NR 509 Final Exam Study Guide
1. Chapter 19: Abdomen: ...
2. An overweight 26-year-old public servant presents to the Emergency De-
partment with 12 hours of intense abdominal pain, light-headedness, 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 β-human 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?: a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perforated bowel wall
e. Ruptured ovarian cyst
3. 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, γ-glutamyl transferase, and alkaline phosphatase
as well as a mildly elevated total bilirubin. He presents for a follow-up
appoint-ment and the clinician performs an abdominal exam to assess his
liver. Which of the following findings would be most consistent with
hepatomegaly?: a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm at the midclavicular line
d. Dullness to percussion over a span of 8 cm at the midsternal line
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
4. A 63-year-old underweight administrative clerk with a 50-pack-year
smok-ing history presents with a several month history of recurrent
, NR 509 Final Exam Study Guide
epigastric
, NR 509 Final Exam Study Guide
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
temper-ature, 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?: a.
Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
5. 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 subse-quently 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?: a.
Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
Submit
6. 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.
, NR 509 Final Exam Study Guide
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
1. Chapter 19: Abdomen: ...
2. An overweight 26-year-old public servant presents to the Emergency De-
partment with 12 hours of intense abdominal pain, light-headedness, 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 β-human 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?: a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perforated bowel wall
e. Ruptured ovarian cyst
3. 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, γ-glutamyl transferase, and alkaline phosphatase
as well as a mildly elevated total bilirubin. He presents for a follow-up
appoint-ment and the clinician performs an abdominal exam to assess his
liver. Which of the following findings would be most consistent with
hepatomegaly?: a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm at the midclavicular line
d. Dullness to percussion over a span of 8 cm at the midsternal line
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
4. A 63-year-old underweight administrative clerk with a 50-pack-year
smok-ing history presents with a several month history of recurrent
, NR 509 Final Exam Study Guide
epigastric
, NR 509 Final Exam Study Guide
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
temper-ature, 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?: a.
Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
5. 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 subse-quently 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?: a.
Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
Submit
6. 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.
, NR 509 Final Exam Study Guide
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
