Chapter 16: Gastrointestinal and Urologic Emergencies

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

A

A hemia that returns to its proper body cavity is said to be: A. reducible B. extractable C. incarcerated D. replaceable

A

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

A

Diarrhea is the principle symptom in: A. Gastroenteritis B. Esophagitis C. Pancreatits D. Peptic Ulcers

A

Distension of the abdomen is gauged by: A. visualization B. auscultaion C. palpation D. the patients complaint of pain around the umbilicus.

A

Esophageal varices MOST commonly occur in patients who: A. drink a lot of alcohol. B. have severe diabetes. C. have a history of esophagitis. D. have weak immune systems.

A

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

A

Pain that may be perceived at a distant point on the surface of the body, such as the back or shoulder, is called: A. referred pain. B. radiating pain. C. visceral pain. D. remote pain.

A

Severe back pain may be associated with which of the following conditions? A. Abdominal aortic aneurysm B. PID C. Appendicitis D. Mittelschmerz

A

The MOST common and significant complication associated with an acute abdomen is: A. peritonitis. B. high fever. C. severe pain. D. internal bleeding.

A

When assessing a patient with abdominal pain, you should: A. palpate the abdomen in a clockwise direction beginning with the quadrant after the one the patient indicates is painful. B. ask the patient to point to the area of pain or tenderness and assess for rebound tenderness over that specific area. C. visually assess the painful area of the abdomen, but avoid palpation because this could worsen his or her condition. D. observe for abdominal guarding, which is characterized by sudden relaxation of the abdominal muscles when palpated.

A

When the abdominal muscles become rigid in an effort to protect the abdomen from further irritation, this is referred to as: A. guarding D. tenderness C. rebound tenderness D. referred pain

A

Which of the following conditions is more common in women than in men? A. cystitis B. hepatitis C. pancreatitis D. cholecystitis

A

Which of the following organs would MOST likely bleed profusely if injured? A. liver B. stomach C. appendix D. gallbladder

A

You have been dispatched to the home of a 52-year-old woman with severe flank pain. In addition to the patient's presentation, which of the following would NOT be an additional expected sign or symptom? A. Diarrhea B. Hematuria C. Nausea D. Vomiting

A

You have been dispatched to the home of a 52-year-old woman with severe flank pain. You should transport her: A. in a position of comfort. B. supine. C. left lateral recumbent. D. in the recovery position.

A

You respond to the residence of a 70-year-old male who complains of weakness and severe shortness of breath. His wife tells you that he is a dialysis patient, but has missed his last two treatments. After applying high-flow oxygen, you auscultate his lungs and hear diffuse rhonchi. The patient is conscious, but appears confused. His blood pressure is 98/54 mm Hg, his pulse rate is 120 beats/min and irregular, and his respirations are 24 breaths/min and labored. You should: A. leave him in a sitting position, keep him warm, and prepare for immediate transport. B. place him in a supine position, elevate his lower extremities, and transport at once. C. treat for shock and request a paramedic unit to respond to the scene and assist you. D. perform a detailed secondary assessment and then transport him to a dialysis center.

A

A 35-year-old mildly obese woman is complaining of localized pain in the right upper quadrant with referred pain to the right shoulder. The MOST likely cause of her pain is: A. acute cystitis. B. acute cholecystitis. C. appendicitis. D. pancreatitis.

B

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

B

A 59-year-old male presents with a sudden onset of 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: A. vigorously palpate the abdomen to establish pain severity. B. administer oxygen and prepare for immediate transport. C. place the patient in a sitting position and transport at once. D. request a paramedic unit to give the patient pain medication.

B

A patient complains of heartburn, pain with swallowing, and feeling like an object is stuck in the throat. Which of the following is MOST likely cause? A. esophageal varices B. esophagitis C. peptic ulcer D. gastroenteritis

B

A patient present with lower quadrant abdominal pain, tenderness above the pubic bone, and frequent urination with urgency. What is the MOST likely underlying condition? A. Cholecystitis B. Cystitis C. Gastroenteritis D. Diverticulitis

B

A patient who presents with vomiting, sign of shock, and history of eating disorder and alcohol abuse is likely to be suffering from: A. diverticulitis B. Mallory-Weiss Syndrome C. appendicitis D. cholecytitis

B

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? A. liver B. kidney C. pancreas D. gallbladder

B

Erosion of the protective layer of the stomach or duodenum secondary to overactivity of digestive juices results in: A. ileus. B. an ulcer. C. appendicitis. D. cholecystitis.

