Vascular Emergencies, Peritonitis, and Mimics Practice Questions

25 multiple-choice questions on Vascular emergencies, peritonitis, and mimics 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. Which patient is at highest risk for an abdominal aortic aneurysm?

   1. A. A 72-year-old male smoker, high BP
   2. B. A 24-year-old female marathon runner
   3. C. A 35-year-old man with GERD
   4. D. A 16-year-old with asthma
   Show answer

   Answer: A. A 72-year-old male smoker, high BP

   Age over 65, male sex, smoking, hypertension, and family history are the main AAA risk factors. Smoking is the strongest modifiable one.

2. A 78-year-old had his aortic aneurysm repaired with a stent graft (EVAR) years ago. He now has sudden back pain and hypotension. You should:

   1. A. Rule out the aorta; it was fixed
   2. B. Suspect a kidney stone and wait
   3. C. Give large fluid boluses to normal BP
   4. D. Treat it as a possible rupture
   Show answer

   Answer: D. Treat it as a possible rupture

   After endovascular repair, blood can still leak around the graft (endoleak) and the aneurysm can enlarge and rupture. Prior repair does not exclude a vascular catastrophe. Fluids are titrated to perfusion, not to a normal BP.

3. A 70-year-old male smoker fainted at home and now has back pain and BP 90/60. The syncope is most worrying because it may signal:

   1. A. A simple vasovagal faint
   2. B. Dehydration from the heat
   3. C. A ruptured aortic aneurysm
   4. D. A muscle strain from falling
   Show answer

   Answer: C. A ruptured aortic aneurysm

   Syncope with back or abdominal pain and hypotension in an older man is a classic presentation of a ruptured AAA. Assuming a vasovagal faint or a strain from the fall risks missing a lethal bleed.

4. A 74-year-old with a known 6-cm aneurysm has new back pain, BP 168/92, and is anxious. The best approach is:

   1. A. A fluid bolus to protect perfusion
   2. B. Gentle handling, pain relief, transport
   3. C. Deep palpation to measure the mass
   4. D. Walking him to the cot to save some time
   Show answer

   Answer: B. Gentle handling, pain relief, transport

   A symptomatic aneurysm may be about to rupture. Avoid exertion and deep palpation, treat pain (which also lowers BP), and transport promptly to a vascular center. He is hypertensive, so a fluid bolus is not indicated.

5. Which pulse finding supports a ruptured AAA?

   1. A. Weak or unequal femoral pulses
   2. B. Strong, equal radial pulses
   3. C. Bounding carotid pulses
   4. D. Slow pulse after brief exertion
   Show answer

   Answer: A. Weak or unequal femoral pulses

   A rupture can reduce blood flow to the legs. Diminished or unequal femoral pulses, or cool legs, support the diagnosis.

6. Mesenteric ischemia is most strongly associated with:

   1. A. Asthma
   2. B. Atrial fibrillation
   3. C. Migraine headaches
   4. D. Primary hypothyroidism
   Show answer

   Answer: B. Atrial fibrillation

   Clots from a fibrillating atrium can lodge in the mesenteric arteries, cutting off blood flow to the bowel.

7. The hallmark of early mesenteric ischemia is:

   1. A. Rigid abdomen from the start
   2. B. Painless bloody diarrhea
   3. C. Fever and jaundice
   4. D. Severe pain, soft abdomen
   Show answer

   Answer: D. Severe pain, soft abdomen

   Early on, the bowel is ischemic but the peritoneum is not inflamed, so pain is severe while the exam is mild. Later, infarction causes peritonitis.

8. A patient with peritonitis has a temperature of 35.6 C (96 F) and BP 84/50. The low temperature should be seen as:

   1. A. Proof there is no infection
   2. B. A reassuring sign of recovery
   3. C. A sign of severe sepsis
   4. D. A result of the room being cool
   Show answer

   Answer: C. A sign of severe sepsis

   Hypothermia in sepsis is associated with higher mortality than fever and reflects a failing response. Lack of fever does not rule out infection, especially in older adults.

