NRDF509DFFinalDFExamDFStudyDFG
uide
1. ChapterD F 19:D F Abdomen:D F ...
2. AnDFoverweightDF26-year-oldDFpublicDFservantDFpresentsDFtoDFtheDFEmergencyDFDe-
partmentDFwithDF12DFhoursDFofDFintenseDFabdominalDFpain,DFlight-
headedness,DFandDFaDFfaintingDFepisodeDFthatDFfinallyDFpromptedDFherDFtoDFseekDFmedicalDFattention
.DFSheDFhasDFaDFstrongDFfamilyDFhistoryDFofDFgallstonesDFandDFisDFconcernedDFaboutDFthisDFpossibilit
y.DFSheDFhasDFnotDFhadDFanyDFvomitingDForDFdiarrhea.DFSheDFhadDFaDFnormalDFbowelDFmovementDFthisD
Fmorning. DFHerDFβ-humanDFchorionicDFgonadotropinDF(β-
hCG)DFisDFpositiveDFatDFtriage.DFSheDFreportsDFthatDFherDFlastDFperiodDFwasDF10DFweeksDFago.DFHerDF
vitalDFsignsDFatDFtriageDFareDFpulse,DF118;DFbloodDFpressure,DF86/68;DFrespiratoryDFrate,DF20/min;DFo
xygenDFsaturation,DF99%;DFandDFtemperature,DF37.3ºCDForally.DFTheDFclinicianDFperformsDFanDFabdo
minalDFexamDFpriorDFtoDFherDFpelvicDFexamDFand,DFonDFpalpationDFofDFherDFabdomen,DFfindsDFinvolu
ntaryDFrigidityDFandDFreboundDFtenderness.DFWhatDFisDFtheDFmostDFlikelyD F diagnosis?:DFa.DFRupturedDFtubalD
F(orDFectopic)DFpregnancy
b. AcuteDFcholecystitis
c. RupturedDFappendix
d. PerforatedDFbowelDFwall
e. RupturedDFovarianDFcyst
3. AD F 63-year-
oldD F janitorD F withD F aD F historyD F ofD F adenomatousD F colonicD F polypsD F presentsDFforD F aD F wellD F visit.
D F BasicD F labsD F areD F performedD F toD F screenD F forD F diabetesD F mellitusD F andDFdyslipidemia.D F Electro
lytesD F andD F liverD F enzymesD F wereD F alsoD F measured.D F HisD F labsD F areD F allD F normalD F expectD F for
D F moderateD F elevationsD F ofD F aspartateD F aminotransferase,D F alanineD F aminotransferase,D F γ-
glutamylD F transferase,D F andD F alkalineD F phosphataseDFasD F wellD F asD F aD F mildlyD F elevatedD F totalD F
bilirubin.D F HeD F presentsD F forD F aD F follow-upD F appoint-
mentD F andD F theD F clinicianD F performsD F anD F abdominalD F examD F toD F assessD F hisD F liver.D F WhichDFofD
FtheDFfollowingDFfindingsDFwouldDFbeDFmostDFconsistentDFwithDFhepatomegaly?:D F a.DFLiverD F spanDFofDF11DFc
mDFatDFtheDFmidclavicularDFline
b. LiverDFspanDFofDF8DFcmDFatDFtheDFmidsternalDFline
c. DullnessDFtoDFpercussionDFoverDFaDFspanDFofDF11DFcmDFatDFtheDFmidclavicularDFline
d. DullnessDFtoDFpercussionDFoverDFaDFspanDFofDF8DFcmDFatDFtheDFmidsternalDFline
e. LiverDFpalpableDF3DFcmDFbelowDFtheDFrightDFcostalDFmargin,DFmidDFclavicularDFline,DFonDFexpiration
