Question

a patient is in clinic for evaluation of sudden onset of abdominal pain. the provider palpates a pulsatile, painful mass between the xiphoid process and the umbilicus. what is the initial action?
order a cbc, type and crossmatch, electrolytes, and renal function tests.
perform an ultrasound examination to evaluate the cause.
schedule the patient for an aortic angiogram.
transfer the patient to the emergency department for a surgical consult.

Explanation:

A pulsatile, painful mass between the xiphoid process and umbilicus may indicate an abdominal - aortic aneurysm (AAA) which can be life - threatening. The most immediate and non - invasive way to evaluate the cause is through an ultrasound. Blood tests (CBC, etc.) are not the first step as they don't directly visualize the mass. Aortic angiogram is more invasive and not the initial step. Transferring to the ED for surgical consult without first confirming the diagnosis via a non - invasive method like ultrasound is premature.

Answer:

Perform an ultrasound examination to evaluate the cause.