Appendicitis, Bowel Obstruction, and Hernias Practice Questions

25 multiple-choice questions on Appendicitis, bowel obstruction, and hernias for paramedic and EMT students, from Chapter 21 (Abdominal and Gastrointestinal Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Compared with adults, young children with appendicitis are more likely to have:

   1. A. Classic migrating RLQ pain
   2. B. A long, mild illness course
   3. C. Pain located only on the left side
   4. D. Rupture by the time of diagnosis
   Show answer

   Answer: D. Rupture by the time of diagnosis

   Young children cannot describe pain well and have a thin omentum, so appendicitis is often diagnosed late and perforation rates are high in those under 5 years. They often do not show the classic migration pattern.

2. Appendicitis is most common in people aged:

   1. A. Under 1 year
   2. B. Over 80 years
   3. C. 40 to 60 years
   4. D. 10 to 30 years
   Show answer

   Answer: D. 10 to 30 years

   It peaks in adolescents and young adults, but can occur at any age. Infants and the elderly often present late and atypically.

3. A 17-year-old had periumbilical pain overnight that has now moved to the RLQ, with nausea and low-grade fever. This is most consistent with:

   1. A. Gastroenteritis
   2. B. Appendicitis
   3. C. Diverticulitis
   4. D. Kidney stone
   Show answer

   Answer: B. Appendicitis

   Migration from central visceral pain to localized RLQ pain is the classic progression. Fever and anorexia often follow.

4. McBurney point tenderness is found:

   1. A. One-third from iliac spine to navel
   2. B. Directly under the left costal margin
   3. C. At the midline above the pubic bone
   4. D. In the left lower quadrant near the hip
   Show answer

   Answer: A. One-third from iliac spine to navel

   McBurney point lies one-third of the way from the right anterior superior iliac spine to the umbilicus, over the usual location of the appendix.

5. Rovsing sign is:

   1. A. RUQ pain when inhaling deeply
   2. B. Bruising around the umbilicus
   3. C. RLQ pain on pressing the LLQ
   4. D. Pain in the left shoulder
   Show answer

   Answer: C. RLQ pain on pressing the LLQ

   Pressing the LLQ shifts bowel contents and stretches the inflamed peritoneum near the appendix, causing RLQ pain.

6. The psoas sign suggests appendicitis when:

   1. A. Extending the right hip causes pain
   2. B. Bending the left knee up causes pain
   3. C. Pressing the RUQ causes pain
   4. D. Coughing causes shoulder pain
   Show answer

   Answer: A. Extending the right hip causes pain

   An inflamed retrocecal appendix lies on the psoas muscle, so stretching the muscle increases pain.

7. A patient with suspected appendicitis suddenly feels better, then becomes febrile and tachycardic with diffuse tenderness. This suggests:

   1. A. Spontaneous resolution
   2. B. Mesenteric adenitis after a virus
   3. C. Rupture with peritonitis
   4. D. Early sepsis from a urinary source
   Show answer

   Answer: C. Rupture with peritonitis

   Rupture briefly relieves pressure, but spilled contents cause diffuse peritonitis and sepsis. Transport urgently. New fever with diffuse abdominal tenderness after a brief lull points to the abdomen, not the urinary tract, and neither spontaneous resolution nor viral lymph node swelling explains it.

8. The most common cause of small bowel obstruction in adults is:

   1. A. Gallstones lodged in the bowel
   2. B. Adhesions from prior surgery
   3. C. Chronic constipation
   4. D. Tumors of the stomach
   Show answer

   Answer: B. Adhesions from prior surgery

   Scar tissue after abdominal surgery can kink or trap the bowel. Hernias are the second most common cause.

9. In a patient with known small bowel obstruction, which change most suggests the trapped bowel is losing its blood supply?

   1. A. Crampy pain that comes and goes
   2. B. Vomiting soon after eating a large meal
   3. C. Mild distension with passing gas
   4. D. Constant pain, fever, and tachycardia
   Show answer

   Answer: D. Constant pain, fever, and tachycardia

   Colicky pain is typical of simple obstruction. When pain becomes constant and is joined by fever, tachycardia, and focal tenderness, the bowel wall may be ischemic, which requires urgent surgery.

10. Compared with a small bowel obstruction, a large bowel obstruction usually has:

    1. A. Earlier and more frequent vomiting
    2. B. No distension at all
    3. C. Bright red hematemesis
    4. D. Later vomiting and more distension
    Show answer

    Answer: D. Later vomiting and more distension

    Colonic obstruction fills slowly, causing marked distension; vomiting comes later. Proximal small bowel obstruction causes early vomiting.

11. Volvulus is:

    1. A. Telescoping of one bowel segment
    2. B. Twisting of the bowel on itself
    3. C. Inflammation of the colon wall
    4. D. A tear in the stomach lining
    Show answer

    Answer: B. Twisting of the bowel on itself

    Twisting cuts off the blood supply and causes obstruction. The sigmoid colon is a common site in older adults.

12. Intussusception most commonly occurs in:

    1. A. Infants and toddlers
    2. B. Teenagers and young adults
    3. C. Middle-aged adults
    4. D. Pregnant women
    Show answer

    Answer: A. Infants and toddlers

    One segment of bowel telescopes into the next. It causes episodes of severe crying and drawing up the legs.

