,"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. Rovsing's sign is pain in the right lower quadrant upon palpation of the left lower
quadrant.
D. The obturator sign is pain upon flexion and internal rotation of the hip.
E. The psoas sign is pain upon extension of the hip." - CORRECT ANSWERS -"A. Vital
signs are usually abnormal, even early in the course of acute appendicitis.
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. Tenderness in the right upper quadrant that is worse with inspiration.
B. Pelvic pain upon flexion of the thigh while the patient is supine.
C. Pelvic pain upon internal and external rotation of the thigh with the knee flexed.
D. Pain that increases with the release of pressure of palpation.
E. Pain in the right lower quadrant when left lower quadrant is palpated." - CORRECT
ANSWERS -"E. Pain in the right lower quadrant when left lower quadrant is palpated.
,The answer is E. 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. Radiation of pain to the scapula is suggestive of acute hepatitis.
B. Cervical motion tenderness is a useful physical finding for differentiating women with
or without acute appendicitis.
C. In patients with sickle cell anemia who present with abdominal pain and diarrhea,
shigellosis should be a top consideration.
D. The onset of pain prior to the occurrence of nausea and vomiting is more often
suggestive of a surgical etiology.
E. Diverticulitis tends to cause pain in the right upper quadrant." - CORRECT
ANSWERS -"D. The onset of pain prior to the occurrence of nausea and vomiting is
more often suggestive of a surgical etiology.
The answer is D. 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. non-radiating, burning epigastric pain
B. pain that awakens a patient in the middle of the night
C. unrelenting pain over a period of weeks
D. relief of abdominal pain with antacids
E. pain that is worse preceding a meal" - CORRECT ANSWERS -"C. unrelenting pain
over a period of weeks
The answer is C. 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?
A. ovarian cyst
B. volvulus
C. appendicitis
D. diverticulitis
E. gastroenteritis" - CORRECT ANSWERS -The answer is D. 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 to keep
anything down. The emesis is non-bloody and non-bilious, however it is projectile in
nature. What is the most likely condition in this patient?
A. viral gastroenteritis
B. constipation
C. appendicitis
D. intussusception
E. pyloric stenosis" - CORRECT ANSWERS -"E. pyloric stenosis
The answer is E. Hypertrophic pyloric stenosis typically presents in the second to sixth
week of life and is four times more common in males than females. Infants with
hypertrophic pyloric stenosis typically are vigorous eaters but shortly afterward
regurgitate the entire feeding contents in a projectile fashion. The emesis is non-bilious.
The classic finding on exam is an "olive" palpable in the abdomen, and diagnosis is
typically via ultrasound. Intussusception typically presents between the ages of 5 and 12
months. Gastroenteritis is characterized by diarrhea as well as vomiting. Neither
constipation nor appendicitis typically present with protracted vomiting, though the latter
condition tends to present atypically in young children (and elderly adults)."
"A 46 year old woman presents to the emergency department complaining of abrupt
onset of intermittent severe pain in the left flank and abdomen that woke her from sleep.
She is pacing around the stretcher and appears extremely uncomfortable. She has
never experienced this type of pain previously and denies fevers or other symptoms.
Renal calculus is suspected. Which of the following is true regarding the diagnosis of
renal calculi in this patient?
A. Urinalysis demonstrating hematuria confirms the diagnosis.
B. KUB detects less than 10% of calculi.
C. Helical CT scan greater than 95% sensitive and specific for renal calculi.
D. Ultrasound is the study of choice for detecting small ureteral calculi.
E. Intravenous pyelogram (IVP) may be used in patients with renal insufficiency." -
CORRECT ANSWERS -"C. Helical CT scan greater than 95% sensitive and specific for
renal calculi.
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. Rovsing's sign is pain in the right lower quadrant upon palpation of the left lower
quadrant.
D. The obturator sign is pain upon flexion and internal rotation of the hip.
E. The psoas sign is pain upon extension of the hip." - CORRECT ANSWERS -"A. Vital
signs are usually abnormal, even early in the course of acute appendicitis.
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. Tenderness in the right upper quadrant that is worse with inspiration.
B. Pelvic pain upon flexion of the thigh while the patient is supine.
C. Pelvic pain upon internal and external rotation of the thigh with the knee flexed.
D. Pain that increases with the release of pressure of palpation.
E. Pain in the right lower quadrant when left lower quadrant is palpated." - CORRECT
ANSWERS -"E. Pain in the right lower quadrant when left lower quadrant is palpated.
,The answer is E. 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. Radiation of pain to the scapula is suggestive of acute hepatitis.
B. Cervical motion tenderness is a useful physical finding for differentiating women with
or without acute appendicitis.
C. In patients with sickle cell anemia who present with abdominal pain and diarrhea,
shigellosis should be a top consideration.
D. The onset of pain prior to the occurrence of nausea and vomiting is more often
suggestive of a surgical etiology.
E. Diverticulitis tends to cause pain in the right upper quadrant." - CORRECT
ANSWERS -"D. The onset of pain prior to the occurrence of nausea and vomiting is
more often suggestive of a surgical etiology.
The answer is D. 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. non-radiating, burning epigastric pain
B. pain that awakens a patient in the middle of the night
C. unrelenting pain over a period of weeks
D. relief of abdominal pain with antacids
E. pain that is worse preceding a meal" - CORRECT ANSWERS -"C. unrelenting pain
over a period of weeks
The answer is C. 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?
A. ovarian cyst
B. volvulus
C. appendicitis
D. diverticulitis
E. gastroenteritis" - CORRECT ANSWERS -The answer is D. 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 to keep
anything down. The emesis is non-bloody and non-bilious, however it is projectile in
nature. What is the most likely condition in this patient?
A. viral gastroenteritis
B. constipation
C. appendicitis
D. intussusception
E. pyloric stenosis" - CORRECT ANSWERS -"E. pyloric stenosis
The answer is E. Hypertrophic pyloric stenosis typically presents in the second to sixth
week of life and is four times more common in males than females. Infants with
hypertrophic pyloric stenosis typically are vigorous eaters but shortly afterward
regurgitate the entire feeding contents in a projectile fashion. The emesis is non-bilious.
The classic finding on exam is an "olive" palpable in the abdomen, and diagnosis is
typically via ultrasound. Intussusception typically presents between the ages of 5 and 12
months. Gastroenteritis is characterized by diarrhea as well as vomiting. Neither
constipation nor appendicitis typically present with protracted vomiting, though the latter
condition tends to present atypically in young children (and elderly adults)."
"A 46 year old woman presents to the emergency department complaining of abrupt
onset of intermittent severe pain in the left flank and abdomen that woke her from sleep.
She is pacing around the stretcher and appears extremely uncomfortable. She has
never experienced this type of pain previously and denies fevers or other symptoms.
Renal calculus is suspected. Which of the following is true regarding the diagnosis of
renal calculi in this patient?
A. Urinalysis demonstrating hematuria confirms the diagnosis.
B. KUB detects less than 10% of calculi.
C. Helical CT scan greater than 95% sensitive and specific for renal calculi.
D. Ultrasound is the study of choice for detecting small ureteral calculi.
E. Intravenous pyelogram (IVP) may be used in patients with renal insufficiency." -
CORRECT ANSWERS -"C. Helical CT scan greater than 95% sensitive and specific for
renal calculi.
