EMS 1010 - Chapter 22: Abdominal Emergencies
[Chapter 22: Post-test] A patient with an abdominal aortic aneurysm would most likely complain of: A. tearing back pain. B. diffuse abdominal pain. C. altered mental status D. palpitations.
A
[Chapter 22: Post-test] If your patient is complaining of severe abdominal pain that is sharp and can be easily localized by having the patient point to it with one hand, that type of pain is known as: A. parietal. B. radicular. C. referred. D. visceral.
A
[Chapter 22: Post-test] Why is visceral pain more difficult to locate than parietal pain? A. Because organs have fewer nerve sensory receptors B. Because nerve pathways from eviscera do not enter the spinal cord C. Because abdominal organs cover a greater area than the peritoneum D. Because visceral pain can be stimulated only by inflammation of the organ
A
[Chapter 22: Post-test] You are assessing a 23-year-old female patient complaining of abdominal pain. Which finding below would lead you to believe that the patient is suffering a life-threatening emergency that requires surgery? A. Patient states she is in her first trimester of pregnancy with lower mid abdominal pain B. Patient states abdominal pain with associated diarrhea and nausea C. Colicky, persistent pain that started nearly 2 weeks ago D. Cramping, menstrual pain
A
[Chapter 22: Post-test] Dull, achy abdominal pain that is difficult to locate is called: A. visceral. B. radiating. C. somatic. D. parietal.
A
[22.5] Your patient presents with left shoulder pain. He states that it is dull, crushing, and constant. Based on these findings, the patient is most likely suffering from: A. cholecystitis B. gallstones. C. renal colic D. appendicitis.
A Cholecystitis (inflammation of the gallbladder) is often caused by gallstones which often present with referred pain to the shoulder.
[22.1] Pain that is felt in a place other than where it originates is called: A. referred pain. B. diffuse pain. C. somatic pain. D. distributed pain.
A Pain that is felt in a place other than where it originates is known as referred pain.
[22.5] Pancreatitis is common in: A. chronic alcoholics. B. younger patients. C. vegetarians. D. asthma patients.
A Pancreatitis is common in patients with a history of chronic alcohol abuse.
[22.3] Referred pain from cholecystitis typically presents as: A. radiating pain to the shoulder. B. pain that radiates down the right leg. C. pain in the right upper region of the abdomen after eating a meal. D. pain felt in the left upper region of the abdomen.
A Referred pain from cholecystitis typically presents as pain in the posterior right shoulder.
[22.2] Which of the following organs helps to regulate carbohydrate levels and detoxify the blood? A. Liver B. Pancreas C. Kidney D. Stomach
A The liver has many functions, including detoxification of the blood.
[22.2] The purpose of the spleen is to: A. aid in the production of blood cells and the filtering and storage of blood. B. filter nutrients from the blood and store glucose. C. hold bile that aids in the digestion of fats. D. aid in digestion and regulate carbohydrate metabolism.
A The spleen is an elongated, oval, solid organ located in the left upper quadrant behind and to the side of the stomach. It aids in the production of blood cells as well as the filtering and storage of blood.
[22.3] Pain that is felt in regions other than the one where the source of the pain lies is called: A. referred pain. B. phantom pain. C. regional pain. D. translocation pain.
A The term "referred pain" describes pain that is referred to a region other than the one where the source of the pain lies.
[22.3] Pain in the abdomen that originates from the organs is termed: A. visceral pain. B. referred pain. C. parietal pain. D. tearing pain.
A Visceral pain is pain in the abdomen that originates from the organs.
[Chapter 22: Post-test] Which of the following statements is TRUE? A. There are few serious causes of abdominal pain. B. EMTs should not delay transport to determine the specific cause of abdominal pain. C. Abdominal complaints are typically easy to diagnose. D. EMTs should determine the cause of abdominal pain before recommending transport.
B
[Chapter 22: Post-test] For assessment and documentation purposes, the abdomen is divided into: A. halves. B. quadrants. C. eighths. D. thirds.
B
[Chapter 22: Post-test] Nerve pathways from the gallbladder share pathways that sense shoulder pain. This commonly leads to: A. radiating pain. B. referred pain. C. vomiting. D. hemorrhage.
