Abdominal Pain Assessment — MCQs
In bladder injury, pain is referred to which of the following areas?
A patient sustained trauma to the left side of the chest and abdomen. Fluid in the peritoneum and signs of hypotension were found on physical examination. What is the most probable diagnosis?
In a patient with a tender and rigid abdomen, what is the expected finding on X-ray?
Grey Turner's sign is seen in:
A patient presents with severe abdominal pain, distention, and jaundice. Serum amylase and lipase are elevated. What is the most likely diagnosis?
Nerve endings sensitive to noxious stimuli are present in all except:
A patient has recurrent abdominal pain and jaundice. The blood investigations reveal reticulocytosis and hyperbilirubinemia. What is the clinical diagnosis?
Which of the following statements regarding lymphoedema are correct? 1. Patients experience constant dull ache and even severe pain sometimes 2. Manual lymphatic drainage has a role 3. Primary lymphoedema is caused by congenital lymphatic dysplasia 4. Nonne Milroy's disease is a type of primary lymphoedema Select the correct answer using the code given below:
In an unconscious patient, spinal injury is assessed by:
A 35-year-old construction worker presents with a 3-month history of abdominal pain, fatigue, and recent onset of numbness and tingling in his hands and feet. He works in renovation of old buildings. Physical examination reveals mild pallor and decreased sensation in a stocking-glove distribution. Blood tests show microcytic anemia with basophilic stippling on peripheral smear. What is the most likely diagnosis?
Abdominal Pain Assessment Indian Medical PG Practice Questions and MCQs
Question 1: In bladder injury, pain is referred to which of the following areas?
- A. Flank
- B. Upper part of thigh
- C. Lower abdominal wall (Correct Answer)
- D. Penis
Explanation: ***Correct Option: Lower abdominal wall*** - **Referred pain** from the bladder is typically felt in the **suprapubic region** of the lower abdominal wall due to shared visceral and somatic afferent innervation. - The **parietal peritoneum** overlying the bladder is innervated by somatic nerves that also supply the abdominal wall. - This convergence of visceral afferents from the bladder and somatic afferents from the abdominal wall at the spinal cord level (particularly S2-S4) results in referred pain to the suprapubic area. *Incorrect Option: Upper part of thigh* - Pain in the upper thigh is more commonly associated with conditions affecting the **hip joint**, **femoral nerve**, or **inguinal region**. - Bladder innervation does not primarily refer pain to the upper thigh. *Incorrect Option: Flank* - Flank pain is typically associated with conditions of the **kidneys** or **ureters**, such as **nephrolithiasis** or **pyelonephritis**. - The bladder's referred pain pattern does not usually extend to the flank. *Incorrect Option: Penis* - While bladder irritation can sometimes cause sensations in the penis, it is more often associated with conditions like **urethritis**, **cystitis**, or **prostatitis**. - Direct referred pain from bladder injury to the penis is less common than to the lower abdominal wall.
Question 2: A patient sustained trauma to the left side of the chest and abdomen. Fluid in the peritoneum and signs of hypotension were found on physical examination. What is the most probable diagnosis?
- A. Diaphragmatic injury
- B. Rib fracture
- C. Renal injury
- D. Splenic injury (Correct Answer)
Explanation: ***Splenic injury*** - Trauma to the left lower chest and upper abdomen, coupled with signs of **hypovolemic shock** (hypotension) and **intraperitoneal fluid** (blood), is highly suggestive of **splenic injury**. - The **spleen** is one of the most commonly injured solid organs in blunt abdominal trauma due to its vascularity and location. *Diaphragmatic injury* - While trauma to the left chest can cause diaphragmatic injury, it typically presents with **respiratory distress** and potential **herniation of abdominal organs** into the chest. - Though it can cause internal bleeding, the primary presentation is not usually significant hypotension from isolated peritoneal fluid. *Rib fracture* - Rib fractures are common with chest trauma and can cause severe pain and bruising, but **isolated rib fractures** do not typically lead to significant **intraperitoneal fluid** and **hypotension**. - Multiple rib fractures can cause internal bleeding, but usually associated with pulmonary compromise rather than isolated peritoneal signs. *Renal injury* - Renal injury would typically cause **hematuria** and potentially **retroperitoneal bleeding**, which might not present as significant free fluid in the peritoneum. - While it can lead to hypotension, the location of the pain (left side) and nature of fluid (peritoneal) points away from an isolated renal injury.
