Testbank Advanced Health Assessment Clinical Diagnosis in Primary Care 6th Edition Dains

Testbank Advanced Health Assessment Clinical Diagnosis in Primary Care 6th Edition DainsTable of Contents Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom analysis ............................................................................................................ 2 Chapter 2. Evidence-based health screening ..................................................................................................................................................................................................................... 5 Chapter 3. Abdomen .................................................................................................................................................................................................................................................................. 10 Chapter 4: Affective Changes ................................................................................................................................................................................................................................................ 30 Chapter 5: Amenorrhea ........................................................................................................................................................................................................................................................... 38 Chapter 6. Breasts lumps and nipple discharge ............................................................................................................................................................................................................... 40 Chapter 7. Breast Pain............................................................................................................................................................................................................................................................. 45 Chapter 8: Chest Pain .............................................................................................................................................................................................................................................................. 48 Chapter 9. Confusion in older adults .................................................................................................................................................................................................................................. 52 Chapter 10: Constipation ......................................................................................................................................................................................................................................................... 56 Chapter 11: Cough ...................................................................................................................................................................................................................................................................... 58 Chapter 12: Diarrhea ................................................................................................................................................................................................................................................................ 61 Chapter 13: Dizziness .............................................................................................................................................................................................................................................................. 66 Chapter 14. Dyspnea ................................................................................................................................................................................................................................................................. 68 Chapter 15. Earache ................................................................................................................................................................................................................................................................ 79 Chapter 16: Fatigue ................................................................................................................................................................................................................................................................... 83 Chapter 17. Fever ...................................................................................................................................................................................................................................................................... 85 Chapter 18: Male Genitourinary Problems .......................................................................................................................................................................................................................... 88 Chapter 19. Headache ............................................................................................................................................................................................................................................................102 Chapter 20: Heartburn and indigestion ............................................................................................................................................................................................................................ 110 Chapter 21. Hoarseness ......................................................................................................................................................................................................................................................... 112 Chapter 22: Lower extremity limb pain ............................................................................................................................................................................................................................. 