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51 Cards in this Set

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what do you call an alligator in a vest?

an investigator

You are called to the scene of a patient with abdominal pain. Upon arrival, you find a 38-year-old Asian man on the floor next to his desk writhing in pain. He is complaining of severe right-sided flank pain. His blood pressure is 140/90, pulse 100, and his skin is ashen and diaphoretic. You suspect:

renal colic. Page Ref: 608Objective: 22.5

You respond to a 75-year-old female who is complaining of epigastric pain that feels like heartburn and radiates to the right shoulder. Her vital signs are stable and she has a previous history of myocardial infarction. She has prescription nitroglycerine tablets. An ALS unit is en route. After performing a physical examination and applying oxygen by nasal cannula, you should:

contact medical control regarding the administration of the patient's nitroglycerin.Page Ref: 606-608Objective: 22.7

Which of the following questions is inappropriate when taking the history of a female patient with abdominal pain?

What is your sexual orientation?CORRECT. Knowing a patient's sexual orientation is not appropriate as the patient's answer would not change your approach in assessing and treating the patient.

You are called to the scene of a 16-year-old female patient complaining of severe lower quadrant abdominal pain. The patient states she is sexually active. Upon palpation, you observe rebound tenderness in the right lower quadrant. You suspect:

appendicitis.CORRECT. Although both appendicitis and ectopic pregnancy have lower right quadrant pain, rebound tenderness is the hallmark of appendicitis.

Organs of the right upper quadrant include:

most of the liver, gallbladder, and part of the large intestine. Page Ref: 602-603Objective: 22.2

Which of the following organs is located in the retroperitoneal space?

KidneysCORRECT. The organs in the retroperitoneal area include the kidneys, the pancreas, and the aorta.

Your patient is a 35-year-old female with abdominal pain. Which of the following findings CANNOT be attributed to the patient experiencing pain?

Slight increase in blood pressurePage Ref: 614-615Objective: 22.3

Which patient is experiencing visceral pain?

45-year-old female complaining of abdominal pain "all over"CORRECT. Visceral pain is often diffuse in nature, making it difficult for the patient to identify the exact location. A patient who is experiencing abdominal pain all over would have visceral pain.

Your patient is a 17-year-old with a history of asthma. She is complaining of pain in her lower abdomen. Assessment reveals that her breath sounds are clear and equal, she has a respiratory rate of 28 breaths per minute, a heart rate of 96 beats per minute, and a blood pressure of 112/74 mmHg. Which of the following is the MOST appropriate next step?

Provide high-concentration oxygen.Page Ref: 615Objective: 22.7

You respond to a 65-year-old patient complaining of abdominal pain. Your physical exam reveals a nonpulsating mass in the lower left quadrant. You suspect:

hernia.CORRECT. A nonpulsating mass in the lower left quadrant is most likely a hernia.

Which of the following is a concern when caring for the patient with abdominal pain?

ShockPatient comfortAirway managementAll of theseCORRECT. The focus of your assessment process will be to accurately perform a secondary assessment to describe the condition and identify potentially serious conditions such as shock. Since patients with abdominal pain may have an increased pulse simply as a result of the pain, serial vitals taken over time will help identify potentially dangerous trends. Calming, placing the patient in a position of comfort, and administering oxygen may actually reduce the pulse, which is a good sign.

Your patient is a 40-year-old female who has n experiencing abdominal pain and vomiting for 2 days. She is now responsive to verbal stimulus; has cool, dry skin; a heart rate of 116; respirations of 24; and a blood pressure of 100/70. Which of the following is the BEST position for transporting this patient?

Left lateral recumbent with the legs bentCORRECT. Since she has altered mental status (AMS) the best choice is left lateral recumbent, especially if she vomits, rather than supine, Fowlers, or semi-Fowlers positions which may lead to aspiration if vomiting occurs.

The patient complaining of parietal abdominal pain would concern you the MOST is the one who:

is lying on the floor very still and quiet with his knees drawn up to his chest.CORRECT. Patients suffering from acute parietal abdominal pain try to stay completely still and quiet to decrease the pain. Drawing the knees to the chest releases some of the tension on the abdominal muscles and can slightly reduce the pain.

You are called to a nursing home for an 85-year-old patient complaining of abdominal pain. The patient has a history of dementia and cannot describe the pain to you. The nurse states the patient has n vomiting dark coffee ground emesis for about an hour. His blood pressure is 90/40, pulse 100, and respiratory rate of 24. In what position should you transport the patient?

Semi-Fowler's


Page Ref: 615Objective: 22.7

Which abdominal quadrant contains the appendix?

Right lowerCORRECT. The appendix is in the right lower quadrant.

Which of the following is true concerning parietal pain?

