Let's look at this question: in which of the following abdominal quadrants is the gallbladder located? Left upper, left lower, right lower, or right upper quadrant? So we know that the abdomen is divided into different quadrants. Where are we going to find the gallbladder? The answer is the right upper quadrant. First, a little bit about what is the gallbladder. The gallbladder stores and releases bile, a fluid that helps digest fats in the small intestine. So, I always think it's helpful to kind of visualize it so we can better understand it. So, the liver sits on top of the gallbladder (you don't need to know this in-depth anatomy, but this can just help you visualize it a little bit). The gallbladder is kind of this little sack that secretes bile into the small intestine. And the purpose of bile is that it helps to break down fats, which allows them to be absorbed. A gallbladder can sometimes become inflamed or develop gallstones, which can cause pain. From our detailed explanations, we're going to be able to break down what exists in the differentquadrants. So we have our right upper quadrant here, left upper quadrant. And remember that this patient is facing us, so this is the right-hand side. And here are some of the major things that we need to remember where they exist. And we can see in the right upper quadrant is where the gallbladder sits. And this is one of those lists that you just have to memorize. In this graphic, we can see if we picture our kind of dividing of the quadrants, we have the gallbladder right here. Which was our question that we just looked at. And for this specific question, I was looking at the liver, which we also see. Kind of the right lobe of the liver is right here. And it's in that upper right quadrant. But our gallbladder right here, right upper. Next question: to which specialist should a patient with fibromyalgia be referred to by a medical assistant? A) Endocrinologist B) Rheumatologist C) Gastroenterologist D) Oncologist So, fibromyalgia, what is that condition? We need to know what fibromyalgia is and then know what each of these different medical specialists do. And the answer is B) Rheumatologist. First, a little bit about fibromyalgia. Fibromyalgia is a pain disorder that can affect the muscles, joints, and soft tissue. So we can see in fibromyalgia this chronic pain disorder, and it causes widespread pain all over, including of the joints. There could be a few people involved in the care of patients with fibromyalgia, but one of them definitely is going to be a rheumatologist. Rheumatologists specialize in treating disorders that affect joints, muscles, and bones. Looking at our answer choices, an endocrinologist is someone that treats disorders of the endocrine system. The endocrine system is all about these different glands that secrete hormones. So, an endocrinologist would treat things like diabetes or thyroid disorder. A gastroenterologist is someone that treats the digestive system. D) Oncologists treat cancer. So, an oncologist is someone that helps to manage patients that have cancer. And then finally, rheumatologists are specialists that treat the joints, muscles, and bones, and they would be the one that's best suited, out of our answer choices, to treat fibromyalgia.
Another possible answer choice that would be valid that isn't on here would be things like a neurologist or a pain specialist, which would also possibly be involved in the care of someone with fibromyalgia. Okay, next question: when administering Heparin subcutaneously, what is the recommended method of injecting the medication? A) Insert the needle at 10 degrees B) Inject the medication slowly C) Use an 18 gauge needle D) Inject the medication into a vein The answer is B) Inject the medication slowly. Related question here: when performing a subcutaneous injection (and we happen to know fromour question that Heparin is injected subcutaneously), which of the following needle sizes should the assistant use? So I know that a subcutaneous injection is done at 25 to 26 gauge. And we're going to use this explanation, this detailed explanation, to learn a little bit more about subcutaneous injections. So, one, a subcutaneous injection is delivered at 45-degree angles via a 25 to 26 gauge short needle. And we can see that 45-degree angle here. And a subcutaneous injection is going underneath the skin into that subcutaneous tissue. So first off, we're learning from this explanation that subcutaneous injections are delivered into fatty tissue. Next, we know from this explanation that we're using a 25 to 26 gauge needle for a subcutaneous injection. An 18 to 21 gauge needle is used for intravenous, and the gauge of the needle just refers to the thickness of it. And people sometimes get confused by this. The higher the gauge, the smaller the diameter of the needle. So, a 26 gauge needle, you can see, is a lot thinner than an 18 gauge needle. So picture an intravenous injection, you want that big, thick needle going in there, whereas a subcutaneous injection into the fatty tissue, you're going to go a lot thinner, which is a higher gauge needle. Okay, so we've eliminated D and we've eliminated C. Next, "insert the needle at 10 degrees." No, we know that for a subcutaneous injection, we're going to deliver the injection at 45 degrees. And that leaves us with answer choice B about injecting the medication slowly. So first off, a little bit of review, what is Heparin? It's a medication used to prevent blood clots. And it's important to inject this medication slowly because it's going into that subcutaneous layer, and that's going to allow it to be absorbed better and prevent discomfort for patients. To review our answer choices: "insert the needle at 10 degrees," no, we know that a subcutaneous injection is given at 45 degrees or 90 degrees for an obese patient. It's an intradermal injection that's given into the skin layer, for example, like in an allergy test. That's given at 10 to 15 degrees. We know B is our correct answer, inject the medication slowly. C, use an 18 gauge needle, no, we know that for a subcutaneous injection, it's going to be 25 to 26gauge. And D, inject the medication into a vein, no, an IV injection is given into a vein. A subcutaneous injection is given into the fatty layer. Next question: what body system is affected by pyloric stenosis?