114 Chapter 23: Upper extremity limb pain .............................................................................................................................................................................................................................. 116 Chapter 24: Low back pain (acute) ...................................................................................................................................................................................................................................... 118 Chapter 25.: Nasal symptoms and sinus congestion ......................................................................................................................................................................................................120 Chapter 26: Palpitations ...................................................................................................................................................................................................................................................... 124 Chapter 27 Penile Discharge ................................................................................................................................................................................................................................................ 127 Chapter 28 Rashes and skin lesions ..................................................................................................................................................................................................................................138 Chapter 29: Rectal pain, itching, and bleeding .............................................................................................................................................................................................................. 148 Chapter 30. Red Eye ............................................................................................................................................................................................................................................................... 150 Chapter 31: Sleep Problems .................................................................................................................................................................................................................................................. 161 Chapter 32. Sore throat ......................................................................................................................................................................................................................................................... 168 Chapter 33: Syncope ............................................................................................................................................................................................................................................................... 171 Chapter 34 Urinary Incontinence ......................................................................................................................................................................................................................................... 173 Chapter 35 Urinary Problems in females and children ................................................................................................................................................................................................ 180 Chapter 36. Vaginal Bleeding ................................................................................................................................................................................................................................................183 Chapter 37. Vaginal Discharge and itching ....................................................................................................................................................................................................................... 186 Chapter 38: Vision Loss ......................................................................................................................................................................................................................................................... 203 Chapter 39: Weight loss/gain(unintentional) ....................................................................................................................................................................................................................215 1 | P a g elOMoAR cPSD | 937 58 10 Chapter 40: The abdominal x-ray ...................................................................................................................................................................................................................................... 220 Chapter 41: The chest x-ray ................................................................................................................................................................................................................................................. 228 Chapter 42. The Transgender Patient ................................................................................................................................................................................................................................ 