lOMoAR cPSD| 64639315
NR509 Bates interactive
Questions Final
Advanced Physical
Assessment (Chamberlain
University)
, lOMoAR cPSD| 64639315
Bates interactive Questions
Week 5Chapter 19- Abdomen
• An overweight 26-year-old public servant presents to the Emergency Department with 12
hours of intense abdominal pain, lightheadedness, and a fainting episode that finally
prompted her to seek medical attention. She has a strong family history of gallstones and
is concerned about this possibility. She has not had any vomiting or diarrhea. She had a
normal bowel movement this morning. Her βhuman chorionic gonadotropin (β-hCG) is
positive at triage. She reports that her last period was 10 weeks ago. Her vital signs at
triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen saturation,
99%; and temperature, 37.3ºC orally. The clinician performs an abdominal exam prior to
her pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound
tenderness. What is the most likely diagnosis? o A- ruptured tubal o B- acute
cholecystitis o C- ruptured appendix o D- perforated bowel wall o E- ruptured ovarian
cyst
Answer: A
• A 63-year-old janitor with a history of adenomatous colonic polyps presents for a well
visit. Basic labs are performed to screen for diabetes mellitus and dyslipidemia.
Electrolytes and liver enzymes were also measured. His labs are all normal expect for
moderate elevations of aspartate aminotransferase, alanine aminotransferase, γglutamyl
transferase, and alkaline phosphatase as well as a mildly elevated total bilirubin. He
presents for a follow-up appointment and the clinician performs an abdominal exam to
assess his liver. Which of the following findings would be most consistent with
hepatomegaly? o A- Liver span of 11cm at the midclavicular line
o B- Liver span of 8cm at the midsternal line
o C- dullness to percussion over a span of 11cm at the midclavicular line
o D- dullness to percussion over a span of 8cm at the midsternal line
o E- Liver palpable 3cm below the right costal margin, midclavicular line on
expiration.
Answer: E:
The liver being palpable 3 cm below the right costal margin, midclavicular
line, would be considered normal on inspiration when the liver is pushed down
into the abdominal cavity on inspiration, but is abnormal on expiration. Findings
to support hepatomegaly would be more convincing if, by percussion, the liver
span was >12 cm at the midclavicular line. For patients with obstructive lung
disease, air trapping in the lungs may displace the liver downwards into the
Downloaded by Skyler Sammuel's ()
, lOMoAR cPSD| 64639315
abdominal cavity. The liver span and dullness to percussion refer to the same
measurement. Measurements of 6–12 cm at the midclavicular line and 4–8 cm at
the midsternal line are considered normal.
• A 63-year-old underweight administrative clerk with a 50-pack-year smoking history
presents with a several month history of recurrent epigastric abdominal discomfort. She
feels fairly well otherwise and denies any nausea, vomiting, diarrhea, or constipation. She
reports that a first cousin died from a ruptured aneurysm at age 68 years. Her vital signs
are pulse, 86; blood pressure, 148/92; respiratory rate, 16; oxygen saturation, 95%; and
temperature, 36.2ºC. Her body mass index is 17.6. On exam, her abdominal aorta is
prominent, which is concerning for an abdominal aortic aneurysm (AAA). Which of the
following is her most significant risk factor for an AAA?
o A- female gender o B- history of smoking o C- underweight
o D- family history of ruptured aneurysm
o E- hypertension
Answer: B
History of smoking is her most significant risk factor for an AAA. Male
gender, not female gender, is considered as risk factor. Underweight is not
a risk factor for AAA. Family history of ruptured aneurysm is vague and
could be a cerebral aneurysm.
• A 76-year-old retired man with a history of prostate cancer and hypertension has been
screened annually for colon cancer using high sensitivity fecal occult blood testing (FOBT).
He presents for follow-up of his hypertension, during which the clinician scans his chart to
ensure he is up to date with his preventive health care. He has a positive FOBT on one
occasion at age 66 years and subsequently went for a colonoscopy. Internal hemorrhoids
and sigmoid diverticuli were found on colonoscopy. He has no first-degree relatives with
a history of colorectal cancer or adenomatous polyps. What are the U.S. Preventive
Services Task Force (USPSTF) screening recommendations for this patient? o A- do not
screen routinely o B- continue annual FOBT screening until age 80 o C- continue annual
FOBT screening until age 85 o D- repeat colonoscopy this year
o E- sigmoidoscopy every 5 years with FOBT every 3 years
Answer: A
The USPSTF recommends not screening routinely. For most adults ages
76–85 years, the gain in life years is small compared to colonoscopy risks.
It is advised to discuss individualized risks and benefits with the patient.
