Abdominal Pain Assessment Quiz

Regarding the "SICK vs NOT SICK" classification in abdominal pain assessment, which findings indicate a SICK patient?

• Diaphoresis/ extreme sweating with pale skin

• Guarding on abdominal examination

• Mild abdominal discomfort that improves with antacids

• Normal breathing pattern with clear speech

• Sustained tachycardia

Answer explanation

Findings like diaphoresis with pale skin, guarding on examination, and sustained tachycardia indicate a SICK patient, suggesting severe underlying issues, unlike mild discomfort that improves with antacids or normal vital signs.

Which of the following is NOT a part of the OPQRST approach?

• Onset

• Recovery

• Quality

• Radiation

• Time

Answer explanation

The OPQRST approach is a mnemonic used in assessing pain, where 'O' stands for Onset, 'Q' for Quality, 'R' for Radiation, 'S' for Severity, and 'T' for Time. 'Recovery' is not part of this framework.

What does rebound tenderness indicate?

• Gallbladder inflammation

• Peritoneal inflammation

• Appendicitis

• Bowel obstruction

Answer explanation

Rebound tenderness is a clinical sign indicating peritoneal inflammation. It occurs when pressure is applied to the abdomen and then released, causing pain, which suggests irritation of the peritoneum, often seen in conditions like appendicitis.

Which quadrant is associated with the appendix?

• Left Lower Quadrant

• Right Lower Quadrant

• Left Upper Quadrant

• Right Upper Quadrant

Answer explanation

The appendix is located in the Right Lower Quadrant of the abdomen. This anatomical position is crucial for identifying appendicitis and other related conditions.

What is the first choice for imaging in Right Upper Quadrant pain?

• Plain Radiographs

• Ultrasonography

• MRI

• CT Scan

Answer explanation

Ultrasonography is the first choice for imaging in Right Upper Quadrant pain due to its ability to quickly assess gallbladder disease, liver conditions, and other abdominal issues without radiation exposure.

What does Murphy's sign assess?

• Gallbladder inflammation/ Acute Cholecystitis

• Colitis

• Diverticulitis

• Appendicitis

Answer explanation

Murphy's sign is a clinical test used to assess for gallbladder inflammation, specifically acute cholecystitis. A positive Murphy's sign indicates tenderness in the right upper quadrant when the gallbladder is palpated.

What does the timing aspect of the OPQRST approach assess?

• Severity of pain

• Quality of pain

• Duration and pattern of pain

• Location of pain

Answer explanation

The timing aspect of the OPQRST approach specifically assesses the duration and pattern of pain, helping to understand how long the pain lasts and if it follows a specific pattern over time.

Regarding the assessment of acute abdominal pain, which statements are TRUE?

• Poor skin signs and sustained tachycardia are red flag symptoms

• Rebound tenderness indicates peritoneal inflammation

• Sudden relief of appendicular pain suggests possible perforation

• The location of pain always directly corresponds to the affected organ

• The pain typically worsens after fatty meals in cholecystitis

Answer explanation

Poor skin signs and sustained tachycardia indicate serious conditions. Rebound tenderness suggests peritoneal inflammation. Sudden relief of appendicular pain may indicate perforation. Cholecystitis pain worsens after fatty meals.

Which of the following is a common differential diagnosis for Right Upper Quadrant pain?

• Diverticulitis

• Cholecystitis

• Sigmoid volvulus

• Colitis

Answer explanation

Cholecystitis is a common cause of right upper quadrant pain due to inflammation of the gallbladder. In contrast, diverticulitis and sigmoid volvulus typically cause left-sided pain, while colitis can present with generalized abdominal discomfort.

Steps for correctly eliciting the MURPHY's Sign. Reorder the following

• Examiner places hand in right upper quadrant below costal margin

• Ask patient to take deep breath

• Sign is positive if there's inspiratory arrest due to pain

• Patient lies supine