383.A 19-year-old teenager is brought to the emergency room after a
single-car accident just 20 minutes earlier in which she lost control of
her car on black ice and hit a retaining column of an overpass at about
45 milesper hour. She was wearing a seat belt but looks pale, has tachy-
cardia and positional hypotension, is extremely nauseated, and is lying in
the fetal position due to increasingly severe abdominal pain. She has no
fractures and a cranial nerve test is normal. You order an abdominal CT
because you suspect which of the following?
a. Lacerated kidney
b. Ruptured spleen
c. Ruptured gallbladder
d. Diverticulitis
e. Hemorrhoids
384.A posteriorly perforating ulcer in the pyloric antrum of the stomach
is most likely to produce an initial localized peritonitis or abscess forma-
tion in which of the following?
a. Greater sac
b. Left subhepatic and hepatorenal spaces (pouch of Morison)
c. Omental bursa
d. Right subphrenic space
e. Right subhepatic space
385.A 55-year-old woman arrives at the emergency room the day after
St. Patrick’s Day coughing up bright red blood. She has frequented your
emergency room before. History includes excessive alcohol consumption.
Using abdominal percussion you determine that her liver extends 5 cm
below the right costal margin at the midclavicular line. You call in a gas-
troenterologist because you suspect that the bright red blood is most likely
the result of which of the following?
a. Hemorrhoids
b. Colon cancer
c. Duodenal ulcer
d. Gastric ulcer
e. Esophageal varices
Abdomen 499