Nokea
The relationship between abdominal pain and vomiting typically can be characterized by saying
- A. When the vomiting precedes pain, the likelihood of surgical abdomen increases appreciably
- B. Conditions that may produce only mild nausea in the younger patient often will cause vomiting in older patients
- C. The majority of surgical abdomens do not produce vomiting as a primary symptom
- D. The presence of bile in vomitus suggests pyloric stenosis
Correct Answer: D
Rationale: Step 1: The presence of bile in vomitus suggests that the vomit originated from the small intestine or stomach, indicating an obstruction in the pyloric region.
Step 2: Pyloric stenosis is a condition characterized by narrowing of the opening from the stomach to the small intestine, leading to projectile vomiting with bile.
Step 3: Therefore, the presence of bile in vomitus suggests pyloric stenosis, making option D the correct answer.
Summary: Option A is incorrect because vomiting preceding pain does not necessarily indicate a surgical abdomen. Option B is incorrect as the severity of symptoms is not solely based on age. Option C is incorrect as some surgical abdomens can present with vomiting as a primary symptom.
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Mr. Jefferson is a 59-year-old male who presents to the emergency department complaining of severe abdominal pain. His medical history is significant for dyslipidemia, and he takes 40 mgof simvastatin daily. He admits to drinking 6 to 10 bottles of beer nightly and to smoking 1 packs of cigarettes a day. He denies any history of chest pain or cardiovascular disease. He was in his usual state of good health until a couple of hours ago, when he developed this acute onset of severe pain in the upper abdomen. He says that he tried to wait it out at home but it was so bad he finally came in. His vital signs are as follows temperature 99.1F, pulse 129 bpm, respirations 22 breaths per minute, and blood pressure 13784 mm Hg. The abdomen is diffusely tender to palpation with some guarding but no rebound tenderness. The AGACNP anticipates that which of the following laboratory tests will be abnormal?
- A. A complete blood count and RBC differential
- B. Liver function enzymes
- C. Serum amylase, lipase, and glucose
- D. A basic metabolic panel
Correct Answer: A
Rationale: The correct answer is A: A complete blood count and RBC differential. In this case, Mr. Jefferson presents with severe abdominal pain, which could indicate various conditions like pancreatitis, a possible complication of his heavy drinking. A complete blood count (CBC) with RBC differential can help assess for signs of inflammation or infection, which may be elevated in conditions like pancreatitis. The RBC differential can also provide insights into potential causes of abdominal pain, such as anemia or other blood disorders.
Summary:
- B: Liver function enzymes may be affected in conditions like alcoholic liver disease, but in this case, the focus should be on investigating acute abdominal pain.
- C: Serum amylase, lipase, and glucose are typically checked in cases of suspected pancreatitis, but a CBC with RBC differential would provide a more comprehensive initial assessment.
- D: A basic metabolic panel may not directly address the underlying cause of the acute abdominal pain and is not the most appropriate test to anticipate
T. G. is a 48-year-old female who presents with biliary colic. She has had previous episodes but has resisted operation because she is afraid of anesthesia. Today her physical exam reveals a clearly distressed middle-aged female with right upper quadrant pain, nausea, and vomiting. Which of the following findings suggests a complication that requires a surgical evaluation?
- A. A temperature of 101.5°F
- B. A leukocyte count of 18,000/µL
- C. A palpable gallbladder
- D. A positive Murphy’s sign
Correct Answer: A
Rationale: The correct answer is A: A temperature of 101.5°F. A fever indicates an inflammatory response, which could be due to a complication like cholecystitis or cholangitis. Elevated leukocyte count (choice B) supports infection but is not as specific as a fever. Palpable gallbladder (choice C) may suggest inflammation but not necessarily a complication. A positive Murphy's sign (choice D) is indicative of gallbladder inflammation but does not directly indicate a complication requiring surgical evaluation.
How can healthcare providers support women after stillbirth?
- A. Offer emotional counseling
- B. Explain causes clearly
- C. Support in planning future pregnancies
- D. All of the above
Correct Answer: D
Rationale: 1. Emotional counseling helps women cope with grief.
2. Explaining causes provides closure and understanding.
3. Supporting future pregnancies ensures better outcomes.
4. All options address different aspects of support needed after stillbirth.
5. Therefore, providing emotional counseling, explaining causes, and supporting future pregnancies collectively offer comprehensive care.
Vaginal delivery is possible in
- A. Brow presentation
- B. Face presentation
- C. Shoulder presentation
- D. Unstable lie
Correct Answer: B
Rationale: The correct answer is B: Face presentation. Vaginal delivery is possible in face presentation as the baby's head is extended, allowing for descent through the birth canal. Brow presentation (A) and shoulder presentation (C) may require cesarean delivery due to the atypical presentation of the baby. Unstable lie (D) refers to the baby being in a transverse position, which also necessitates a cesarean section. Face presentation is the only option where vaginal delivery may be possible due to the extended position of the baby's head.
A non-pharmacological measure of pain relief in labour includes
- A. Entonox
- B. Cyclothane
- C. Homeopathy
- D. Diamorphine
Correct Answer: C
Rationale: The correct answer is C: Homeopathy. Homeopathy involves using highly diluted substances to stimulate the body's natural healing processes. In labor, homeopathy can help manage pain and support relaxation. Entonox (A) and Diamorphine (D) are pharmacological measures, while Cyclothane (B) is not a recognized pain relief option in labor. Homeopathy aligns with non-pharmacological approaches, making it the most suitable choice for pain relief in labor.