Vol 3 Ch 6

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Gastrointestinal emergencies account for​ ________ percent of emergency room visits annually. A. 2.5 B. 5 C. 10 D. 7.5

B. 5

Your patient is a​ 68-year-old female complaining of diffuse abdominal pain. She has a history of intestinal hernias and adhesions from previous abdominal surgery. Your suspicion should be highest​ for: A. Bowel obstruction B. Diverticulitis C. Ulcerative colitis D. Appendicitis

A. Bowel obstruction

You are examining a patient who is exhibiting signs of hypovolemia. Upon inspection of the​ patient's flank, you notice ecchymosis. This is known​ as: A. Edwards sign. B. ​Cullen's sign. C. Grey​ Turner's sign. D. rigidity sign.

C. Grey​ Turner's sign.

Persistent abdominal pain is considered a surgical emergency when lasting longer​ than: A. 2 hours. B. 2 days. C. 6 days. D. 6 hours.

D. 6 hours.

Your​ patient, who has a history of​ cholecystitis, is experiencing pain in her right shoulder. She is most likely experiencing​ ________ pain. A. Peritoneal B. Somatic C. Visceral D. Referred

D. Referred

You respond to a patent who complains of having​ dark, tarry stools. Upon​ arrival, you notice that the patient is​ pale, cool, and clammy. After initiation of two​ large-bore IVs, your initial fluid bolus should​ be: A. 250 mL. B. 20​ mL/kg. C. 1000 mL. D. 10​ mL/kg.

B. 20​ mL/kg.

Persistent abdominal pain is considered a surgical emergency when lasting longer​ than: A. 2 days. B. 6 hours. C. 6 days. D. 2 hours.

B. 6 hours.

Which of the following mechanisms is not characteristic for a rectal foreign​ body? A. Psychosis on the part of the patient B. Accidental trauma C. Accidental swallowing of something D. Sexual gratification

B. Accidental trauma

Which of the following mechanisms is not characteristic for a rectal foreign​ body? A. Sexual gratification B. Accidental trauma C. Psychosis on the part of the patient D. Accidental swallowing of something

B. Accidental trauma

Your patient is a​ 38-year-old female with a history of​ Crohn's disease. She is conscious and alert and complaining of abdominal pain. She describes a​ one-week history of increasingly​ diffuse, crampy abdominal pain. She also states that she has had nausea and​ vomiting, fever, and diarrhea the past two days. Physical examination reveals that her skin is warm and dry and that her abdomen is tender to palpation in all quadrants with no masses or distension noted. HR​ = 100, BP​ = 118/78, RR​ = 14, SaO2 ​= 99%. Which of the following treatments is appropriate in the prehospital management of this​ patient? A. Diphenydramine B. Antiemetics C. Methylprednisolone D. Ketorolac​ (Toradol)

B. Antiemetics

All of the following contribute to the pathogenesis of diverticulosis​ EXCEPT: A. Herniation of mucosa and submucosa through the teniae coli B. Decreased colon motility C. Increased colon pressure D. ​Low-fiber diet

B. Decreased colon motility

All of the following are considered part of the lower gastrointestinal tract EXCEPT​ the: A. Jejunum B. Duodenum C. Ileum D. Large intestine

B. Duodenum

A​ 46-year-old female alcoholic is​ hypotensive, in severe​ distress, complaining of​ dysphagia, and vomiting bright red blood. Of the​ following, which is the most likely cause of this​ patient's clinical​ condition? A. Acute gastric ulcer perforation B. Esophageal varices C. Hemorrhagic pancreatitis D. Acute gastroenteritis

B. Esophageal varices

Your patient is a​ 66-year-old female who is conscious and​ alert, complaining of a​ one-week history of progressive​ "lightheadedness" with exertion. She also complains of mild​ nausea; dark, sticky​ stools; and pain in her lower abdomen. Which of the following is the most likely cause of this​ patient's condition? A. Diverticulosis B. Gastrointestinal bleeding C. Ingestion of an iron or a​ bismuth-containing medication D. Acute cholecystitis

B. Gastrointestinal bleeding

Which of the following statements about hepatitis is​ TRUE? A. All types of hepatitis are typically fatal within six months to two years. B. Hepatitis is caused by a wide range of potential causes. C. All types of hepatitis lead to chronic liver disease. D. The most common cause of hepatitis is alcohol abuse.