B

Functions of the liver include: A. storage of bile, which is produced in the gallbladder. B. production of substances necessary for blood clotting. C. production of hormones that regulate blood sugar levels. D. release of amylase, which breaks down starches into sugar.

B

In the presence of ileus, the only way the stomach can empty itself is by: A. diarrhea. B. vomiting. C. muscular contraction. D. spontaneous rupture.

B

Pain that is localized to the lower back and/or lower abdominal quadrants is MOST suggestive of: A. acute pancreatitis. B. an aortic aneurysm. C. a kidney infection. D. acute appendicitis.

B

Pain that radiates to the right lower quadrant from the umbilical area, nausea and vomiting, and anorexia are MOST indicative of: A. pancreatitis. B. appendicitis. C. cholecystitis. D. gastroenteritis.

B

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

B

Peritonitis, with associated fluid loss, is the result of: A. abnormal shift of fluid from body tissue into the bloodstream. B. abnormal shift of fluid from bloodstream into body tissue. C. normal shift of fluid form body tissue into the bloodstream. D. normal shift of fluid bloodstream into body tissue.

B

Regulation of acidity and blood pressure is largely attributed to the: A. liver B. kidneys C. gallbladder D. pancreas

B

Solid abdominal organs include the: A. stomach and small intestine. B. spleen, kidneys, and pancreas. C. gallbladder and large intestine. D. urinary bladder, colon, and ureters.

B

The _______ are found in the retroperitoneal space. A. stomach and gallbladder B. kidneys, ovaries, and pancreas C. liver and pancreas D. adrenal glands and uterus

B

Which of the following statements regarding gastrointestinal bleeding is correct? A. In the majority of cases, bleeding within the gastrointestinal tract occurs acutely and is severe. B. Bleeding within the gastrointestinal tract is a symptom of another disease, not a disease itself. C. Lower gastrointestinal bleeding results from conditions such as Mallory-Weiss syndrome. D. Chronic bleeding within the gastrointestinal tract is usually more severe than bleeding that occurs acutely.

B

________ occur(s) when there is excess pressure within the portal system and surround vessel; may lead to life-threatening bleeding. A. esophageal rupture B. esophageal varices C. esophageal ulcers D. esophageal reflux

B

_________ commonly produces symptoms about 30 minutes after a particular fatty meal and usually at night. A. Peptic ulcers B. Cholecystitis C. Appendicitis D. Pancreatits

B

Bowel inflammation, diverticulitis, and hemorrhoids are common causes of bleeding in the: A. upper GI tract B. middle GI tract C. lower GI tract D. all of the above

C

Chronic renal failure is a condition that: A. can be reversed with prompt treatment. B. occurs from conditions such as dehydration. C. is often caused by hypertension or diabetes. D. causes dehydration from excessive urination.

C

Pain that initially starts in the umbilical area and then later moves to the lower right quadrant is typically associated with: A. gastroenteritis B. pancreaitis C. appendicitis D. diverticulitis

C

Patients with acute abdominal pain should not be given anything to eat or drink because: A. it will create referred pain and obscure the diagnosis. B. food will rapidly travel through the digestive system. C. substances in the stomach increase the risk of aspiration. D. digestion prevents accurate auscultation of bowel sounds.

C

Pregnancy, straining at stool, and chronic constipation cause increased pressure that could result in: A. Mallory-Weiss Syndrome B. Diverticulitis C. Hemorrhoids D. Gallstones

C

The MOST important treatment for a patient with severe abdominal pain and signs of shock includes: A. administering high-flow oxygen. B. giving oral fluids to maintain perfusion. C. transporting the patient without delay. D. positioning the patient on his or her side.

C

The kidneys help to regulate blood pressure by: A. retaining key electrolytes, such as potassium. B. eliminating toxic waste products from the body. C. removing sodium, and thus water, from the body. D. accommodating a large amount of blood volume.

C

The parietal peritoneum lines the: A. retroperitoneal space. B. lungs and chest cavity. C. walls of the abdominal cavity. D. surface of the abdominal organs.

