Essentials of Anatomy and Physiology 8th Edition
Questions & Answers A+GRADE Chapter 1-22
Complete Guide.
A 54-year-old female dietician presents for a routine annual examination. On review of
systems, she reports that she has had many breast findings over several years, including
one biopsy with normal pathology. She feels that her breasts have become far less lumpy
since she underwent menopause 3 years ago. Which of the following is true regarding
changes in the breasts with menopause?
✓ Glandular tissue of the breast atrophies with menopause, primarily due to decrease
in the number of lobules.
An overweight 26-year-old public servant presents to the Emergency Department 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 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?
✓ Ruptured tubal (or ectopic) pregnancy
,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 appointment and the clinician performs an abdominal exam to
assess his liver. Which of the following findings would be most consistent with
hepatomegaly?
✓ Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
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?
✓ History of smoking
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 followup 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?
✓ Do not screen routinely
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-the-counter 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?
✓ Functional change in bowel movement
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?
✓ Tympany to percussion in the right upper quadrant, dullness to percussion of the left
upper quadrant
An otherwise healthy 28-year-old lawyer presents to the Emergency Department with a 1-
day history of severe abdominal pain. The emergency physician suspects appendicitis and
, general surgery is consulted. The resident believes the patient has signs of peritonitis on
exam. Which of the following physical exam findings supports peritonitis?
✓ Pressing down onto the abdomen firmly and slowly and withdrawing the hand
quickly produces pain
A 58-year-old man with a history of diabetes and alcohol addiction has been sober for the
last 10 months. He presents with a 4-month history of increasing weakness, recurrent
epigastric pain radiating to his back, chronic diarrhea with stools 6-8 times daily, and
weight loss of 18 lb over 4 months. What is the mechanism of his most likely diagnosis?
✓ Fibrosis of the pancreas
A 46-year-old executive who is obese and otherwise healthy presents to a family medicine
clinic with a 3-month course of recurrent severe abdominal pain that usually resolves on
its own after a few hours. Her last episode was prolonged lasting 6 hours, and she is
frustrated that she has had to leave or miss work on three separate occasions. She would
like a diagnosis and the problem fixed. Which symptoms or signs would be most
suggestive of a diagnosis of biliary colic?
✓ Associated right shoulder pain
A 67-year-old electronics technician with a history of hypertension and type 2 diabetes
presents for his yearly physical examination and complains of progressively worsening
erectile dysfunction (ED). While counseling him, the clinician mentions that multiple
processes must take place to achieve an erection. Which of the following structures would
be most affected by vascular deficiencies related to his preexisting medical conditions and
is likely contributing to his symptoms?
Questions & Answers A+GRADE Chapter 1-22
Complete Guide.
A 54-year-old female dietician presents for a routine annual examination. On review of
systems, she reports that she has had many breast findings over several years, including
one biopsy with normal pathology. She feels that her breasts have become far less lumpy
since she underwent menopause 3 years ago. Which of the following is true regarding
changes in the breasts with menopause?
✓ Glandular tissue of the breast atrophies with menopause, primarily due to decrease
in the number of lobules.
An overweight 26-year-old public servant presents to the Emergency Department 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 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?
✓ Ruptured tubal (or ectopic) pregnancy
,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 appointment and the clinician performs an abdominal exam to
assess his liver. Which of the following findings would be most consistent with
hepatomegaly?
✓ Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
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?
✓ History of smoking
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 followup 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?
✓ Do not screen routinely
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-the-counter 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?
✓ Functional change in bowel movement
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?
✓ Tympany to percussion in the right upper quadrant, dullness to percussion of the left
upper quadrant
An otherwise healthy 28-year-old lawyer presents to the Emergency Department with a 1-
day history of severe abdominal pain. The emergency physician suspects appendicitis and
, general surgery is consulted. The resident believes the patient has signs of peritonitis on
exam. Which of the following physical exam findings supports peritonitis?
✓ Pressing down onto the abdomen firmly and slowly and withdrawing the hand
quickly produces pain
A 58-year-old man with a history of diabetes and alcohol addiction has been sober for the
last 10 months. He presents with a 4-month history of increasing weakness, recurrent
epigastric pain radiating to his back, chronic diarrhea with stools 6-8 times daily, and
weight loss of 18 lb over 4 months. What is the mechanism of his most likely diagnosis?
✓ Fibrosis of the pancreas
A 46-year-old executive who is obese and otherwise healthy presents to a family medicine
clinic with a 3-month course of recurrent severe abdominal pain that usually resolves on
its own after a few hours. Her last episode was prolonged lasting 6 hours, and she is
frustrated that she has had to leave or miss work on three separate occasions. She would
like a diagnosis and the problem fixed. Which symptoms or signs would be most
suggestive of a diagnosis of biliary colic?
✓ Associated right shoulder pain
A 67-year-old electronics technician with a history of hypertension and type 2 diabetes
presents for his yearly physical examination and complains of progressively worsening
erectile dysfunction (ED). While counseling him, the clinician mentions that multiple
processes must take place to achieve an erection. Which of the following structures would
be most affected by vascular deficiencies related to his preexisting medical conditions and
is likely contributing to his symptoms?
