NR509 Advanced Physical Assessment Exam Questions
What are the symptoms of the 26-year-old public servant presenting to the Emergency
Department? - correct answer Intense abdominal pain, light-headedness, and a fainting
episode.
What is the family medical history concern for the 26-year-old patient? - correct answer Strong
family history of gallstones.
What is the significance of the positive β-hCG in the 26-year-old patient? - correct answer It
indicates a possible pregnancy.
What vital sign abnormalities were noted in the 26-year-old patient? - correct answer Pulse of
118, blood pressure of 86/68.
What abdominal exam findings were noted in the 26-year-old patient? - correct answer
Involuntary rigidity and rebound tenderness.
What is the most likely diagnosis for the 26-year-old patient? - correct answer Ruptured tubal
pregnancy.
What lab findings were noted for the 63-year-old janitor during his well visit? - correct answer
Moderate elevations of liver enzymes and mildly elevated total bilirubin.
What finding would be most consistent with hepatomegaly in the 63-year-old janitor? - correct
answer Liver palpable 3 cm below the right costal margin, midclavicular line on expiration.
What is considered a normal liver span measurement at the midclavicular line? - correct answer
6-12 cm.
What is the significance of dullness to percussion over the liver span? - correct answer It
indicates the size and condition of the liver.
What is the primary concern for the underweight 63-year-old administrative clerk? - correct
answer Prominent abdominal aorta concerning for an abdominal aortic aneurysm (AAA).
What is the most significant risk factor for an abdominal aortic aneurysm (AAA) in the
underweight clerk? - correct answer History of smoking.
What vital signs were recorded for the underweight administrative clerk? - correct answer
Pulse of 86, blood pressure of 148/92.
What is the BMI of the underweight administrative clerk? - correct answer 17.6.
What is the age of the first cousin who died from a ruptured aneurysm? - correct answer 68
years.
,What are the normal ranges for liver span measurements at the midsternal line? - correct
answer 4-8 cm.
What is the clinical significance of a liver span greater than 12 cm at the midclavicular line? -
correct answer It supports the diagnosis of hepatomegaly.
What is the expected liver position during inspiration? - correct answer The liver is pushed
down into the abdominal cavity.
What is the expected liver position during expiration? - correct answer The liver is normally
palpable at the right costal margin.
What is the relationship between obstructive lung disease and liver position? - correct answer
Air trapping may displace the liver downwards into the abdominal cavity.
What is the significance of a patient's family history in assessing risk for AAA? - correct answer
Family history of ruptured aneurysms increases risk.
What is the clinical relevance of a patient's smoking history in relation to AAA? - correct answer
Smoking is a significant risk factor for developing an abdominal aortic aneurysm.
What are the potential symptoms of an abdominal aortic aneurysm? - correct answer
Recurrent epigastric abdominal discomfort.
What is the importance of performing an abdominal exam in patients with concerning
symptoms? - correct answer To assess for abnormalities such as hepatomegaly or AAA.
What is the most significant risk factor for an abdominal aortic aneurysm (AAA) in the provided
notes? - correct answer History of smoking.
Which gender is considered a risk factor for AAA? - correct answer Male gender.
What is the relevance of family history in relation to AAA risk? - correct answer Family history
of ruptured aneurysm is vague and could refer to cerebral aneurysm.
What is the USPSTF recommendation for routine colon cancer screening in a 76-year-old man? -
correct answer Do not screen routinely.
What is the life expectancy necessary for colon cancer screening to be potentially beneficial
according to USPSTF? - correct answer A life expectancy greater than 7 years.
What should be discussed with patients aged 76-85 regarding colon cancer screening? - correct
answer Individualized risks and benefits.
What screening method may continue until age 80-85 if benefits outweigh risks? - correct
answer Annual FOBT screening.
,What findings on a colonoscopy would indicate no need for a repeat colonoscopy? - correct
answer Absence of any cancerous or precancerous findings.