B
[Chapter 22: Post-test] What type of pain is characterized as a dull or aching discomfort that is poorly localized by the patient? A. Referred B. Visceral C. Parietal D. Radicular
B
[Chapter 22: Post-test] Why does referred pain occur? A. Because the nerve endings near the origin of the pain have been destroyed B. Because of the stimulation of associated nerve pathways C. Because of patient misperception, since it is not true pain D. Because adjacent visceral structures are also involved in the disease process
B
[Chapter 22: Post-test] Your patient complains of epigastric pain. He took several antacids before your arrival, but they provided no relief. You should suspect: A. expired antacids. B. a cardiac problem. C. a diabetic problem. D. a low pain threshold.
B
[22.7] A patient with an acute abdomen would be considered a high priority if the patient displayed: A. blood pressure of 120/80. B. pale, cool, clammy skin. C. a breathing rate of 15 breaths per minute. D. a pulse rate of 68 beats per minute.
B A patient with an acute abdomen that shows evidence of poor peripheral perfusion or significant sympathetic discharge should be considered a high priority for transport. The skin findings and vitals will demonstrate the seriousness of the situation.
[22.6] You arrive on scene to a 54-year-old male complaining of abdominal pain. He states he does not want to go to the hospital but simply wants you to check his vital signs. As you assess your patient, which assessment finding would lead you to believe he is suffering an acute myocardial infarction? A. Right upper quadrant pain unrelieved by position. B. Patient states dull, cramping pain in his mid-upper abdomen. C. Flank pain radiating to the groin. D. Right upper quadrant pain persistent for the past 2 days
B All epigastric pain should be considered cardiac in nature until proven otherwise. Pain from acute coronary syndrome may present as abdominal discomfort.
[22.5] What type of bleeding is MOST likely associated with dark, tarry stool? A. Esophageal varices B. GI bleeding C. External bleeding D. Cholecystitis
B Dark, tarry stool is an indication of possible GI bleeding.
[22.4] Upper central abdominal pain just below the xiphoid is called: A. umbilical pain. B. epigastric pain. C. lower quadrant pain. D. subgastric pain.
B Epigastric pain is upper abdominal pain, just below the xiphoid.
[22.5] Problems with the kidneys can sometimes present with pain to the: A. chest. B. flank. C. feet. D. neck.
B Given their retroperitoneal location behind the abdominal cavity, pain that originates from the kidneys often radiates into the back.
[22.8] In a woman who has a gynecological complaint, the MOST serious complication for which you should be alert is: A. nausea and vomiting. B. signs of developing shock. C. fever or chills. D. irregular vaginal bleeding or cramping.
B In the field, the most serious signs for which the EMT should be alert when a female patient has a gynecological complaint are those of shock (tachycardia, pallor, and hypotension).
[22.1] "Tearing" abdominal pain is most likely caused by an emergency involving the: A. large intestine. B. aorta. C. pancreas. D. gallbladder.
B Most abdominal structures cannot sense "tearing" pain. The aorta is an exception.
[22.4] Which patient scenario best describes referred pain? A. Right sided flank pain upon palpation due to kidney stones. B. Patient complaining of shoulder pain due to cholecystitis. C. Patient with acute sharp, stabbing pain with rebound tenderness to the right of the umbilicus due to an inflamed appendix. D. Intermittent cramping pains diffuse across the abdomen due to acute food poisoning.
B Referred pain is pain in a location other than its origin. Pain radiating to the left shoulder is common with irritation of the gallbladder. Radiating pain can originate from both solid and hollow organs. Bleeding, hemorrhage, and localized irritation are just a few causes of radiating pain and cannot be distinguished in the prehospital environment.
[22.3] The mechanism behind the cause of tearing pain is: A. the actual tearing of the external layer of the blood vessel. B. the injury that occurs to the middle lining of the artery, causing pressure on the external lining. C. the pulling away of the blood vessel from supporting structures. D. the shear forces that are imposed on the organs.
B Tearing pain often involves the separation of the internal lining from the external lining of the blood vessel.
[22.2] Which of the following is a solid abdominal organ? A. Stomach B. Liver C. Gallbladder D. Appendix
B The liver is a solid organ. The others are all hollow organs.
