EMT Chapter 19 Gastrointestinal and Urologic Emergencies

Solid abdominal organs include the:

A. urinary bladder, colon, and ureters.

B. gallbladder and large intestine.

C. stomach and small intestine.

D. spleen, kidneys, and pancreas.

D. spleen, kidneys, and pancreas

Most patients with abdominal pain prefer to:

A. sit fully upright because it helps relax the abdominal muscles.

B. lie in a supine position with their knees in a flexed position.

C. lie on their side with their knees drawn into the abdomen.

D. sit in a semi-Fowler position with their knees slightly bent.

C. lie on their side with their knees drawn into the abdomen

A 29-year-old pregnant woman has had severe vomiting for the last 2 days. Today, she is vomiting large amounts of blood. Her skin is cool and pale, and she is tachycardic. The EMT should suspect:

A. esophageal varices.

B. esophagitis.

C. acute pancreatitis.

D. Mallory-Weiss tear.

D. Mallory-Weiss tear

The kidneys help to regulate blood pressure by:

A. accommodating a large amount of blood volume.

B. eliminating toxic waste products from the body.

C. retaining key electrolytes, such as potassium.

D. removing sodium and water from the body.

D. removing sodium and water from the body

You respond to the residence of a 70-year-old male who complains of weakness and severe shortness of breath. His wife tells you that he is a dialysis patient, but has missed his last two treatments. After applying oxygen, you auscultate his lungs and hear diffuse rhonchi. The patient is conscious, but appears confused. His blood pressure is 98/54 mm Hg, his pulse rate is 120 beats/min and irregular, and his respirations are 24 breaths/min and labored. You should:

A. treat for shock and request a paramedic unit to respond to the scene and assist you.

B. perform a detailed secondary assessment and then transport him to a dialysis center.

C. leave him in a sitting position, keep him warm, and prepare for immediate transport.

D. place him in a supine position, elevate his lower extremities, and transport at once.

C. leave him in a sitting position, keep him warm, and prepare for immediate transport

Which of the following statements regarding the acute abdomen is correct?

A. An acute abdomen almost always occurs as the result of blunt trauma to solid abdominal organs.

B. The parietal peritoneum is typically the first abdominal layer that becomes inflamed or irritated.

C. The initial pain associated with an acute abdomen tends to be vague and poorly localized.

D. The most common cause of an acute abdomen is inflammation of the gallbladder and liver.

C. The initial pain associated with an acute abdomen tends to be vague and poorly localized

Pain that may be perceived at a distant point on the surface of the body, such as the back or shoulder, is called:

A. visceral pain.

B. remote pain.

C. radiating pain.

D. referred pain.

D. referred pain

In the presence of ileus, the only way the stomach can empty itself is by:

A. diarrhea.

B. muscular contraction.

C. spontaneous rupture.

D. vomiting.

D. vomiting

The principal symptom in both infectious and noninfectious gastroenteritis is:

A. dysuria.

B. high fever.

C. vomiting.

D. diarrhea.

D. diarrhea

Functions of the liver include:

A. secretion of bile and filtration of toxic substances.

B. absorption of nutrients and toxins.

C. release of amylase, which breaks down starches into sugar.

D. production of hormones that regulate blood sugar levels.

A. secretion of bile and filtration of toxic substances

A 59-year-old male presents with sudden-onset severe lower back pain. He is conscious and alert, but very restless and diaphoretic. Your assessment reveals a pulsating mass to the left of his umbilicus. You should:

A. request a paramedic unit to give the patient pain medication.

B. administer oxygen and prepare for immediate transport.

C. place the patient in a sitting position and transport at once.

D. vigorously palpate the abdomen to establish pain severity.

B. administer oxygen and prepare for immediate transport

Older patients with abdominal problems may not exhibit the same pain response as younger patients because of:

A. progressive deterioration of abdominal organ function.

B. chronic dementia, which inhibits communication.

C. age-related deterioration of their sensory systems.

D. interactions of the numerous medications they take.

C. age-related deterioration of their sensory systems

You are transporting a 49-year-old male with "tearing" abdominal pain. You are approximately 30 miles away from the closest hospital. During your reassessment, you determine that the patient's condition has deteriorated significantly. You should:

A. immediately perform a rapid physical examination.

B. consider requesting a rendezvous with an ALS unit.

C. continue transporting and alert the receiving hospital.

D. assist his ventilations with a bag-valve mask.

B. consider requesting a rendezvous with an ALS unit

Which of the following statements regarding gastrointestinal bleeding is correct?