B. Hepatitis is caused by a wide range of potential causes.

Esophageal varices are most associated​ with: A. Pancreatitis B. Liver disease C. Kidney disease D. Gastroesophageal reflux disease

B. Liver disease

What is the most common cause of chronic​ gastroenteritis? A. Use of NSAIDs B. Microbial infection C. Floral infection D. Elevated cortisol

B. Microbial infection

A​ 52-year-old male is in moderate distress and complaining of nausea and vomiting. He describes a​ three-day history of left upper quadrant abdominal pain described as sharp and radiating to his back. You note a slightly distended abdomen. He called EMS today when he developed nausea and vomiting. He denies any change of bowel habits and states he has a history of alcoholism. Of the​ following, which is the most likely cause of his clinical​ condition? A. Gastroenteritis B. Pancreatitis C. Peptic ulcer disease D. Hepatitis

B. Pancreatitis

Increased hepatic resistance to blood​ flow, as happens in​ cirrhosis, results​ in: A. Hepatic vein hypertension and hepatic vein aneurysm B. Portal vein hypertension and esophageal varices C. Portal artery hypertension and ascites D. Hepatic arterial hypertension and obstruction of the common bile duct

B. Portal vein hypertension and esophageal varices

The cause of esophageal varices can be attributed​ to: A. portal hypotension. B. portal hypertension. C. pulmonary hypotension. D. pulmonary hypertension.

B. portal hypertension.

Abdominal pain that is sharp in nature and can be localized is known​ as: A. referred pain. B. somatic pain. C. visceral pain. D. ​Kehr's sign.

B. somatic pain.

You respond to a call of an ill person. Upon​ arrival, you find your patient complaining of diffuse abdominal pain and hematemesis. When​ asked, the patient states that the emesis was​ "coffee ground" in nature. You​ suspect: A. lower GI bleed. B. upper GI bleed. C. esophageal varices. D. melena.

B. upper GI bleed.

Which of the following questions would best help you determine if the pathology of a​ patient's complaint has been​ progressing? A. ​"When did your pain first​ start?" B. ​"On a scale of 0 to​ 10, with 10 being the worst pain​ possible, how would you have rated the pain when it​ started? How would you rate the pain​ now?" C. ​"Have you ever felt this pain​ before?" D. ​"On a scale of 1 to​ 10, with 10 being the worst pain​ possible, how would you rate this​ pain?"

B. ​"On a scale of 0 to​ 10, with 10 being the worst pain​ possible, how would you have rated the pain when it​ started? How would you rate the pain​ now?"

You are examining a patient who was recently involved in a traumatic incident. You notice that the patient is now exhibiting periumbilical ecchymosis. This is known​ as: A. rigidity sign. B. ​Cullen's sign. C. Edwards sign. D. Grey​ Turner's sign.

B. ​Cullen's sign.

While palpating the lower abdomen of a​ 63-year-old male complaining of back​ pain, you note a pulsating mass. You​ should: A. Determine if the mass is fixed or freely mobile in the abdomen B. Ask your partner to confirm the finding C. Ask the patient to take a deep​ breath, then palpate the mass while he exhales D. Stop palpating

D. Stop palpating

Bleeding in the gastrointestinal tract proximal to the ligament of Treitz is considered to be in​ the: A. Lower GI tract B. Colon C. Small intestine D. Upper GI tract

D. Upper GI tract

You respond to a call of an ill person. Upon​ arrival, you find your patient complaining of diffuse abdominal pain and hematemesis. When​ asked, the patient states that the emesis was​ "coffee ground" in nature. You​ suspect: A. esophageal varices. B. lower GI bleed. C. melena. D. upper GI bleed.

