NREMT Paramedic Cognitive ExamMedicalEasy
A 50-year-old female presents with acute onset of severe, sharp, right upper quadrant abdominal pain radiating to her right shoulder. She reports the pain started after eating a fatty meal. She is nauseated and has vomited once. Her skin is warm and dry, and she has no fever. What is the MOST likely cause of her pain?
- ACholecystitis
- BPerforated ulcer
- CPancreatitis
- DAppendicitis
Show answer & explanationAnswer & explanation
Correct answer: A. Cholecystitis
The classic presentation of acute cholecystitis (inflammation of the gallbladder) includes severe, sharp right upper quadrant pain, often radiating to the right shoulder, and typically exacerbated by fatty meals. Nausea and vomiting are common. The absence of fever suggests it might be acute cholelithiasis (gallstones) without infection yet, or early cholecystitis.
Why the other options are wrong
- B. A perforated ulcer typically causes sudden, severe, generalized abdominal pain ('board-like' rigidity) due to peritonitis, which is not consistent with this localized pain and radiation.
- C. Pancreatitis causes severe epigastric pain, often radiating to the back, and is associated with nausea/vomiting, but the pain location and radiation are different from this case.
- D. Appendicitis causes periumbilical pain migrating to the right lower quadrant, usually with fever and anorexia, not typically related to fatty meals or radiating to the shoulder.
Acute Cholecystitis
Acute cholecystitis is inflammation of the gallbladder, usually caused by gallstones obstructing the cystic duct, characterized by severe right upper quadrant pain, often radiating to the right shoulder, and triggered by fatty meals.
- RUQ pain, often radiating to right shoulder/scapula.
- Triggered or exacerbated by fatty meals.
- Nausea and vomiting are common.
- Murphy's sign (inspiratory arrest with RUQ palpation) is a key finding.
Memory trick: Fatty meal, RUQ pain? Gallbladder's to blame!