232 2 | P a g elOMoAR cPSD | 937 58 10 Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom analysis Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which type of clinical decision-making is most reliable? A. Intuitive B. Analytical C. Experiential D. Augenblick 2. Which of the following is false? To obtain adequate history, health-care providers must be: A. Methodical and systematic B. Attentive to the patient’s verbal and nonverbal language C. Able to accurately interpret the patient’s responses D. Adept at reading into the patient’s statements 3. Essential parts of a health history include all of the following except: A. Chief complaint B. History of the present illness C. Current vital signs D. All of the above are essential history components 4. Which of the following is false? While performing the physical examination, the examiner must be able to: A. Differentiate between normal and abnormal findings B. Recall knowledge of a range of conditions and their associated signs and symptoms C. Recognize how certain conditions affect the response to other conditions D. Foresee unpredictable findings 5. The following is the least reliable source of information for diagnostic statistics: A. Evidence-based investigations B. Primary reports of research C. Estimation based on a provider’s experience D. Published meta-analyses 6. The following can be used to assist in sound clinical decision-making: A. Algorithm published in a peer-reviewed journal article B. Clinical practice guidelines C. Evidence-based research D. All of the above 7. If a diagnostic study has high sensitivity, this indicates a: A. High percentage of persons with the given condition will have an abnormal result B. Low percentage of persons with the given condition will have an abnormal result C. Low likelihood of normal result in persons without a given condition D. None of the above 8. If a diagnostic study has high specificity, this indicates a: A. Low percentage of healthy individuals will show a normal result B. High percentage of healthy individuals will show a normal result C. High percentage of individuals with a disorder will show a normal result D. Low percentage of individuals with a disorder will show an abnormal result 9. A likelihood ratio above 1 indicates that a diagnostic test showing a: A. Positive result is strongly associated with the disease B. Negative result is strongly associated with absence of the disease C. Positive result is weakly associated with the disease D. Negative result is weakly associated with absence of the disease 10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? 3 | P a g elOMoAR cPSD | 937 58 10 A. Clinical practice guideline B. Clinical decision rule C. Clinical algorithm MULTIPLE CHOICE ANSWERS 1. ANS: B Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive decision- making (similar to Augenblink decision-making) is based on the experience and intuition of the clinician and is less reliable andpaired with fairly common errors. In contrast, analytical decision-making is based on careful consideration and has greater reliability with rare errors. PTS: 2. 1 ANS: D To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and nonverbal language, and able to accurately interpret the patient’s responses to questions. Rather than reading into the patient’s statements, they clarify any areas of uncertainty. PTS: 3. 1 ANS: C Vital signs are part of the physical examination portion of patient assessment, not part of the health history. PTS: 1 4. ANS: D While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings, recall knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affect the response to other conditions, and distinguish the relevance of varied abnormal findings. PTS: 5. 1 ANS: C Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-analyses. Another source of statistics, the one that has been most widely used and available for application to the reasoning process, is the estimation based ona provider’s experience, although these are rarely accurate. Over the past decade, the availability of evidence on which to base clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be based on scientific evidence. Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical decision-making. PTS: 6. 1 ANS: D To assist in clinical decision-making, a number of evidence-based resources have been developed to assist the clinician. Resources, such as algorithms and clinical practice guidelines, assist in clinical reasoning when properly applied. PTS: 7. 1 ANS: A The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an abnormal, or positive, result. A high sensitivity indicates that a greater percentage of persons with the given condition will have an abnormal result. PTS: 8. 1 ANS: B The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result. The greater the specificity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the target condition. PTS: 9. 1 ANS: A The likelihood ratio is the probability that a positive test result will be associated with a person 4 | P a g elOMoAR cPSD | 937 58 10 who has the target condition and a negative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated with the disease; a likelihood ratio less than 1 indicates that a negative result is associated with an absence of the disease PTS: 1 10. ANS: B Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence- basedresources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met with regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain situations, settings, and/or patient characteristics. PTS: 1 5 | P a g elOMoAR cPSD | 937 58 10 Chapter 2. Evidence-based health screening Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The first step in the genomic assessment of a patient is obtaining information regarding: A. Family history B. Environmental exposures C. Lifestyle and behaviors D. Current medications 2. An affected individual who manifests symptoms of a particular condition through whom a family with a genetic disorder is ascertained is called a(n): A. Consultand B. Consulband C. Index patient D. Proband 3. An autosomal dominant disorder involves the: A. X chromosome B. Y chromosome C. Mitochondrial DNA D. Non-sex chromosomes 4. To illustrate a union between two second cousin family members in a pedigree, draw: A. Arrows pointing to the male and female B. Brackets around the male and female C. Double horizontal lines between the male and female D. Circles around the male and female 5. To illustrate two family members in an adoptive relationship in a pedigree: A. Arrows are drawn pointing to the male and female B. Brackets are drawn around the male and female C. Double horizontal lines are drawn between the male and female D. Circles are drawn around the male and female 6. When