NR 569
NR 509 Final Exam Study Guide Questions
with Correct Detailed Answers 2025
Chapter 19: Abdomen
...
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. Perforated bowel wall
e. Ruptured ovarian cyst
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?
NR 569
,NR 569
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
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
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?
NR 569
,NR 569
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
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?
a. A large, firm fecal mass in the rectum
b. Decreased fecal bulk
c. Functional change in bowel movement
d. Spasm of the external sphincter
e. Impairment of autonomic innervations
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?
a. Tympany to percussion in the right upper quadrant, dullness to percussion
of the left upper quadrant
b. Protuberant abdomen that has scattered areas of tympany and dullness; stool is
felt on palpation
NR 569
, NR 569
c. Liver dullness in the right upper quadrant that is displaced downward by the low
diaphragm due to chronic obstructive pulmonary disease
d. Dullness to percussion of the left lower anterior chest wall roughly at the
anterior axillary line
e. A change in percussion from tympany to dullness in the left lower anterior chest
wall on inspiration
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?
a. Voluntary contraction of the abdominal wall that persists over several
examinations
b. Pressing down onto the abdomen firmly and slowly and withdrawing the
hand quickly produces pain
c. Abdominal pain that increases with hip flexion
d. Localized pain over McBurney point, which lies 2 inches from the anterior
superior iliac spinous process on a line drawn from the umbilicus
e. Pain with internal rotation of the right hip
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?
a. Helicobacter pylori infection
b. Inflammation of the gallbladder
c. Inflammation of colonic diverticulum
d. Reduced blood supply to the bowel
e. Fibrosis of the pancreas
NR 569
NR 509 Final Exam Study Guide Questions
with Correct Detailed Answers 2025
Chapter 19: Abdomen
...
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. Perforated bowel wall
e. Ruptured ovarian cyst
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?
NR 569
,NR 569
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
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
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?
NR 569
,NR 569
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
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?
a. A large, firm fecal mass in the rectum
b. Decreased fecal bulk
c. Functional change in bowel movement
d. Spasm of the external sphincter
e. Impairment of autonomic innervations
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?
a. Tympany to percussion in the right upper quadrant, dullness to percussion
of the left upper quadrant
b. Protuberant abdomen that has scattered areas of tympany and dullness; stool is
felt on palpation
NR 569
, NR 569
c. Liver dullness in the right upper quadrant that is displaced downward by the low
diaphragm due to chronic obstructive pulmonary disease
d. Dullness to percussion of the left lower anterior chest wall roughly at the
anterior axillary line
e. A change in percussion from tympany to dullness in the left lower anterior chest
wall on inspiration
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?
a. Voluntary contraction of the abdominal wall that persists over several
examinations
b. Pressing down onto the abdomen firmly and slowly and withdrawing the
hand quickly produces pain
c. Abdominal pain that increases with hip flexion
d. Localized pain over McBurney point, which lies 2 inches from the anterior
superior iliac spinous process on a line drawn from the umbilicus
e. Pain with internal rotation of the right hip
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?
a. Helicobacter pylori infection
b. Inflammation of the gallbladder
c. Inflammation of colonic diverticulum
d. Reduced blood supply to the bowel
e. Fibrosis of the pancreas
NR 569