[22.2] The right upper abdominal quadrant contains: A. part of the large intestine and the female reproductive organs. B. the liver and gallbladder. C. the appendix. D. the spleen and pancreas.
B The right upper quadrant (RUQ) contains most of the liver, the gallbladder, and part of the large intestine. The right kidney is behind the abdominal lining.
[22.7] Diarrhea is a common symptom of which types of medical disorders? A. Liver disease B. Intestinal disorders C. Kidney stones D. Cholecysitis
B When patients have acute GI tract conditions, it is not uncommon for them to have diarrhea.
[Chapter 22: Post-test] A patient with abdominal pain and signs of shock should be: A. monitored for at least 15 minutes before a transport decision is made. B. placed on low-flow oxygen. C. considered a high transport priority. D. give tepid water to drink.
C
[Chapter 22: Post-test] Patients who are experiencing a heart attack often complain of: A. headache. B. diarrhea. C. epigastric pain. D. extremity pain.
C
[Chapter 22: Post-test] The colon is also known as the: A. stomach. B. gallbladder. C. large intestine. D. small intestine.
C
[22.2] How would you compare the amount of bleeding from injured solid organs as compared to injured hollow organs? A. Hollow organs tend to be more vascular than solid organs. B. Solid organs will bleed less than the hollow organs. C. Solid organs will bleed more than the hollow organs. D. Solid and hollow organs will bleed about the same.
C Although solid organs are not considered vascular organs (carrying blood as their sole purpose), they are highly vascular and can bleed quite significantly if injuredlong dashcertainly more so than the thin tissue wall of a hollow organ.
[22.7] You are assessing a 34-year-old female patient complaining of right lower quadrant pain. What is the proper technique to assess her abdomen? A. Palpate deeply in order to thoroughly evaluate abnormalities in the abdomen B. Press into the left upper quadrant with the palm of your hands C. Palpate the right lower quadrant last D. Palpate the right lower quadrant first
C Always palpate the area that has pain or discomfort last as palpating it first could mask the patient's response to findings in the other quadrants. Light palpation with the fingertips is acceptable to feel rigidity or hardening.
[22.5] Your patient complains of tenderness upon palpation of the right lower abdomen. Based on the location of the patient's tenderness, what is the MOST likely cause? A. Pancreatitis B. abdominal aortic aneurysm C. Appendicitis D. Cholecystitis
C Gastric contents, bowel contents, and blood are common causes of peritonitis.
[22.7] You are treating a patient in his mid-50s who is complaining of acute abdominal distress. When should you consider the use of oxygen therapy? A. Oxygen should not be administered until you consult medical direction B. Additional signs of hypoperfusion must be present to consider oxygen therapy C. Oxygen therapy is appropriate if there are signs of hypoperfusion D. Oxygen is appropriate for any patient with abdominal pain
C Oxygen is indicated for patients with abdominal pain if there are signs or symptoms of hypoperfusion or hypoxia.
[22.5] You are caring for a 48-year-old female patient who is suffering from abdominal pain. She was released from the hospital earlier in the day and was told that she may have an irritation to the lining of the abdomen caused by an infection. You should suspect: A. pancreatitis. B. a stomach ulcer. C. peritonitis. D. a gallbladder condition.
C Peritonitis is a painful condition resulting from inflammation in the lining of the abdominal wall. Medical conditions, such as appendicitis, or traumatic injuries as with ruptured spleens can lead to life-threatening peritonitis.
[22.4] Renal colic refers to: A. appendicitis. B. abdominal bleeding. C. kidney stones. D. gallstones.
C Renal colic is another term for kidney stones.
[22.1] The abdominal region between the abdomen and the back is called the: A. anterior space. B. mediastinum. C. retroperitoneal space. D. superior cavity.
C The abdominal area between the abdomen and the back is called the retroperitoneal space. The kidneys and appendix are the two most notable organs located in this space.
[22.5] The MOST common type of abdominal surgery is: A. renal colic. B. gallstones. C. appendicitis. D. cholecystitis.
C The most common cause of a patient's requiring abdominal surgery is appendicitis.
[22.2] After suffering a trauma, this organ may leak bacterial fluids into the abdomen. A. Spleen B. Lungs C. Stomach D. Liver
C The stomach is a hollow organ that contains acids and bacteria that aid in the digestion of food. If it becomes perforated from trauma, these chemical contents may leak into the abdominal cavity.