9. The most common cause of bacterial peritonitis is:

   1. A. Urinary tract infection
   2. B. Upper respiratory infection
   3. C. Skin abscess
   4. D. Hollow organ perforation
   Show answer

   Answer: D. Hollow organ perforation

   A ruptured appendix, perforated ulcer, or bowel perforation releases bacteria into the peritoneal cavity.

10. A patient with peritonitis may develop shock primarily due to:

    1. A. Peritoneal bleeding
    2. B. Primary heart pump failure
    3. C. Sepsis and fluid shifts
    4. D. Loss of spinal sympathetic tone
    Show answer

    Answer: C. Sepsis and fluid shifts

    Bacteria and inflammation cause vasodilation and capillary leak. Fluid moves into the abdomen, reducing circulating volume. Peritonitis is an infection, not a bleed, and it does not begin as pump failure or loss of spinal sympathetic tone.

11. Which cardiac emergency commonly presents as epigastric pain and nausea?

    1. A. Inferior wall MI
    2. B. Stable angina at rest
    3. C. Acute pericarditis
    4. D. Mitral valve prolapse
    Show answer

    Answer: A. Inferior wall MI

    The inferior wall is near the diaphragm, so ischemia may be felt in the epigastrium. Obtain a 12-lead ECG.

12. A diabetic patient in DKA may complain of:

    1. A. Sudden headache with a stiff neck
    2. B. Abdominal pain and vomiting
    3. C. Sharp pain on deep breathing
    4. D. Burning pain in both feet
    Show answer

    Answer: B. Abdominal pain and vomiting

    DKA often causes abdominal pain, nausea, and vomiting, especially in children. Check glucose in any vomiting patient with diabetes. Burning feet reflect chronic neuropathy rather than DKA, and a sudden headache with a stiff neck or sharp pain on breathing points to other problems.

13. Which condition in a young woman can mimic appendicitis?

    1. A. Gastric ulcer disease
    2. B. Esophagitis
    3. C. Ovarian torsion
    4. D. Hepatitis A
    Show answer

    Answer: C. Ovarian torsion

    Ovarian torsion causes sudden lower abdominal pain, nausea, and vomiting. Ectopic pregnancy and PID can also mimic appendicitis.

14. A patient with fever, cough, and right upper quadrant pain may actually have:

    1. A. Left-sided diverticulitis
    2. B. Testicular torsion
    3. C. Sigmoid volvulus
    4. D. Lower lobe pneumonia
    Show answer

    Answer: D. Lower lobe pneumonia

    Basilar pneumonia irritates the diaphragm and lower intercostal nerves. Listen to the lungs and check for fever and cough.

15. Testicular torsion may present with:

    1. A. Bright red hematemesis
    2. B. Lower abdominal pain
    3. C. Black, tarry stools
    4. D. RUQ pain after fatty meals
    Show answer

    Answer: B. Lower abdominal pain

    Boys and young men may report abdominal pain rather than scrotal pain. Torsion is a surgical emergency with a narrow window.

16. Which overdose is known for causing early vomiting, abdominal pain, and GI bleeding?

    1. A. Iron
    2. B. Carbon monoxide
    3. C. Opioids
    4. D. Benzodiazepines
    Show answer

    Answer: A. Iron

    Iron overdose damages the gut lining, and chronic lead exposure causes colicky abdominal pain. Ask about ingestions.

17. Sickle cell crisis can cause:

    1. A. Polycythemia
    2. B. A low white cell count
    3. C. Severe abdominal pain
    4. D. Bradycardia and hypothermia
    Show answer

    Answer: C. Severe abdominal pain

    Sickled cells block small vessels, causing ischemia in organs including the spleen and bowel. Pain may be severe. Sickle cell disease causes anemia, not polycythemia, the white count is often raised rather than low, and a crisis usually brings tachycardia rather than bradycardia.