So in order to answer this question, we need to be able to determine what pyloric stenosis is. Is it affecting: A) Nervous system B) Respiratory system C) Musculoskeletal D) Gastrointestinal The answer is D) Gastrointestinal. We can either memorize what pyloric stenosis is just to get the question right if it shows up on our test, but we also can try and understand a little bit better. So, in the stomach, this bottom area of the stomach where the stomach connects with the small intestine is called the pylorus. And stenosis refers to a narrowing. So pyloric stenosis is the idea that the pylorus region, the pyloric region, is narrowing. This can make it difficult for food to passthrough. Pyloric stenosis is most common in infants and can cause them to have difficulty with absorbing nutrients and lead to weight loss and dehydration. And it often requires surgery. And because pyloric stenosis involves the stomach and the small intestine, we know that it's related to the gastrointestinal tract. Gastrointestinal meaning the stomach (gastric) as well as intestines. It's that digestive system that passes all the way from the mouth and throat all the way down into the rectum. Next question: which of the following statements made by a patient demonstrates their understanding of administering an insulin injection? A) I will use the same site of injection daily B) I will swallow the insulin on an empty stomach C) Iwill shake the bottle vigorously before drawing the medication D) I will roll the bottle between myhands before drawing the medication The answer is D) I will roll the bottle between my hands before drawing the medication. So let's go through some of the incorrect answer choices first. A) I will use the same site of injection daily. This is incorrect. This can lead to tissue damage because you keep on damaging and bruising that area, which can lead to the inability for the insulin to be absorbed properly. So it's important for diabetics to rotate the site of injections and not keep on using the same site day in and day out. B) I will swallow the insulin on an empty stomach. This is incorrect because insulin is injected subcutaneously. It must be injected subcutaneously, so into that subcutaneous fatty layer that we talked about before to be effective. It isn't swallowed. Diabetics take other medication like metformin, oral medications to help manage their diabetes, but that's different than the insulin itself, which actually must be injected to be effective. C) I will shake the bottle before drawing the medication. This kind of relates to "I will roll the bottle" right. These are opposite ideas. One is shaking and one is rolling the bottle of insulin. And shaking the insulin bottle can cause the insulin to foam, and that can affect the accuracy when they're trying to draw out from the bottle into their syringe. Whereas, opposed to rolling the bottle, we have this insulin that's in suspension. You have the medication, it's kind of in this liquid. And rolling the bottle helps to mix the medication to ensure that the insulin is evenly
dispersed throughout that liquid. But because we're rolling it versus shaking it, when we roll it, it doesn't cause that bubbling and foaming. And therefore, we can ensure that the patient is getting the correct dosage. And this relates to patient education, right? This is something that you have a new diabetic patient or you're reviewing how to administer the medication with a patient. It's important that weknow this information so that we can give them the proper instructions. And again, this is a high-yield question that definitely shows up on the NHA CCMA.