4. AD F 63-year-oldD F underweightD F administrativeD F clerkD F withD F aD F 50-pack-yearD F smok-
ingDFhistoryDFpresentsDFwithDFaDFseveralDFmonthDFhistoryDFofDFrecurrentDFepigastric
, NRDF509DFFinalDFExamDFStudyDFG
uide
abdominalD F discomfort.D F SheD F feelsD F fairlyD F wellD F otherwiseD F andD F deniesD F anyD F nausea,DFvomit
ing,DFdiarrhea,DForDFconstipation.DFSheDFreportsDFthatDFaDFfirstDFcousinDFdiedDFfromDFaDFrupturedDFa
neurysmDFatDFageDF68DFyears.DFHerDFvitalDFsignsDFareDFpulse,DF86;DFbloodDFpressure,D F 148/92;D F resp
iratoryD F rate,D F 16;D F oxygenD F saturation,D F 95%;D F andD F temper-
ature,D F 36.2ºC.D F HerD F bodyD F massD F indexD F isD F 17.6.D F OnD F exam,D F herD F abdominalD F aorta
isDFprominent,DFwhichDFisDFconcerningDFforDFanDFabdominalDFaorticDFaneurysmDF(AAA).DFWhichDF
ofDFtheDFfollowingDFisDFherDFmostDFsignificantDFriskDFfactorDFforDFanDFAAA?:DFa.DFFemaleDFgender
b. HistoryDFofDFsmoking
c. Underweight
d. FamilyDFhistoryDFofDFrupturedDFaneurysm
e. Hypertension
5. AD F 76-year-
oldD F retiredD F manD F withD F aD F historyD F ofD F prostateD F cancerD F andD F hypertensionDFhasD F beenD F screen
edD F annuallyD F forD F colonD F cancerD F usingD F highD F sensitivityD F fecalD F occultDFbloodDFtestingDF(FOB
T).DFHeDFpresentsDFforDFfollow-
upDFofDFhisDFhypertension,DFduringDFwhichDFtheDFclinicianDFscansDFhisDFchartDFtoDFensureDFheDFisDFupDFt
oDFdateDFwithDFhisDFpreventiveD F healthDFcare.DFHeDFhasDFaDFpositiveDFFOBTDFonDFoneDFoccasionDFatDFageD
F66DFyearsDFandDFsubse-
quentlyD F wentD F forD F aD F colonoscopy.D F InternalD F hemorrhoidsD F andD F sigmoidD F diverticuliD F wer
eDFfoundDFonDFcolonoscopy.DFHeDFhasDFnoDFfirst-
degreeDFrelativesDFwithDFaDFhistoryDFofD F colorectalD F cancerD F orD F adenomatousD F polyps.D F WhatD F ar
eD F theD F U.S.D F PreventiveDFServicesDFTaskDFForceDF(USPSTF)DFscreeningDFrecommendationsDFforDFthis
DFpatient?:DFa.
DoDFnotDFscreenDFroutinely
b. ContinueDFannualDFFOBTDFscreeningDFuntilDFageDF80DFyears
c. ContinueDFannualDFFOBTDFscreeningDFuntilDFageDF85DFyears
d. RepeatDFcolonoscopyDFthisDFyear
e. SigmoidoscopyDFeveryDF5DFyearsDFwithDFFOBTDFeveryDF3DFyearsDFSub
mit
6. AnD F otherwiseD F healthyD F 31-year-
oldD F accountantD F presentsD F toD F anD F outpatientD F clinicDFwithDFaDF3-
yearDFhistoryDFofDFrecurrentDFcrampyDFabdominalDFpainDFthatDFlastsDFforDFaboutDF1-
2D F weeksD F eachD F episodeD F andD F isD F associatedD F withD F onsetD F ofD F constipation.D F SheDFdescribesD F