It is generally localized to a particular area.CORRECT. Parietal pain is a localized, intense pain that arises from the parietal peritoneum, the lining of the abdominal cavity.

The detection of a bulging mass through the belly button that is not pulsating should make the EMT suspicious that the patient may be suffering from which of the following?

HerniaCORRECT. The patient experiencing an umbilical hernia would have a bulging mass through the umbilical region. The hernia may present with a lump or mass but will usually not be pulsating.

Which of the following is NOT a cause of abdominal pain?

StrokeCORRECT. You may be called to evaluate patients who have complaints that appear nonspecific but involve the digestive system. Nausea, vomiting, and diarrhea are examples. Some of these complaints will result from digestive system disorders, whereas other causes could be cardiac issues, diabetic issues, food poisoning, or the flu. Stroke will cause headaches and problems with speech, coordination, and senses like eyesight, but will not cause abdominal pain.

You are called to a residential neighborhood at 12:30 A.M. Your patient has just finished eating a super-sized meal of deep fried fish. He is now complaining of a "crampy" pain in the right upper quadrant and has had two episodes of nausea and vomiting with a green emesis. What condition do you suspect that your patient is experiencing?

CholecystitisCORRECT. Cholecystitis or inflammation of the gallbladder is commonly precipitated by ingesting food high in saturated fat and will occur many times after eating. The green vomitus is likely due to the obstruction of the bile duct.

In what position should the patient complaining of severe abdominal pain be placed if there are no signs or symptoms of shock?

One of comfortCORRECT. When treating a patient with acute abdominal pain without signs of hypoperfusion (shock), you should place the patient in the position of most comfort. Typically, patients with acute abdominal pain position themselves bent over at the waist with their knees bent and drawn up toward their chest. Often this position reduces the tension on the abdominal muscles, thus reducing pain.

Pain that the patient feels in a body part or area of the body that has nothing to do with a diseased organ is termed:

referred pain.CORRECT. Referred pain is felt in a body part other than its point of origin. Pain associated with abdominal and other conditions can be referred or felt in other areas of the body. This phenomenon is associated with the proximity of separate nerve tracks as they enter the spinal cord.

You respond to the scene of a 50-year-old male complaining of severe abdominal pain. He has a history of alcohol and drug abuse. His vital signs are stable and he presents with epigastric pain that radiates to the back. He has guarding and point tenderness in the upper quadrants. You suspect:

pancreatitis.CORRECT. The patient's alcoholic history, along with epigastric pain that radiates to the back, most likely indicates pancreatitis. It is important to remember that only a physician in a hospital setting can make the final diagnosis.

Which of the following is a cause of gynecological emergencies?

Soft-tissue trauma to the external genitaliaSexual assaultDisorders of the female reproductive organsAll of theseCORRECT. Soft-tissue trauma, sexual assault, and disorders of the female reproductive organs are all causes of gynecological emergencies.

You respond to an abdominal pain call. Your partner suspects that the patient is having an abdominal aortic aneurysm (AAA). What type of pain is the patient most likely experiencing?

TearingCORRECT. In cases of abdominal aortic aneurysm, you may palpate a pulsating mass (abnormal bulge or lump). This mass may be found in conjunction with tearing or sharp pain in the back. Tearing pain is the hallmark of an abdominal aortic aneurysm (AAA). Patients experiencing parietal, visceral, and referred pain do not have a feeling of tearing. The aorta is the only structure capable of feeling the tearing sensation associated with dissection of the layers of the artery.

When treating a patient with acute abdominal pain, you should do which of the following?

Have the patient lie still and assume a position of comfortCORRECT. Allow the patient to assume a position of comfort and remain still.

Your patient is a 34-year-old male complaining of pain "in his right side." He is pale and diaphoretic with a heart rate of 90 beats per minute, a respiratory rate of 28 breaths per minute, and a blood pressure of 132/80 mmHg. The patient is very agitated and anxious. Which approach is most appropriate?

Reassure him that you will make him as comfortable as possible and get him to the hospital for additional care.CORRECT. The focus of your assessment process will be to accurately perform a secondary assessment to describe the condition and identify potentially serious conditions such as shock. Since patients with abdominal pain may have an increased pulse simply as a result of the pain, serial vitals taken over time will help identify potentially dangerous trends. Calming, placing the patient in a position of comfort, and administering oxygen may actually reduce the pulse, which is a good sign.

You are called to a nursing home for an 85-year-old patient complaining of abdominal pain. The patient has a history of dementia and cannot describe the pain to you. The nurse states the patient has n vomiting dark coffee ground emesis for about an hour. His blood pressure is 90/40, pulse 100, and respiratory rate of 24. Why should the EMT use an oxygen mask with caution?