What is the most likely physiological mechanism for constipation in the 31-year-old
accountant? - correct answer Functional change in bowel movement.
What are the three patterns of irritable bowel syndrome (IBS)? - correct answer Diarrhea
predominant, constipation predominant, or mixed.
What is characteristic of fecal impaction? - correct answer A large, firm fecal mass in the
rectum.
What dietary characteristic is associated with decreased fecal bulk? - correct answer A diet low
in fiber.
What condition is spasm of the external sphincter associated with? - correct answer Painful
anal lesions.
What conditions are associated with impairment of autonomic innervations? - correct answer
Multiple sclerosis, spinal cord injuries, and Hirschsprung disease.
What symptom did the accountant experience that is associated with constipation? - correct
answer Recurrent crampy abdominal pain.
What did the accountant resort to for relief from constipation? - correct answer Over-the-
counter laxatives.
What is a common characteristic of IBS related to bowel movements? - correct answer
Functional changes in bowel movement.
What was found during the colonoscopy of the 76-year-old man? - correct answer Internal
hemorrhoids and sigmoid diverticuli.
What is the significance of a positive FOBT in the context of colon cancer screening? - correct
answer It indicates the need for further investigation, such as a colonoscopy.
What is the age limit for routine colon cancer screening according to the USPSTF? - correct
answer Age 75 years.
What is the recommended frequency for sigmoidoscopy and FOBT in the notes? - correct
answer Sigmoidoscopy every 5 years with FOBT every 3 years.
What is the typical resolution pattern for the accountant's constipation symptoms? - correct
answer Symptoms typically gradually resolve with bowel movements.
What is the common stool characteristic reported by the accountant? - correct answer
Infrequent, small hard stool.
, What congenital condition is associated with the 23-year-old woman's chronic sinusitis and
bronchiectasis? - correct answer Kartagener syndrome.
What is the significance of situs inversus in the context of the abdominal exam findings? -
correct answer In situs inversus, the stomach and gastric air bubble are on the right, and liver
dullness is on the left.
What physical exam finding indicates peritonitis in the 28-year-old lawyer suspected of having
appendicitis? - correct answer Rebound tenderness, where pressing down firmly and slowly
and then quickly withdrawing the hand produces pain.
What does involuntary contraction of the abdominal wall indicate during an exam? - correct
answer It indicates rigidity, which is different from voluntary contraction.
How does abdominal pain change with hip flexion in patients with peritonitis? - correct answer
Patients with peritonitis tend to keep their hips flexed to reduce stretch and irritation of the
parietal peritoneum.
What is McBurney's point and its relevance in appendicitis? - correct answer McBurney's point
is located 2 inches from the anterior superior iliac spine on a line drawn from the umbilicus and
is associated with localized pain in appendicitis.
What is the most likely diagnosis for the 58-year-old man with chronic diarrhea and weight
loss? - correct answer Chronic pancreatitis.
What mechanism leads to diarrhea in chronic pancreatitis? - correct answer Fibrosis of the
pancreas leads to decreased pancreatic function and enzyme insufficiency.
What is the role of H. Pylori infection in gastrointestinal conditions? - correct answer H. Pylori
infection may cause peptic ulcer disease and dyspepsia, but is not usually associated with
diarrhea.
What condition is characterized by inflammation of the colonic diverticulum? - correct answer
Diverticulitis, which typically causes left-lower-quadrant pain, fever, and sometimes diarrhea.
What is mesenteric ischemia and its associated symptoms? - correct answer Mesenteric
ischemia is characterized by reduced blood supply to the bowel, causing diffuse abdominal
pain, vomiting, diarrhea, or constipation.
What are the common symptoms of chronic pancreatitis? - correct answer Increasing
weakness, recurrent epigastric pain radiating to the back, chronic diarrhea, and weight loss.
What does a protuberant abdomen with scattered areas of tympany and dullness indicate? -
correct answer It may suggest fluid accumulation or other abdominal abnormalities, but is not
the best fit for the case presented.