13. Three days after hip surgery, a bedbound 80-year-old has a hugely distended, tympanic abdomen, but imaging shows no blockage. This is most likely:

    1. A. A strangulated hernia
    2. B. Acute appendicitis
    3. C. Colonic pseudo-obstruction
    4. D. A perforated ulcer with peritonitis
    Show answer

    Answer: C. Colonic pseudo-obstruction

    Acute colonic pseudo-obstruction (Ogilvie syndrome) is massive colonic dilation without a mechanical blockage, typically in older hospitalized patients after surgery or with opioids and electrolyte problems. The cecum can perforate if it becomes very dilated.

14. Paralytic ileus differs from mechanical obstruction because it is:

    1. A. Always caused by a groin hernia
    2. B. A twist of the large bowel
    3. C. Painful, bloody diarrhea
    4. D. Loss of peristalsis, no blockage
    Show answer

    Answer: D. Loss of peristalsis, no blockage

    Ileus is a temporary loss of bowel movement after surgery, trauma, infection, or certain drugs. Mechanical obstruction has a physical blockage.

15. A hernia is called incarcerated when it:

    1. A. Cannot be pushed back in
    2. B. Is easily reduced by hand
    3. C. Contains only fat tissue
    4. D. Disappears when lying down
    Show answer

    Answer: A. Cannot be pushed back in

    The protruding contents are trapped. If blood supply is cut off, it becomes strangulated.

16. A strangulated hernia is a surgical emergency because:

    1. A. The bulge may rupture through the skin
    2. B. It causes lasting constipation
    3. C. Trapped bowel loses blood supply
    4. D. The groin muscles are torn apart
    Show answer

    Answer: C. Trapped bowel loses blood supply

    Without blood flow, the bowel becomes ischemic and dies, leading to perforation, peritonitis, and sepsis. Skin rupture, constipation, and torn muscle are not what makes strangulation an emergency; the dying bowel is.

17. Signs that a hernia may be strangulated include:

    1. A. A soft bulge that goes away lying down
    2. B. A firm, discolored, very tender bulge
    3. C. A painless swelling present for years
    4. D. A bulge that grows only with coughing
    Show answer

    Answer: B. A firm, discolored, very tender bulge

    Red or dusky skin, tenderness, fever, and vomiting suggest strangulation. A soft, reducible bulge is usually not an emergency.

18. The most common type of hernia is:

    1. A. Umbilical hernia
    2. B. Inguinal hernia
    3. C. Hiatal hernia
    4. D. Incisional hernia
    Show answer

    Answer: B. Inguinal hernia

    Inguinal hernias are most common, especially in men, appearing as a groin bulge that may extend into the scrotum.

19. In the field, you should manage a suspected incarcerated hernia by:

    1. A. Not forcing it back; transport
    2. B. Pushing it back firmly
    3. C. Applying a tight binder
    4. D. Applying heat packs to the bulge
    Show answer

    Answer: A. Not forcing it back; transport

    Forcing it back can push dead bowel into the abdomen. Position comfortably, give analgesia per protocol, and transport.

20. Which patient is at highest risk for an atypical, late-presenting appendicitis?

    1. A. A healthy 19-year-old student
    2. B. A 25-year-old athlete
    3. C. A 79-year-old with diabetes
    4. D. A 15-year-old with fever
    Show answer

    Answer: C. A 79-year-old with diabetes

    Older and diabetic patients have blunted pain and fever responses and are more likely to present with rupture.

21. Appendicitis in late pregnancy may cause pain higher in the abdomen because:

    1. A. The appendix shrinks in pregnancy
    2. B. Hormones block abdominal pain
    3. C. The appendix moves to the left side
    4. D. The uterus displaces the appendix
    Show answer

    Answer: D. The uterus displaces the appendix

    The enlarging uterus pushes the appendix upward, so pain may be in the right flank or RUQ. Delayed diagnosis raises fetal risk.

22. A 70-year-old with constipation has a hugely distended abdomen and is vomiting. The most likely cause is:

    1. A. Peptic ulcer
    2. B. Viral gastroenteritis
    3. C. Pancreatitis
    4. D. Sigmoid volvulus
    Show answer

    Answer: D. Sigmoid volvulus

    Sigmoid volvulus is common in older, bedridden, or constipated adults. It causes marked distension and can lead to bowel death.

23. Prolonged vomiting from an obstruction can cause:

    1. A. Increased stomach acid and ulcers
    2. B. Elevated blood sugar only
    3. C. Dehydration and electrolyte loss
    4. D. High blood pressure
    Show answer

    Answer: C. Dehydration and electrolyte loss

    Loss of fluid, sodium, potassium, and chloride leads to hypovolemia and dangerous electrolyte changes.

24. An umbilical hernia in an adult with cirrhosis and ascites is concerning because:

    1. A. It signals the liver is recovering
    2. B. Rupture risks leakage and infection
    3. C. It shows the ascites is infected
    4. D. It means the portal vein has clotted
    Show answer

    Answer: B. Rupture risks leakage and infection

    High abdominal pressure from ascites stretches the hernia. Skin breakdown can cause fluid leakage and peritonitis. The hernia itself does not show that the liver is recovering, that the fluid is infected, or that the portal vein has clotted.

25. Which question best helps identify a cause of bowel obstruction?

    1. A. Have you had abdominal surgery?
    2. B. Do you eat a high-fiber diet?
    3. C. Have you eaten spicy food?
    4. D. Do you take an antacid every day?
    Show answer

    Answer: A. Have you had abdominal surgery?

    Previous surgery suggests adhesions, the leading cause of small bowel obstruction. Also ask about hernias and bowel habits. Diet, spicy food, and antacid use do not point to a mechanical cause of obstruction.