D. upper GI bleed.

Your patient is a​ 25-year-old female who is complaining of pain in the midline of the lower abdomen. Which of the following questions helps LEAST when determining the etiology of the​ patient's pain? A. ​"Are you having any pain with​ urination?" B. ​"When was your last menstrual​ period?" C. ​"Are you experiencing pain anywhere other than your lower​ abdomen?" D. ​"Do you feel​ nauseated?"

D. ​"Do you feel​ nauseated?"

Your patient is a​ 22-year-old female in mild distress that is complaining of left lower quadrant abdominal pain and nausea. Which of the following questions would be LEAST helpful when determining the etiology of her abdominal​ pain? A. ​"When did your last menstrual period​ start?" B. ​"Are you having any vomiting or​ diarrhea?" C. ​"When did the pain​ start?" D. ​"Have you ever had a sexually transmitted​ disease?"

D. ​"Have you ever had a sexually transmitted​ disease?"

Which three mechanisms can produce visceral​ pain? A. Blunt​ trauma, penetrating​ trauma, and medical illness B. ​Somatic, referred, and peritonitis C. ​Peritonitis, cholecystitis, and a ruptured abdominal aorta D. ​Distension, ischemia, and inflammation

D. ​Distension, ischemia, and inflammation

Upon palpation of your​ patient's abdomen you note that it is very tender under the right costal margin. This should be documented as a positive​ ________ sign. A. ​Cullen's B. ​McBurney's C. ​Grey-Turner's D. ​Murphy's

D. ​Murphy's

Which of the following is the most common chief complaint related to acute​ pancreatitis? A. Diarrhea B. Headache C. Blood in the stool D. Intense abdominal pain

D. Intense abdominal pain

Which of the following would be most typical of a patient suffering from​ diverticulitis? A. ​Dark, tarry stools B. Inability to have a bowel movement C. Diffuse abdominal pain D. Left lower quadrant pain

D. Left lower quadrant pain

McBurney's point, a common site of pain secondary to​ appendicitis, is​ located: A. At the midway point of a line from 1 to 2 inches above the right iliac crest to the umbilicus B. One to two inches above the iliac crest in the right midaxillary line C. At the midway point of a line from the symphysis pubis to the right​ anterior, superior iliac crest D. Two inches above the umbilicus in the midline

A. At the midway point of a line from 1 to 2 inches above the right iliac crest to the umbilicus

Your patient is a​ 44-year-old female with a history of hiatal hernia. She is complaining of diffuse abdominal pain. All four quadrants are tender to palpation. She also states that she has vomited numerous times and describes the presence of bile. You note that her abdomen is slightly​ distended, and auscultation of her abdomen reveals absent bowel sounds. Of the​ following, which is the most likely cause of her clinical​ condition? A. Bowel obstruction B. Diverticulitis C. Pancreatitis D. Cholecystitis

A. Bowel obstruction

A​ Mallory-Weiss tear is a disorder of​ the: A. Esophagus B. Rectum C. Stomach D. Liver

A. Esophagus

Which of the following assessment findings should you most expect in a patient with chronic​ pancreatitis? A. Hypotension B. ​Dark-colored urine C. ​Clay-colored stool D. Right lower quadrant pain

A. Hypotension

Esophageal varices are most associated​ with: A. Liver disease B. Gastroesophageal reflux disease C. Kidney disease D. Pancreatitis

A. Liver disease

With occlusion of the SMA or IMA vascular​ structures, what gastrointestinal emergency may​ occur? A. Mesenteric ischemia B. Pancreatitis C. Hepatic encephalitis D. Renal infarction

A. Mesenteric ischemia

​Murphy's sign​ is: A. Pain produced by pressing under the right costal margin in the presence of an inflamed gallbladder B. Petechial hemorrhage of the abdominal wall C. Pain produced by pushing 1 to 2 inches above the iliac crest on a line to the umbilicus D. Bruising around the umbilicus