Annual FOBT screening may continue until age 80–85 years if benefits to
doing so outweigh risks for the individual patient; however, screening
should not be routinely continued. In general, a life expectancy >7 years is
Downloaded by Skyler Sammuel's ()
, lOMoAR cPSD| 64639315
necessary for screening to be potentially beneficial. There is no indication
to repeat a colonoscopy given the absence of any cancerous or
precancerous findings on his colonoscopy 10 years ago. Sigmoidoscopy
every 5 years with FOBT every 3 years is a valid screening option, but
again screening is not routinely recommended for patients age >75 years.
• An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a 3-
year history of recurrent crampy abdominal pain that lasts for about 1–2 weeks each
episode and is associated with onset of constipation. She describes infrequent, small hard
stool that she finds very difficult to pass. She has tried to increase dietary fiber and water
intake, but usually this is not sufficient and she resorts to over-thecounter laxatives, which
she finds upset her stomach but do resolve the constipation. Symptoms typically gradually
resolve with bowel movements. Which of the following is the most likely physiological
mechanism for her constipation? o A- a large, firm fecal mass in the rectum o B-
decreased fecal bulk o C- Functional change in bowel movement o D- spasm of the
externa sphincter o E- impairment of autonomic innervations
Answer: C
Functional change in bowel movement is characteristic of irritable bowel
syndrome (IBS). IBS is characterized by three patterns: diarrhea
predominant, constipation predominant, or mixed. Other functional
causes for her constipation should be excluded prior to making this
diagnosis. A large firm fecal mass in the rectum is characteristic of fecal
impaction, which is common in debilitated, bedridden individuals.
Decreased fecal bulk is characteristic of a diet low in fiber. This patient
had not found that increasing fiber helps her constipation. Spasm of the
external sphincter is associated with painful anal lesions, which this
patient does not report. Impairment of autonomic innervations is
characteristic of patients with multiple sclerosis, spinal cord injuries, and
Hirschsprung disease. She has no known diagnosis that would increase
suspicion of neurological impairment.
• A 23-year-old woman comes to the respirology clinic for follow-up of her chronic sinusitis
and bronchiectasis that is associated with a rare congenital condition called Kartagener
syndrome. The preceptor notes that she has situs inversus and asks for a physical exam.
Which of the following descriptions best fits with findings on the abdominal exam?
o A- Tympany to percussion in the RUQ, dullness to percussion of the LUQ
o B- protuberant abdomen that has scattered areas of tympany and dullness; stool
is felt on palpation
o C- Liver dullness in the RUQ that is displaxed downward by low diaphragm due to
COPD
Downloaded by Skyler Sammuel's ()
NR509 Bates interactive
Questions Final
Advanced Physical
Assessment (Chamberlain
University)
, lOMoAR cPSD| 64639315
Bates interactive Questions
Week 5Chapter 19- Abdomen
• An overweight 26-year-old public servant presents to the Emergency Department with 12
hours of intense abdominal pain, lightheadedness, and a fainting episode that finally
prompted her to seek medical attention. She has a strong family history of gallstones and
is concerned about this possibility. She has not had any vomiting or diarrhea. She had a
normal bowel movement this morning. Her βhuman chorionic gonadotropin (β-hCG) is
positive at triage. She reports that her last period was 10 weeks ago. Her vital signs at
triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen saturation,
99%; and temperature, 37.3ºC orally. The clinician performs an abdominal exam prior to
her pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound
tenderness. What is the most likely diagnosis? o A- ruptured tubal o B- acute
cholecystitis o C- ruptured appendix o D- perforated bowel wall o E- ruptured ovarian
cyst
Answer: A
• A 63-year-old janitor with a history of adenomatous colonic polyps presents for a well
visit. Basic labs are performed to screen for diabetes mellitus and dyslipidemia.
Electrolytes and liver enzymes were also measured. His labs are all normal expect for
moderate elevations of aspartate aminotransferase, alanine aminotransferase, γglutamyl
transferase, and alkaline phosphatase as well as a mildly elevated total bilirubin. He
presents for a follow-up appointment and the clinician performs an abdominal exam to
assess his liver. Which of the following findings would be most consistent with
hepatomegaly? o A- Liver span of 11cm at the midclavicular line
o B- Liver span of 8cm at the midsternal line
o C- dullness to percussion over a span of 11cm at the midclavicular line
o D- dullness to percussion over a span of 8cm at the midsternal line
o E- Liver palpable 3cm below the right costal margin, midclavicular line on
expiration.
Answer: E:
The liver being palpable 3 cm below the right costal margin, midclavicular
line, would be considered normal on inspiration when the liver is pushed down
into the abdominal cavity on inspiration, but is abnormal on expiration. Findings
to support hepatomegaly would be more convincing if, by percussion, the liver
span was >12 cm at the midclavicular line. For patients with obstructive lung
disease, air trapping in the lungs may displace the liver downwards into the
Downloaded by Skyler Sammuel's ()
, lOMoAR cPSD| 64639315
abdominal cavity. The liver span and dullness to percussion refer to the same
measurement. Measurements of 6–12 cm at the midclavicular line and 4–8 cm at
the midsternal line are considered normal.
