Vol 3 Ch 6
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