A. Pain produced by pressing under the right costal margin in the presence of an inflamed gallbladder

Pain that is well​ localized, allowing an examiner to pinpoint the area of irritation is​ ________ pain. A. Somatic B. Parietal C. Referred D. Visceral

A. Somatic

Your patient is a​ 44-year-old female complaining of a​ three-day history of localized abdominal pain in her midepigastric region after eating. The pain tends to subside with antacids. Today she is experiencing​ nausea, and the pain did not subside with antacids. The patient gives a history of smoking and moderate alcohol consumption. The​ patient's skin is warm and​ dry, and she has a blood pressure of​ 128/88, a heart rate of​ 84, and respirations of 20. Your course of treatment should consist​ of: A. Transporting the patient in a position of comfort and giving reassurance B. Sodium bicarbonate IV C. IV of NS with 250 cc fluid bolus D. ​High-concentration oxygen by nonrebreathing mask

A. Transporting the patient in a position of comfort and giving reassurance

Your patient is a​ 68-year-old female who is being treated for colon cancer. She is conscious and​ alert, in mild​ distress, and complaining of progressive weakness over the past three days. Palpation of her abdomen reveals tenderness to the lower right quadrant. Her skin is​ pale, cool, and​ dry, and you note the smell and appearance of melena in her stool. HR​ = 108, BP​ = 100/60, RR​ = 12, SaO2 ​= 97%. Proper treatment of this patient might​ include: A. Two​ large-bore IVs of normal​ saline, 20​ mL/kg fluid bolus to begin treating hemorrhagic hypovolemia B. Two​ large-bore IVs of lactated​ Ringer's solution, wide open C. IV of 5 percent dextrose solution at 30 mL per hour D. IV of normal saline with a 250 mL fluid​ challenge, repeated if necessary

A. Two​ large-bore IVs of normal​ saline, 20​ mL/kg fluid bolus to begin treating hemorrhagic hypovolemia

Your male patient complaining of abdominal pain describes his pain as a​ dull, crampy sensation that is making him nauseous. The patient is most likely describing​ ________ pain. A. Visceral B. Parietal C. Somatic D. Referred

A. Visceral

The main purpose of the GI tract​ is: A. to convert food into nutrients for the body. B. glucogenolysis. C. to facilitate metabolism. D. to expel waste products.

A. to convert food into nutrients for the body.

Abdominal pain that is dull in nature and cannot be narrowed to one specific area is known​ as: A. visceral pain. B. somatic pain. C. referred pain. D. ​Kehr's sign.

A. visceral pain.

Which of the following statements would be most typical of a patient with​ hepatitis? A. ​"My stools are really light in​ color." B. ​"I have sharp pain on the left side of my​ abdomen." C. ​"I have to urinate all the​ time." D. ​"It seems like everything has a yellow tinge to​ it."

A. ​"My stools are really light in​ color."

Your patient is a​ 55-year-old male whose wife called EMS after the patient complained of bright red bleeding during a bowel movement. The patient refuses​ transport, stating he has hemorrhoids and has had similar bleeding in the past. Which of the following statements is most​ appropriate? A. ​"Similar bleeding can be caused by more serious​ conditions." B. ​"I'm sure you are​ right; there is nothing to worry​ about." C. ​"This does not sound like​ hemorrhoids." D. ​"Even though this sounds like​ hemorrhoids, the bleeding may become​ life-threatening."

A. ​"Similar bleeding can be caused by more serious​ conditions."

Your​ 43-year-old male patient is alert and oriented and complaining of abdominal pain. He states that he is experiencing nausea and has vomited twice. Which of the following is the most appropriate​ follow-up question? A. ​"What did the material you vomited look​ like?" B. ​"Do you drink more than three alcoholic beverages a​ day?" C. ​"Did you become dizzy or faint while you were​ vomiting?" D. ​"What were you doing when the vomiting​ started?"