[22.8] You are caring for a middle-aged male patient who complains of sudden, sharp, cramping pain in the right upper region of his abdomen; a dull ache in his right shoulder blade; and some nausea and vomiting. He states that the pain began about 30 minutes after he ate a lobster dinner, and he rates the pain as a 7 on a scale of 10. The pain is unrelieved with antacids. What would you suspect the cause of his discomfort to be? A. Hepatitis B. Appendicitis C. Cholecystitis D. Kidney stones
C This clinical presentation is most commonly associated with cholecystitis or gallstones. The referred pain to the right shoulders is a common sign of cholecystitis.
[22.1] Abdominal pain that is sharp, constant, and localized is called: A. radiating. B. visceral. C. diffuse. D. parietal.
D Parietal pain arises from the parietal peritoneum (lining of the abdominal cavity) and is typically sharp, constant, and localized.
[22.1] Acute abdominal pain, sometimes called an acute abdomen, is a common condition. Which of the following is TRUE about an acute abdomen? A. Most causes of an acute abdomen will be obvious. B. Medical texts list only a few causes of abdominal pain. C. Acute abdominal pain has a sudden onset. D. There is no need for the EMT to consider abdominal pain to be life threatening.
C "Acute" means sudden or emergent onset.
[Chapter 22: Post-test] How should you respond if your female patient is reluctant to discuss the specifics of her gynecological complaint with you? A. Insist that she provide you with the information. B. Have her sign a refusal of treatment form. C. Tell her that you are unable to perform your duties without the requested information. D. Respect her wishes, and transport her to the ED for a more thorough assessment.
D
[Chapter 22: Post-test] Your abdominal pain patient presents with guarding. This position is described as: A. sitting in a chair with the hands on the knees, leaning forward. B. flat on the back with legs extended and hands clenched over the abdomen. C. on the knees, leaning forward, hands on the floor supporting the body. D. knees drawn up and hands over the abdomen.
D
[22.6] You are treating a patient who has sudden onset stomach pain. The 56-year-old male patient states he was mowing his yard when he began having sharp, stabbing pain in his epigastric region. He feels it may be from the lunch he ate 15 minutes prior to your arrival. What is the BEST way to manage this patient? A. Assist the patient in taking anti-acid medications such as Maalox or Tums. B. Check for allergies, contact medical control, and administer activated charcoal for potential food poisoning. C. Ensure the medications you have in your medical bag are within date and administer aspirin and nitroglycerin. D. Presume the patient is having a myocardial infarction and treat accordingly.
D All patients with epigastric abdominal pain should be considered cardiac in nature until proven otherwise. Contact medical direction to treat for possible myocardial infarction.
[22.5] Your patient is a 58-year-old male who is complaining of a sudden onset of severe, constant abdominal pain, radiating to the lower back. He describes the pain as "tearing." When you palpate the area, you note a pulsating abdominal mass. You suspect: A. esophageal varices. B. an ulcer. C. an intestinal obstruction. D. an abdominal aortic aneurysm.
D An abdominal aortic aneurysm (AAA) is a weakened, ballooned, and enlarged area of the wall of the abdominal aorta. The aneurysm may eventually rupture and is one of the most lethal causes of abdominal pain.
[22.8] What question should you ask to determine if your female patient is experiencing an ectopic pregnancy? A. What form of birth control do you use? B. How many times has you been pregnant? C. Have you ever had a miscarriage? D. Are you sexually active?
D Asking if your female patient with abdominal pain is sexually active can help rule in the possibility of an ectopic pregnancy.
[22.6] You are on scene with a 47-year-old female patient complaining of "stomach pain" but tells you that she thinks she's having a "heart attack." She states she has a history of "gall stones, high blood pressure, and kidney stones." What assessment finding would lead you to believe that the patient may be suffering a myocardial infarction? A. Non-radiating right lower quadrant pain B. Flank pain radiating to anterior mid abdomen C. Right upper quadrant pain unrelieved by position D. Acute epigastric pain
D Epigastric abdominal pain should be considered cardiac in nature until proven otherwise.
