SAEM - Abdominal Pain Exam Questions with correct Answers

SAEM - Abdominal Pain Exam Questions with correct Answers Regarding the diagnosis of acute appendicitis, all the following are true EXCEPT: A. Vital signs are usually abnormal, even early in the course of acute appendicitis. B. Rebound is usually elicited only after the appendix has ruptured or infarcted. C. The psoas sign is pain upon extension of the hip. D. Rovsing's sign is pain in the right lower quadrant upon palpation of the left lower quadrant. E. The obturator sign is pain upon flexion and internal rotation of the hip. - Answer ️️ -The answer is A. The presentation of acute appendicitis varies tremendously. Early in its course, vital signs including temperature may be normal. Once perforation has occurred, the rate of low-grade fever (<38 C) increases to about 40%. Other variations in presentation include pain in the right upper quadrant, typically from a retrocecal or retroiliac appendix. Rosving's sign is described as: A. Pelvic pain upon flexion of the thigh while the patient is supine. B. Pelvic pain upon internal and external rotation of the thigh with the knee flexed. C. Pain in the right lower quadrant when left lower quadrant is palpated. D. Pain that increases with the release of pressure of palpation. E. Tenderness in the right upper quadrant that is worse with inspiration. - Answer ️️ -The answer is C. Rosving's sign is pain in the right lower quadrant when the left lower quadrant is palpated. Rebound tenderness occurs with the release of pressure. The iliopsoas sign is pain associated with thigh flexion. The obturator sign is pain that occurs with thigh rotation. All of these signs are associated with appendicitis. Murphy's sign is cessation of inspiration during palpation of the right upper quadrant and is associated with acute cholecystitis. In establishing a differential diagnosis of abdominal pain, which of the following is true? A. Diverticulitis tends to cause pain in the right upper quadrant. B. Cervical motion tenderness is a useful physical finding for differentiating women with or without acute appendicitis. C. The onset of pain prior to the occurrence of nausea and vomiting is more often suggestive of a surgical etiology. D. In patients with sickle cell anemia who present with abdominal pain and diarrhea, shigellosis should be a top consideration. E. Radiation of pain to the scapula is suggestive of acute hepatitis. - Answer ️️ -The answer is C. Pain prior to nausea and vomiting is often suggestive of a surgical etiology of the pain, such as small bowel obstruction. Cervical motion tenderness has been noted in up to 25% of women with acute appendicitis. Patients with sickle cell anemia are prone to Salmonella infections. Radiation of pain to the scapula is classically present in acute choleycystitis. Diverticulitis pain is generally located in the left lower quadrant. Of the following pain patterns, which is the least likely associated with diagnosis of peptic ulcer disease? A. unrelenting pain over a period of weeks B. pain that awakens a patient in the middle of the night C. relief of abdominal pain with antacids D. pain that is worse preceding a meal E. non-radiating, burning epigastric pain - Answer ️️ -The answer is A. Pain from peptic ulcer disease typically occurs in periods of exacerbation and remission. Unrelenting pain over weeks or months should suggest an alternative diagnosis. Pain is classically described as non-radiating, burning epigastric pain. Some patients may also complain of chest or back pain. Pain is frequently severe enough to awaken patients from sleep in early morning hours but is often not present upon waking in the morning, as gastric acid secretion peaks around 2 a.m. and nadirs upon awakening. A 78 year old female presents to the E.D. with a sensation of left-lower quadrant abdominal pain, accompanied by some irregular bowel movements and loss of appetite. Her abdominal CT (two images) is shown in the Figure. What is the most likely diagnosis? [image] A. diverticulitis B. ovarian cyst C. volvulus D. appendicitis E. gastroenteritis - Answer ️️ -The answer is A. A patient with this general picture is most likely to have diverticulitis, which is revealed on the CT scan as diverticular disease with inflammation (wall thickening and stranding). A mother brings her 6 week old boy to the emergency room. She states the baby has been vomiting everything she's tried to feed him for the past 12 hours. She states that he usually eats readily and completes an entire feeding, but he is unable