A. ​"What did the material you vomited look​ like?"

Which of the following correctly lists the organs and regions of the gastrointestinal tract in sequence after the​ stomach? A. ​Duodenum, jejunum,​ ileum, ascending​ colon, transverse​ colon, descending​ colon, rectum, anus B. ​Duodenum, ileum,​ jejunum, large​ intestine, anus, rectum C. ​Duodenum, jejunum,​ ileum, descending​ colon, transverse​ colon, ascending​ colon, rectum, anus D. ​Jejunum, duodenum,​ ileum, large​ intestine, anus, rectum

A. ​Duodenum, jejunum,​ ileum, ascending​ colon, transverse​ colon, descending​ colon, rectum, anus

A​ 56-year-old female is conscious and alert and complaining of diarrhea and nausea. The patient describes a​ two-day history of her symptoms and states that the pain is​ "all over her​ abdomen." All four quadrants are tender to palpation. She also describes hematochezia. PMH includes​ CAD, and she recently began taking 325 mg of ASA once a day. Of the​ following, which is the most likely cause of her clinical​ condition? A. Acute pancreatitis B. Diverticulitis C. Acute gastroenteritis D. Peptic ulcer

C. Acute gastroenteritis

Your patient is a​ 24-year-old male complaining of a​ one-week history of abdominal pain. He describes the pain as in the upper right​ quadrant, dull and reproducible with movement and palpation. He also describes a decreased​ appetite, weight​ loss, and​ clay-colored stool over the same period. Of the​ following, which is the most likely cause of his clinical​ condition? A. Pancreatitis B. Cholecystitis C. Acute hepatitis D. Colitis

C. Acute hepatitis

Your patient is a​ 19-year-old male complaining of a​ two-day history of abdominal pain described as diffuse and​ colicky, located around his umbilical area. He also states a loss of appetite and a​ low-grade fever over the same period. Palpation of his abdomen reveals tenderness and guarding to the periumbilical area. Of the​ following, which is the most likely cause of his clinical​ condition? A. Cholecystitis B. Peptic ulcer disease C. Appendicitis D. Bowel obstruction

C. Appendicitis

Your patient is a​ 20-year-old male who is​ conscious, alert, and in severe distress. He describes a​ three-day history of diffuse abdominal pain near his umbilicus that became sharp and migrated to his lower right quadrant this morning. He states that the pain became acutely worse half an hour ago and that he is now lightheaded and nauseated and has vomited numerous times. You believe he may be suffering from appendicitis. Based on his clinical​ presentation, the most proper​ treatment, in addition to giving​ oxygen, would​ be: A. IV of normal saline wide​ open, Trendelenburg​ position, rapid transport B. IV of normal saline wide​ open, left lateral recumbent​ position, phenergan​ IV, transport C. Provide​ comfort, manage the​ airway, establish IV​ access, expedited transport D. Provide​ comfort, expedited transport

C. Provide​ comfort, manage the​ airway, establish IV​ access, expedited transport

Which of the following properly accounts for the differences between visceral and somatic​ pain? A. Spilled organ contents and bacteria can result in visceral​ pain, while somatic pain is caused by organ distension. B. The nerves that carry somatic pain impulses enter the spinal column at various​ levels, while the nerves that carry visceral impulses enter the spinal column via specific nerve routes. C. The nerves that carry visceral pain impulses enter the spinal column at various​ levels, while the nerves that carry somatic impulses enter the spinal column via specific nerve routes. D. Visceral pain originates in the walls of hollow​ organs, while somatic pain originates in skeletal muscle.

C. The nerves that carry visceral pain impulses enter the spinal column at various​ levels, while the nerves that carry somatic impulses enter the spinal column via specific nerve routes.

