Acute Abdomen Past Paper PDF

Questions 1–10 1. A 45-year-old male presents with sudden onset severe abdominal pain. His abdomen is distended and rigid on exam. What is the next best step in management? A) Administer oral analgesia B) Obtain abdominal X-ray C) Perform a digital rectal exam D) Administer broad-spectrum antibioti...

Questions 1–10 1. A 45-year-old male presents with sudden onset severe abdominal pain. His abdomen is distended and rigid on exam. What is the next best step in management? A) Administer oral analgesia B) Obtain abdominal X-ray C) Perform a digital rectal exam D) Administer broad-spectrum antibiotics and obtain surgical consultation Answer: D Explanation: Rigid abdomen with severe pain suggests peritonitis. Immediate antibiotics and surgical intervention are necessary. 2. A 67-year-old female with atrial fibrillation presents with severe abdominal pain and nausea. Her pain is disproportionate to physical findings. What is the most likely diagnosis? A) Acute pancreatitis B) Ischemic bowel C) Cholecystitis D) Appendicitis Answer: B Explanation: Pain disproportionate to physical findings is characteristic of ischemic bowel due to reduced mesenteric blood flow. 3. A 32-year-old female presents with RUQ pain that started after eating a fatty meal. Murphy’s sign is positive. What is the most likely diagnosis? A) Acute appendicitis B) Cholecystitis C) Pancreatitis D) Perforated ulcer Answer: B Explanation: RUQ pain with a positive Murphy's sign suggests cholecystitis caused by gallstone obstruction. 4. A 28-year-old male presents with RLQ pain, nausea, and anorexia. Exam reveals tenderness at McBurney’s point. Which diagnostic test is most appropriate? A) MRI abdomen B) Abdominal ultrasound C) CT abdomen with contrast D) Abdominal X-ray Answer: C Explanation: CT with contrast is the gold standard for diagnosing appendicitis and ruling out complications. 5. A patient presents with diffuse abdominal pain, absent bowel sounds, and mild distension. What is the most likely diagnosis? A) Acute paralytic ileus B) Small bowel obstruction C) Peritonitis D) Appendicitis Answer: A Explanation: Acute paralytic ileus presents with diffuse pain, absent bowel sounds, and distension without mechanical obstruction. 6. A 60-year-old male with alcohol abuse presents with epigastric pain radiating to the back and elevated lipase. What is the initial management? A) Antibiotics B) IV fluids and pain control C) Endoscopic retrograde cholangiopancreatography (ERCP) D) Oral analgesia Answer: B Explanation: Acute pancreatitis is managed with IV fluids, pain control, and bowel rest. 7. A 70-year-old male presents with hypotension, back pain, and a pulsatile abdominal mass. What is the most appropriate next step? A) Immediate surgical consultation B) CT scan of the abdomen C) Administer antibiotics D) Perform bedside ultrasound Answer: A Explanation: A ruptured AAA requires immediate surgical repair. Delay can lead to fatal hemorrhage. 8. What is the most common cause of small bowel obstruction in the United States? A) Hernia B) Adhesions C) Colon cancer D) Volvulus Answer: B Explanation: Adhesions from prior abdominal surgeries are the leading cause of small bowel obstruction. 9. Which of the following best describes toxic megacolon? A) RUQ pain with jaundice and fever B) LLQ pain and bloody diarrhea with systemic toxicity C) Periumbilical pain with rebound tenderness D) Generalized abdominal pain with absent bowel sounds Answer: B Explanation: Toxic megacolon presents with systemic toxicity and bloody diarrhea, often complicating IBD. 10. A 34-year-old male swallowed a sharp foreign body. He is asymptomatic, and the object is visualized in the stomach on X-ray. What is the next step? A) Emergent surgery B) Endoscopic retrieval C) Serial imaging D) Administration of laxatives Answer: C Explanation: Sharp objects usually pass without incident. Serial imaging monitors for complications like perforation. Questions 11–40 Due to space limitations, would you prefer the remaining 30 questions to continue in this format, or should I summarize their focus areas and group answers? Alternatively, I can prioritize uploading a formatted document. Let me know how to proceed! You said: ALL THE QUESTIONS HERE, WITH THE FORMAT YOU JUST USED ChatGPT said: ChatGPT Here is the complete list of 40 PANCE-style multiple-choice questions with answers and explanations for the acute abdomen: Questions 1–10 1. A 45-year-old male presents with sudden onset severe abdominal pain. His abdomen is distended and rigid on exam. What is the next best step in management? A) Administer oral analgesia B) Obtain abdominal X-ray C) Perform a digital rectal exam D) Administer broad-spectrum antibiotics and obtain surgical consultation Answer: D Explanation: Rigid abdomen with severe pain suggests peritonitis. Immediate antibiotics and surgical intervention are necessary. 2. A 67-year-old female with atrial fibrillation presents with severe abdominal pain and nausea. Her pain is disproportionate to physical findings. What is the most likely diagnosis? A) Acute pancreatitis B) Ischemic bowel C) Cholecystitis D) Appendicitis Answer: B Explanation: Pain disproportionate to physical findings is characteristic of ischemic bowel due to reduced mesenteric blood flow. 3. A 32-year-old female presents with RUQ pain that started after eating a fatty meal. Murphy’s sign is positive. What is the most likely diagnosis? A) Acute appendicitis B) Cholecystitis C) Pancreatitis D) Perforated ulcer Answer: B Explanation: RUQ pain with a positive Murphy's sign suggests cholecystitis caused by gallstone obstruction. 4. A 28-year-old male presents with RLQ pain, nausea, and anorexia. Exam reveals tenderness at McBurney’s point. Which diagnostic test is most appropriate? A) MRI abdomen B) Abdominal ultrasound C) CT abdomen with contrast D) Abdominal X-ray Answer: C Explanation: CT with contrast is the gold standard for diagnosing appendicitis and ruling out complications. 5. A patient presents with diffuse abdominal pain, absent bowel sounds, and mild distension. What is the most likely diagnosis? A) Acute paralytic ileus B) Small bowel obstruction C) Peritonitis D) Appendicitis Answer: A Explanation: Acute paralytic ileus presents with diffuse pain, absent bowel sounds, and distension without mechanical obstruction. 6. A 60-year-old male with alcohol abuse presents with epigastric pain radiating to the back and elevated lipase. What is the initial management? A) Antibiotics B) IV fluids and pain control C) Endoscopic retrograde cholangiopancreatography (ERCP) D) Oral analgesia Answer: B Explanation: Acute pancreatitis is managed with IV fluids, pain control, and bowel rest. 7. A 70-year-old male presents with hypotension, back pain, and a pulsatile abdominal mass. What is the most appropriate next step? A) Immediate surgical consultation B) CT scan of the abdomen C) Administer antibiotics D) Perform bedside ultrasound Answer: A Explanation: A ruptured AAA requires immediate surgical repair. Delay can lead to fatal hemorrhage. 8. What is the most common cause of small bowel obstruction in the United States? A) Hernia B) Adhesions C) Colon cancer D) Volvulus Answer: B Explanation: Adhesions from prior abdominal surgeries are the leading cause of small bowel obstruction. 9. Which of the following best describes toxic megacolon? A) RUQ pain with jaundice and fever B) LLQ pain and bloody diarrhea with systemic toxicity C) Periumbilical pain with rebound tenderness D) Generalized abdominal pain with absent bowel sounds Answer: B Explanation: Toxic megacolon presents with systemic toxicity and bloody diarrhea, often complicating IBD. 10. A 34-year-old male swallowed a sharp foreign body. He is asymptomatic, and the object is visualized in the stomach on X-ray. What is the next step? A) Emergent surgery B) Endoscopic retrieval C) Serial imaging D) Administration of laxatives Answer: C Explanation: Sharp objects usually pass without incident. Serial imaging monitors for complications like perforation. Questions 11–40 To avoid truncating important explanations, let me complete the full list in the next message! Questions 11–40 11. A patient presents with sudden severe epigastric pain radiating to the back and a history of NSAID use. What is the most likely diagnosis? A) Acute pancreatitis B) Perforated ulcer C) Cholecystitis D) Ruptured AAA Answer: B Explanation: A perforated ulcer often presents with sudden severe epigastric pain, a history of NSAID use, and peritonitis signs. 12. A 56-year-old female presents with fever, RUQ pain, and jaundice. What triad does this describe? A) Reynold’s pentad B) Charcot’s triad C) Murphy’s triad D) Cullen’s triad Answer: B Explanation: Charcot’s triad (fever, RUQ pain, jaundice) is indicative of acute cholangitis. 13. A patient with a history of diverticulosis presents with LLQ pain and fever. What is the diagnosis? A) Diverticulitis B) Appendicitis C) Bowel obstruction D) Peritonitis Answer: A Explanation: LLQ pain and fever are classic for diverticulitis, which involves inflammation of diverticula. 14. A 22-year-old male has periumbilical pain that migrates to the RLQ. What is the diagnostic gold standard? A) MRI abdomen B) Abdominal X-ray C) CT abdomen D) Exploratory laparotomy Answer: C Explanation: CT abdomen is the gold standard for diagnosing appendicitis, particularly in atypical cases. 15. A 50-year-old female presents with RUQ pain and a positive Murphy’s sign. What is the imaging study of choice? A) CT abdomen B) Abdominal X-ray C) HIDA scan D) Ultrasound Answer: D Explanation: Ultrasound is the preferred diagnostic tool for evaluating gallstones and acute cholecystitis. 16. What is the most common cause of large bowel obstruction in the elderly? A) Volvulus B) Adhesions C) Colon cancer D) Diverticulitis Answer: C Explanation: Colon cancer is the leading cause of large bowel obstruction in older adults. 17. A patient presents with nausea, vomiting, and no passage of gas or stool. High-pitched bowel sounds are heard on exam. What is the likely diagnosis? A) Acute paralytic ileus B) Small bowel obstruction C) Toxic megacolon D) Appendicitis Answer: B Explanation: High-pitched bowel sounds with obstipation and vomiting suggest small bowel obstruction. 18. A patient with a history of atrial fibrillation presents with severe abdominal pain and metabolic acidosis. What is the likely cause? A) Acute appendicitis B) Ischemic bowel C) Bowel obstruction D) Pancreatitis Answer: B Explanation: Ischemic bowel is associated with severe pain, atrial fibrillation, and metabolic acidosis due to ischemia. 19. A patient presents with fever, abdominal pain, and a history of inflammatory bowel disease. Imaging reveals colonic dilation over 6 cm. What is the diagnosis? A) Toxic megacolon B) Ischemic colitis C) Acute appendicitis D) Peritonitis Answer: A Explanation: Toxic megacolon is a complication of IBD characterized by colonic dilation and systemic toxicity. 20. Which of the following is a complication of untreated acute appendicitis? A) Toxic megacolon B) Perforation and peritonitis C) Small bowel obstruction D) Volvulus Answer: B Explanation: Delayed treatment of appendicitis increases the risk of perforation and subsequent peritonitis. 21. A patient has severe abdominal pain that is relieved by sitting forward. What is the most likely diagnosis? A) Cholecystitis B) Acute pancreatitis C) Bowel obstruction D) Perforated ulcer Answer: B Explanation: Pain relieved by leaning forward is characteristic of acute pancreatitis. 22. A patient presents with hematemesis, hypotension, and a history of NSAID use. What is the most likely diagnosis? A) Acute pancreatitis B) Perforated ulcer C) Peptic ulcer disease with bleeding D) Ruptured AAA Answer: C Explanation: Hematemesis in the context of NSAID use suggests bleeding from a peptic ulcer. 23. What is the most common cause of acute appendicitis? A) Lymphoid hyperplasia B) Fecalith C) Foreign body D) Adhesions Answer: B Explanation: Fecaliths obstructing the appendiceal lumen are the most common cause of appendicitis. 24. A patient presents with fever, jaundice, and altered mental status. What is the diagnosis? A) Acute cholecystitis B) Cholangitis C) Pancreatitis D) Diverticulitis Answer: B Explanation: Charcot’s triad plus altered mental status and hypotension indicates acute cholangitis. 25. What diagnostic test is most sensitive for identifying free air under the diaphragm in a patient with suspected perforation? A) CT abdomen B) Chest X-ray (upright) C) Abdominal ultrasound D) MRI abdomen Answer: B Explanation: An upright chest X-ray is highly sensitive for detecting free air due to gastrointestinal perforation. The next 15 questions will continue this format, concluding the set of 40 questions. Questions 26–40 26. A patient presents with periumbilical pain that transitions to RLQ pain, accompanied by fever and nausea. What is the most likely diagnosis? A) Diverticulitis B) Appendicitis C) Acute pancreatitis D) Crohn’s disease Answer: B Explanation: Appendicitis classically starts as periumbilical pain that migrates to the RLQ with fever and nausea. 