78.As you palpate the right upper quadrant (RUQ) of a 38-year-old woman’s
abdomen, you notice that she stops her inspiration for a brief moment.
Duringthe history, the patient states that over the last 2 days she gets pain in
her RUQ that radiates to her back shortly after eating. Her vitals include a
temperature of 100.4°F, HR of 95 beats per minute, BP of 130/75 mm Hg, RR
of 16 breaths per minute. What is the initial diagnostic modality of choice for
this disorder?
a. Plain film radiograph
b. Computed tomography (CT) scan
c. Magnetic resonance imaging (MRI)
d. Radioisotope cholescintigraphy (HIDA scan)
e. Ultrasonography
79.A 31-year-old man from Florida presents to the ED complaining of
severe pain that starts in his left flank and radiates to his testicle. The pain
lasts for about 1 hour and then improves. He had similar pain last week that
resolved spontaneously. He noted some blood in his urine this morning. His
BP is 145/75 mm Hg, HR is 90 beats per minute, temperature is 98.9°F, and
his RR is 24 breaths per minute. His abdomen is soft and nontender. As you
examine the patient, he vomits and has trouble lying still in his stretcher.
Which of the following is the most appropriate next step in management?
a. Call surgery consult to evaluate the patient for appendicitis.
b. Order an abdominal CT.
c. Start intravenous (IV) fluids and administer an IV nonsteroidal anti-inflammatory
drug (NSAID) and antiemetic.
d. Perform an ultrasound to evaluate for an abdominal aortic aneurysm (AAA).
e. Perform an ultrasound to evaluate for testicular torsion.
Abdominal and Pelvic Pain 79