Week 10 Online Quiz

Question 1

A patient presents with acute onset of anorexia, fever, and abdominal pain that began in the umbilical area and is now radiating into the right lower quadrant. Which of the following conditions is most likely?

a. gastroenteritis
b. pancreatitis
c. cholecystitis
d. appendicitis

Answer 1

d. appendicitis

Question 2

A patient has had abdominal pain for the past 2 weeks that is most tender over McBurney’s point. The pain is worse when she lifts her head and shoulders off the exam table. Which condition is most likely?

a. appendicitis
b. myofascial trigger point
c. colon cancer
d. splenomegaly

Answer 2

b. myofascial trigger point

Note: Increased pain with lifting the head and shoulders is a positive Carnett’s sign and suggests the pain is coming from the abdominal wall.

Question 3

Epigastric pain that radiates to the back, is worse with lying down, and better with leaning forward suggests which condition?

a. appendicitis
b. gastroenteritis
c. pancreatitis
d. cholecystitis

Answer 3

c. pancreatitis

Question 4

A 40 year old female presents with RUQ pain for several hours that radiates to the scapula. On exam she has a slight fever and a positive Murphy’s sign. What condition is most likely?

a. appendicits
b. ectopic pregnancy
c. pancreatitis
d. cholecystitis

Answer 4

d. cholecystitis

Question 5

Abdominal rigidity refer to contraction of the abdominal muscles that is:
Select one:
a. voluntary
b. involuntary

Answer 5

b. involuntary

Note: this is an indication for immediate referral to the the emergency department

Question 6

Which is most likely to cause a patient to have abdominal rigidity on exam?

a. ventral hernia that is NOT incarcerated
b. bowel ischemia
c. peritonitis

Answer 6

c. peritonitis

Question 7

What is the most likely cause of R upper flank pain that radiates to the groin and is accompanied by R sided CVA (costovertebral angle tenderness) on exam?

a. ectopic pregnancy
b. bowel ischemia
c. AAA
d. nephrolithiasis

Answer 7

d. nephrolithiasis

Question 8

A patient presents with acute onset of severe abdominal pain. On exam you note that the patient has a fever, rebound tenderness, guarding, and rigidity. What is the most likely diagnosis?

a. peritonitis
b. ulcerative colitis
c. Crohn disease
d. diverticulitis

Answer 8

a. peritonitis

Question 9

A patient presents with chronic diarrhea. She notes mucous in the stool and occasionally blood. She has pain in the RLQ. Which of the following is more likely?

a. ulcerative colitis
b. Crohn disease

Answer 9

b. Crohn disease

Question 10

A 30-year-old male presents with 6 months of recurrent bloody diarrhea. He is also experiencing LLQ abdominal pain. Which is more likely?

a. ulcerative colitis
b. Crohn disease

Answer 10

a. ulcerative colitis

Question 11

A patient complains of abdominal bloating, cramping lower abdominal pain that gets better with a bowel movement, and alternating diarrhea and constipation. She has had symptoms for several months but denies any weight loss or blood in the stool. Which of the following is most likely?

a. ulcerative colitis
b. gastroenteritis
c. irritable bowel syndrome
d. peptic ulcer disease

Answer 11

c. irritable bowel syndrome

Question 12

Gentle pressure applied to the left lower quadrant may elicit right lower quadrant pain in a patient with appendicitis. What is this sign called?

a. Rovsing’s
b. Psoas
c. Obturator

Answer 12

a. Rovsing’s

Question 13

Which is more pain sensitive?

a. visceral peritoneum
b. parietal peritoneum

Answer 13

b. parietal peritoneum

Question 14

The area of maximal tenderness in the right lower quadrant of a patient with an appendicitis is called:

a. Murphy’s sign
b. McBurney’s point

Answer 14

b. McBurney’s point

Question 15

Which of the following symptoms is NOT considered a red flag for an acute abdomen requiring emergency evaluation?

a. abdominal pain with fever
b. severe pain
c. gradual onset of pain

Answer 15

c. gradual onset of pain

Note: sudden onset of and sudden worsening of pain are more worrisome