infrequent,D F smallD F hardD F stoolD F thatD F sheD F findsD F veryD F difficultD F toD F pass.D F SheDFhasDFtriedDFto
DFincreaseDFdietaryDFfiberDFand DFwaterDFintake,DFbutDFusually DFthisDFisDFnot
, NRDF509DFFinalDFExamDFStudyDFG
uide
sufficientD F andD F sheD F resortsD F toD F over-the-
counterD F laxatives,D F whichD F sheD F findsD F upsetDFherD F stomachD F butD F doD F resolveD F theD F constipatio
n.D F SymptomsD F typicallyD F graduallyD F resolveD F withD F bowelD F movements.D F WhichD F ofD F theD F fol
lowingD F isD F theD F mostD F likelyD F physiologicalDFmechanismDFforDFherDFconstipation?:DFa.DFADFlarge,DFfirmDFfecal
DFmassDFinDFtheDFrectum
b. DecreasedDFfecalDFbulk
c. FunctionalDFchangeDFinDFbowelDFmovement
d. SpasmDFofDFtheDFexternalDFsphincter
e. ImpairmentD F ofD F autonomicD F innervations
7. AD F 23-year-oldD F womanD F comesD F toD F theD F respirologyD F clinicD F forD F follow-
upD F ofD F herD F chronicD F sinusitisD F andD F bronchiectasisD F thatD F isD F associatedD F withD F aD F rareD F cong
enitalD F conditionD F calledD F KartagenerD F syndrome.D F TheD F preceptorD F notesD F thatD F sheD F hasD F situsD
FinversusD F andD F asksD F forD F aD F physicalD F exam.D F WhichD F ofD F theD F followingD F descriptionsDFbestDFfi
tsDFwithDFfindingsDFonDFtheDFabdominalDFexam?:DFa.DFTympanyDFtoDFpercussionDFinDFtheDFrightDFupperDFquadrant,DFdullnessDFto
DFpercussion DFofDFtheDFleftDFupperDFquadrant
b. ProtuberantDFabdomenDFthatDFhasDFscatteredDFareasDFofDFtympanyDFandDFdullness;DFstoolDFisDFfeltDFonDFpalpation
c. LiverDFdullnessDFinDFtheDFrightDFupperDFquadrantDFthatDFisDFdisplacedDFdownwardDFbyDFtheDFlowDFdiaphragmDFdueDFtoDFchronicDFobstructiveDFp
ulmonaryDFdisease
d. DullnessDFtoDFpercussionDFofDFtheDFleftDFlowerDFanteriorDFchestDFwallDFroughlyDFatDFtheDFanteriorDFaxillaryDFline
e. ADFchangeDFinDFpercussionDFfromDFtympanyDFtoDFdullnessDFinDFtheDFleftDFlowerDFanteriorDFchestDFwallDFonDFinspiration
8. AnD F otherwiseD F healthyD F 28-year-oldD F lawyerD F presentsD F toD F theD F EmergencyD F Depart-
mentD F withD F aD F 1-
dayD F historyD F ofD F severeD F abdominalD F pain.D F TheD F emergencyD F physicianDFsuspectsD F appendicitis
D F andD F generalD F surgeryD F isD F consulted.D F TheD F residentD F believesDFtheD F patientD F hasD F signsD F ofD F
peritonitisD F onD F exam.D F WhichD F ofD F theD F followingD F physicalD F examDFfindingsDFsupportsDFperitonitis?:DFa.
