Deck 6: Gastroenterology

Question 1

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) Visceral pain originates in the walls of hollow organs, while somatic pain originates in skeletal muscle.
C) 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.
D) 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.

Answer 1

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.

Question 2

Your patient, who has a history of cholecystitis, is experiencing pain in her right shoulder. She is most likely experiencing ________ pain.

A) somatic
B) visceral
C) referred
D) peritoneal

Answer 2

referred

Question 3

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) Colitis
C) Upper GI bleed
D) Hemorrhoids

Answer 3

Hemorrhoids

Question 4

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) Ketorolac (Toradol)
C) Methylprednisolone
D) Antiemetics

Question 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) appendicitis.
B) diverticulitis.
C) bowel obstruction.
D) ulcerative colitis.

Question 6

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) transporting the patient in a position of comfort and giving reassurance.
C) high-concentration oxygen by nonrebreathing mask.
D) IV of NS with 250 cc fluid bolus.

Question 7

Increased hepatic resistance to blood flow, as happens in cirrhosis, results in:

A) hepatic arterial hypertension and obstruction of the common bile duct.
B) portal vein hypertension and esophageal varices.
C) portal artery hypertension and ascites.
D) hepatic vein hypertension and hepatic vein aneurysm.

Question 8

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) diazepam.
B) Compazine.
C) IV of NaCl or lactated Ringer's solution.
D) Zofran.

Question 9

Which three mechanisms can produce visceral pain?

A) Peritonitis, cholecystitis, and a ruptured abdominal aorta
B) Blunt trauma, penetrating trauma, and medical illness
C) Somatic, referred, and peritonitis
D) Distension, ischemia, and inflammation

Question 10

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) IV of NS with fluid challenge.
B) aggressive suctioning of the airway and intubation.
C) dopamine infusion.
D) placing the patient in shock position.

Question 11

Bleeding in the gastrointestinal tract proximal to the ligament of Treitz is considered to be in the:

A) small intestine.
B) lower GI tract.
C) upper GI tract.
D) colon.

Question 12

Pain that is well localized, allowing an examiner to pinpoint the area of irritation is ________ pain.

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

Question 13

All of the following contribute to the pathogenesis of diverticulosis EXCEPT:

A) decreased colon motility.
B) herniation of mucosa and submucosa through the teniae coli.
C) increased colon pressure.
D) low-fiber diet.

Question 14

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) IV of normal saline with a 250 mL fluid challenge, repeated if necessary.
B) IV of 5 percent dextrose solution at 30 mL per hour.
C) two large-bore IVs of lactated Ringer's solution, wide open.
D) two large-bore IVs of normal saline, 20 mL/kg fluid bolus.

Question 15

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) Acute cholecystitis
B) Diverticulosis
C) Gastrointestinal bleeding
D) Ingestion of an iron or a bismuth-containing medication

Question 16

All of the following are considered part of the lower gastrointestinal tract EXCEPT the:

A) jejunum.
B) large intestine.
C) ileum.
D) duodenum.

Question 17

While palpating the lower abdomen of a 63-year-old male complaining of back pain, you note a pulsating mass. You should:

A) ask the patient to take a deep breath, then palpate the mass while he exhales.
B) ask your partner to confirm the finding.
C) determine if the mass is fixed or freely mobile in the abdomen.
D) stop palpating.

Question 18

Which of the following correctly lists the organs and regions of the gastrointestinal tract in sequence after the stomach?

A) Duodenum, jejunum, ileum, descending colon, transverse colon, ascending colon, rectum, anus
B) Duodenum, ileum, jejunum, large intestine, anus, rectum
C) Jejunum, duodenum, ileum, large intestine, anus, rectum
D) Duodenum, jejunum, ileum, ascending colon, transverse colon, descending colon, rectum, anus

Question 19

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) referred
C) somatic
D) parietal

Question 20

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 the pain start?"
B) "How would you describe the pain: dull, sharp, constant, intermittent?"
C) "Are you having any vomiting or diarrhea?"
D) "Have you ever had a sexually transmitted disease?"

Question 21

Which of the following statements about hepatitis is TRUE?

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

Question 22

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) Murphy's
B) Cullen's
C) McBurney's
D) Grey-Turner's

Question 23

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) Pancreatitis
B) Hepatitis
C) Peptic ulcer disease
D) Gastroenteritis

Question 24

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) "Do you feel nauseated?"
B) "Are you having any pain with urination?"
C) "Are you experiencing pain anywhere other than your lower abdomen?"
D) "When was your last menstrual period?"

Question 25

Murphy's sign is:

A) bruising around the umbilicus.
B) pain produced by pressing under the right costal margin in the presence of an inflamed gallbladder.
C) pain produced by pushing 1 to 2 inches above the iliac crest on a line to the umbilicus.
D) petechial hemorrhage of the abdominal wall.

Question 26

Which of the following statements would be most typical of a patient with hepatitis?