The patient cannot clear any additional emesis.Page Ref: 615-616Objective: 22.7

You arrive on the scene to find an approximately 60-year-old male patient writhing on the floor. He is complaining of a tearing pain radiating to his lower back. He has absent femoral pulses and has a pulsatile mass just superior to his umbilicus. You suspect which of the following conditions?

Abdominal aortic aneurysmCORRECT. The pulsatile mass, tearing pain radiating to the lower back, and the absent femoral pulses are signs indicative of an abdominal aortic aneurysm that is currently rupturing.

You are responding to a 52-year-old male patient complaining of heartburn with epigastric pain. The patient's vital signs are stable and he does not have any pain upon palpation. He has a history of reflux disease and is on several medications for heartburn and acid reflux. What is your greatest concern with this patient?

He is suffering from a myocardial infarction.Page Ref: 608Objective: 22.6

Pain that originates in an organ, such as the intestines, is called ________ pain.

visceral Page Ref: 605Objective: 22.1

Your patient was diagnosed with cholecystitis (gallbladder inflammation) three days ago. The patient now presents with nausea, vomiting, and pain in the right shoulder. The pain in the shoulder can be classified as:

referred pain.CORRECT. Irritation under the diaphragm can cause referred pain that can present as shoulder pain.

Which of the following structures is (are) NOT located in the abdominal cavity?

KidneysCORRECT. The area outside the peritoneum is called extraperitoneal space, which includes the retroperitoneal space, the area between the abdomen and the back. The organs in the retroperitoneal area, which is technically not part of the abdomen, include the kidneys, the pancreas, and the aorta.

You respond to a 75-year-old female who is complaining of epigastric pain that feels like heartburn. The pain radiates to the right shoulder. Her vital signs are stable and she has a previous history of a myocardial infarction. She has prescription nitroglycerin tablets. She is most likely suffering from:

cholecystitis.CORRECT. The referred right shoulder pain makes cholecystitis the most likely answer.

Which of the following is a characteristic of referred pain?

It is felt in a location other than the organ causing it.CORRECT. Referred pain is pain felt in a place other than where the pain originates. For example, when a gallbladder is diseased, pain is often felt not in the area of the gallbladder but, instead, in the area of the right shoulder blade. This is because nerve pathways from the gallbladder return to the spinal cord by way of shared pathways with nerves that sense pain in the shoulder area. Referred pain into the shoulder is also a common complaint associated with ectopic pregnancies.

Most organs of the abdomen are enclosed within the:

peritoneum.CORRECT. Most of the organs of the abdomen are enclosed within the peritoneum. These organs include the stomach, liver, spleen, appendix, small and large colon, and in women the uterus, fallopian tubes, and ovaries. There are two layers of the peritoneum: the visceral peritoneum, which covers the organs, and the parietal peritoneum, which is attached to the abdominal wall.

When the gallbladder is diseased, the pain is not only felt in the right upper quadrant (RUQ) but also in the right shoulder. This is known as:

referred pain.CORRECT. Referred pain is pain felt in a place other than where the pain originates.

Which of the following is NOT true concerning abdominal pain in geriatric patients?

The causes of abdominal pain in the elderly are rarely serious.CORRECT. Geriatric patients may present some dilemmas when you are assessing abdominal pain. This will, of course, make obtaining a history and description of the pain or discomfort more difficult. It is also important to remember that older patients are likely to have a more serious cause of their abdominal pain than younger patients. Many geriatric patients also take medications (e.g., beta blockers such as atenolol or metoprolol) for high blood pressure or heart conditions, which will reduce the heart rate. These medications may prevent the patient's pulse from rising during shock.

Pain felt in the epigastric region of the abdomen is of concern because of the possibility of which of the following?

Myocardial infarctionCORRECT. Pain from a heart attack (myocardial infarction) may be felt as abdominal discomfort. This pain, often described as indigestion or digestive discomfort, is commonly felt in the epigastric region (the area below the xiphoid, in the upper center of the abdomen). All epigastric abdominal pain should be considered cardiac in nature until proven otherwise.

Which of the following questions may help the EMT assess a patient with abdominal pain?

Do you have any allergies to foods or medicines?Do you have any medical problems, such as diabetes or heart problems?What medications are you taking?All of theseCORRECT. After you have elicited information about the patient's signs and symptoms continue with questions pertaining to the patient's allergies, medications, pertinent past history, last oral intake, and events leading to the present emergency. Inquire if the patient has any allergies and, if so, what he is allergic to. Diabetics can experience abdominal pain as a symptom of blood sugar abnormalities for which they may be taking prescribed medications. The patient's medical history may provide information about past problems that may be related to the current problem. If the patient has a history of past abdominal problems, ask what these conditions are, if the pain resembles past experiences with the condition, and what happened last time. Certain abdominal conditions that have been present in the past can present chronically.