Question 3: In a patient with a tender and rigid abdomen, what is the expected finding on X-ray?
- A. Blood under the diaphragm
- B. Air under the diaphragm (Correct Answer)
- C. Hazy lung fields
- D. Prominent vascular markings
Explanation: ***Air under the diaphragm*** - The presence of **free air** (pneumoperitoneum) beneath the diaphragm on an upright abdominal X-ray is a classic sign of **visceral perforation**. - A **tender and rigid abdomen** (peritoneal signs) indicates irritation of the peritoneum, most commonly due to a ruptured hollow viscus. *Blood under the diaphragm* - While blood can accumulate under the diaphragm (e.g., from **trauma** or a ruptured ectopic pregnancy), it typically manifests as a **hemoperitoneum** on imaging. - Blood is **fluid** and would appear as a fluid collection, not free air, on X-ray. *Hazy lung fields* - **Hazy lung fields** suggest conditions like **pulmonary edema**, pneumonia, or acute respiratory distress syndrome (ARDS). - These findings are primarily associated with pulmonary pathology and are not directly indicative of an acute abdominal emergency like perforation. *Prominent vascular markings* - **Prominent vascular markings** often indicate increased blood flow to the lungs or **pulmonary hypertension**. - This finding is unrelated to acute abdominal pain or peritoneal irritation.
Question 4: Grey Turner's sign is seen in:
- A. Acute pancreatitis (Correct Answer)
- B. Acute cholecystitis
- C. Acute hepatitis
- D. Acute appendicitis
Explanation: ***Acute pancreatitis*** - **Grey Turner's sign** is characterized by **flank ecchymosis** (bruising) resulting from retroperitoneal hemorrhage in cases of severe acute pancreatitis [1]. - This sign indicates pancreatic necrosis and hemorrhage, often associated with a **worse prognosis** [1]. *Acute cholecystitis* - Acute cholecystitis primarily presents with **right upper quadrant pain**, fever, and leukocytosis due to gallbladder inflammation, not flank ecchymosis [2]. - **Murphy's sign** (inspiratory arrest on palpation of the right upper quadrant) is characteristic. *Acute hepatitis* - Acute hepatitis involves **liver inflammation** causing jaundice, fatigue, and elevated liver enzymes, but does not cause flank bruising. - It does not present with signs of retroperitoneal hemorrhage. *Acute appendicitis* - Acute appendicitis typically causes **periumbilical pain** that migrates to the right lower quadrant, associated with nausea, vomiting, and fever [2]. - Classic signs include **McBurney's point tenderness** and rebound tenderness, not flank ecchymosis.
Question 5: A patient presents with severe abdominal pain, distention, and jaundice. Serum amylase and lipase are elevated. What is the most likely diagnosis?
- A. Peptic ulcer disease
- B. Hepatitis
- C. Acute pancreatitis (Correct Answer)
- D. Gallstones
Explanation: ***Acute pancreatitis*** - The combination of **severe abdominal pain**, **distention**, and **jaundice**, along with **elevated serum amylase and lipase**, is highly indicative of acute pancreatitis [1]. - **Jaundice** may result from the obstruction of the common bile duct by inflammation or gallstones, a common cause of acute pancreatitis [2]. *Peptic ulcer disease* - While it can cause **severe abdominal pain**, it does not typically lead to **distention** or **jaundice** unless complicated by perforation or obstruction, and **amylase/lipase** are usually normal [1]. - Diagnosis is often confirmed by endoscopy, revealing **ulcerations** in the stomach or duodenum. *Hepatitis* - **Hepatitis** can cause **jaundice** and abdominal pain, particularly in the right upper quadrant, but it does not generally cause **abdominal distention** or elevated **amylase/lipase** levels. - Liver enzymes like **ALT and AST** would be significantly elevated. *Gallstones* - **Gallstones** can cause severe abdominal pain (biliary colic), and if they obstruct the common bile duct, can lead to **jaundice** and sometimes pancreatitis [2]. - However, **gallstones** themselves are a cause, not the diagnosis, for the described constellation of symptoms including **elevated amylase and lipase** which strongly points to acute pancreatitis.
