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 after eating a fatty meal and is accompanied by nausea and vomiting. She is afebrile. Her vital signs are stable. What is the most likely diagnosis?
- APeptic ulcer disease.
- BAcute cholecystitis.
- CAcute appendicitis.
- DGastroenteritis.
Show answer & explanationAnswer & explanation
Correct answer: B. Acute cholecystitis.
The patient's presentation with acute, severe, sharp right upper quadrant (RUQ) pain radiating to the right shoulder, occurring after a fatty meal, and accompanied by nausea and vomiting, is classic for acute cholecystitis (inflammation of the gallbladder, usually due to gallstones).
Why the other options are wrong
- A. Peptic ulcer disease usually causes burning epigastric pain, often relieved by food or antacids, and is not typically triggered by fatty meals or radiating to the shoulder.
- C. Acute appendicitis typically presents with periumbilical pain migrating to the right lower quadrant and is often associated with fever and anorexia, not RUQ pain radiating to the shoulder after a fatty meal.
- D. Gastroenteritis typically involves diffuse abdominal cramping, diarrhea, and vomiting, but not usually localized, sharp RUQ pain radiating to the shoulder.
Acute Cholecystitis Presentation
Acute cholecystitis is inflammation of the gallbladder, usually due to gallstones obstructing the cystic duct. It classically presents with severe right upper quadrant pain, often radiating to the right shoulder, triggered by fatty meals.
- Right upper quadrant (RUQ) pain, often radiating to right shoulder/scapula.
- Pain often triggered by fatty foods.
- Associated with nausea and vomiting.
- Murphy's sign (inspiratory arrest on RUQ palpation) is a classic finding.
Memory trick: Gallbladder's Gripe: Greasy Food, Right Upper Pain, Radiates to Shoulder.