOST likely causing her pain?

Select one:

A. Liver
B. Gallbladder
C. Pancreas
D. Kidney

Answer 5

D. Kidney

Explanation:

Bladder infections can extend up the ureter & into the kidney. When this happens the person may have a high fever and severe tenderness to the light tapping over the costovertebral angle on the infected side.

Question 6

An important aspect in the treatment of a patient with severe abdominal pain is to:

Select one:

A. administer analgesic medications to alleviate pain.
B. encourage the patient to remain in a supine position.
C. give 100% oxygen only if signs of shock are present.
D. provide emotional support en route to the hospital.

Answer 6

D. provide emotional support en route to the hospital.

Question 7

For a patient with a gastrointestinal complaint, it is MOST important for the EMT to _________.

Select one:

A. determine the cause of the patient’s complaint
B. identify whether the patient requires rapid transport
C. avoid transporting the patient if the condition is minor
D. perform all interventions prior to transport

Answer 7

B. identify whether the patient requires rapid transport

Question 8

Most patients with abdominal pain prefer to:

Select one:

A. sit in a semi-Fowler position with their knees slightly bent.
B. lie in a supine position with their knees in a flexed position.
C. sit fully upright because it helps relax the abdominal muscles.
D. lie on their side with their knees drawn into the abdomen.

Answer 8

D. lie on their side with their knees drawn into the abdomen.

Question 9

Pain that may be perceived at a distant point on the surface of the body, such as the back or shoulder, is called:

Select one:

A. visceral pain.
B. radiating pain.
C. referred pain.
D. remote pain.

Answer 9

C. referred pain.

Question 10

Peritonitis may result in shock because:

Select one:

A. severe pain causes systemic dilation of the vasculature.
B. fluid shifts from the bloodstream into body tissues.
C. intra-abdominal hemorrhage is typically present.
D. abdominal distention impairs cardiac contractions.

Answer 10

B. fluid shifts from the bloodstream into body tissues.

Question 11

Urinary tract infections are more common in ____________.

Select one:

A. men
B. sedentary adults
C. women
D. active adults

Answer 11

C. women

Question 12

When assessing a patient with abdominal pain, you should:

Select one:

A. palpate the abdomen in a clockwise direction, beginning with the quadrant after the one the patient indicates is painful.

B. visually assess the painful area of the abdomen but avoid palpation because this could worsen his or her condition.

C. observe for abdominal guarding, which is characterized by sudden relaxation of the abdominal muscles when palpated.

D. ask the patient to point to the area of pain or tenderness and assess for rebound tenderness over that specific area.

Answer 12

A. palpate the abdomen in a clockwise direction, beginning with the quadrant after the one the patient indicates is painful.

Question 13

Which of the following helps filter the blood and has no digestive function?

Select one:

A. Small intestine
B. Stomach
C. Large intestine
D. Spleen

Answer 13

D. Spleen

Question 14

Which of the following is correct about the secondary assessment for a high-priority patient?

Select one:

A. The secondary assessment must be performed prior to transport.

B. You may not have time to complete a secondary assessment.

C. Never contact medical direction before completing the secondary assessment.

D. Never perform a secondary assessment on a high-priority patient.

Answer 14

B. You may not have time to complete a secondary assessment.

Question 15

Which of the following may help reduce your patient’s nausea?

Select one:

A. Positive-pressure ventilation
B. Low-flow oxygen
C. Cricoid pressure
D. Oral glucose

Answer 15

B. Low-flow oxygen

Question 16

Which of the following organs lies in the retroperitoneal space?

Select one:

A. Gallbladder
B. Pancreas
C. Liver
D. Spleen

Answer 16

B. Pancreas

Question 17

Which of the following statements regarding dialysis is correct?

Select one:

A. Acute hypertension is a common adverse effect of dialysis.
B. The purpose of dialysis is to help the kidneys retain salt and water.
C. Patients who miss a dialysis treatment often present with weakness.
D. Hemodialysis is effective but carries a high risk of peritonitis.

Answer 17

C. Patients who miss a dialysis treatment often present with weakness.

Question 18

Which of the following statements regarding the acute abdomen is correct?

Select one:

A. An acute abdomen almost always occurs as the result of blunt trauma to solid abdominal organs.

B. The most common cause of an acute abdomen is inflammation of the gallbladder and liver.

C. The initial pain associated with an acute abdomen tends to be vague and poorly localized.

D. The parietal peritoneum is typically the first abdominal layer that becomes inflamed or irritated.

Answer 18

C. The initial pain associated with an acute abdomen tends to be vague and poorly localized.

Question 19

Your patient complains of abdominal pain that occurs mostly at night or after eating fatty foods. You should suspect ____________.

Select one:

A. cholecystitis
B. appendicitis
C. kidney stones
D. a hernia

Answer 19

A. cholecystitis

Question 20

Your patient complains of chronic “burning” stomach pain that improves after eating. You should suspect:

Select one:

A. peptic ulcer disease.
B. pneumonia.
C. kidney stones.
D. aortic aneurysm.

Answer 20

A. peptic ulcer disease.