Week 8 NR 509 Advanced Health Assessment
Final Questions and Verified Answers, 100%
Guaranteed Pass ||Complete A+ Guide
1. CHAPTER 19: Abdomen
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 ²-human chorionic gonadotropin ( ²- hCG) is positive at
triage. She reports that her last periterm-12od 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
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive ²h- CG, 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 ²h
- CG testing and her unstable
vital signs make ruptured ectopic pregnancy more likely.
2. CHAPTER 19: Abdomen
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, -³glutamyl 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?: 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. CHAPTER 19: Abdomen
A 63-year-old underweight administrative clerk with a 50-pack-year smoking
history presents with a several month history of recurrent epigastric ab-
dominal 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?:
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.
4. CHAPTER 19: Abdomen
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 rela-
tives 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
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
Final Questions and Verified Answers, 100%
Guaranteed Pass ||Complete A+ Guide
1. CHAPTER 19: Abdomen
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 ²-human chorionic gonadotropin ( ²- hCG) is positive at
triage. She reports that her last periterm-12od 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
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive ²h- CG, 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 ²h
- CG testing and her unstable
vital signs make ruptured ectopic pregnancy more likely.
2. CHAPTER 19: Abdomen
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, -³glutamyl 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?: 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. CHAPTER 19: Abdomen
A 63-year-old underweight administrative clerk with a 50-pack-year smoking
history presents with a several month history of recurrent epigastric ab-
dominal 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?:
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.
4. CHAPTER 19: Abdomen
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 rela-
tives 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
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