[22.7] Your patient presents with abdominal guarding. This is a sign of: A. infection. B. severe chest pain. C. hypotension. D. severe abdominal pain.
D Guarding is a sign of severe pain.
[22.2] The liver is located primarily in the: A. right lower quadrant. B. left upper quadrant. C. left lower quadrant. D. right upper quadrant.
D Most of the liver resides in the right upper quadrant, with some extension into the left upper quadrant.
[22.5] You respond to a scene where a 67-year-old male presents as pale, cool, and diaphoretic. He states he has severe mid-abdominal pain that began "about an hour ago," and has not resolved itself. What assessment finding would lead you to suspect a large, arterial GI bleed? A. dark, tarry stools B. rebound tenderness in right lower quadrant C. right upper quadrant abdominal pain D. bright, red vomitus
D Patient suffering from GI bleeds may present in different ways. The difference in presentation of signs and symptoms depends largely on which vessel is the source of hemorrhage. Small bleeds may resolve itself or result in chronic gastrointestinal hemorrhage with associated signs and symptoms appearing over a longer period of time. Large arterial GI bleeds are acute and associated with severe pain as well as bright red blood from the rectum or in the vomit.
[22.5] You respond to the scene of a 22-year-old male who was squatting "heavy weights" when he experienced sudden and severe lower mid abdominal pain. While assessing the patient, he denies any radiating pain, stating that most of his pain "is near his groin." Based on these findings, what is the patient MOST likely suffering: A. GI bleeding. B. an abdominal evisceration. C. appendicitis. D. a hernia.
D Rapid onset of abdominal pain while heavy lifting may cause the intestines to push through a weakened area in the abdominal wall creating a hernia.
[22.4] Your patient complains of right shoulder pain. She denies trauma. Which of the following is most likely? A. Appendicitis B. Food poisoning C. Intestinal obstruction D. Gallbladder problems
D Referred pain to the right shoulder is common with gallbladder problems.
[22.5] Your patient is in severe pain stating that his discomfort radiates from his flank to his groin. You also note that the patient is feeling nauseous and cannot find a position of comfort. Based on these assessment findings, what is most likely the cause of his distress? A. Hernia B. GI Bleeding C. Appendicitis D. Renal colic
D Renal colic may cause severe pain as the kidney stones descend down the ureter. Typical signs of pain is flank pain radiating to the groin as well as associated nausea and vomiting.
[22.7] our patient presents with abdominal pain. Which of the following questions is MOST important to ask? A. Have you ever called 911 before? B. Is the pain really that bad? C. Why did you wait to call? D. How would you describe the pain?
D The most relevant question is about the patient's quality of pain. The other questions are either not relevant or not appropriate.
[22.7] Your abdominal pain patient presents with pale, cool skin, tachycardia, and hypotension. You should first: A. perform a complete secondary assessment. B. assess orthostatic vital signs. C. ask the patient about illegal drug use. D. treat the patient for shock.
D The patient is presenting with signs of shock and should be treated for shock immediately. Treating for shock is part of the primary assessment and should be performed first on all patients regardless of chief complaint.
[22.2] Absorption of nutrients from the intestinal tract is performed in the: A. stomach. B. transverse colon. C. large intestine. D. small intestine.
D The small intestine is a tube-like structure that begins at the distal end of the stomach and ends at the beginning of the large intestine. Its digestive function is to absorb nutrients from intestinal contents.
[22.8] Until it is proven otherwise, you should assume that a missed or late menstrual period is due to: A. IUD. B. menopause. C. stress. D. pregnancy.
D Until it is proven otherwise, you should assume that any missed or late period is due to pregnancy, even if your patient denies it. Direct questions such as "Could you be pregnant?" are generally unlikely to get an accurate response. Inquire about other signs, including a late or missed period, breast tenderness, bloating, urinary frequency, and nausea and vomiting.
[22.6] Your patient complains of epigastric pain. He has a cardiac history and an ulcer. Which of the following is most indicative of a cardiac problem? A. Lying down increases the pain. B. Antacids help to reduce the pain. C. The pain is relieved by eating. D. The pain is heavy and constant.
D Heavy, constant epigastric pain is commonly cardiac in origin. Antacids and eating relieves pain associated with ulcers while lying down increases that discomfort.