Deck 22: Abdominal Emergencies

Question 1

You respond to the scene of a 50-year-old male complaining of severe abdominal pain.He has a history of alcohol and drug abuse.His vital signs are stable and he presents with epigastric pain that radiates to the back.He has guarding and point tenderness in the upper quadrants.You suspect:

A) cholecystitis.
B) myocardial infarction.
C) gastroesophageal reflux disease (GERD).
D) pancreatitis.

Answer 1

pancreatitis.

Question 2

Which of the following organs is located in the retroperitoneal space?

A) Liver
B) Stomach
C) Kidneys
D) Uterus

Answer 2

Kidneys

Question 3

Which of the following is true concerning parietal pain?

A) It is often described as "crampy" or "colicky."
B) It arises from solid organs.
C) It is usually intermittent in nature.
D) It is generally localized to a particular area.

Answer 3

It is generally localized to a particular area.

Question 4

With the exception of the ________,most abdominal organs are not able to sense tearing sensations.

A) aorta
B) ovaries
C) liver
D) colon

Question 5

Which of the following is a characteristic of referred pain?

A) It is only felt in hollow organs.
B) It is felt in a location other than the organ causing it.
C) It is caused by psychological stress.
D) It is usually described as "crampy" or "colicky."

Question 6

Pain that the patient feels in a body part or area of the body that has nothing to do with a diseased organ is termed:

A) epigastric pain.
B) abdominal pain.
C) retroperitoneal pain.
D) referred pain.

Question 7

Pain that originates in an organ,such as the intestines,is called ________ pain.

A) visceral
B) referred
C) acute
D) parietal

Question 8

Which of the following structures is (are)NOT located in the abdominal cavity?

A) Kidneys
B) Liver
C) Spleen
D) Stomach

Question 9

Which patient is experiencing visceral pain?

A) 24-year-old male complaining of severe left flank pain
B) 19-year-old female complaining of severe cramps in the lower abdominal quadrants
C) 45-year-old female complaining of abdominal pain "all over"
D) 28-year-old male with rebound tenderness

Question 10

Which abdominal quadrant contains the appendix?

A) Left lower
B) Right upper
C) Right lower
D) Left upper

Question 11

When the gallbladder is diseased,the pain is not only felt in the right upper quadrant (RUQ)but also in the right shoulder.This is known as:

A) parietal pain.
B) visceral pain.
C) referred pain.
D) tearing pain.

Question 12

Your patient is a 35-year-old female with abdominal pain.Which of the following findings CANNOT be attributed to the patient experiencing pain?

A) Slight increase in blood pressure
B) Shallow respirations
C) Increased heart rate
D) Decreased level of consciousness

Question 13

The patient complaining of parietal abdominal pain would concern you the MOST is the one who:

A) walks out to the ambulance informing you he has the worst "belly ache."
B) is sitting upright in a chair, moaning in pain, and drinking antacid.
C) is rolling about on the floor complaining of pain.
D) is lying on the floor very still and quiet with his knees drawn up to his chest.

Question 14

You are called to a residential neighborhood at 12:30 A.M.Your patient has just finished eating a super-sized meal of deep fried fish.He is now complaining of a "crampy" pain in the right upper quadrant and has had two episodes of nausea and vomiting with a green emesis.What condition do you suspect that your patient is experiencing?

A) Peptic ulcer
B) Intestinal obstruction
C) Cholecystitis
D) Appendicitis

Question 15

Your patient was diagnosed with cholecystitis (gallbladder inflammation)three days ago.The patient now presents with nausea,vomiting,and pain in the right shoulder.The pain in the shoulder can be classified as:

A) referred pain.
B) visceral pain.
C) pancreatic pain.
D) somatic pain.

Question 16

You are called to a 25-year-old male complaining of right lower quadrant (RLQ)pain.His other symptoms are nausea and vomiting,fever,and decreasing pain in the umbilicus area.As an EMT,you feel this patient might have:

A) appendicitis.
B) pancreatitis.
C) cholecystitis.
D) peritonitis.

Question 17

Organs of the right upper quadrant include:

A) pancreas, spleen, and part of the liver.
B) most of the liver, gallbladder, and part of the large intestine.
C) small intestine, stomach, and spleen.
D) most of the liver, spleen, and gallbladder.

Question 18

Which of the following is NOT a cause of parietal pain?

A) Muscle spasm
B) Bleeding into the abdominal cavity
C) Inflammation
D) Infection

Question 19

Most organs of the abdomen are enclosed within the:

A) extraperitoneal.
B) peritoneum.
C) retroperitoneal.
D) midline.

Question 20

You respond to an abdominal pain call.Your partner suspects that the patient is having an abdominal aortic aneurysm (AAA).What type of pain is the patient most likely experiencing?

A) Parietal
B) Visceral
C) Referred
D) Tearing

Question 21

You are responding to a 52-year-old male patient complaining of heartburn with epigastric pain.The patient's vital signs are stable and he does not have any pain upon palpation.He has a history of reflux disease and is on several medications for heartburn and acid reflux.What is your greatest concern with this patient?

