D118 Gastrointestinal Renal, Fitzgerald
(New) 2023
15. All of the following are typically noted in a young adult with the diagnosis of acute
appendicitis except
A. epigastric pain
B. positive obturator sign
C. rebound tenderness
D. marked febrile response - ✔D. marked febrile response
16. A 26 year old man presents with acute abdominal pain. As part of the evaluation for
acute appendicitis, you order a WBC count with differential and anticipate the following
results
A. total WBCs, 4500 mm3; neutrophils, 35%; bands, 2%; lymphocytes, 45%
B. total WBCs, 14,000 mm3; neutrophils, 55%; bands, 3%; lymphocytes 38%
C. total WBCs, 16,500 mm3; neutrophils, 66%; bands, 8%; lymphocytes, 22%
D. total WBCs, 18,100 mm3; neutrophils, 55%; bands, 3%; lymphocytes, 28% - ✔C.
total WBCs, 16,500 mm3; neutrophils, 66%; bands, 8%; lymphocytes, 22%
17. You see a 72 year old woman who reports vomiting and abdominal cramping
occurring over the past 24 hours. In evaluating a patient with suspected appendicitis,
the clinician considers that
A. the presentation can differ according to the anatomical location of the appendix
B. this is a common reason for acute abdominal pain in elderly patients
C. vomiting before onset of abdominal pain is often seen
D. the presentation is markedly different from the presentation of pelvic inflammatory
disease - ✔A. the presentation can differ according to the anatomical location of the
appendix
18. The psoas sign can be best described as abdominal pain elicited by
A. passive extension of the hip
,B. passive flexion and internal rotation of the hip
C. deep palpation
D. asking the patient to cough - ✔A. passive extension of the hip
19. The obturator sign can be best described as abdominal pain elicited by
A. passive extension of the hip
B. passive flexion and internal rotation of the hip
C. deep palpation
D. asking the patient to cough - ✔B. passive flexion and internal rotation of the hip
20. An 18 year old man presents with periumbilical pain, vomiting, and abdominal
cramping over the past 48 hours. Physical exam reveals rebound tenderness, and
laboratory analysis shows the presence of bandemia and a total WBC of 28,000 mm3.
To support the diagnosis of acute appendicitis with suspected appendiceal rupture, you
consider obtaining the following abdominal imaging study
A. MRI
B. CT scan
C. ultrasound
D. flat plate - ✔B. CT scan
21. Which of the following WBC forms is an ominous finding in the presence of severe
bacterial infection?
A. neutrophil
B. lymphocyte
C. basophil
D. metamyelocyte - ✔D. metamyelocyte
22. Which of the following best represents the peak ages for occurrence of acute
appendicitis?
A. 1 to 20 years
,B. 20 to 40 years
C. 10 to 30 years
D. 30 to 50 years - ✔C. 10 to 30 years
23. Clinical findings most consistent with appendiceal rupture include all of the following
except
A. abdominal discomfort less than 48 hours in duration
B. fever greater than 102
C. palpable abdominal mass
D. marked leukocytosis with total WBC greater than 20,000 mm3 - ✔A. abdominal
discomfort less than 48 hours in duration
24. Which of the following imaging studies potentially exposes the patient being
evaluated for abdominal pain to the lowest ionizing radiation burden?
A. ultrasound
B. barium enema
C. CT scan
D. abdominal flat plate - ✔A. ultrasound
25. Commonly encountered diagnoses other than acute appendicitis can include which
of the following in a 28 year old with a 2 day history of lower abdominal pain and with
right sided pain slightly worse than left? (More than one can apply)
A. constipation
B. PID
C. ectopic pregnancy
D. splenetic infarct - ✔A. constipation
B. PID
C. ectopic pregnancy
26. Rebound tenderness is best described as abdominal pain that worsens with
, A. light palpation at the site of the discomfort
B. release of deep palpation at the site of the discomfort
C. palpation on the contralateral side of the abdomen
D. deep palpation at the site of the discomfort - ✔B. release of deep palpation at the site
of the discomfort
27. Abdominal palpation that yields rebound tenderness is also known as a positive
____ sign
A. Markel's
B. Murphy's
C. Blumberg's
D. Nikolsky's - ✔C. Blumberg's
28. Which of the following findings would you expect to encounter in a 33 year old man
with appendiceal abscess?
