(1_50)MCQs Surgical pathology 2DD Prof. Kou Kimheak 2nd2017
Where is the appendix located in the body?:
In the upper right abdomen
In the lower right abdomen
In the upper left abdomen
In the center of the abdomen
McBurney Point is located ________:
In the upper abdomen
Around the umbilicus
In the left lower abdomen
In the right lower abdomen
Sam Ath is admitted to the hospital with a possible diagnosis of appendicitis. On physical examination, the nurse should be looking for tenderness on palpation at McBurney's point, which is located in the :
Left upper quadrant
Right upper quadrant
C. Right lower quadrant
D. Left lower quadrant
Who is most likely to develop appendicitis?:
An obese woman
An alcoholic male
People between the ages of 10 and 30 years of age
People who suffer from acid reflux
Lower fiber
What kind of a diet can induce appendicitis
What is a good AB choice is appendicitis is likely
What will be positive during an obturator sign
What is always a secondary liver issue
Which of the following most often initiates the development of acute appendicitis?:
A viral infection
Acute gastroenteritis.
Obstruction of the appendiceal lumen
A primary clostridial infection
A client is admitted with right lower quadrant pain, anorexia, nausea, low-grade fever, and elevated white blood cell count. Which complication is most likely the cause?:
Fecalith
Bowel Kinking
Internal bowel occlusion
Abdominal wall swelling
The diagnosis of acute appendicitis is most difficult to establish in
Persons aged 60 and older
Women aged 18 to 35.
Infants younger than 1 year.
Pregnant women
Which of the following position should the client with appendicitis assume to relieve pain?
Prone
Sitting
Supine
Lying with legs drawn up
When the abdominal muscles become rigid in an effort to protect the abdomen from further irritation, this is referred to as:
Guarding
Tenderness
Rebound tenderness
Referred pain
Rebound and percussion tenderness, Guarding; Roving’s sign = Pain > in RIF than LIF when LIF is pressed, PR painful on right; Tender mass (occasionally) in RIF, Tachardia, Fever, Lying still, coughing hurts, shallow breaths.:
Signs of Acute Appendicitis
Complications of Acute Appendicitic Mass
RIF pain differentials
Symptoms of Acute Appendicitis
Pressing the abdomen at Mc Burney's point and then rapidly released, the patient may increase in pain, is
The pointing sign.
The psoas sign.
The obturator sign.
Rovsing's sign.
Blumbert’s sign.
Pain felt in the right iliac fossa when you press deeply in his left iliac fossa is:
The pointing sign
The psoas sign
The obturator sign.
Rovsing's sign
Blumbert’s sign
Rebound tenderness. Abdominal is compressed at Mc.Burneys point, and when release of pressure , pain is felt. :
Describe blumberg sign
Describe physical causes of peritonitis
Describe primary generalised peritonitis
Describe chemical
Dunphy's sign
Increased pain in the right lower quadrant with coughing
Pain in the RIF by percussion of heel
Blumberg’s sign in Petit’s triangle. Symptoms of retrocaecal appendicitis.
Localized pain always has the FID (pt Mc Burney) during palpation of the area, the patient being in lateral decubitus left
Pain in the hypogastrium when internal rotation of the hip is :
The pointing sign.
The psoas sign
The obturator sign.
Rovsing's sign.
Blumbert’s sign
Move the patient's legs the pain felt in the right iliac fossa on extension of the hip, and the right hip flexed for pain relief is:
The pointing sign
The psoas sign
The obturator sign
Rovsing's sign
Blumbert’s sign
Appendix shows the histology of the necrotic area, images of vascular thrombosis, an inflammatory infiltrate small. They are:
A normal appendix.
A catarrhal appendicitis
A gangrenous appendix.
An appendiceal abscess
A subacute endoappendicite
Mr. Sok, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F. The doctor ordered for a complete blood count. After the test, Nurse Sokha received the result from the laboratory. Which laboratory values will confirm the diagnosis of appendicitis? :
Hgb 15 g/dL
Hct 44 %
WBC 13, 000/mm3
RBC 5.5 x 106/mm3
What US findings are suggestive of acute appendicitis?:
< 4 mm in diameter and compressible
> 6 mm in diameter and not compressible
< 4 mm in diameter and not compressible
> 6 mm in diameter and compressible
Complication of appendicitis:
Peritonitis
Appendicitis
Peritonitis wound care
Phlegmon
Intestinal obstruction
What is volvulus?
With complete mechanical obstruction and sometimes even incomplete mechanical obstruction, Always with strangulated
Twisting of the intestine
Keep patient NPO until physician gives orders
Abdominal surgery, Radiation therapy, inflammatory bowel disease, Gallstones, Hernias, Trauma, Peritonitis, Tumors, Familial relations with above diseases
Antibiotics for strangulation, Octreotide acetate (Sandostatin) used for paralytic ileus / enhances gastric motility
A passenger presents severe abdominal pain by moving crisis amid ongoing pain, and vomiting with lost materials and gases. The review shows that you practice a distended abdomen without contracture. You think:
Appendicitis
A ruptured ectopic pregnancy.
A Hepatic colic.
Intestinal obstruction
In elderly patients the most frequent cause of obstructive bowel obstruction is:
Tumors.
Gallstones.
Coproliths.
