NREMT Paramedic Cognitive ExamMedicalEasy
A 50-year-old female presents with acute onset of severe, sharp, right upper quadrant abdominal pain that radiates to her right shoulder. The pain began shortly after eating a fatty meal and is accompanied by nausea and vomiting. She denies fever. Her vital signs are stable. On palpation, she has tenderness in the right upper quadrant. Which of the following is the most likely diagnosis?
- AAcute Cholecystitis
- BAppendicitis
- CAcute Pancreatitis
- DGastroenteritis
Show answer & explanationAnswer & explanation
Correct answer: A. Acute Cholecystitis
The patient's symptoms (acute, severe, sharp right upper quadrant pain radiating to the right shoulder, post-fatty meal onset, nausea, vomiting, RUQ tenderness) are classic for acute cholecystitis, which is inflammation of the gallbladder, often due to gallstones.
Why the other options are wrong
- B. Appendicitis typically presents with periumbilical pain migrating to the right lower quadrant, not the right upper quadrant or radiating to the shoulder.
- C. Acute pancreatitis typically presents with severe epigastric pain radiating to the back, often associated with alcohol abuse or gallstones, but less commonly sharp RUQ pain radiating to the shoulder.
- D. Gastroenteritis typically involves diffuse abdominal pain, diarrhea, and vomiting, but not usually localized severe RUQ pain or radiation to the shoulder.
Acute Cholecystitis
Acute inflammation of the gallbladder, usually caused by gallstones obstructing the cystic duct, often triggered by fatty meals.
- Severe right upper quadrant pain
- Pain often radiates to the right shoulder or back
- Triggered by fatty meals, accompanied by nausea/vomiting
Memory trick: Fatty Food, Shoulder Pain, Gallbladder Blame!