18. Which finding most strongly suggests the pain is from an AAA rather than a kidney stone?

    1. A. Blood in the urine
    2. B. Pain radiating to the groin
    3. C. Nausea and vomiting
    4. D. Hypotension, pulsing mass
    Show answer

    Answer: D. Hypotension, pulsing mass

    Hematuria, groin radiation, and vomiting can occur with both. Shock and a pulsatile mass point toward AAA.

19. A 70-year-old has 3 days of burning, band-like pain wrapping around the right flank. There is no rash, and his abdomen is soft and nontender. You should consider:

    1. A. Early shingles before the rash
    2. B. A ruptured spleen
    3. C. A left-sided kidney stone
    4. D. Acute appendicitis with rupture
    Show answer

    Answer: A. Early shingles before the rash

    Herpes zoster can cause dermatomal burning pain for days before the rash appears, mimicking abdominal or chest disease. Appendicitis causes tenderness, and the spleen and a left stone do not fit a right-sided band of pain.

20. After a cocaine binge, a 34-year-old has severe abdominal pain with a soft abdomen and bloody stools. You should suspect:

    1. A. Gastroenteritis
    2. B. Bowel ischemia
    3. C. Constipation
    4. D. An anal fissure
    Show answer

    Answer: B. Bowel ischemia

    Cocaine causes intense vasoconstriction and can produce intestinal ischemia, with pain out of proportion to exam and bloody stools, even in young patients. Gastroenteritis and constipation do not explain this combination.

21. The major concern with abdominal pain in a dialysis patient on peritoneal dialysis is:

    1. A. Low blood sugar from the dialysate
    2. B. Kidney stones from the dialysate
    3. C. A ruptured spleen
    4. D. Peritonitis from the catheter
    Show answer

    Answer: D. Peritonitis from the catheter

    Bacteria can enter through the catheter. Cloudy dialysate, fever, and abdominal pain suggest peritonitis. Dialysate contains glucose, so it raises rather than lowers blood sugar, and it does not form kidney stones or injure the spleen.

22. Abdominal pain after blunt trauma with hypotension should be assumed to be:

    1. A. Abdominal muscle strain
    2. B. Gastritis
    3. C. Internal bleeding
    4. D. Constipation
    Show answer

    Answer: C. Internal bleeding

    Solid organ injury (spleen, liver) can bleed heavily with few external signs. Treat for shock and transport to a trauma center.

23. Why might a patient with a ruptured AAA have a normal blood pressure at first?

    1. A. The retroperitoneum holds the blood
    2. B. The bleeding stays inside the aneurysm
    3. C. The kidneys raise the BP
    4. D. The bleed comes from low-pressure veins
    Show answer

    Answer: A. The retroperitoneum holds the blood

    A rupture into the retroperitoneum can be contained briefly. Free rupture into the abdomen quickly causes profound shock. A rupture by definition leaks blood out of the aneurysm, the bleeding is arterial, and the kidneys cannot raise the pressure fast enough to explain it.

24. Which finding with abdominal pain suggests sepsis?

    1. A. Normal vitals and mild pain
    2. B. Fever, tachycardia, and confusion
    3. C. Pain only with movement
    4. D. Localized tenderness without fever
    Show answer

    Answer: B. Fever, tachycardia, and confusion

    Systemic signs such as fever, tachycardia, hypotension, and altered mental status suggest the infection has spread.

25. An older patient with heart failure has abdominal pain, distension, and RUQ fullness. Which cause should you consider?

    1. A. Ruptured spleen from trauma
    2. B. Pyloric stenosis
    3. C. Acute appendicitis
    4. D. Hepatic congestion
    Show answer

    Answer: D. Hepatic congestion

    Right-sided heart failure backs blood into the liver, causing tender hepatomegaly and ascites.