DFVoluntary DFcontraction DFofDFtheDFabdominal DFwallDFthatDFpersistsDFoverDFseveralDFexaminations
b. PressingDFdownDFontoDFtheDFabdomenDFfirmlyDFandDFslowlyDFandDFwithdrawingDFtheDFhandDFquicklyDFproducesDFpain
c. AbdominalDFpainDFthatDFincreasesDFwithDFhipDFflexion
d. LocalizedDFpainDFoverDFMcBurneyDFpoint,DFwhichDFliesDF2DFinchesDFfromDFtheDFanteriorDFsuperiorDFiliacDFspinousDFprocessDFonDFaDFlineDFdrawnDFfro
mDFtheDFumbilicus
e. PainDFwithDFinternalDFrotationDFofDFtheDFrightDFhip
9. ADF58-year-
oldDFmanDFwithDFaDFhistoryDFofDFdiabetesDFandDFalcoholDFaddictionDFhasDFbeenDFsoberDFforDFtheDFlastD
F10DFmonths.DFHeDFpresentsDFwithDFaDF4-monthDFhistoryDFofDFincreasing
, NRDF509DFFinalDFExamDFStudyDFG
uide
weakness,D F recurrentD F epigastricD F painD F radiatingD F toD F hisD F back,D F chronicD F diarrheaD F withD F sto
olsD F 6-
8D F timesD F daily,D F andD F weightD F lossD F ofD F 18D F lbD F overD F 4D F months.D F WhatD F isD F theDFmechanismDFofDF
hisDFmostDFlikelyDFdiagnosis?:DFa.DFHelicobacterDFpyloriDFinfection
b. InflammationDFofDFtheDFgallbladder
c. InflammationDFofDFcolonicDFdiverticulum
d. ReducedDFbloodDFsupplyDFtoDFtheDFbowel
e. FibrosisDFofDFtheDFpancreas
10. ADF46-year-
oldDFexecutiveDFwhoDFisDFobeseDFandDFotherwiseDFhealthyDFpresentsDFtoDFaDFfamilyDFmedicineDFclin
icDFwithDFaDF3-
monthDFcourseDFofDFrecurrentDFsevereDFabdominalDFpainDFthatDFusuallyDFresolvesDFonDFitsDFownDFaf
terDFaDFfewDFhours.DFHerDFlastDFepisodeDFwasDFprolongedD F lastingD F 6D F hours,D F andD F sheD F isD F frus
tratedD F thatD F sheD F hasD F hadD F toD F leaveDForDFmissDFworkDFonDFthreeDFseparateDFoccasions.DFSheDF
wouldDFlikeDFaDFdiagnosisDFandDFtheDFproblemDFfixed.DFWhichDFsymptomsDForDFsignsDFwouldDFbeDF
mostDFsuggestiveDFofDFaDFdiagnosisDFofDFbiliaryDFcolic?:DFa.DFExacerbatingDFfactorDFincludesDFalcoholDFintake
b. PositiveDFMcBurneyDFpointDFtenderness
c. PoorlyDFlocalizedDFperiumbilicalDFpain
d. VomitingDFofDFbile
e. AssociatedDFrightDFshoulderDFpain
11. ChapterDF22DFAnus,DFRectum,DFandDFProstate:
12. AD F 49-year-
oldD F maleD F nurseD F experiencesD F fecalD F incontinenceD F afterD F aD F motorDFvehicleD F accidentD F thatD F l
eftD F himD F paralyzedD F belowD F theD F waist.D F HeD F asksD F hisD F rehabil-
itationD F physicianD F aboutD F theD F controlD F ofD F thisD F functionD F inD F aD F personD F withoutD F his
DFinjuries.D F WhichD F ofD F theD F followingD F isD F trueD F regardingD F theD F muscleD F controlD F ofD F t
heDFanalD F sphincter?:D F a.DFTheDFinternalDFanalDFsphincterDFisDFunderDFvoluntaryDFcontrol,DFwhereasDFtheDFexternalDFanalDFsphincterDFisDFund
erDFinvoluntaryDFcontrol.
b. TheDFinternalDFanalDFsphincterDFisDFunderDFinvoluntaryDFcontrol,DFwhereasDFtheDFexternalDFanalDFsphincterDFisDFunderDFvoluntaryDFcontrol.
c. BothDFinternalDFandDFexternalDFanalDFsphincterDFareDFunderDFvoluntaryDFcontrol.
d. BothDFinternalDFandDFexternalDFanalDFsphincterDFareDFunderDFinvoluntaryDFcontrol.