Question 6: Nerve endings sensitive to noxious stimuli are present in all except:
- A. Intestine
- B. Stomach
- C. Liver (Correct Answer)
- D. Mesentery
Explanation: ***Liver*** - The **liver parenchyma** itself is notable for its lack of **pain receptors**; therefore, sensations like cutting or burning of the liver tissue do not evoke direct pain. - Pain associated with the liver typically arises from the stretching of its **fibrous capsule (Glisson's capsule)** or involvement of surrounding structures, rather than from within the organ. *Intestine* - The intestine contains abundant **nociceptors** that respond to a variety of noxious stimuli, including **distention**, **ischemia**, and **chemical irritants**. - These nerve endings play a crucial role in mediating **visceral pain** experienced during conditions such as inflammatory bowel disease or irritable bowel syndrome. *Stomach* - The stomach is richly innervated with **nociceptors** that detect painful stimuli such as extreme **distension**, potent **chemical irritants**, and **ischemia**. - These nerve endings contribute to the sensation of **gastric pain** associated with conditions like gastritis, ulcers, and gastroesophageal reflux disease. *Mesentery* - The mesentery contains numerous **nociceptors** that are highly sensitive to **stretching**, **ischemia**, and **inflammation**. - Pain originating from the mesentery can be intense and is often implicated in conditions like **mesenteric ischemia** or **peritonitis**.
Question 7: A patient has recurrent abdominal pain and jaundice. The blood investigations reveal reticulocytosis and hyperbilirubinemia. What is the clinical diagnosis?
- A. Hereditary spherocytosis (Correct Answer)
- B. Mirizzi's syndrome
- C. Sclerosing cholangitis
- D. Choledochal cyst
Explanation: ***Hereditary spherocytosis*** - The combination of **recurrent abdominal pain**, **jaundice**, **reticulocytosis**, and **hyperbilirubinemia** is highly suggestive of hereditary spherocytosis, which causes chronic hemolytic anemia [1, 3]. - **Jaundice** and **abdominal pain** can result from pigment gallstones (due to chronic hemolysis) and splenic enlargement, both common in this condition [2, 3]. *Mirizzi's syndrome* - Characterized by **extrinsic compression of the common hepatic duct** by a stone impacted in the cystic duct or gallbladder neck. - While it causes jaundice and abdominal pain, it does not typically present with **reticulocytosis** or **hemolysis** [1]. *Sclerosing cholangitis* - A chronic cholestatic liver disease characterized by **inflammation and fibrosis** of the bile ducts. - While it causes jaundice and abdominal pain, it is not associated with **reticulocytosis** or signs of **hemolysis** [1]. *Choledochal cyst* - A **congenital dilation of the bile ducts**, leading to recurrent abdominal pain, jaundice, and a palpable mass. - It does not involve **hemolysis** or **reticulocytosis**, making it less likely in this context.
