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Self-Assessment Questions

Emergency Medicine

Acute Abdominal Pain: Review Questions

David B. Levy, DO, FAAEM, FACEP

Dr. Levy is Residency Program Director of Emergency Medicine,
Temple University Hospital, Philadelphia, PA, and Associate Professor of Medicine,
Temple University School of Medicine, Philadelphia, PA.

Choose the single best answer for each question.

1. What is the most common discharge diagnosis for patients presenting to the emergency department (ED) with acute abdominal pain?
  1. Appendicitis
  2. Gastroenteritis
  3. Intestinal obstruction
  4. Nonspecific abdominal pain
  5. Pancreatitis
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2. All of the following causes of acute abdominal pain occur more frequently in patients older than age 50 years than in patients younger than age 50 years EXCEPT:

  1. Cholecystitis
  2. Diverticular disease
  3. Intestinal obstruction
  4. Vascular-related pathology
  5. Appendicitis
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3. Which of the following statements regarding pain medication in the management of acute abdominal pain is correct?

  1. Pain medication should always be withheld until the surgeon makes a definitive diagnosis.
  2. Signed consent from patients premedicated with opioid analgesics is invalid in the ED setting.
  3. If pain medication is unequivocally necessary, ketorolac 60 mg given intramuscularly is the best choice.
  4. Generally, intravenous opioids are safe for management of acute abdominal pain.
  5. Major respiratory depression is a frequent complication of intravenous analgesia in the ED.
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4. Which of the following statements regarding plain film radiography for the diagnosis of acute abdominal pain is correct?
  1. A routine abdominal radiograph series excludes serious disease in patients with nonspecific abdominal pain.
  2. Abdominal radiographs should be part of the routine work-up of any patient with an upper gastrointestinal bleed.
  3. Abdominal radiographs prove more than 75% sensitive in the detection of acute appendicitis.
  4. An upright abdominal plain film radiograph is most sensitive for the detection of free air.
  5. Abdominal radiographs are most useful in the diagnosis of intestinal obstruction.
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5. Which of the following statements regarding ancillary testing to determine the correct etiology of acute abdominal pain is TRUE?

  1. A normal complete blood count essentially rules out appendicitis.
  2. Leukocytosis proves specific for acute appendicitis in patients demonstrating right lower quadrant pain.
  3. An abnormal urinalysis effectively excludes appendicitis as the diagnosis.
  4. Combined testing of serum amylase and serum lipase levels improves diagnostic accuracy without raising cost in the diagnosis of acute pancreatitis.
  5. A single serum lipase value is a useful screening test for acute pancreatitis because of its high negative predictive value (0.99).
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