e. ControlDFofDFtheDFanalDFsphinctersDFisDFvariableDFbetweenDFindividuals
13. ADF62-year-
oldDFmaleDFwhoDFisDFundergoingDFevaluationDFforDFpossibleDFprostateDFcancerDFstronglyDFdecli
nesDFaDFrectalDFexamination,DFstatingDFthat,DF"SomeDFtrainee
uide
1. ChapterD F 19:D F Abdomen:D F ...
2. AnDFoverweightDF26-year-oldDFpublicDFservantDFpresentsDFtoDFtheDFEmergencyDFDe-
partmentDFwithDF12DFhoursDFofDFintenseDFabdominalDFpain,DFlight-
headedness,DFandDFaDFfaintingDFepisodeDFthatDFfinallyDFpromptedDFherDFtoDFseekDFmedicalDFattention
.DFSheDFhasDFaDFstrongDFfamilyDFhistoryDFofDFgallstonesDFandDFisDFconcernedDFaboutDFthisDFpossibilit
y.DFSheDFhasDFnotDFhadDFanyDFvomitingDForDFdiarrhea.DFSheDFhadDFaDFnormalDFbowelDFmovementDFthisD
Fmorning. DFHerDFβ-humanDFchorionicDFgonadotropinDF(β-
hCG)DFisDFpositiveDFatDFtriage.DFSheDFreportsDFthatDFherDFlastDFperiodDFwasDF10DFweeksDFago.DFHerDF
vitalDFsignsDFatDFtriageDFareDFpulse,DF118;DFbloodDFpressure,DF86/68;DFrespiratoryDFrate,DF20/min;DFo
xygenDFsaturation,DF99%;DFandDFtemperature,DF37.3ºCDForally.DFTheDFclinicianDFperformsDFanDFabdo
minalDFexamDFpriorDFtoDFherDFpelvicDFexamDFand,DFonDFpalpationDFofDFherDFabdomen,DFfindsDFinvolu
ntaryDFrigidityDFandDFreboundDFtenderness.DFWhatDFisDFtheDFmostDFlikelyD F diagnosis?:DFa.DFRupturedDFtubalD
F(orDFectopic)DFpregnancy
b. AcuteDFcholecystitis
c. RupturedDFappendix
d. PerforatedDFbowelDFwall
e. RupturedDFovarianDFcyst
3. AD F 63-year-
oldD F janitorD F withD F aD F historyD F ofD F adenomatousD F colonicD F polypsD F presentsDFforD F aD F wellD F visit.
D F BasicD F labsD F areD F performedD F toD F screenD F forD F diabetesD F mellitusD F andDFdyslipidemia.D F Electro
lytesD F andD F liverD F enzymesD F wereD F alsoD F measured.D F HisD F labsD F areD F allD F normalD F expectD F for
D F moderateD F elevationsD F ofD F aspartateD F aminotransferase,D F alanineD F aminotransferase,D F γ-
glutamylD F transferase,D F andD F alkalineD F phosphataseDFasD F wellD F asD F aD F mildlyD F elevatedD F totalD F
bilirubin.D F HeD F presentsD F forD F aD F follow-upD F appoint-
mentD F andD F theD F clinicianD F performsD F anD F abdominalD F examD F toD F assessD F hisD F liver.D F WhichDFofD
FtheDFfollowingDFfindingsDFwouldDFbeDFmostDFconsistentDFwithDFhepatomegaly?:D F a.DFLiverD F spanDFofDF11DFc
mDFatDFtheDFmidclavicularDFline
b. LiverDFspanDFofDF8DFcmDFatDFtheDFmidsternalDFline
c. DullnessDFtoDFpercussionDFoverDFaDFspanDFofDF11DFcmDFatDFtheDFmidclavicularDFline
d. DullnessDFtoDFpercussionDFoverDFaDFspanDFofDF8DFcmDFatDFtheDFmidsternalDFline
