NR 509 Week 5 Abdomen And GU Quiz –
Chamberlain College | 2025 Updated
Version – Score 100%
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 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. Perf - Good!
a. Ruptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive β-hCG, and findings suggestive of peritoneal
inflammation/irritation strongly suggest a ruptured ectopic pregnancy with
significant intra-abdominal bleeding leading to peritoneal signs. This case is
emergent and requires immediate treatment of her hypotension and
presumed blood loss as well as gynecological consult for emergent surgery.
Ruptured ectopic pregnancies can lead to life-threatening intra-abdominal
bleeding.
Although acute cholecystitis, ruptured appendix, bowel wall perforation, and
ruptured ovarian cyst are all possibilities, the positive β-hCG testing and her
unstable vital signs make ruptured ectopic pregnancy more likely.
2. 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?
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
expi - e. Liver palpable 3 cm below the right costal margin, mid clavicular
line, on expiration
Rationale: 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 abdominal cavity.
The liver span and dullness to percussion refer to the same measurement.
Measurements of 6-12 cm at the mid-clavicular line and 4-8 cm at the
midsternal line are considered normal.
3. 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?
a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension - b. History of smoking
Rationale: 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.
, Further, her family history is in a first-degree cousin not a first-degree
relative (biologic parents, siblings, and children).
Hypertension could contribute to atherosclerosis, which is a risk factor.
Further, a diagnosis of hypertension is not based on one elevated blood
pressure reading.
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?
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 - a. Do not screen
routinely
Rationale: 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
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
Chamberlain College | 2025 Updated
Version – Score 100%
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 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. Perf - Good!
a. Ruptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive β-hCG, and findings suggestive of peritoneal
inflammation/irritation strongly suggest a ruptured ectopic pregnancy with
significant intra-abdominal bleeding leading to peritoneal signs. This case is
emergent and requires immediate treatment of her hypotension and
presumed blood loss as well as gynecological consult for emergent surgery.
Ruptured ectopic pregnancies can lead to life-threatening intra-abdominal
bleeding.
Although acute cholecystitis, ruptured appendix, bowel wall perforation, and
ruptured ovarian cyst are all possibilities, the positive β-hCG testing and her
unstable vital signs make ruptured ectopic pregnancy more likely.
2. 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?
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
expi - e. Liver palpable 3 cm below the right costal margin, mid clavicular
line, on expiration
Rationale: 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 abdominal cavity.
The liver span and dullness to percussion refer to the same measurement.
Measurements of 6-12 cm at the mid-clavicular line and 4-8 cm at the
midsternal line are considered normal.
3. 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?
a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension - b. History of smoking
Rationale: 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.
, Further, her family history is in a first-degree cousin not a first-degree
relative (biologic parents, siblings, and children).
Hypertension could contribute to atherosclerosis, which is a risk factor.
Further, a diagnosis of hypertension is not based on one elevated blood
pressure reading.
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?
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 - a. Do not screen
routinely
Rationale: 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
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