A) "It seems like everything has a yellow tinge to it."
B) "I have sharp pain on the left side of my abdomen."
C) "I have to urinate all the time."
D) "My stools are really light in color."

Question 27

Which of the following is the most common chief complaint related to acute pancreatitis?

A) Headache
B) Intense abdominal pain
C) Blood in the stool
D) Diarrhea

Question 28

Which of the following questions would best help you determine if the pathology of a patient's complaint has been progressing?

A) "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?"
B) "When did your pain first start?"
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?"

Question 29

Gastrointestinal emergencies account for ________ percent of emergency room visits annually.

A) 5
B) 10
C) 2.5
D) 7.5

Question 30

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 were you doing when the vomiting started?"
B) "Do you drink more than three alcoholic beverages a day?"
C) "Did you become dizzy or faint while you were vomiting?"
D) "What did the material you vomited look like?"

Question 31

Pain at McBurney's point is associated with:

A) cholecystitis.
B) kidney stones.
C) appendicitis.
D) pancreatitis.

Question 32

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) Colitis
B) Cholecystitis
C) Acute hepatitis
D) Pancreatitis

Question 33

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) Pancreatitis
B) Cholecystitis
C) Diverticulitis
D) Bowel obstruction

Question 34

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

Question 35

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) "I'm sure you are right; there is nothing to worry about."
B) "Similar bleeding can be caused by more serious conditions."
C) "This does not sound like hemorrhoids."
D) "Even though this sounds like hemorrhoids, the bleeding may become life-threatening."

Question 36

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) Diverticulitis
B) Peptic ulcer
C) Acute pancreatitis
D) Acute gastroenteritis

Question 37

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) Hemorrhagic pancreatitis
B) Acute gastroenteritis
C) Esophageal varices
D) Acute gastric ulcer perforation

Question 38

The mortality rate of ruptured esophageal varices is ________ percent.

A) over 35
B) 10 to 15
C) 20 to 30
D) 15

Question 39

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) Bowel obstruction
B) Appendicitis
C) Peptic ulcer disease
D) Cholecystitis

Question 40

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) 2 inches above the umbilicus in the midline.
C) 1 to 2 inches above the iliac crest in the right midaxillary line.
D) at the midway point of a line from the symphysis pubis to the right anterior, superior iliac crest.

Question 41

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.

Question 42

Abdominal pain that is originating in a region other than where it is felt is known as:

A) referred pain.
B) somatic pain.
C) visceral pain.
D) Kehr's sign.

Question 43

A Mallory-Weiss tear is a disorder of the:

A) stomach.
B) liver.
C) rectum.
D) esophagus.

Question 44

With occlusion of the SMA or IMA vascular structures, what gastrointestinal emergency may occur?

A) Renal infarction
B) Hepatic encephalitis
C) Pancreatitis
D) Mesenteric ischemia

Question 45

Which of the following mechanisms is NOT characteristic for a rectal foreign body?

A) Adhesion progression
B) Accidental trauma
C) Accidental swallowing of something
D) Tumor growth

Question 46

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) melena.
D) esophageal varices.

Question 47

What is the most common cause of chronic gastroenteritis?

A) Microbial infection
B) Floral infection
C) Elevated cortisol
D) Use of NSAIDs

Question 48

Esophageal varices are most associated with:

A) kidney disease.
B) liver disease.
C) gastroesophageal reflux disease.
D) pancreatitis.

Question 49

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) Grey Turner's sign.
B) Cullen's sign.
C) Edwards' sign.
D) rigidity sign.

Question 50

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) Grey Turner's sign.
B) Cullen's sign.
C) Edwards' sign.
D) rigidity sign.

Question 51

The cause of esophageal varices can be attributed to:

A) pulmonary hypertension.
B) portal hypertension.
C) pulmonary hypotension.
D) portal hypotension.

Question 52

Which of the following would be most typical of a patient suffering from diverticulitis?

A) Dark, tarry stools
B) Diffuse abdominal pain
C) Left lower quadrant pain
D) Inability to have a bowel movement

Question 53

Which of the following best explains the underlying problem in diverticulitis?

A) Infection in an outpouching of the distal colon
B) Ulceration of the lining of the colon
C) Increased motility of the colon with increased mucus production
D) The presence of polyps in the sigmoid colon

Question 54

The main purpose of the GI tract is:

A) to convert food into nutrients for the body.
B) to expel waste products.
C) to facilitate metabolism.
D) glucogenolysis.

Question 55

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) 10 mL/kg.
B) 20 mL/kg.
C) 250 mL.
D) 1000 mL.

Question 56

Persistent abdominal pain is considered a surgical emergency when lasting longer than:

A) 2 days.
B) 2 hours.
C) 6 days.
D) 6 hours.

Question 57

Abdominal pain that is dull in nature and cannot be narrowed to one specific area is known as:

A) referred pain.
B) somatic pain.
C) visceral pain.
D) Kehr's sign.