e. LiverDFpalpableDF3DFcmDFbelowDFtheDFrightDFcostalDFmargin,DFmidDFclavicularDFline,DFonDFexpiration
4. AD F 63-year-oldD F underweightD F administrativeD F clerkD F withD F aD F 50-pack-yearD F smok-
ingDFhistoryDFpresentsDFwithDFaDFseveralDFmonthDFhistoryDFofDFrecurrentDFepigastric
, NRDF509DFFinalDFExamDFStudyDFG
uide
abdominalD F discomfort.D F SheD F feelsD F fairlyD F wellD F otherwiseD F andD F deniesD F anyD F nausea,DFvomit
ing,DFdiarrhea,DForDFconstipation.DFSheDFreportsDFthatDFaDFfirstDFcousinDFdiedDFfromDFaDFrupturedDFa
neurysmDFatDFageDF68DFyears.DFHerDFvitalDFsignsDFareDFpulse,DF86;DFbloodDFpressure,D F 148/92;D F resp
iratoryD F rate,D F 16;D F oxygenD F saturation,D F 95%;D F andD F temper-
ature,D F 36.2ºC.D F HerD F bodyD F massD F indexD F isD F 17.6.D F OnD F exam,D F herD F abdominalD F aorta
isDFprominent,DFwhichDFisDFconcerningDFforDFanDFabdominalDFaorticDFaneurysmDF(AAA).DFWhichDF
ofDFtheDFfollowingDFisDFherDFmostDFsignificantDFriskDFfactorDFforDFanDFAAA?:DFa.DFFemaleDFgender
b. HistoryDFofDFsmoking
c. Underweight
d. FamilyDFhistoryDFofDFrupturedDFaneurysm
e. Hypertension
5. AD F 76-year-
oldD F retiredD F manD F withD F aD F historyD F ofD F prostateD F cancerD F andD F hypertensionDFhasD F beenD F screen
edD F annuallyD F forD F colonD F cancerD F usingD F highD F sensitivityD F fecalD F occultDFbloodDFtestingDF(FOB
T).DFHeDFpresentsDFforDFfollow-
upDFofDFhisDFhypertension,DFduringDFwhichDFtheDFclinicianDFscansDFhisDFchartDFtoDFensureDFheDFisDFupDFt
oDFdateDFwithDFhisDFpreventiveD F healthDFcare.DFHeDFhasDFaDFpositiveDFFOBTDFonDFoneDFoccasionDFatDFageD
F66DFyearsDFandDFsubse-
quentlyD F wentD F forD F aD F colonoscopy.D F InternalD F hemorrhoidsD F andD F sigmoidD F diverticuliD F wer
eDFfoundDFonDFcolonoscopy.DFHeDFhasDFnoDFfirst-
degreeDFrelativesDFwithDFaDFhistoryDFofD F colorectalD F cancerD F orD F adenomatousD F polyps.D F WhatD F ar
eD F theD F U.S.D F PreventiveDFServicesDFTaskDFForceDF(USPSTF)DFscreeningDFrecommendationsDFforDFthis
DFpatient?:DFa.
DoDFnotDFscreenDFroutinely
b. ContinueDFannualDFFOBTDFscreeningDFuntilDFageDF80DFyears
c. ContinueDFannualDFFOBTDFscreeningDFuntilDFageDF85DFyears
d. RepeatDFcolonoscopyDFthisDFyear
e. SigmoidoscopyDFeveryDF5DFyearsDFwithDFFOBTDFeveryDF3DFyearsDFSub
mit
6. AnD F otherwiseD F healthyD F 31-year-
oldD F accountantD F presentsD F toD F anD F outpatientD F clinicDFwithDFaDF3-
yearDFhistoryDFofDFrecurrentDFcrampyDFabdominalDFpainDFthatDFlastsDFforDFaboutDF1-