analyzing the pedigree for autosomal dominant disorders, it is common to see: A. Several generations of affected members B. Many consanguineous relationships C. More members of the maternal lineage affected than paternal D. More members of the paternal lineage affected than maternal 7. In autosomal recessive (AR) disorders, individuals need: A. Only one mutated gene on the sex chromosomes to acquire the disease B. Only one mutated gene to acquire the disease C. Two mutated genes to acquire the disease D. Two mutated genes to become carriers 8. In autosomal recessive disorders, carriers have: A. Two mutated genes; one from each parent that cause disease B. A mutation on a sex chromosome that causes a disease C. A single gene mutation that causes the disease D. One copy of a gene mutation but not the disease 9. With an autosomal recessive disorder, it is important that parents understand that if they both carry a mutation, the following are the risks to each of their offspring (each pregnancy): A. 50% chance that offspring will carry the disease B. 10% chance of offspring affected by disease 6 | P a g elOMoAR cPSD | 937 58 10 11. In creating your female patient’s pedigree, you note that she and both of her sisters were affected by the same genetic disorder. Although neither of her parents had indications of the disorder, her paternal 7 | P a g elOMoAR cPSD | 937 58 10 grandmother and her paternal grandmother’s two sisters were affected by the same condition. This pattern suggests: A. Autosomal dominant disorder B. Chromosomal disorder C. Mitochondrial DNA disorder D. X-linked dominant disorder 12. A woman affected with an X-linked recessive disorder: A. Has one X chromosome affected by the mutation B. Will transmit the disorder to all of her children C. Will transmit the disorder to all of her sons D. Will not transmit the mutation to any of her daughters 13. Which of the following are found in an individual with aneuploidy? A. An abnormal number of chromosomes B. An X-linked disorder C. Select cells containing abnormal-appearing chromosomes D. An autosomal recessive disorder 14. The pedigree of a family with a mitochondrial DNA disorder is unique in that: A. None of the female offspring will have the disease B. All offspring from an affected female will have disease C. None of the offspring of an affected female will have the disease D. All the offspring from an affected male will have disease 15. Which population is at highest risk for the occurrence of aneuploidy in offspring? A. Mothers younger than 18 B. Fathers younger than 18 C. Mothers over age 35 D. Fathers over age 35 16. A. B. C. D. 17. Approximately what percentage of cancers is due to a single-gene mutation? 50% to 70% 30% to 40% 20% to 25% 5% to 10% According to the Genetic Information Nondiscrimination Act (GINA): A. NPs should keep all genetic information of patients confidential B. NPs must obtain informed consent prior to genetic testing of all patients C. Employers cannot inquire about an employee’s genetic information D. All of the above 18. The leading causes of death in the United States are due to: A. Multifactorial inheritance B. Single gene mutations C. X-linked disorders D. Aneuploidy Which of the following would be considered a “red flag” that requires more investigation in a patient assessment? 19. 8 | P a g elOMoAR cPSD| 9375810 A. Colon cancer in family member at age 70 B. Breast cancer in family member at age 75 C. Myocardial infarction in family member at age 35 D. All of the above 20. When patients express variable forms of the same hereditary disorder, this is due to: A. Penetrance B. Aneuploidy C. De novo mutation D. Sporadic inheritance 21. Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures, single transverse palmar crease, and a low nasal bridge. These are referred to as: A. Variable expressivity related to inherited disease B. Dysmorphic features related to genetic disease C. De novo mutations of genetic disease D. Different penetrant signs of genetic disease 22. A. Ask patients to complete a family history worksheet In order to provide a comprehensive genetic history of a patient, the NP should: B. Seek out pathology reports related to the patient’s disorder C. Interview family members regarding genetic disorders D. All of the above Answer Section MULTIPLE CHOICE 1. ANS: A A critical first step in genomic assessment, including assessment of risk, is the use of family history. Family history is considered the first genetic screen (Berry & Shooner 2004) and is a critical component of care because it reflects shared genetic susceptibilities, shared environment, and common behaviors (Yoon, Scheuner, & Khoury 2003). PTS: 2. 1 ANS: D A proband is defined as the affected individual who manifests symptoms of a particular condition through whom a family with a genetic disorder is ascertained (Pagon et al. 1993– 2013). The proband is the affected individual that brings the family to medical attention. PTS: 3. 1 ANS: D Autosomal dominant (AD) inheritance is a result of a gene mutation in one of the 22 autosomes. PTS: 1 4. ANS: C A consanguineous family is related by descent from a common ancestry and is defined as a “union between two individuals whoare related as second cousins or closer” (Hamamy 2012). Consanguinity, if present in the family history, is portrayed using two horizontal lines to establish the relationship between the male and female partners. PTS: 5. 1 ANS: B For adopted members of the family, use brackets as the appropriate standardized pedigree symbol ([e.g., brackets]). 9 | P a g elOMoAR cPSD | 937 58 10 PTS: 6. 