Your patient is a​ 44-year-old female complaining of a​ three-day history of localized abdominal pain in her midepigastric region after eating. The pain tends to subside with antacids. Today she is experiencing​ nausea, and the pain did not subside with antacids. The patient gives a history of smoking and moderate alcohol consumption. The​ patient's skin is warm and​ dry, and she has a blood pressure of​ 128/88, a heart rate of​ 84, and respirations of 20. Your course of treatment should consist​ of: A. Sodium bicarbonate IV B. IV of NS with 250 cc fluid bolus C. Transporting the patient in a position of comfort and giving reassurance ​D. High-concentration oxygen by nonrebreathing mask

C. Transporting the patient in a position of comfort and giving reassurance

The mortality rate of ruptured esophageal varices is​ ________ percent. A. 15 B. 10 to 15 C. over 35 D. 20 to 30

C. over 35

The cause of esophageal varices can be attributed​ to: A. pulmonary hypotension. B. pulmonary hypertension. C. portal hypertension. D. portal hypotension.

C. portal hypertension.

Abdominal pain that is originating in a region other than where it is felt is known​ as: A. visceral pain. B. somatic pain. C. referred pain. D. ​Kehr's sign.

C. referred pain.

Your patient is a​ 22-year-old female in mild distress that is complaining of left lower quadrant abdominal pain and nausea. Which of the following questions would be LEAST helpful when determining the etiology of her abdominal​ pain? A. ​"Are you having any vomiting or​ diarrhea?" B. ​"When did your last menstrual period​ start?" C. ​"Have you ever had a sexually transmitted​ disease?" D. ​"When did the pain​ start?"

C. ​"Have you ever had a sexually transmitted​ disease?"

Pain at​ McBurney's point is associated​ with: A. Kidney stones B. Cholecystitis C. Pancreatitis D. Appendicitis

D. Appendicitis

Your patient is a​ 12-year-old male who is conscious and alert and complaining of diffuse abdominal pain. He states that the pain began about 3 hours after eating supper. He has had severe diarrhea and some vomiting. Any of the following could be therapeutic​ EXCEPT: A. Promethazine B. Compazine C. IV of NS D. Diazepam

D. Diazepam

Your patient is a​ 42-year-old male with a history of alcohol abuse who is in severe distress with dysphagia and hematemesis. You note that he is becoming lethargic and is having trouble keeping his head up. His skin is cool and clammy. HR​ = 138, BP​ = 82/56, RR​ = 8, SaO2 ​= 90%. Proper treatment of this patient would include all of the following​ EXCEPT: A. Placing the patient in shock position B. IV of NS with fluid challenge C. Aggressive suctioning of the airway and intubation D. Dopamine infusion

D. Dopamine infusion

Your patient is a​ 48-year-old female with advanced hepatitis secondary to drug and alcohol abuse. She is confused and is noncompliant with her medications. Which of the following is the most likely cause of her​ confusion? A. Anemia B. Hyperglycemia C. Hypercoagulative state D. Elevated ammonia levels

D. Elevated ammonia levels

Your patient is a​ 46-year-old male truck driver who is sitting on a toilet complaining of bleeding with defecation. He states that he had to strain significantly to produce a bowel​ movement, then noted blood on his stool afterward. He claims no significant medical​ history, has had no recent​ illness, and takes no medications. You note the presence of bright red blood on the surface of his stool. Of the​ following, which is the most likely cause of his clinical​ condition? A. ​Crohn's disease B. Upper GI bleed C. Colitis D. Hemorrhoids

D. Hemorrhoids

Which of the following assessment findings should you most expect in a patient with chronic​ pancreatitis? A. ​Dark-colored urine B. Right lower quadrant pain C. ​Clay-colored stool D. Hypotension

D. Hypotension

Which of the following best explains the underlying problem in​ diverticulitis? A. Ulceration of the lining of the colon B. The presence of polyps in the sigmoid colon C. Increased motility of the colon with increased mucus production D. Infection in an outpouching of the distal colon

D. Infection in an outpouching of the distal colon


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