Question 8: Which of the following statements regarding lymphoedema are correct? 1. Patients experience constant dull ache and even severe pain sometimes 2. Manual lymphatic drainage has a role 3. Primary lymphoedema is caused by congenital lymphatic dysplasia 4. Nonne Milroy's disease is a type of primary lymphoedema Select the correct answer using the code given below:
- A. 1 and 2 only
- B. 1, 2, 3 and 4 (Correct Answer)
- C. 3 and 4 only
- D. 1, 2 and 3 only
Explanation: ***1, 2, 3 and 4*** - All four statements are correct regarding lymphoedema. Patients often experience **constant dull ache and severe pain** due to the swelling and tissue changes. - **Manual lymphatic drainage (MLD)** is a key component of complete decongestive therapy for lymphoedema, aiming to reduce swelling and improve lymphatic flow. **Primary lymphoedema** is indeed caused by **congenital lymphatic dysplasia**, which refers to abnormalities in lymphatic system development from birth. **Milroy's disease** (also known as Nonne-Milroy disease) is a specific type of primary lymphoedema characterized by early-onset lymphatic dysfunction. *1 and 2 only* - This option is incomplete as statements 3 and 4 are also correct. - It correctly identifies the role of manual lymphatic drainage and the presence of pain in lymphoedema but omits other accurate facts. *3 and 4 only* - This option is incomplete as statements 1 and 2 are also correct. - While correctly identifying the nature of primary lymphoedema and Milroy's disease, it misses other important aspects of lymphoedema. *1, 2, and 3 only* - This option is incomplete because statement 4, concerning Milroy's disease as a type of primary lymphoedema, is also correct. - It provides correct information about pain, MLD, and the cause of primary lymphoedema but omits a specific example of primary lymphoedema.
Question 9: In an unconscious patient, spinal injury is assessed by:
- A. Absence of response to painful stimulus
- B. Abdominal respiration
- C. Absence of deep tendon reflexes
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** In an unconscious patient, spinal cord injury assessment relies on a **comprehensive clinical examination** using multiple findings, as the patient cannot provide history or cooperate with neurological examination. All three assessment methods are used: - **Absence of response to painful stimulus below a certain level** indicates sensory pathway disruption and helps localize the level of spinal injury - **Abdominal (diaphragmatic) respiration** occurs when intercostal muscles are paralyzed due to high cervical/thoracic spinal cord injury (typically C3-C5), forcing the diaphragm to compensate - this is a key clinical sign - **Absence of deep tendon reflexes** below the injury level indicates spinal shock or complete spinal cord lesion, as neural pathways for reflexes are interrupted Since the patient is unconscious and cannot communicate, clinicians must use **objective physical findings** - all three signs together help assess for potential spinal injury and guide urgent management including spinal immobilization and imaging. *Why individual findings alone would be insufficient:* Each sign can have other causes, so comprehensive assessment using all findings together increases diagnostic accuracy and prevents missed injuries in this high-risk scenario.
Question 10: A 35-year-old construction worker presents with a 3-month history of abdominal pain, fatigue, and recent onset of numbness and tingling in his hands and feet. He works in renovation of old buildings. Physical examination reveals mild pallor and decreased sensation in a stocking-glove distribution. Blood tests show microcytic anemia with basophilic stippling on peripheral smear. What is the most likely diagnosis?
- A. Coeliac disease
- B. Sickle cell disease
- C. Lead poisoning (Correct Answer)
- D. Hookworm infestation
Explanation: **Lead poisoning** - The patient's occupation in **renovating old buildings** poses a significant risk for lead exposure [1]. - Classic symptoms of lead poisoning, such as **abdominal pain** [1], **fatigue**, **peripheral neuropathy** (numbness/tingling in stocking-glove distribution) [2], **pallor** [2], **microcytic anemia**, and **basophilic stippling** [1], are all present. *Coeliac disease* - While it can cause **abdominal pain** and **fatigue** due to malabsorption, it typically leads to **iron deficiency anemia**. - **Neuropathy** is less common and **basophilic stippling** is not a feature of coeliac disease. *Sickle cell disease* - Causes **hemolytic anemia** and painful crises, but is a genetic disorder typically diagnosed in childhood and presents with different symptoms. - While it can present with **fatigue** and **pallor**, **basophilic stippling** is not typical, and neuropathy in a stocking-glove distribution is rare. *Hookworm infestation* - Primarily causes **iron deficiency anemia** due to chronic blood loss from the gut, leading to **fatigue** and **pallor**. - It does not typically cause **basophilic stippling** or prominent **peripheral neuropathy** as described.
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