1 ANS: A Pedigrees associated with autosomal dominant (AD) disorders typically reveal multiple affected family members with the disease or syndrome. When analyzing the pedigree for AD disorders or syndromes, it is common to see a “vertical” pattern denoting several generations of affected members. PTS: 1 7. ANS: C In autosomal recessive (AR) disorders, the offspring inherits the condition by receiving one copy of the gene mutation from each of the parents. Autosomal recessive disorders must be inherited through both parents (Nussbaum et al. 2007). Individuals who have an AR disorder have two mutated genes, one on each locus of the chromosome. Parents of an affected person are called carriers because each carries one copy of the mutation on one chromosome and a normal gene on the other chromosome. Carriers typically are not affected by the disease. PTS: 1 8. ANS: D Individuals who have an AR disorder have two mutated genes, one on each allele of the chromosome. Parents of an affected person are called carriers because each parent carries one copy of the mutation on one chromosome and a normal gene on the other chromosome. Carriers typically are not affected by the disease. In pedigrees with an AR inheritance patterns, males and females will be equally affected because the gene mutation is on an autosome. PTS: 1 9. ANS: A It is important that parents understand that if they both carry a mutation, the risk to each of their offspring (each pregnancy) is an independent event: 25% disease free, 25% affected, and 50% carrier. PTS: 1 10. ANS: B Everyone born with an X-linked dominant disorder will be affected with the disease. Transmission of the disorder to the nextgeneration varies by gender, however. A woman will transmit the mutation to 50% of all her offspring (male or female). PTS: 1 11. ANS: D A man with an X-linked dominant disorder will transmit the mutation to 100% of his daughters (they receive his X chromosome) and none of his sons (they receive his Y chromosome). The pedigree of a family with an X-linked dominant disorder would reveal all the daughters and none of the sons affected with the disorder if the father has an X-linked disorder. PTS: 1 12. ANS: C An X-linked recessive disorder means that in a woman, both X chromosomes must have the mutation if she is to be affected. Because males have only one copy of the X chromosome, they will be affected if their X chromosome carries the mutation. PTS: 1 13. ANS: A An individual with an abnormal number of chromosomes has a condition called aneuploidy, which is frequently associated withmental problems or physical problems or both (Jorde, Carey, & Bamshad 2010; Nussbaum et al. 2007). PTS: 1 14. ANS: B Mitochondrial DNA is inherited from the ovum and, therefore, from the mother. The pedigree of a family with a mitochondrial DNA disorder is unique in that all offspring (regardless of gender) of an affected female will have the disease, and none of the offspring from an affected male will have the disease. PTS: 1 15. ANS: C Some individuals or couples have unique identifiable risks that should be discussed prior to 10 | P a g elOMoAR cPSD | 937 58 10 conception whenever possible. Forexample, women who will be 35 years of age or older at delivery (advanced maternal age) are at increased risk for aneuploidy. PTS: 1 16. ANS: D The majority of cancers are sporadic or multifactorial due to a combination of genetic and environmental factors; however, approximately 5% to 10% of all cancers are due to a single-gene mutation (Garber & Offit 2005). PTS: 17. 1 ANS: D On May 21, 2008, President George W. Bush signed the Genetic Information Nondiscrimination Act (GINA) to protect Americans against discrimination based upon their genetic information when it comes to health insurance and employment, paving the way for patient personalized genetic medicine without fear of discrimination (National Human Genome Research Institute 2012). PTS: 18. 1 ANS: A Most disease-causing conditions are not due to a single-gene disorder but are due to multifactorial inheritance, a result of genomics and environmental or behavioral influences. In fact, the leading causes of mortality in the United States—heart disease, cerebrovascular disease, diabetes, and cancer—are all multifactorial. Most congenital malformation, hypertension, arthritis, asthma, obesity, epilepsy, Alzheimer’s, and mental health disorders are also multifactorial. PTS: 19. 1 ANS: C Early onset cancer syndromes, heart disease, or dementia are red flags that warrant further investigation regarding hereditary disorders. PTS: 20. 1 ANS: A Some disorders have a range of expression from mild to severe. This variability is referred to as the penetrance of genetic disease. For example, patients with neurofibromatosis (NF1), an AD disorder of the nervous system, may manifest with many forms of the disease. For instance, some patients with NF1 may have mild symptoms, like café-au-lait spots or freckling on the axillary or skin, while others may have life-threatening spinal cord tumors or malignancy (Jorde, Carey, & Bamshad 2010; Nussbaum et al. 2007). PTS: 21. 1 ANS: B Assessing for dysmorphic features may enable identification of certain syndromes or genetic or chromosomal disorders (Jorde, Carey, & Bamshad 2010; Prichard & Korf 2008). Dysmorphology is defined as “the study of abnormal physical development” (Jorde, Carey, & Bamshad 2010, 302). PTS: 22. 1 ANS: D Asking the patient to complete a family history worksheet prior to the appointment saves time in the visit while offering the patient an opportunity to contribute to the collection of an accurate family history. Reviewing the family information can also help establish family rapport while verifying medical conditions in individual family members. If a hereditary condition is being considered but family medical information is unclear or unknown, requesting medical records and pathology or autopsy reports may be warranted. PTS: 1 11 | P a g elOMoAR cPSD | 937 58 10 Chapter 3. Abdomen Multiple Choice Identify the choice that best completes the statement or answers the question. 