C

Which of the following organs assists in the filtration of blood, serves as a blood reservoir, and produces antibodies? A. liver B. kidney C. spleen D. pancreas

C

Which of the following organs is part of the lymphatic system and plays a role in regulation of red blood cells and the immune system? A. bladder B. liver C. spleen D. pancreas

C

Which of the following organs lies in the retroperitoneal space? A. liver B. spleen C. pancreas D. gallbladder

C

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

C

Which of the following statements regarding the acute abdomen is correct? A. The most common cause of an acute abdomen is inflammation of the gallbladder and liver. B. The parietal peritoneum is typically the first abdominal layer that becomes inflamed or irritated. C. The initial pain associated with an acute abdomen tends to be vague and poorly localized. D. An acute abdomen almost always occurs as the result of blunt trauma to solid abdominal organs.

C

You are dispatched to an apartment complex for a young male with abdominal pain. Your priority upon arriving at the scene should be to: A. quickly gain access to the patient. B. notify the dispatcher of your arrival. C. assess the scene for potential hazards. D. place a paramedic ambulance on standby.

C

You have been dispatched to the home of a 52-year-old woman with severe flank pain. Which of the following is NOT a function of the liver? A. It filters toxic substances B. It creates glucose stores C. It acts as reservoir for bile D. It produces substances for blood clotting.

C

You have been dispatched to the home of a 52-year-old woman with severe flank pain. Which of the following would be an appropriate question to ask regarding the pain? A. Have you experienced any belching? B. Do you feel nauseous? C. Is the pain constant or intermittent? D. Have you been urinating more or less?

C

_______ can be caused by an obstructing gallstone, alcohol abuse, and other diseases A. Appendicitis B. Peptic ulcer C. Pancreatitis D. Diverticulitis

C

_______ is responsible for the breakdown of starches into sugar A. insulin B. bile C. amylase D. bicarbonate

C

_________ regulates the amount of glucose in the bloodstream A. Bicarbonate B. Amylase C. Insulin D. Bile

C

A strangulated hernia is one that: A. spontaneously reduces without any surgical intervention. B. can be pushed back into the body cavity to which it belongs. C. is reducible if surgical intervention occurs within 2 hours. D. loses its blood supply due to compression by local tissues.

D

Elderly patients with abdominal problems may not exhibit the same pain response as younger patients because of: A. chronic dementia, which inhibits communication. B. interactions of the numerous medications they take. C. progressive deterioration of abdominal organ function. D. age-related deterioration of their sensory systems.

D

If a patient misses a dialysis treatment, weakness and _____ can be the first in a series of conditions that can become progressively more serious. A. diarrhea B. chest pain C. vomiting D. pulmonary edema

D

In contrast to the parietal peritoneum, the visceral peritoneum: A. is supplied by the same nerves from the spinal cord that supply the skin of the abdomen. B. lines the walls of the abdominal cavity and is stimulated when the solid abdominal organs contract. C. is less likely to become inflamed or infected because it lines the abdominal organs themselves. D. is supplied by nerves of the autonomic nervous system, which are less able to localize pain or sensation.

D

Infected pouches in the lining of the colon are associated with: A. Cholecystitis B. Cystitis C. Gastroenteritis D. Diverticulitis

D

Injury to a hollow abdominal organ would MOST likely result in: A. pain secondary to blood in the peritoneum. B. profound shock due to severe internal bleeding. C. impairment in the blood's clotting abilities. D. leakage of contents into the abdominal cavity.

D

When an organ of the abdomen is enlarged, rough palpation may cause ________ of the organ. A. distension B. nausea C. swelling D. rupture

D

Which of the following is NOT a common disease that produces signs of an acute abdomen? A. Diverticulitis B. Cholecystitis C. Acute appendicitis D. Glomerulonephritis

D

Which of the following is NOT part of the male reproductive system? A. Epididymis B. Prostate gland C. Seminal vesicles D. Fallopian tubes

D

Which of the following is characteristic of peptic ulcer disease (PUD)? A. the passage of bright red blood in the stool or coughing up blood B. symptom relief after taking nonsteroidal anti-inflammatory drugs C. sharp pain that is typically located in both lower abdominal quadrants D. burning or pain in the stomach that subsides immediately after eating

D

You are transporting a 49-year-old male with "tearing" abdominal pain. You are approximately 30 miles away from the closest hospital. During your reassessment, you determine that the patient's condition has deteriorated significantly. You should: A. assist his ventilations with a bag-mask device. B. immediately perform a rapid physical examination. C. continue transporting and alert the receiving hospital. D. consider requesting a rendezvous with an ALS unit.

D

You have been dispatched to the home of a 52-year-old woman with severe flank pain. The patient tells you that she has right flank pain that radiates into her groin. What is MOST likely cause of her condition? A. cholecystitis B. Ileus C. appendicitis D. kidney stone

D