All answers are correct
Following abdominal surgeries, trauma, mesenteric ischemia, or infection:
The two types of intestinal obstruction
Nonmechanical obstruction is seen when
In mechanical obstructions what kind of bowel sounds are heard and where
Nonmechanical obstruction occurs when
The most frequent localisation of tumors which are complicated by oobstructive bowel obstruction is
Cecum;
Ascendant colon
Transversal colon
Descendant and sigmoid colon.
Handling of intestines during abdominal surgery causes it to lose function Electrolyte disturbances-especially hypokalemia; Peritonitis, intestinal ischemia/ lack of blood to intestines.:
Most common cause of paralytic ileus (non-mechanical obstruction)
Postoperative care for minimally invasive stabilization
Most common cause of obstruction in people 65 and older
Best way to treat non-mechanical / partial obstruction
Regarding small bowel obstruction:
In the United Kingdom is most often due to an obstructed hernia.
Causes colicky abdominal pain and vomiting
Abdominal distension is seen in all patients
All cases can be managed conservatively for the first 24 hours
Rarely requires aggressive fluid resuscitation
Paralytic or adynamic, ileus is what kind of obstructions?:
Large and small intestine usually as dramatic
Shock and death
In a thin person
Following abdominal surgeries, trauma, mesenteric ischemia, or infection
Non mechanical
Among the following which ones can be retained as a cause of intestinal obstruction by strangulation?: 1. The occlusion of the sigmoid cancer. 2. The occlusion by volvulus adhesion. 3. The gallstone ileus. 4. The strangulated hernia. 5. The acute intussusception
1-4-5
1- 2-3
1-2-4
1-3-5
2-4-5
Occlusion in strangulation of the small intestine: 1. The pain syndrome begins abruptly. 2. The central abdominal bloating. 3. Vomiting is early and abundant. 4. The infectious syndrome is important from the outset. 5. The cul de sac (uterorectal or vesicorectal pouch) is painful at rectal examination.
1-5-4
1-4-3
1-2-3
2-3-5
1-2-5
The most common area for volvulus is:
Cecum
Ascending colon
Transverse colon
Splenic flexure
Sigmoid colon
Before a bowel obstruction which is on the item for a small bowel obstruction due to strangulation
The gradual onset of pain.
The existence of an abdominal scar.
No matter the digital rectal examination.
The permanent nature of the pain.
The absence of fluid levels on radiographs of the abdomen without preparation.
Closed-loop obstruction of sigmoid colon caused by the bowel twisting on itself. Can result in vascular compromise and bowel infarction?:
How does management of caecum volvulus differ from sigmoid volvulus
Sigmoid volvulus
In what population does sigmoid volvulus most often occur
Signs and symptoms
Bloat of the pelvic colon volvulus 1. Has an asymmetrical layout. 2. Was tympanic to percussion. 3. Accompanied by peristaltic waves. 4. Accompanied by abdominal contraction. 5. Accompanied by removal of abdominal skin reflexes
1-4
2-3
1-2
3-5
1-5
The inability to pass a collection of hard stool:
Functional Constipation
Fecal Impaction
Can the skill of removing a fecal impaction be delegated to a NAP
What position should a patient be in during digital fecal removal
A fecal impaction is a solid, immobile bulk of stool that can develop in the rectum as a result of chronic ________.:
Ulcerative colitis
Crohn's disease
Irritable bowel syndrome
Constipation
The most helpful diagnostic radiographic procedure in small bowel obstruction is:
CT of the abdomen.
Contrast study of the intestine.
Supine and erect x-rays of the abdomen.
Ultrasonography of the abdomen.
What is/are among the following radiological elements which permit to diagnose a small gut obstruction on erect film (APF)?:
Central air-fluid level
Air-fluid level higher than larger.
Aerobilia.
Air under diaphragmatic
Which of the following conditions is most likely to directly cause peritonitis?:
Cholelithiasis
Gastritis
Perforated ulcer
Incarcerated hernia
Chemical Causes of Peritonitis:
Leakage of Bile, Pancreatic Enzymes, Gastric Acid.
Controlling the contamination, Removal of foreign material, Removal of foreign material, Draining collected fluid.
Caused by contamination from bacteria or chemicals.
Elevated WBC > 20,000; Low H/H; Altered Electrolytes- K, Na, Cl-; Abdominal X-ray and US; Abdominal CT; Peritoneal aspiration and culture.
Before performing an abdominal examination, the examiner should:
Have the patient empties his or her bladder.
Ascertain the patient's HIV status.
Don double gloves.
Completely disrobe the patient.
After thorough inspection of the abdomen, the next assessment step is:
Percussion.
Palpation.
Auscultation.
Rectal examination.
Which of the following is true of Spontaneous bacterial peritonitis?:
A survival rate of over 50% is expected at one year
Gentamicin is the treatment of choice
is diagnosed by culture of ascitic fluid.
is due to intestinal perforation
Gastric juices/bile/pancreatic/blood/urine:
What are chemical irritations of aseptic peritonitis
What is the most common obstruction seen in acute appendicitis
What are symptoms of subacute bacterial peritonitis
What are infectious causes of peritonitis
What is clinical presentation of peritonitis?:
WBC > 20k
Abscess/free air/fat stranding
Localized bacterial overgrowth which leads to wall invasion > edema > vascular compromise > gangrene/perforation because of tissue death
Acute abdominal pain
Appendicular luminal obstruction
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