Acute Abdo Scenario

Question 1 of 15

1. Question

What pain relief would be suitable for your patient?

IV Morphine after a blood pressure reading

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IV paracetamol

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IM Morphine without blood pressure reading

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Methoxyflurane

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Entonox

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Question 2 of 15

2. Question

You gain IV access quickly and give your IV paracetamol and morphine. As the patient’s pain settles, you can complete your observations and gain some more history. You record observations of; 24 RR, 98% Sp02, 112 HR, 138/78 BP, 4.9 blood sugar reading and 38.1 Temperature.

She has never experienced pain like this before but over the last few months has changed her diet as fatty and spicy foods caused a lot of abdominal discomfort.

What is this patients NEWS score?

5

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4

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7

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3

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Question 3 of 15

3. Question

The patient explains she has been nauseated but hasn’t vomited. You consider giving Ondansetron for this symptom but see that there are associated contraindications and cautions regarding a prolonged QT interval. What figures would give a prolonged QT interval?

440ms for males and 460ms for females

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400ms for males and 420ms for females

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500ms for males and females

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440ms for males and females

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Question 4 of 15

4. Question

Your ECG monitor should read a ‘corrected’ QT interval reading (QTc) you can use to check for this. What value is corrected to allow comparison of ECGs and detection of risk of abnormalities?

It corrects for heart rate

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It corrects for age

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It corrects for ECG artefact to increase reliability

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It corrects for any ST elevation or depression

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Question 5 of 15

5. Question

You complete your ECG and it looks normal, so you give Ondansetron. You then look at completing an abdominal assessment. There are no abnormalities on inspection or percussion and find hypoactive bowel sounds on auscultation. Do hypoactive bowel sounds indicate the patient must have an intestinal blockage somewhere?

False

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True

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Question 6 of 15

6. Question

You continue to palpate and find the patient has guarding and tenderness on the upper right abdomen. There is no rebound tenderness, no flank pain, and no rigidity. You ask the patient to complete a deep inhalation as you palpate under the ribs on the right upper quadrant. The patient is unable to complete the full breath. What is this a positive sign for?

Murphy's sign

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McBurney's sign

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Grey Turner sign

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Roving's sign

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Question 7 of 15

7. Question

What condition does a positive Murphy’s sign relate to?

Acute cholecystitis

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Appendicitis

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Ruptured AAA

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Spleen Laceration

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Question 8 of 15

8. Question

When assessing the abdomen, you can have the patient lay supine with the knees flexed at 90 degrees to relax the abdominal wall?

True

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False

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Question 9 of 15

9. Question

You are confident that your patient has acute cholecystitis. You have the patients’ pain under control and her nausea has subsided, she is a lot more comfortable. What first choice destination would benefit this patient where available?

Surgical assessment unit or SDEC (if appropriate for local pathways and are available)

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Nearest ED

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Discussion with GP for discharge and medicine management

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Medical assessment unit (if appropriate for local pathways and are available)

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Question 10 of 15

10. Question

Approximately what percentage of A&E acute abdominal pain presentations are for acute cholecystitis?

30%

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20%

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10%

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5%

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Question 11 of 15

11. Question

What pathophysiology describes an acute cholecystitis diagnosis?

Inflammation of the gallbladder caused by a cease of gallbladder emptying

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Gallstone causing a blocking of the bile duct

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Hyperactivity of the gallbladder

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Hypoactive bile production caused by liver malfunction

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Question 12 of 15

12. Question

90-95% of acute cholecystitis patients have associated gallstones?

True

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False

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Question 13 of 15

13. Question

What risk factors are associated with gallstones and are therefore in directly acute cholecystitis?

Increasing age (especially the forty’s)

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Female gender

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Obesity

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Low fibre diet

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Sickle cell disease

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Question 14 of 15

14. Question

What complications can be associated with acute cholecystitis?

Necrosis of the gallbladder wall (Gangrenous cholecystitis)

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Perforation of the gallbladder

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Jaundice

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Sepsis

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Small bowel obstruction

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Pyelonephritis

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Question 15 of 15

15. Question

Early recognition and treatment of uncomplicated acute cholecystitis is associated with very low mortality rates and excellent prognosis?

True

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False

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