2D F weeksD F eachD F episodeD F andD F isD F associatedD F withD F onsetD F ofD F constipation.D F SheDFdescribesD F
infrequent,D F smallD F hardD F stoolD F thatD F sheD F findsD F veryD F difficultD F toD F pass.D F SheDFhasDFtriedDFto
DFincreaseDFdietaryDFfiberDFand DFwaterDFintake,DFbutDFusually DFthisDFisDFnot
, NRDF509DFFinalDFExamDFStudyDFG
uide
sufficientD F andD F sheD F resortsD F toD F over-the-
counterD F laxatives,D F whichD F sheD F findsD F upsetDFherD F stomachD F butD F doD F resolveD F theD F constipatio
n.D F SymptomsD F typicallyD F graduallyD F resolveD F withD F bowelD F movements.D F WhichD F ofD F theD F fol
lowingD F isD F theD F mostD F likelyD F physiologicalDFmechanismDFforDFherDFconstipation?:DFa.DFADFlarge,DFfirmDFfecal
DFmassDFinDFtheDFrectum
b. DecreasedDFfecalDFbulk
c. FunctionalDFchangeDFinDFbowelDFmovement
d. SpasmDFofDFtheDFexternalDFsphincter
e. ImpairmentD F ofD F autonomicD F innervations
7. AD F 23-year-oldD F womanD F comesD F toD F theD F respirologyD F clinicD F forD F follow-
upD F ofD F herD F chronicD F sinusitisD F andD F bronchiectasisD F thatD F isD F associatedD F withD F aD F rareD F cong
enitalD F conditionD F calledD F KartagenerD F syndrome.D F TheD F preceptorD F notesD F thatD F sheD F hasD F situsD
FinversusD F andD F asksD F forD F aD F physicalD F exam.D F WhichD F ofD F theD F followingD F descriptionsDFbestDFfi
tsDFwithDFfindingsDFonDFtheDFabdominalDFexam?:DFa.DFTympanyDFtoDFpercussionDFinDFtheDFrightDFupperDFquadrant,DFdullnessDFto
DFpercussion DFofDFtheDFleftDFupperDFquadrant
b. ProtuberantDFabdomenDFthatDFhasDFscatteredDFareasDFofDFtympanyDFandDFdullness;DFstoolDFisDFfeltDFonDFpalpation
c. LiverDFdullnessDFinDFtheDFrightDFupperDFquadrantDFthatDFisDFdisplacedDFdownwardDFbyDFtheDFlowDFdiaphragmDFdueDFtoDFchronicDFobstructiveDFp
ulmonaryDFdisease
d. DullnessDFtoDFpercussionDFofDFtheDFleftDFlowerDFanteriorDFchestDFwallDFroughlyDFatDFtheDFanteriorDFaxillaryDFline
e. ADFchangeDFinDFpercussionDFfromDFtympanyDFtoDFdullnessDFinDFtheDFleftDFlowerDFanteriorDFchestDFwallDFonDFinspiration
8. AnD F otherwiseD F healthyD F 28-year-oldD F lawyerD F presentsD F toD F theD F EmergencyD F Depart-
mentD F withD F aD F 1-
dayD F historyD F ofD F severeD F abdominalD F pain.D F TheD F emergencyD F physicianDFsuspectsD F appendicitis
D F andD F generalD F surgeryD F isD F consulted.D F TheD F residentD F believesDFtheD F patientD F hasD F signsD F ofD F
peritonitisD F onD F exam.D F WhichD F ofD F theD F followingD F physicalD F examDFfindingsDFsupportsDFperitonitis?:DFa.
