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Free NREMT practice questionsFree Paramedic practice questions · Medical/Obstetrics/Gynecology

1 free Paramedic practice questions: Abdominal Pain

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Question 1 of 1

A 71-year-old patient reports the sudden onset of severe, constant abdominal pain that radiates into the back and began 1 hour ago. The patient has a history of hypertension and has smoked for 40 years. The abdomen is tender, and a pulsatile mass is palpated to the left of the midline above the umbilicus. The skin is pale, cool, and diaphoretic. The vital signs are BP 88/56, P 124, and R 24, with SpO₂ 95% on room air. What condition should the paramedic most strongly suspect as the cause of this emergency?

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Correct answer · Abdominal aortic aneurysm

This patient has a leaking abdominal aortic aneurysm. A pulsatile mass sits to the left of the midline above the umbilicus. No other option produces a pulsatile mass. The patient also has high blood pressure and has smoked for 40 years. High blood pressure and smoking are the classic history for an abdominal aortic aneurysm. The aneurysm is leaking blood, and the pain goes straight through to the back. The pulse of 124, the blood pressure of 88/56, and the pale, cool, diaphoretic skin tell you the patient is losing blood. Handle this patient gently, and do not keep pressing on the mass. Start large bore IV access, but do not push fluid to bring the blood pressure back to normal. A higher pressure can push more blood out of the aneurysm. Transport right away to a hospital that has vascular surgery.

Why the others are wrong

Perforated peptic ulcer: A perforated peptic ulcer causes sudden, severe abdominal pain with a rigid abdomen. A perforated ulcer never produces a pulsatile mass, and the pulsatile mass points to the aorta.

Acute pancreatitis: gives severe upper abdominal pain that goes through to the back. Pancreatitis is common with alcohol use or gallstones, and nothing in this history points to either one. An inflamed pancreas also never gives you a pulsatile mass.

Renal colic: A kidney stone causes renal colic, with sudden, severe flank pain that moves toward the groin. Renal colic comes in waves, and this patient's pain is constant. A kidney stone does not explain the pulsatile mass above the umbilicus. A stone also does not drop the blood pressure to 88/56. That pressure, with a pulse of 124 and pale, cool, diaphoretic skin, means this patient is losing blood.

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