1. When performing abdominal assessment, the clinician should perform examination techniques in the following order: A. B. C. D. 2. Inspection, palpation, percussion, and auscultation Inspection, percussion, palpation, and auscultation Inspection, auscultation, percussion, and palpation Auscultation, palpation, percussion, and inspection The clinician should auscultate the abdomen to listen for possible bruits of the: A. Aorta B. Renal artery C. Iliac artery D. All of the above 3. On abdominal examination, which of the following is assessed using percussion? A. Liver B. Kidneys C. Pancreas D. Esophagus 4. In abdominal assessment, a digital rectal examination is performed to assess for: A. Hemorrhoids B. Prostate size C. Blood in stool D. Ureteral stenosis 5. Rebound tenderness of the abdomen is a sign of: A. Constipation B. Peritoneal inflammation C. Elevated venous pressure D. Peritoneal edema 6. While assessing the abdomen, the clinician deeply palpates the left lower quadrant of the abdomen, and this causes pain in the patient’s right lower abdomen. This is most commonly indicative of: A. Constipation B. Diverticulitis C. Appendicitis D. Hepatitis 7. Your patient complains of severe right lower quadrant abdominal pain. To assess the patient for peritoneal inflammation, the examiner should: A. Percuss the right lower quadrant of the abdomen B. Deeply palpate the right lower quadrant of the abdomen C. Auscultate the right lower quadrant for hyperactive bowel sounds D. Strike the plantar surface of the patient’s heel while the patient is supine 8. Your patient is lying supine and you ask him to raise his leg while you place resistance against the thigh. The examiner is testing the patient for: A. Psoas sign B. Obturator sign C. Rovsing’s sign D. Murphys’ sign 12 | P a g elOMoAR cPSD | 937 58 10 9. A patient is lying supine and the clinician deeply palpates the right upper quadrant of the abdomen 13 | P a g elOMoAR cPSD | 937 58 10 while the patient inhales. The examiner is testing the patient for: A. Psoas sign B. Obturator sign C. Rovsing’s sign D. Murphys’ 10. Your patient has abdominal pain, and it is worsened when the examiner rotates the patient’s right hip inward with the knee bent and the obturator internus muscle is stretched. This is a sign of: A. Diverticulitis B. Cholecystitis C. Appendicitis D. Mesenteric adenitis 11. jugular vein distension becomes obvious. Hepatojugular reflux is indicative of: A. Acute hepatitis B. Right ventricular failure C. Cholecystitis D. Left ventricular failure 12. of: A. Cholecyst itis B. Appendici tis C. Ascites D. Hepatitis 13. Your 44-year-old female patient complains of right upper quadrant pain. Her skin and sclera are yellow, and she has hyperbilirubinemia and elevated liver enzymes. The clinician should suspect: A. Acute pancreatitis B. Biliary duct obstruction C. Acute hepatitis D. Atypical appendicitis 14. The most common cause of acute pancreatitis is: A. Trauma B. Hepatitis virus A C. Hyperlipidem ia D. Alcohol abuse 15. is a risk of: A. Pleural involvement B. Alcoholism C. High mortality D. Bile duct obstruction 16. Your patient complains of left upper quadrant pain, fever, extreme fatigue, and spontaneous bruising. The clinician should recognize that these symptoms are often related to: A. Hematopoetic disorders B. Hepatomegaly 14 | P a g e Your patient with pancreatitis has a Ranson rule score of 8. The clinician should recognize that this Your patient demonstrates positive shifting dullness on percussion of the abdomen. This is indicative On abdominal examination as the clinician presses on the right upper quadrant to assess liver size,lOMoAR cPSD | 937 58 10 C. Esophageal varices D. Pleural effusion 15 | P a g elOMoAR cPSD | 937 58 10 17. and left upper quadrant pain. The physical examination reveals splenomegaly. The clinician should recognize the probability of: A. Bacterial endocarditis B. Infectious mononucleosis C. Pneumonia with pleural effusion D. Pancreatic cancer 18. of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. Theclinician needs to consider: A. Diverticulitis B. Appendicitis C. Colon cancer Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss A 16-year-old patient presents with sore throat, cervical lymphadenopathy, fever, extreme fatigue, 16 | P a g elOMoAR cPSD | 937 58 10 D. Peptic ulcer disease 19. A. Decreased lower esophageal sphincter tone Which of the following is the most common cause of heartburn-type epigastric pain? B. Helicobacteria pylori infection of stomach C. Esophageal spasm D. Excess use of NSAIDs 20. pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over theright lower quadrant. The clinician should recognize the importance of: A. Digital rectal examination B. Endoscopy C. Ultrasound D. Pelvic examination 21. A. Sudden onset of severe epigastric pain The major sign of ectopic pregnancy is: B. Amenorrhea with unilateral lower quadrant pain C. Lower back and rectal pain D. Palpable abdominal mass 22. When ruptured ectopic pregnancy is suspected, the following procedure is most important: A. Culdocentesis B. CT scan C. Abdominal x-ray D. Digital rectal examination 23. A. Transverse colon The majority of colon cancers are located in the: B. Cecum C. Rectosigmoid region D. Ascending colon The following symptom(s) in the patient’s history should raise the clinician’s suspicion of colon cancer: 24. A. Alternating constipation and diarrhea B. Narrowed caliber of stool C. Hematochezia D. All of the above 25. A patient presents to the emergency department with nausea and severe, colicky back pain that radiates into the groin. When asked to locate the pain, he points to the right costovertebral angle region. His physical examination is unremarkable. Which of the following lab tests is most important for the diagnosis? A. Urinalysis B. Serum electrolyte levels C. Digital rectal exam D. Lumbar x-ray 17 | P a g e A 22-year-old female enters the emergency room with complaints of right lower quadrant abdominallOMoAR cPSD | 937 58 10 Your 34-year-old female patient complains of a feeling of “heaviness” in the right lower quadrant, achiness, and 26. bloating. On pelvic examination, there is a palpable mass in the right lower quadrant. Urine and serum pregnancy tests are negative. The diagnostic tool that would be most helpful is: A. Digital rectal exam B. Transvaginal ultrasound C. Pap smear D. Urinalysis Your 54-year-old male patient complains of a painless “lump” in his lower left abdomen that comes and goes for the past couple of weeks. When examining the abdomen, you should have the patient: