prevent pregnancy. Hepatitis B vaccination should be administered to
patients who never received the vaccine. If vaccination status is unclear,
obtain hepatitis serology, and if not immune, proceed with vaccination. For
patients who were previously fully vaccinated for hepatitis B, further ther-
apy is not required. Tetanus is administered to patients who have sustained
tetanus-prone injuries.
116.The answer is e.(Rosen, pp 1283-1287.)Overall, adhesions, hernias,
and cancer account for more than 90% of cases of SBO. Postoperative adhe-
sionsare the most common cause of SBO(50%-55%), followed by incar-
cerated hernia (25%) (c).Approximately 5% of all postoperativelaparotomy
patients develop adhesive obstruction, years after surgery. The most com-
mon locations of obstruction from a hernia are inguinal, followed by
femoral. Cancer (b)is the cause 10% of the time. Other, less common
causes include inflammatory bowel disease, gallstones (d),volvulus, intus-
susception, radiation enteritis, abscesses, congenital lesions, andbezoars(a).
117.The answer is c.(Rosen, pp 1422-1423.)Manual detorsionis a
maneuver used to untwist the spermatic cord to reestablish blood flow to
the testis.This procedure should be performed in any patient with sus-
pected torsion while the patient is being prepared for the OR. Most testes
torse lateral to medial. If you were to stand at the foot of the patient’s bed,
you would perform detorsion for either testis just as you would open a
book—rotating each testicle in a medial to lateral direction.Successful
detorsion results in immediate reduction of pain. In many cases, detorsion
is not successful or the testis twists again.
(a)The relief of pain that occurs with elevation of the testicle is called
Prehn sign. Though usually associated with epididymitis, Prehn sign can-
not be used to distinguish epididymitis from torsion owing to its low sen-
sitivity and specificity. (b, d,ande)These techniques are incorrect.
118.The answer is a.(Rosen, pp 1176-1183.)The radiograph demon-
strates an abdominal aortic aneurysm. On the lateral radiograph, it is the
circular structure just anterior to the vertebral column; on the AP view, it is
the circular structure overlying the lower vertebrae, most prominently on
the patient’s left side. Signs of AAA large enough to cause symptoms are
seen on plain radiographs approximately 66% to 75% of the time. The
most common findings are curvilinear calcification of the aortic wallor
aparavertebral soft tissue mass.Rarely, with longstanding aneurysms,
Abdominal and Pelvic Pain Answers 125