A. Chronic bleeding within the gastrointestinal tract is usually more severe than bleeding that occurs acutely.

B. Lower gastrointestinal bleeding results from conditions such as Mallory-Weiss syndrome.

C. Bleeding within the gastrointestinal tract is a symptom of another disease, not a disease itself.

D. In the majority of cases, bleeding within the gastrointestinal tract occurs acutely and is severe.

C. bleeding within the gastrointestinal tract is a symptom of another disease, not a disease itself

Which of the following is characteristic of peptic ulcer disease (PUD)?

A. Sharp pain that is typically located in both lower abdominal quadrants

B. Burning or gnawing stomach pain that subsides immediately after eating

C. Symptom relief after taking nonsteroidal anti-inflammatory drugs

D. The passage of bright red blood in the stool or coughing up blood

B. burning or gnawing stomach pain that subsides immediately after eating

Which of the following organs assists in the filtration of blood, serves as a blood reservoir, and produces antibodies?

A. Spleen

B. Kidneys

C. Pancreas

D. Liver

A. spleen

A 35-year-old obese woman is complaining of localized pain in the right upper quadrant with referred pain to the right shoulder. The MOST likely cause of her pain is:

A. pancreatitis.

B. appendicitis.

C. acute cholecystitis.

D. acute cystitis.

C. acute cholecystitis

Pain that is localized to the lower back and/or lower abdominal quadrants is MOST suggestive of:

A. an aortic aneurysm.

B. a kidney infection.

C. acute pancreatitis.

D. acute appendicitis.

A. an aortic aneurysm

Which of the following statements regarding dialysis is correct?

A. Hemodialysis is effective but carries a high risk of peritonitis.

B. Acute hypertension is a common adverse effect of dialysis.

C. The purpose of dialysis is to help the kidneys retain salt and water.

D. Patients who miss a dialysis treatment often present with weakness.

D. Patients who miss a dialysis treatment often present with weakness

An important aspect in the treatment of a patient with severe abdominal pain is to:

A. give 100% oxygen only if signs of shock are present.

B. provide emotional support en route to the hospital.

C. encourage the patient to remain in a supine position.

D. administer analgesic medications to alleviate pain.

B. provide emotional support en route to the hospital

A strangulated hernia is one that:

A. is reducible if surgical intervention occurs within 2 hours.

B. can be pushed back into the body cavity to which it belongs.

C. loses its blood supply due to compression by local tissues.

D. spontaneously reduces without any surgical intervention.

C. loses its blood supply due to compression by local tissues

The parietal peritoneum lines the:

A. surface of the abdominal organs.

B. retroperitoneal space.

C. lungs and chest cavity.

D. walls of the abdominal cavity.

D. walls of the abdominal cavity

A 47-year-old male presents with severe abdominal pain of 3 hours' duration. His abdomen is distended and guarded. Your MOST important consideration for this patient should be to:

A. determine the exact location and cause of his pain.

B. be alert for signs and symptoms of shock.

C. assess his blood pressure to determine perfusion adequacy.

D. transport him in a supine position.

B. be alert for signs and symptoms of shock

A 30-year-old woman with a history of alcoholism presents with severe upper abdominal pain and is vomiting large amounts of bright red blood. Her skin is cool, pale, and clammy; her heart rate is 120 beats/min and weak; and her blood pressure is 70/50 mm Hg. Your MOST immediate action should be to:

A. protect her airway from aspiration.

B. rapidly transport her to the hospital.

C. keep her supine and keep her warm.

D. give her high-flow supplemental oxygen.

A. protect her airway from aspiration

Peritonitis may result in shock because:

A. abdominal distention impairs cardiac contractions.

B. severe pain causes systemic dilation of the vasculature.

C. fluid shifts from the bloodstream into body tissues.

D. intra-abdominal hemorrhage is typically present.

C. fluid shifts from the bloodstream into body tissues

The MOST common and significant complication associated with an acute abdomen is:

A. internal bleeding.

B. high fever.

C. peritonitis.

D. severe pain.

C. peritonitis

Patients with acute abdominal pain should not be given anything to eat or drink because:

A. food will rapidly travel through the digestive system.

B. substances in the stomach increase the risk of aspiration.

C. it will create referred pain and obscure the diagnosis.

D. digestion prevents accurate auscultation of bowel sounds.

B. substances in the stomach increase the risk of aspiration

Which of the following organs lies in the retroperitoneal space?

A. Gallbladder

B. Spleen

C. Pancreas

D. Liver

C. pancreas

Chronic renal failure is a condition that:

A. can be reversed with prompt treatment.

B. occurs from conditions such as dehydration.

C. is often caused by hypertension or diabetes.

D. causes dehydration from excessive urination.

C. is often caused by hypertension or diabetes

Esophageal varices MOST commonly occur in patients who:

A. have weak immune systems.

B. consume a lot of alcohol.

C. have a history of esophagitis.

D. have uncontrolled diabetes.

B. consume a lot of alcohol

Pain that radiates to the right lower quadrant from the umbilical area, nausea and vomiting, and lack of appetite are MOST indicative of:

A. appendicitis.

B. pancreatitis.

C. gastroenteritis.

D. cholecystitis.

A. appendicitis

When assessing a patient with abdominal pain, you should:

A. visually assess the painful area of the abdomen, but avoid palpation because this could worsen his or her condition.

B. observe for abdominal guarding, which is characterized by sudden relaxation of the abdominal muscles when palpated.

C. palpate the abdomen in a clockwise direction, beginning with the quadrant after the one the patient indicates is painful.

D. ask the patient to point to the area of pain or tenderness and assess for rebound tenderness over that specific area.

C. palpate the abdomen in a clockwise direction, beginning with the quadrant after the one the patient indicates is painful

Which of the following conditions is more common in women than in men?

A. Pancreatitis

B. Cholecystitis

C. Cystitis

D. Hepatitis

C. Cystits

A 60-year-old female presents with a tearing sensation in her lower back. Her skin is sweaty, and she is tachycardic. The EMT should suspect:

A. strangulated hernia.

B. aortic aneurysm.

C. kidney stones.

D. acute pancreatitis.

B. aortic aneurysm

The MOST important treatment for a patient with severe abdominal pain and signs of shock is:

A. positioning the patient on his or her side.

B. transporting the patient without delay.

C. administering high-flow oxygen.

D. giving oral fluids to maintain perfusion.

B. transporting the patient without delay

A young female presents with costovertebral angle tenderness. She is conscious and alert with stable vital signs. Which of the following organs is MOST likely causing her pain?

A. Kidney

B. Gallbladder

C. Liver

D. Pancreas

A. Kidney

Which of the following organs would MOST likely bleed profusely if injured?

A. Appendix

B. Gallbladder

C. Stomach

D. Liver

D. Liver

Injury to a hollow abdominal organ would MOST likely result in:

A. impairment in the blood's clotting abilities.

B. profound shock due to severe internal bleeding.

C. leakage of contents into the abdominal cavity.

D. pain secondary to blood in the peritoneum.

C. leakage of contents into the abdominal cavity

You are dispatched to an apartment complex for a young male with abdominal pain. Your priority upon arriving at the scene should be to:

A. assess the scene for potential hazards.

B. notify the dispatcher of your arrival.

C. place a paramedic ambulance on standby.

D. quickly gain access to the patient.

A. assess the scene for potential hazards

Your patient's past medical history includes hypertension, congestive heart failure, diabetes, and seizures. Today, he presents with signs of acute renal failure. Which of his medical problems MOST likely caused this?

A. Diabetes

B. Heart failure

C. Seizures

D. Hypertension

B. heart failure