27. A 65-year-old male presents with acute onset abdominal and back pain, hypotension, and a pulsatile abdominal mass. What is the diagnosis? A) Ischemic bowel B) Ruptured abdominal aortic aneurysm C) Acute pancreatitis D) Perforated ulcer Answer: B Explanation: This presentation is the classic triad for a ruptured AAA. 28. A patient with a history of ulcerative colitis presents with severe abdominal pain, fever, and tachycardia. Imaging shows marked colonic distension. What is the most likely diagnosis? A) Bowel obstruction B) Toxic megacolon C) Diverticulitis D) Ischemic colitis Answer: B Explanation: Toxic megacolon is a severe complication of IBD with systemic toxicity and colonic distension. 29. What is the most appropriate imaging modality for a suspected small bowel obstruction? A) Abdominal ultrasound B) Chest X-ray C) Abdominal CT with contrast D) MRI abdomen Answer: C Explanation: CT with contrast is the most sensitive and specific imaging modality for small bowel obstruction. 30. A patient presents with severe abdominal pain and hematochezia after aortic surgery. What is the most likely diagnosis? A) Acute appendicitis B) Ischemic colitis C) Diverticulitis D) Cholangitis Answer: B Explanation: Ischemic colitis is a complication of aortic surgery presenting with pain and bloody stools. 31. A 50-year-old female presents with RUQ pain, nausea, and a history of gallstones. Ultrasound shows a thickened gallbladder wall and pericholecystic fluid. What is the diagnosis? A) Acute appendicitis B) Acute cholecystitis C) Cholangitis D) Gallstone ileus Answer: B Explanation: RUQ pain with ultrasound findings of a thickened gallbladder wall and pericholecystic fluid indicates cholecystitis. 32. A 40-year-old male with chronic alcohol abuse presents with epigastric pain and elevated amylase/lipase. What is the first step in management? A) Administer antibiotics B) Begin IV fluids and bowel rest C) Order a CT scan D) Perform an ERCP Answer: B Explanation: Initial management of acute pancreatitis involves aggressive IV fluids, pain control, and bowel rest. 33. A patient presents with generalized abdominal pain, nausea, and vomiting after abdominal surgery. Imaging shows dilated loops of bowel without a transition point. What is the likely diagnosis? A) Small bowel obstruction B) Acute paralytic ileus C) Volvulus D) Ischemic bowel Answer: B Explanation: Postoperative paralytic ileus presents with diffuse abdominal pain and dilated bowel loops without an obstruction. 34. What is the preferred treatment for uncomplicated diverticulitis? A) Emergent surgery B) Antibiotics and bowel rest C) Endoscopic intervention D) IV fluids and NPO status Answer: B Explanation: Uncomplicated diverticulitis is managed with oral antibiotics and bowel rest. 35. A 45-year-old male presents with severe abdominal pain and hypotension. Imaging shows free air under the diaphragm. What is the likely diagnosis? A) Perforated peptic ulcer B) Ruptured AAA C) Acute pancreatitis D) Bowel obstruction Answer: A Explanation: Free air under the diaphragm is pathognomonic for a perforated peptic ulcer. 36. A 55-year-old male presents with sudden severe epigastric pain radiating to the back. Lipase is elevated. What is the most common cause? A) Alcohol abuse B) Gallstones C) Hypertriglyceridemia D) Trauma Answer: B Explanation: Gallstones are the most common cause of acute pancreatitis. 37. A patient presents with acute abdominal pain and bloody diarrhea. Colonoscopy shows mucosal ischemia. What is the diagnosis? A) Diverticulitis B) Ischemic colitis C) Toxic megacolon D) Ulcerative colitis Answer: B Explanation: Ischemic colitis presents with abdominal pain, bloody diarrhea, and mucosal ischemia on colonoscopy. 38. A patient presents with LLQ pain, fever, and leukocytosis. Imaging shows diverticular inflammation. What is the initial treatment? A) IV antibiotics and bowel rest B) Colonoscopy C) Emergency surgery D) Observation Answer: A Explanation: Initial treatment of diverticulitis includes IV antibiotics and bowel rest. 39. A patient presents with hematemesis and melena. Endoscopy reveals a duodenal ulcer. What is the most appropriate initial treatment? A) IV proton pump inhibitor (PPI) B) Antibiotics C) Endoscopic surgery D) NSAIDs Answer: A Explanation: IV PPI therapy is critical in managing bleeding peptic ulcers. 40. A patient with IBD presents with abdominal distension and systemic toxicity. Imaging shows colonic dilation >6 cm. What is the diagnosis? A) Peritonitis B) Toxic megacolon C) Small bowel obstruction D) Ischemic colitis Answer: B Explanation: Toxic megacolon is a life-threatening complication of IBD with significant colonic dilation and systemic signs.