A. leukopenia with lymphocytosis
B. positive Cullen's sign
C. protracted nausea and vomiting
D. dullness to percussion in the abdominal right lower quadrant - ✔D. dullness to
percussion in the abdominal right lower quadrant
29. A 43 year old woman has a 12 hour history of sudden onset of right upper quadrant
abdominal pain with radiation to the shoulder, fever, and chills. She has had similar,
milder episodes in the past. Exam reveals marked tenderness to right upper quadrant
abdominal palpitation. Her most likely diagnosis is
A. hepatoma
B. acute cholecystitis
C. acute hepatitis
D. cholelithiasis - ✔B. acute cholecystitis
30. Which of the following is usually not seen in the diagnosis of acute cholecystitis?
(New) 2023
15. All of the following are typically noted in a young adult with the diagnosis of acute
appendicitis except
A. epigastric pain
B. positive obturator sign
C. rebound tenderness
D. marked febrile response - ✔D. marked febrile response
16. A 26 year old man presents with acute abdominal pain. As part of the evaluation for
acute appendicitis, you order a WBC count with differential and anticipate the following
results
A. total WBCs, 4500 mm3; neutrophils, 35%; bands, 2%; lymphocytes, 45%
B. total WBCs, 14,000 mm3; neutrophils, 55%; bands, 3%; lymphocytes 38%
C. total WBCs, 16,500 mm3; neutrophils, 66%; bands, 8%; lymphocytes, 22%
D. total WBCs, 18,100 mm3; neutrophils, 55%; bands, 3%; lymphocytes, 28% - ✔C.
total WBCs, 16,500 mm3; neutrophils, 66%; bands, 8%; lymphocytes, 22%
17. You see a 72 year old woman who reports vomiting and abdominal cramping
occurring over the past 24 hours. In evaluating a patient with suspected appendicitis,
the clinician considers that
A. the presentation can differ according to the anatomical location of the appendix
B. this is a common reason for acute abdominal pain in elderly patients
C. vomiting before onset of abdominal pain is often seen
D. the presentation is markedly different from the presentation of pelvic inflammatory
disease - ✔A. the presentation can differ according to the anatomical location of the
appendix
18. The psoas sign can be best described as abdominal pain elicited by
A. passive extension of the hip
,B. passive flexion and internal rotation of the hip
C. deep palpation
D. asking the patient to cough - ✔A. passive extension of the hip
19. The obturator sign can be best described as abdominal pain elicited by
A. passive extension of the hip
B. passive flexion and internal rotation of the hip
C. deep palpation
D. asking the patient to cough - ✔B. passive flexion and internal rotation of the hip
20. An 18 year old man presents with periumbilical pain, vomiting, and abdominal
cramping over the past 48 hours. Physical exam reveals rebound tenderness, and
laboratory analysis shows the presence of bandemia and a total WBC of 28,000 mm3.
To support the diagnosis of acute appendicitis with suspected appendiceal rupture, you
consider obtaining the following abdominal imaging study
A. MRI
B. CT scan
C. ultrasound
D. flat plate - ✔B. CT scan
21. Which of the following WBC forms is an ominous finding in the presence of severe
bacterial infection?
A. neutrophil
B. lymphocyte
C. basophil
D. metamyelocyte - ✔D. metamyelocyte
22. Which of the following best represents the peak ages for occurrence of acute
appendicitis?
A. 1 to 20 years
,B. 20 to 40 years
C. 10 to 30 years
D. 30 to 50 years - ✔C. 10 to 30 years
23. Clinical findings most consistent with appendiceal rupture include all of the following
except
A. abdominal discomfort less than 48 hours in duration
B. fever greater than 102
C. palpable abdominal mass
D. marked leukocytosis with total WBC greater than 20,000 mm3 - ✔A. abdominal
discomfort less than 48 hours in duration
24. Which of the following imaging studies potentially exposes the patient being
evaluated for abdominal pain to the lowest ionizing radiation burden?
A. ultrasound
B. barium enema
C. CT scan
D. abdominal flat plate - ✔A. ultrasound
25. Commonly encountered diagnoses other than acute appendicitis can include which
of the following in a 28 year old with a 2 day history of lower abdominal pain and with
right sided pain slightly worse than left? (More than one can apply)
A. constipation
B. PID
C. ectopic pregnancy
D. splenetic infarct - ✔A. constipation
B. PID
C. ectopic pregnancy
26. Rebound tenderness is best described as abdominal pain that worsens with
, A. light palpation at the site of the discomfort
B. release of deep palpation at the site of the discomfort
C. palpation on the contralateral side of the abdomen
D. deep palpation at the site of the discomfort - ✔B. release of deep palpation at the site
of the discomfort
27. Abdominal palpation that yields rebound tenderness is also known as a positive
____ sign
A. Markel's
B. Murphy's
C. Blumberg's
D. Nikolsky's - ✔C. Blumberg's
28. Which of the following findings would you expect to encounter in a 33 year old man
with appendiceal abscess?
A. leukopenia with lymphocytosis
B. positive Cullen's sign
C. protracted nausea and vomiting
D. dullness to percussion in the abdominal right lower quadrant - ✔D. dullness to
percussion in the abdominal right lower quadrant
29. A 43 year old woman has a 12 hour history of sudden onset of right upper quadrant
abdominal pain with radiation to the shoulder, fever, and chills. She has had similar,
milder episodes in the past. Exam reveals marked tenderness to right upper quadrant
abdominal palpitation. Her most likely diagnosis is
A. hepatoma
B. acute cholecystitis
C. acute hepatitis
D. cholelithiasis - ✔B. acute cholecystitis
30. Which of the following is usually not seen in the diagnosis of acute cholecystitis?