DFVoluntary DFcontraction DFofDFtheDFabdominal DFwallDFthatDFpersistsDFoverDFseveralDFexaminations
b. PressingDFdownDFontoDFtheDFabdomenDFfirmlyDFandDFslowlyDFandDFwithdrawingDFtheDFhandDFquicklyDFproducesDFpain
c. AbdominalDFpainDFthatDFincreasesDFwithDFhipDFflexion
d. LocalizedDFpainDFoverDFMcBurneyDFpoint,DFwhichDFliesDF2DFinchesDFfromDFtheDFanteriorDFsuperiorDFiliacDFspinousDFprocessDFonDFaDFlineDFdrawnDFfro
mDFtheDFumbilicus
e. PainDFwithDFinternalDFrotationDFofDFtheDFrightDFhip
9. ADF58-year-
oldDFmanDFwithDFaDFhistoryDFofDFdiabetesDFandDFalcoholDFaddictionDFhasDFbeenDFsoberDFforDFtheDFlastD
F10DFmonths.DFHeDFpresentsDFwithDFaDF4-monthDFhistoryDFofDFincreasing
, NRDF509DFFinalDFExamDFStudyDFG
uide
weakness,D F recurrentD F epigastricD F painD F radiatingD F toD F hisD F back,D F chronicD F diarrheaD F withD F sto
olsD F 6-
8D F timesD F daily,D F andD F weightD F lossD F ofD F 18D F lbD F overD F 4D F months.D F WhatD F isD F theDFmechanismDFofDF
hisDFmostDFlikelyDFdiagnosis?:DFa.DFHelicobacterDFpyloriDFinfection
b. InflammationDFofDFtheDFgallbladder
c. InflammationDFofDFcolonicDFdiverticulum
d. ReducedDFbloodDFsupplyDFtoDFtheDFbowel
e. FibrosisDFofDFtheDFpancreas
10. ADF46-year-
oldDFexecutiveDFwhoDFisDFobeseDFandDFotherwiseDFhealthyDFpresentsDFtoDFaDFfamilyDFmedicineDFclin
icDFwithDFaDF3-
monthDFcourseDFofDFrecurrentDFsevereDFabdominalDFpainDFthatDFusuallyDFresolvesDFonDFitsDFownDFaf
terDFaDFfewDFhours.DFHerDFlastDFepisodeDFwasDFprolongedD F lastingD F 6D F hours,D F andD F sheD F isD F frus
tratedD F thatD F sheD F hasD F hadD F toD F leaveDForDFmissDFworkDFonDFthreeDFseparateDFoccasions.DFSheDF
wouldDFlikeDFaDFdiagnosisDFandDFtheDFproblemDFfixed.DFWhichDFsymptomsDForDFsignsDFwouldDFbeDF
mostDFsuggestiveDFofDFaDFdiagnosisDFofDFbiliaryDFcolic?:DFa.DFExacerbatingDFfactorDFincludesDFalcoholDFintake
b. PositiveDFMcBurneyDFpointDFtenderness
c. PoorlyDFlocalizedDFperiumbilicalDFpain
d. VomitingDFofDFbile
e. AssociatedDFrightDFshoulderDFpain
11. ChapterDF22DFAnus,DFRectum,DFandDFProstate:
12. AD F 49-year-
oldD F maleD F nurseD F experiencesD F fecalD F incontinenceD F afterD F aD F motorDFvehicleD F accidentD F thatD F l
eftD F himD F paralyzedD F belowD F theD F waist.D F HeD F asksD F hisD F rehabil-
itationD F physicianD F aboutD F theD F controlD F ofD F thisD F functionD F inD F aD F personD F withoutD F his
DFinjuries.D F WhichD F ofD F theD F followingD F isD F trueD F regardingD F theD F muscleD F controlD F ofD F t
heDFanalD F sphincter?:D F a.DFTheDFinternalDFanalDFsphincterDFisDFunderDFvoluntaryDFcontrol,DFwhereasDFtheDFexternalDFanalDFsphincterDFisDFund
erDFinvoluntaryDFcontrol.
b. TheDFinternalDFanalDFsphincterDFisDFunderDFinvoluntaryDFcontrol,DFwhereasDFtheDFexternalDFanalDFsphincterDFisDFunderDFvoluntaryDFcontrol.
c. BothDFinternalDFandDFexternalDFanalDFsphincterDFareDFunderDFvoluntaryDFcontrol.
d. BothDFinternalDFandDFexternalDFanalDFsphincterDFareDFunderDFinvoluntaryDFcontrol.
e. ControlDFofDFtheDFanalDFsphinctersDFisDFvariableDFbetweenDFindividuals
13. ADF62-year-
oldDFmaleDFwhoDFisDFundergoingDFevaluationDFforDFpossibleDFprostateDFcancerDFstronglyDFdecli
nesDFaDFrectalDFexamination,DFstatingDFthat,DF"SomeDFtrainee
