Q- A 19-year-old man has abdominal pain that started around the umbilicus and moved to the right lower quadrant, with nausea and fever. Pressing on the left lower quadrant causes pain in the right lower quadrant. What is this sign called?
A- Rovsing sign
B- Murphy sign
C- Cullen sign
D- Kehr sign
A- Rovsing sign, a classic finding in acute appendicitis (along with the psoas and obturator signs). Murphy sign (inspiratory arrest on RUQ palpation) suggests cholecystitis, Cullen sign (periumbilical bruising) suggests hemorrhagic pancreatitis or retroperitoneal bleeding, and Kehr sign (left shoulder pain) suggests splenic rupture.
Q- A 30-year-old man is brought in after a motorcycle crash. He is unresponsive and has gurgling respirations. What is the first step in management?
A- Secure the airway
B- Start two large-bore IV lines
C- Obtain a CT scan of the head
D- Obtain a chest X-ray
A- Secure the airway. Trauma care follows the primary survey: Airway (with cervical spine protection), Breathing, Circulation, Disability, Exposure. A patient with gurgling respirations and a low level of consciousness needs airway suctioning and usually intubation before anything else.
Q- After a stab wound to the right chest, a patient is hypotensive with distended neck veins, absent breath sounds on the right, and a trachea deviated to the left. What is the next step?
A- Chest X-ray
B- Immediate needle decompression
C- Pericardiocentesis
D- CT scan of the chest
B- Immediate needle decompression. This is tension pneumothorax, a clinical diagnosis: do not wait for imaging. Decompress with a needle (2nd intercostal space at the midclavicular line, or the 4th to 5th intercostal space just anterior to the midaxillary line in adults), then place a chest tube. Cardiac tamponade also causes hypotension and distended neck veins, but breath sounds are normal and the trachea is midline.
Q- A 60-year-old woman who had a hysterectomy 10 years ago has colicky abdominal pain, vomiting, distension, and no passage of gas. X-ray shows dilated small bowel loops with air-fluid levels. What is the most likely cause?
A- Adhesions
B- Incarcerated hernia
C- Colon cancer
D- Gallstone ileus
A- Adhesions. Postoperative adhesions are the most common cause of small bowel obstruction in adults who have had abdominal surgery. Hernias are the most common cause in patients without prior surgery. Initial management is bowel rest, nasogastric decompression, and IV fluids. Signs of strangulation (fever, constant pain, peritonitis) require urgent surgery.
Q- A 40-year-old woman has right upper quadrant pain for 8 hours after a fatty meal, fever, and inspiratory arrest during palpation of the right upper quadrant. What is the best initial imaging test?
A- Right upper quadrant ultrasound
B- HIDA scan
C- CT scan of the abdomen
D- ERCP
A- Right upper quadrant ultrasound. This is acute cholecystitis. Ultrasound shows gallstones, gallbladder wall thickening, pericholecystic fluid, and a sonographic Murphy sign. A HIDA scan is used if ultrasound is equivocal, and ERCP is used for common bile duct stones or cholangitis. Treatment is antibiotics and cholecystectomy.
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