NR 509 FINAL EXAM 88 REVISION HANDBOOK
2026 HISTORY TAKING AND CLINICAL
FINDINGS INTERPRETATION
◉ Liver palpable 3cm below the right costal margin, mid clavicular
line, on expiration.
Answer: 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 y-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?
◉ History of smoking.
Answer: 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 , 36.2 ° C . 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?
◉ Do not screen routinely.
Answer: 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?
◉ Functional change in bowel movement.
Answer: 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?
◉ Tympany to percussion in the right upper quadrant, dullness to
percussion of the left upper quadrant.
Answer: 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?
◉ Pressing down onto the abdomen firmly and slowly and
withdrawing the hand quickly produces pain.
Answer: 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?
◉ Fibrosis of the pancreas.
Answer: 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?
◉ Associated right shoulder pain.
Answer: 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
acter 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?
◉ The anal canal has a rich somatosensory innervation, making
poorly directed examinations painful in this area.
Answer: A 62-year-old male who is undergoing evaluation for
possible prostate cancer strongly declines a rectal examination,
stating that, "Some trainee once did that and it hurt badly." Which of
the following is true about the innervation of the anus and rectum
that may explain this patient's experience of discomfort?
◉ The median lobe of the prostate is located anterior to the urethra
and is not palpable on DRE.
Answer: A 54-year-old male with a strong family history of breast
and prostate cancer presents to his primary care provider to discuss
prostate screening. His father died at age 73 years from prostate
2026 HISTORY TAKING AND CLINICAL
FINDINGS INTERPRETATION
◉ Liver palpable 3cm below the right costal margin, mid clavicular
line, on expiration.
Answer: 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 y-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?
◉ History of smoking.
Answer: 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 , 36.2 ° C . 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?
◉ Do not screen routinely.
Answer: 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?
◉ Functional change in bowel movement.
Answer: 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?
◉ Tympany to percussion in the right upper quadrant, dullness to
percussion of the left upper quadrant.
Answer: 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?
◉ Pressing down onto the abdomen firmly and slowly and
withdrawing the hand quickly produces pain.
Answer: 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?
◉ Fibrosis of the pancreas.
Answer: 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?
◉ Associated right shoulder pain.
Answer: 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
acter 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?
◉ The anal canal has a rich somatosensory innervation, making
poorly directed examinations painful in this area.
Answer: A 62-year-old male who is undergoing evaluation for
possible prostate cancer strongly declines a rectal examination,
stating that, "Some trainee once did that and it hurt badly." Which of
the following is true about the innervation of the anus and rectum
that may explain this patient's experience of discomfort?
◉ The median lobe of the prostate is located anterior to the urethra
and is not palpable on DRE.
Answer: A 54-year-old male with a strong family history of breast
and prostate cancer presents to his primary care provider to discuss
prostate screening. His father died at age 73 years from prostate