A) He will aspirate on vomit.
B) He will develop peritonitis.
C) His appendix will rupture.
D) He is suffering from a myocardial infarction.

Question 22

Your patient is a 60-year-old male who is complaining of severe epigastric abdominal pain and difficulty breathing.He is pale,sweaty,and pleads with you,"Don't let me die,I think I'm going to die." Which of the following measures is NOT part of your initial treatment of this patient?

A) Giving 15 lpm of oxygen by nonrebreather mask
B) Applying the defibrillator pads to his chest
C) Determining whether you should assist the patient in taking nitroglycerin
D) Placing the patient in a position of comfort

Question 23

The detection of a bulging mass through the belly button that is not pulsating should make the EMT suspicious that the patient may be suffering from which of the following?

A) Hernia
B) Ulcer
C) Gastroenteritis
D) Abdominal aortic aneurysm

Question 24

You are called to a residence for a 48-year-old male patient.He is lying in bed and is incoherent.He is unable to follow commands.His blood pressure is 80/40,pulse 136,and respiratory rate of 36.His wife states that he had lower right abdominal pain for about two days and it progressively worsened.He said about an hour ago he had a sudden increase in pain and then became incoherent.The wife states the husband refused to see a doctor before,but she finally called 911.You suspect:

A) appendicitis.
B) splenic rupture.
C) renal colic.
D) peritonitis.

Question 25

You arrive on the scene to find an approximately 60-year-old male patient writhing on the floor.He is complaining of a tearing pain radiating to his lower back.He has absent femoral pulses and has a pulsatile mass just superior to his umbilicus.You suspect which of the following conditions?

A) Myocardial infarction
B) Abdominal aortic aneurysm
C) Acute pancreatitis
D) Ruptured appendix

Question 26

You respond to a 75-year-old female who is complaining of epigastric pain that feels like heartburn and radiates to the right shoulder.Her vital signs are stable and she has a previous history of myocardial infarction.She has prescription nitroglycerine tablets.An ALS unit is en route.After performing a physical examination and applying oxygen by nasal cannula,you should:

A) transport the patient in the Trendelenburg position for shock.
B) apply the AED and prepare for imminent cardiac arrest from a myocardial infarction.
C) contact medical control regarding the administration of the patient's nitroglycerin.
D) cancel the ALS unit: this is just gallstones and BLS can transport.

Question 27

You are treating a 38-year-old female patient with abdominal distress.The patient's vital signs are stable and you are getting ready to transport.What is the BEST position to transport the patient?

A) Right lateral
B) On side with knees bent
C) Trendelenburg
D) Left lateral

Question 28

You are called to a nursing home for an 85-year-old patient complaining of abdominal pain.The patient has a history of dementia and cannot describe the pain to you.The nurse states the patient has n vomiting dark coffee ground emesis for about an hour.His blood pressure is 90/40,pulse 100,and respiratory rate of 24.Aside from the airway,what is your greatest concern?

A) The patient will go into hypovolemic shock.
B) The patient will have a myocardial infarction.
C) The patient will have a stroke.
D) The patient will become combative.

Question 29

Which of the following is NOT a cause of abdominal pain?

A) Stroke
B) Food poisoning
C) Heart attack
D) Diabetes

Question 30

You are called to the scene of a patient with abdominal pain.Upon arrival,you find a 38-year-old Asian man on the floor next to his desk writhing in pain.He is complaining of severe right-sided flank pain.His blood pressure is 140/90,pulse 100,and his skin is ashen and diaphoretic.You suspect:

A) cholecystitis.
B) Mittelschmerz.
C) renal colic.
D) myocardial infarction.

Question 31

Your patient is a 40-year-old female who has n experiencing abdominal pain and vomiting for 2 days.She is now responsive to verbal stimulus; has cool,dry skin; a heart rate of 116; respirations of 24; and a blood pressure of 100/70.Which of the following is the BEST position for transporting this patient?

A) Supine with the knees bent
B) Left lateral recumbent with the legs bent
C) Sitting up at a 90-degree angle
D) Sitting up at a 45-degree angle

Question 32

You respond to a 75-year-old female who is complaining of epigastric pain that feels like heartburn.The pain radiates to the right shoulder.Her vital signs are stable and she has a previous history of a myocardial infarction.She has prescription nitroglycerin tablets.She is most likely suffering from:

A) cholecystitis.
B) abdominal aortic aneurysm.
C) Mittelschmerz.
D) renal colic.

Question 33

Which of the following is a concern when caring for the patient with abdominal pain?

A) Shock
B) Patient comfort
C) Airway management
D) All of the above

Question 34

Your patient is a 17-year-old with a history of asthma.She is complaining of pain in her lower abdomen.Assessment reveals that her breath sounds are clear and equal,she has a respiratory rate of 28 breaths per minute,a heart rate of 96 beats per minute,and a blood pressure of 112/74 mmHg.Which of the following is the MOST appropriate next step?

A) Provide high-concentration oxygen.
B) Assist the patient in the administration of her metered-dose inhaler.
C) Have the patient breathe into a paper bag to rebreathe some of her carbon dioxide.
D) Insert a nasopharyngeal airway in the patient's nose.