What are the symptoms of the 26-year-old public servant presenting to the Emergency
Department? - correct answer Intense abdominal pain, light-headedness, and a fainting
episode.
What is the family medical history concern for the 26-year-old patient? - correct answer Strong
family history of gallstones.
What is the significance of the positive β-hCG in the 26-year-old patient? - correct answer It
indicates a possible pregnancy.
What vital sign abnormalities were noted in the 26-year-old patient? - correct answer Pulse of
118, blood pressure of 86/68.
What abdominal exam findings were noted in the 26-year-old patient? - correct answer
Involuntary rigidity and rebound tenderness.
What is the most likely diagnosis for the 26-year-old patient? - correct answer Ruptured tubal
pregnancy.
What lab findings were noted for the 63-year-old janitor during his well visit? - correct answer
Moderate elevations of liver enzymes and mildly elevated total bilirubin.
What finding would be most consistent with hepatomegaly in the 63-year-old janitor? - correct
answer Liver palpable 3 cm below the right costal margin, midclavicular line on expiration.
What is considered a normal liver span measurement at the midclavicular line? - correct answer
6-12 cm.
What is the significance of dullness to percussion over the liver span? - correct answer It
indicates the size and condition of the liver.
What is the primary concern for the underweight 63-year-old administrative clerk? - correct
answer Prominent abdominal aorta concerning for an abdominal aortic aneurysm (AAA).
What is the most significant risk factor for an abdominal aortic aneurysm (AAA) in the
underweight clerk? - correct answer History of smoking.
What vital signs were recorded for the underweight administrative clerk? - correct answer
Pulse of 86, blood pressure of 148/92.
What is the BMI of the underweight administrative clerk? - correct answer 17.6.
What is the age of the first cousin who died from a ruptured aneurysm? - correct answer 68
years.
,What are the normal ranges for liver span measurements at the midsternal line? - correct
answer 4-8 cm.
What is the clinical significance of a liver span greater than 12 cm at the midclavicular line? -
correct answer It supports the diagnosis of hepatomegaly.
What is the expected liver position during inspiration? - correct answer The liver is pushed
down into the abdominal cavity.
What is the expected liver position during expiration? - correct answer The liver is normally
palpable at the right costal margin.
What is the relationship between obstructive lung disease and liver position? - correct answer
Air trapping may displace the liver downwards into the abdominal cavity.
What is the significance of a patient's family history in assessing risk for AAA? - correct answer
Family history of ruptured aneurysms increases risk.
What is the clinical relevance of a patient's smoking history in relation to AAA? - correct answer
Smoking is a significant risk factor for developing an abdominal aortic aneurysm.
What are the potential symptoms of an abdominal aortic aneurysm? - correct answer
Recurrent epigastric abdominal discomfort.
What is the importance of performing an abdominal exam in patients with concerning
symptoms? - correct answer To assess for abnormalities such as hepatomegaly or AAA.
What is the most significant risk factor for an abdominal aortic aneurysm (AAA) in the provided
notes? - correct answer History of smoking.
Which gender is considered a risk factor for AAA? - correct answer Male gender.
What is the relevance of family history in relation to AAA risk? - correct answer Family history
of ruptured aneurysm is vague and could refer to cerebral aneurysm.
What is the USPSTF recommendation for routine colon cancer screening in a 76-year-old man? -
correct answer Do not screen routinely.
What is the life expectancy necessary for colon cancer screening to be potentially beneficial
according to USPSTF? - correct answer A life expectancy greater than 7 years.
What should be discussed with patients aged 76-85 regarding colon cancer screening? - correct
answer Individualized risks and benefits.
What screening method may continue until age 80-85 if benefits outweigh risks? - correct
answer Annual FOBT screening.
,What findings on a colonoscopy would indicate no need for a repeat colonoscopy? - correct
answer Absence of any cancerous or precancerous findings.
