NSG 6020 GI review-questions-latest-update-2020-with-complete-solutio

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All of the following are typically noted in a young adult with the diagnosis of acute appendicitis except: • epigastric pain. • positive obturator sign. • rebound tenderness. • marked febr... ile response. A 26 year old man presents with acute abdominal pain. As part of the evaluation for acute appendicitis, you order a white blood cell (WBC) count with differential and anticipate the following results: • total WBCs, 4500 mm3; neutrophils, 35%; bands, 2%; lymphocytes, 45% • total WBCs, 14,000 mm3; neutrophils, 55%; bands, 3%; lymphocytes, 38% • total WBCs, 16,500 mm3; neutrophils; 66%; bands, 8%; lymphocytes, 22% • total WBCs, 18,100 mm3; neutrophils, 55%; bands, 3%; lymphocytes, 28% In evaluating a patient with suspected appendicitis, the clinician considers that: • the presentation may differ according to the anatomical location of the appendix. • this is a common reason for acute abdominal pain in elderly patients. • vomiting before the onset of abdominal pain is often seen. • the presentation is markedly different from the presentation of pelvic inflammatory disease. There is no true classic presentation of acute appendicitis. Vague epigastric or periumbilical pain often heralds its beginning.The psoas sign can be best described as abdominal pain elicited by: • passive extension of the hip. • passive flexion and internal rotation of the hip. • deep palpation. • asking the patient to cough. The obturator sign can be best described as abdominal pain elicited by: • passive extension of the hip. • passive flexion and internal rotation of the hip. • deep palpation. • asking the patient to cough. To support the diagnosis of acute appendicitis with suspected appendiceal rupture, you consider obtaining the following abdominal imaging study: • magnetic resonance image. • computed tomography (CT) scan. • ultrasound. • flat plate. Which of the following WBC forms is an ominous finding in the presence of severe bacterial infection? • neutrophil • lymphocyte • basophil • metamyelocyte Myelocytes and metamyelocytes are immature neutrophil forms that are typically found in only the granulopoiesis pool. The presence of thses cells is an ominous marker of lifethreatening infection, and these are occasionally found in the presence of appendiceal rupture. Which of the following best represents the peak ages for occurrence of acute appendicitis? • 1 to 20 years • 20 to 40 years • 10 to 30 years • 30 to 50 years. The peak age of patients with acute appendicitis is 10 to 30 years; this condition is uncommon in infants and elderly adults. At either end of the life span, a delay in diagnosis of appendicitis commonly occurs because providers do not consider appendicitis a possibility. Clinical findings most consistent with appendiceal rupture include all of the following except: • abdominal discomfort less than 24 hours in duration. • fever greater than 102 F (> 38 C) • palpable abdominal mass. • marked leukocytosis with total WBC greater than 20,000/mm3. A 43 year old woman has a 12 hour history of sudden onset of right upper quadrant abdominal pain with radiation to the shoulder, fever, and chills. She has had similar, milder episodes in the past. Examination reveals marked tenderness to right upper quadrant abdominal palpation. Her most likely diagnosis is: • hepatoma. • acute chlolecystitis • acute hepatitis • cholelithiasis White of the following is usually not seen in the diagnosis of acute cholecystitis? • elevated lactic dehydrogenase level. • increased alkaline phosphatase level. • leukocytosis. • elevated aspartate aminotransferase (AST) level Murphy's sign can be best described as abdominal pain elicited by: • right upper quadrant abdominal palpation [Show More]

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