Question 1

A patient is in clinic for evaluation of sudden onset of abdominal pain. The provider palpates a pulsatile, painful mass between the xiphoid process and the umbilicus. What is the initial action?&#10;A) Order a CBC, type and crossmatch, electrolytes, and renal function tests.&#10;B) Perform an ultrasound examination to evaluate the cause.&#10;C) Schedule the patient for an aortic angiogram.&#10;D) Transfer the patient to the emergency department for a surgical consult.

Accepted Answer

The presence of a pulsatile, painful mass in the abdomen is concerning for an abdominal aortic aneurysm (AAA), which has the potential to rupture and cause life-threatening hemorrhage. Immediate transfer to the emergency department for a surgical consultation and evaluation is the appropriate action. Ordering laboratory tests or imaging studies can be done after the patient has been stabilized.

Question 2

Which symptoms noted in a patient reporting abdominal pain are suggestive of appendicitis? (Select all that apply.)&#10;A) Abdominal rigidity along with pain&#10;B) Pain accompanied by low-grade fever&#10;C) Pain occurring prior to nausea and vomiting&#10;D) Pain that begins in the left lower quadrant&#10;E) Prolonged duration of right lower quadrant pain

Accepted Answer

Appendicitis typically presents with abdominal rigidity, low-grade fever, and pain that starts before nausea and vomiting. Pain usually begins in the periumbilical area and later localizes to the right lower quadrant, not the left. Prolonged pain is not characteristic of appendicitis, which often requires prompt treatment.

Question 3

An adult patient reports intermittent, crampy abdominal pain with vomiting. The provider notes marked abdominal distention and hyperactive bowel sounds. What will the provider do initially?&#10;A) Admit the patient to the hospital for consultation with a surgeon&#10;B) Obtain upright and supine radiologic views of the abdomen&#10;C) Prescribe an antiemetic and recommend a clear liquid diet for 24 hours&#10;D) Schedule the patient for a barium swallow and enema

Accepted Answer

The patient's presentation is concerning for an obstruction in the bowel, which would be best evaluated with imaging studies. Obtaining upright and supine radiologic views of the abdomen can help identify any potential areas of blockage. Admitting the patient to the hospital and consulting a surgeon may be necessary depending on the results of the imaging studies, but this is premature without further evaluation. Prescribing an antiemetic and recommending a clear liquid diet may provide symptomatic relief but does not address the underlying etiology. A barium swallow and enema may also be used to evaluate for an obstruction, but this is less commonly done and may not be the best initial test.

Deck 109: Abdominal Pain and Infections