Question 35

Pain felt in the epigastric region of the abdomen is of concern because of the possibility of which of the following?

A) Influenza
B) Extreme diarrhea with dehydration
C) Myocardial infarction
D) Kidney stones

Question 36

You respond to a 65-year-old patient complaining of abdominal pain.Your physical exam reveals a nonpulsating mass in the lower left quadrant.You suspect:

A) aortic abdominal aneurysm.
B) appendicitis.
C) splenic rupture.
D) hernia.

Question 37

You are called to the scene of a 16-year-old female patient complaining of severe lower quadrant abdominal pain.The patient states she is sexually active.Upon palpation,you observe rebound tenderness in the right lower quadrant.You suspect:

A) appendicitis.
B) ectopic pregnancy.
C) cholecystitis.
D) renal colic.

Question 38

Which of the following is the main focus of the EMT's assessment and history taking of the patient with abdominal pain?

A) Determining the possible need for immediate surgery
B) Determining if the patient meets criteria to refuse treatment and transport
C) Determining the cause of the pain
D) Determining the presence of shock

Question 39

Your patient is a 34-year-old male complaining of pain "in his right side." He is pale and diaphoretic with a heart rate of 90 beats per minute,a respiratory rate of 28 breaths per minute,and a blood pressure of 132/80 mmHg.The patient is very agitated and anxious.Which approach is most appropriate?

A) Try to determine the cause of his pain.
B) Tell the patient that you cannot transport him unless he calms down and lies still.
C) Insert an oropharyngeal airway.
D) Reassure him that you will make him as comfortable as possible and get him to the hospital for additional care.

Question 40

You respond,along with fire department Emergency Medical Responders,to a 48-year-old female having a syncope episode in the bathroom.You find the patient sitting on the commode vomiting into the trash can.The vomitus appears to look like coffee grounds and has a foul smell.The patient is pale and has n weak for the past few days.She has:

A) peritonitis.
B) abdominal aortic aneurysm.
C) hernia.
D) GI bleeding.

Question 41

You are examining a 24-year-old female patient with lower quadrant abdominal pain.What is the MOST lethal possibility?

A) Pelvic inflammatory disease
B) Ectopic pregnancy
C) Cholecystitis
D) Mittelschmerz

Question 42

Which of the following is a cause of gynecological emergencies?

A) Soft-tissue trauma to the external genitalia
B) Sexual assault
C) Disorders of the female reproductive organs
D) All of the above

Question 43

Which of the following questions may help the EMT assess a patient with abdominal pain?

A) Do you have any allergies to foods or medicines?
B) Do you have any medical problems, such as diabetes or heart problems?
C) What medications are you taking?
D) All of the above

Question 44

Which of the following questions is inappropriate when taking the history of a female patient with abdominal pain?

A) Are you having vaginal bleeding or discharge now?
B) What is your sexual orientation?
C) Have you had sexual intercourse since your last menstrual period?
D) If you are menstruating, is the flow normal?

Question 45

Which of the following is of greatest concern for the EMT in the prehospital care of a woman with vaginal bleeding?

A) Finding out if the patient is currently sexually active
B) Monitoring for hypovolemic shock
C) Obtaining a thorough gynecological history
D) Preventing infection

Question 46

You are called to a nursing home for an 85-year-old patient complaining of abdominal pain.The patient has a history of dementia and cannot describe the pain to you.The nurse states the patient has n vomiting dark coffee ground emesis for about an hour.His blood pressure is 90/40,pulse 100,and respiratory rate of 24.In what position should you transport the patient?

A) Trendelenburg
B) Supine
C) Semi-Fowler's
D) Supine with knees bent

Question 47

Which of the following is NOT true concerning abdominal pain in geriatric patients?

A) The elderly person may not be able to give a specific description of the pain.
B) The elderly have a decreased ability to perceive pain.
C) Medications may mask signs of shock associated with an abdominal complaint.
D) The causes of abdominal pain in the elderly are rarely serious.

Question 48

You are called to a nursing home for an 85-year-old patient complaining of abdominal pain.The patient has a history of dementia and cannot describe the pain to you.The nurse states the patient has n vomiting dark coffee ground emesis for about an hour.His blood pressure is 90/40,pulse 100,and respiratory rate of 24.Why should the EMT use an oxygen mask with caution?

A) The oxygen will cause the patient to start vomiting again.
B) The patient may hyperventilate.
C) The patient may go unresponsive.
D) The patient cannot clear any additional emesis.

Question 49

When treating a patient with acute abdominal pain,you should do which of the following?

A) Have him take antacids in an attempt to decrease the pain
B) Administer sips of water if patient complains of thirst
C) Have him drink milk to coat the stomach and reduce the pain
D) Have the patient lie still and assume a position of comfort

Question 50

In what position should the patient complaining of severe abdominal pain be placed if there are no signs or symptoms of shock?

A) Supine with feet elevated
B) One of comfort
C) Left lateral recumbent
D) Semi-Fowler with knees bent