What is the most likely physiological mechanism for constipation in the 31-year-old
accountant? - correct answer Functional change in bowel movement.
What are the three patterns of irritable bowel syndrome (IBS)? - correct answer Diarrhea
predominant, constipation predominant, or mixed.
What is characteristic of fecal impaction? - correct answer A large, firm fecal mass in the
rectum.
What dietary characteristic is associated with decreased fecal bulk? - correct answer A diet low
in fiber.
What condition is spasm of the external sphincter associated with? - correct answer Painful
anal lesions.
What conditions are associated with impairment of autonomic innervations? - correct answer
Multiple sclerosis, spinal cord injuries, and Hirschsprung disease.
What symptom did the accountant experience that is associated with constipation? - correct
answer Recurrent crampy abdominal pain.
What did the accountant resort to for relief from constipation? - correct answer Over-the-
counter laxatives.
What is a common characteristic of IBS related to bowel movements? - correct answer
Functional changes in bowel movement.
What was found during the colonoscopy of the 76-year-old man? - correct answer Internal
hemorrhoids and sigmoid diverticuli.
What is the significance of a positive FOBT in the context of colon cancer screening? - correct
answer It indicates the need for further investigation, such as a colonoscopy.
What is the age limit for routine colon cancer screening according to the USPSTF? - correct
answer Age 75 years.
What is the recommended frequency for sigmoidoscopy and FOBT in the notes? - correct
answer Sigmoidoscopy every 5 years with FOBT every 3 years.
What is the typical resolution pattern for the accountant's constipation symptoms? - correct
answer Symptoms typically gradually resolve with bowel movements.
What is the common stool characteristic reported by the accountant? - correct answer
Infrequent, small hard stool.
, What congenital condition is associated with the 23-year-old woman's chronic sinusitis and
bronchiectasis? - correct answer Kartagener syndrome.
What is the significance of situs inversus in the context of the abdominal exam findings? -
correct answer In situs inversus, the stomach and gastric air bubble are on the right, and liver
dullness is on the left.
What physical exam finding indicates peritonitis in the 28-year-old lawyer suspected of having
appendicitis? - correct answer Rebound tenderness, where pressing down firmly and slowly
and then quickly withdrawing the hand produces pain.
What does involuntary contraction of the abdominal wall indicate during an exam? - correct
answer It indicates rigidity, which is different from voluntary contraction.
How does abdominal pain change with hip flexion in patients with peritonitis? - correct answer
Patients with peritonitis tend to keep their hips flexed to reduce stretch and irritation of the
parietal peritoneum.
What is McBurney's point and its relevance in appendicitis? - correct answer McBurney's point
is located 2 inches from the anterior superior iliac spine on a line drawn from the umbilicus and
is associated with localized pain in appendicitis.
What is the most likely diagnosis for the 58-year-old man with chronic diarrhea and weight
loss? - correct answer Chronic pancreatitis.
What mechanism leads to diarrhea in chronic pancreatitis? - correct answer Fibrosis of the
pancreas leads to decreased pancreatic function and enzyme insufficiency.
What is the role of H. Pylori infection in gastrointestinal conditions? - correct answer H. Pylori
infection may cause peptic ulcer disease and dyspepsia, but is not usually associated with
diarrhea.
What condition is characterized by inflammation of the colonic diverticulum? - correct answer
Diverticulitis, which typically causes left-lower-quadrant pain, fever, and sometimes diarrhea.
What is mesenteric ischemia and its associated symptoms? - correct answer Mesenteric
ischemia is characterized by reduced blood supply to the bowel, causing diffuse abdominal
pain, vomiting, diarrhea, or constipation.
What are the common symptoms of chronic pancreatitis? - correct answer Increasing
weakness, recurrent epigastric pain radiating to the back, chronic diarrhea, and weight loss.
What does a protuberant abdomen with scattered areas of tympany and dullness indicate? -
correct answer It may suggest fluid accumulation or other abdominal abnormalities, but is not
the best fit for the case presented.
