Buttaro Final 667 revised final Questions With Complete
Solutions
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?
a. Admit the patient to the hospital for consultation with a
surgeon
b. Obtain upright and supine radiologic views of the abdomen
c. Prescribe an antiemetic and recommend a clear liquid diet for
24 hours
d. Schedule the patient for a barium swallow and enema
ANS: B
If available, the primary care provider can order radiographic
studies of the abdomen and chest. Once small bowel obstruction
is confirmed or suspected, immediate hospitalization with
surgeon referral is necessary. Because small bowel obstruction
can have potentially serious or life-threatening consequences,
waiting 24 hours is not recommended.
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?
,a. Order a CBC, type and crossmatch, electrolytes, and renal
function tests.
b. Perform an ultrasound examination to evaluate the cause.
c. Schedule the patient for an aortic angiogram.
d. Transfer the patient to the emergency department for a
surgical consult
ANS: D
This patient has symptoms and physical findings consistent with
a ruptured aortic aneurysm and should have an immediate
surgical consult. Ordering other tests is not necessary by the
primary provider.
Which symptoms noted in a patient reporting abdominal pain
are suggestive of appendicitis? (Select all that apply.)
a. Abdominal rigidity along with pain
b. Pain accompanied by low-grade fever
c. Pain occurring prior to nausea and vomiting
d. Pain that begins in the left lower quadrant
e. Prolonged duration of right lower quadrant pain
ANS: A, B, C
Patients with appendicitis typically have pain that begins in the
epigastric or periumbilical area and migrates to the left lower
quadrant. Abdominal rigidity is common, as is low-grade fever.
Pain precedes other symptoms and when the symptoms occur in
,any other order, the diagnosis of appendicitis should be
questioned. Pain is usually of short duration.
A patient reports anal pruritis and occasional bleeding with
defecation. An examination of the perianal area reveals external
hemorrhoids around the anal orifice as the patient is bearing
down. The provider orders a colonoscopy to further evaluate this
patient. What is the treatment for this patient's symptoms?
a. A high-fiber diet and increased fluid intake
b. Daily laxatives to prevent straining with stools
c. Infiltration of a local anesthetic into the hemorrhoid
d. Referral for possible surgical intervention
ANS: A
Most hemorrhoids, unless incarcerated or painful, are treated
conservatively. A high-fiber diet and increased fluid intake are
recommended first. Daily laxatives are not recommended
because the variation in stool consistency makes hemorrhoid
management more difficult. Infiltration of a local anesthetic is
performed for thrombosed external hemorrhoid prior to
removing the clot. Hemorrhoidectomy is performed for severe
or very painful hemorrhoids.
What recommendations are appropriate for patients with chronic
pruritus ani? (Select all that apply.)
a. Application of a topical antihistamine
b. Applying a of 1% hydrocortisone cream for several months
, c. Avoid tight-fitting or non-breathable clothing
d. Avoiding perfumed soaps and toilet papers
e. Using a hair dryer on the cool setting to control itching
ANS: C, D, E
Measures to control itching include avoiding tight-fitting
clothing as well as perfumed products and keeping the area
clean and dry and using a cool hair dryer to dry the skin. Topical
antihistamines are not used. Using a topical steroid longer than 2
weeks causes thinning of the skin.
A patient has sudden onset of right upper quadrant (URQ) and
epigastric abdominal pain with fever, nausea, and vomiting. The
emergency department provider notes yellowing of the sclerae.