You respond, along with fire department Emergency Medical Responders, to a 48-year-old female having a syncope episode in the bathroom. You find the patient sitting on the commode vomiting into the trash can. The vomitus appears to look like coffee grounds and has a foul smell. The patient is pale and has n weak for the past few days. She has:

GI bleeding.CORRECT. Bleeding can occur from within the GI system anywhere from the esophagus to the rectum. Depending on the size of the source blood vessel, GI bleeding may be gradual or sudden and massive. Because this type of bleeding occurs inside the lumen of the esophagus, stomach, or intestines, blood eventually has to pass out through the rectum and/or through the mouth. Patients may report the passage of abnormal stools that are dark black or maroon in color and tarry in appearance, or they may simply pass frank blood without stool from the rectum. If the patient is bleeding from an upper GI source (the esophagus, stomach, or first portion of the small bowel), he also may exhibit vomiting of frank blood or coffee-ground vomit.

Which of the following is the main focus of the EMT's assessment and history taking of the patient with abdominal pain?

Determining the presence of shockCORRECT. There are many potential causes of abdominal pain that the EMT should not be concerned with field diagnosing a particular cause. The focus of your assessment process will be to accurately perform a secondary assessment to describe the condition and identify potentially serious conditions such as shock.

You are examining a 24-year-old female patient with lower quadrant abdominal pain. What is the MOST lethal possibility?

Ectopic pregnancyCORRECT. Ectopic pregnancy is a potentially fatal condition that presents with lower quadrant abdominal pain.

Which of the following is NOT a cause of parietal pain?

Muscle spasmCORRECT. Parietal pain may be sharp or constant and localized to a particular area. When obtaining the history, you may find the patient will describe this type of pain as worsening when he moves and getting better when he remains still or lies with the knees drawn up. Muscle spasm pain would present as a sharp stabbing pain over the skeletal muscle involved, which does not happen with parietal pain.

You are called to a nursing home for an 85-year-old patient complaining of abdominal pain. The patient has a history of dementia and cannot describe the pain to you. The nurse states the patient has n vomiting dark coffee ground emesis for about an hour. His blood pressure is 90/40, pulse 100, and respiratory rate of 24. Aside from the airway, what is your greatest concern?

The patient will go into hypovolemic shock. Page Ref: 608Objective: 22.7

You are called to a residence for a 48-year-old male patient. He is lying in bed and is incoherent. He is unable to follow commands. His blood pressure is 80/40, pulse 136, and respiratory rate of 36. His wife states that he had lower right abdominal pain for about two days and it progressively worsened. He said about an hour ago he had a sudden increase in pain and then became incoherent. The wife states the husband refused to see a doctor before, but she finally called 911. You suspect:

peritonitis.Page Ref: 606Objective: 22.5

Your patient is a 60-year-old male who is complaining of severe epigastric abdominal pain and difficulty breathing. He is pale, sweaty, and pleads with you, "Don't let me die, I think I'm going to die." Which of the following measures is NOT part of your initial treatment of this patient?

Applying the defibrillator pads to his chest Page Ref: 615Objective: 22.6

With the exception of the ________, most abdominal organs are not able to sense tearing sensations.

aortaCORRECT. Most abdominal structures or organs (like the liver, ovaries, or colon) do not have the ability to detect tearing sensations. The exception is the aorta and the stomach. In cases of an expanding abdominal aortic aneurysm (AAA), the inner layer of the aorta is damaged and blood leaks from the inner portions of the vessel to the outer layers. This causes a tearing of the vessel lining and pockets of blood resting in a weak area of the vessel. Much like a balloon, the area of collected blood creates an expanding pouch in the blood vessel wall. This is often sensed as a tearing pain in the back.

You are treating a 38-year-old female patient with abdominal distress. The patient's vital signs are stable and you are getting ready to transport. What is the BEST position to transport the patient?

On side with knees bentCORRECT. Having the patient bend her knees will relax the abdominal muscles and help to improve her level of comfort while still allowing for adequate use of the stretcher's seat belts. Many patients in abdominal pain will instinctively curl up in the fetal position for this reason.

You are called to a 25-year-old male complaining of right lower quadrant (RLQ) pain. His other symptoms are nausea and vomiting, fever, and decreasing pain in the umbilicus area. As an EMT, you feel this patient might have:

appendicitis.Page Ref: 606Objective: 22.5

Which of the following is of greatest concern for the EMT in the prehospital care of a woman with vaginal bleeding?

Monitoring for hypovolemic shockPage Ref: 607Objective: 22.8