• A 63-year-old underweight administrative clerk with a 50-pack-year smoking history
presents with a several month history of recurrent epigastric abdominal discomfort. She
feels fairly well otherwise and denies any nausea, vomiting, diarrhea, or constipation. She
reports that a first cousin died from a ruptured aneurysm at age 68 years. Her vital signs
are pulse, 86; blood pressure, 148/92; respiratory rate, 16; oxygen saturation, 95%; and
temperature, 36.2ºC. Her body mass index is 17.6. On exam, her abdominal aorta is
prominent, which is concerning for an abdominal aortic aneurysm (AAA). Which of the
following is her most significant risk factor for an AAA?
o A- female gender o B- history of smoking o C- underweight
o D- family history of ruptured aneurysm
o E- hypertension
Answer: B
History of smoking is her most significant risk factor for an AAA. Male
gender, not female gender, is considered as risk factor. Underweight is not
a risk factor for AAA. Family history of ruptured aneurysm is vague and
could be a cerebral aneurysm.
• A 76-year-old retired man with a history of prostate cancer and hypertension has been
screened annually for colon cancer using high sensitivity fecal occult blood testing (FOBT).
He presents for follow-up of his hypertension, during which the clinician scans his chart to
ensure he is up to date with his preventive health care. He has a positive FOBT on one
occasion at age 66 years and subsequently went for a colonoscopy. Internal hemorrhoids
and sigmoid diverticuli were found on colonoscopy. He has no first-degree relatives with
a history of colorectal cancer or adenomatous polyps. What are the U.S. Preventive
Services Task Force (USPSTF) screening recommendations for this patient? o A- do not
screen routinely o B- continue annual FOBT screening until age 80 o C- continue annual
FOBT screening until age 85 o D- repeat colonoscopy this year
o E- sigmoidoscopy every 5 years with FOBT every 3 years
Answer: A
The USPSTF recommends not screening routinely. For most adults ages
76–85 years, the gain in life years is small compared to colonoscopy risks.
It is advised to discuss individualized risks and benefits with the patient.
Annual FOBT screening may continue until age 80–85 years if benefits to
doing so outweigh risks for the individual patient; however, screening
should not be routinely continued. In general, a life expectancy >7 years is
Downloaded by Skyler Sammuel's ()
, lOMoAR cPSD| 64639315
necessary for screening to be potentially beneficial. There is no indication
to repeat a colonoscopy given the absence of any cancerous or
precancerous findings on his colonoscopy 10 years ago. Sigmoidoscopy
every 5 years with FOBT every 3 years is a valid screening option, but
again screening is not routinely recommended for patients age >75 years.
• An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a 3-
year history of recurrent crampy abdominal pain that lasts for about 1–2 weeks each
episode and is associated with onset of constipation. She describes infrequent, small hard
stool that she finds very difficult to pass. She has tried to increase dietary fiber and water
intake, but usually this is not sufficient and she resorts to over-thecounter laxatives, which
she finds upset her stomach but do resolve the constipation. Symptoms typically gradually
resolve with bowel movements. Which of the following is the most likely physiological
mechanism for her constipation? o A- a large, firm fecal mass in the rectum o B-
decreased fecal bulk o C- Functional change in bowel movement o D- spasm of the
externa sphincter o E- impairment of autonomic innervations
Answer: C
Functional change in bowel movement is characteristic of irritable bowel
syndrome (IBS). IBS is characterized by three patterns: diarrhea
predominant, constipation predominant, or mixed. Other functional
causes for her constipation should be excluded prior to making this
diagnosis. A large firm fecal mass in the rectum is characteristic of fecal
impaction, which is common in debilitated, bedridden individuals.
Decreased fecal bulk is characteristic of a diet low in fiber. This patient
had not found that increasing fiber helps her constipation. Spasm of the
external sphincter is associated with painful anal lesions, which this
patient does not report. Impairment of autonomic innervations is
characteristic of patients with multiple sclerosis, spinal cord injuries, and
Hirschsprung disease. She has no known diagnosis that would increase
suspicion of neurological impairment.
• A 23-year-old woman comes to the respirology clinic for follow-up of her chronic sinusitis
and bronchiectasis that is associated with a rare congenital condition called Kartagener
syndrome. The preceptor notes that she has situs inversus and asks for a physical exam.
Which of the following descriptions best fits with findings on the abdominal exam?
o A- Tympany to percussion in the RUQ, dullness to percussion of the LUQ
o B- protuberant abdomen that has scattered areas of tympany and dullness; stool
is felt on palpation
o C- Liver dullness in the RUQ that is displaxed downward by low diaphragm due to
COPD
Downloaded by Skyler Sammuel's ()