What is the probable cause of these findings?
a. Acute acalculous cholecystitis
b. Chronic cholelithiasis
c. Common bile duct obstruction
d. Infectious cholecystitis
ANS: C
This patient has symptoms of cholecystitis with bile duct
obstruction, which causes jaundice. The common triad of RUQ
pain, fever, and jaundice occurs when a stone is lodged in the
common bile duct. Acute acalculous cholecystitis is
inflammation without stones. Chronic cholelithiasis does not
Solutions
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?
a. Admit the patient to the hospital for consultation with a
surgeon
b. Obtain upright and supine radiologic views of the abdomen
c. Prescribe an antiemetic and recommend a clear liquid diet for
24 hours
d. Schedule the patient for a barium swallow and enema
ANS: B
If available, the primary care provider can order radiographic
studies of the abdomen and chest. Once small bowel obstruction
is confirmed or suspected, immediate hospitalization with
surgeon referral is necessary. Because small bowel obstruction
can have potentially serious or life-threatening consequences,
waiting 24 hours is not recommended.
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?
,a. Order a CBC, type and crossmatch, electrolytes, and renal
function tests.
b. Perform an ultrasound examination to evaluate the cause.
c. Schedule the patient for an aortic angiogram.
d. Transfer the patient to the emergency department for a
surgical consult
ANS: D
This patient has symptoms and physical findings consistent with
a ruptured aortic aneurysm and should have an immediate
surgical consult. Ordering other tests is not necessary by the
primary provider.
Which symptoms noted in a patient reporting abdominal pain
are suggestive of appendicitis? (Select all that apply.)
a. Abdominal rigidity along with pain
b. Pain accompanied by low-grade fever
c. Pain occurring prior to nausea and vomiting
d. Pain that begins in the left lower quadrant
e. Prolonged duration of right lower quadrant pain
ANS: A, B, C
Patients with appendicitis typically have pain that begins in the
epigastric or periumbilical area and migrates to the left lower
quadrant. Abdominal rigidity is common, as is low-grade fever.
Pain precedes other symptoms and when the symptoms occur in
,any other order, the diagnosis of appendicitis should be
questioned. Pain is usually of short duration.
A patient reports anal pruritis and occasional bleeding with
defecation. An examination of the perianal area reveals external
hemorrhoids around the anal orifice as the patient is bearing
down. The provider orders a colonoscopy to further evaluate this
patient. What is the treatment for this patient's symptoms?
a. A high-fiber diet and increased fluid intake
b. Daily laxatives to prevent straining with stools
c. Infiltration of a local anesthetic into the hemorrhoid
d. Referral for possible surgical intervention
ANS: A
Most hemorrhoids, unless incarcerated or painful, are treated
conservatively. A high-fiber diet and increased fluid intake are
recommended first. Daily laxatives are not recommended
because the variation in stool consistency makes hemorrhoid
management more difficult. Infiltration of a local anesthetic is
performed for thrombosed external hemorrhoid prior to
removing the clot. Hemorrhoidectomy is performed for severe
or very painful hemorrhoids.
What recommendations are appropriate for patients with chronic
pruritus ani? (Select all that apply.)
a. Application of a topical antihistamine
b. Applying a of 1% hydrocortisone cream for several months
, c. Avoid tight-fitting or non-breathable clothing
d. Avoiding perfumed soaps and toilet papers
e. Using a hair dryer on the cool setting to control itching
ANS: C, D, E
Measures to control itching include avoiding tight-fitting
clothing as well as perfumed products and keeping the area
clean and dry and using a cool hair dryer to dry the skin. Topical
antihistamines are not used. Using a topical steroid longer than 2
weeks causes thinning of the skin.
A patient has sudden onset of right upper quadrant (URQ) and
epigastric abdominal pain with fever, nausea, and vomiting. The
emergency department provider notes yellowing of the sclerae.
What is the probable cause of these findings?
a. Acute acalculous cholecystitis
b. Chronic cholelithiasis
c. Common bile duct obstruction
d. Infectious cholecystitis
ANS: C
This patient has symptoms of cholecystitis with bile duct
obstruction, which causes jaundice. The common triad of RUQ
pain, fever, and jaundice occurs when a stone is lodged in the
common bile duct. Acute acalculous cholecystitis is
inflammation without stones. Chronic cholelithiasis does not
