WEEK 8 NR 509 ADVANCED HEALTH
ASSESSMENT FINAL, PD II - LIPPINCOTT
ABDOMEN QUIZ PREP EXAM
WITH ACTUAL CORRECT QUESTIONS
AND VERIFIED DETAILED
ANSWERS|FREQUENTLY TESTED
QUESTIONS AND
SOLUTIONS|NEWEST|GUARANTEED
PASS 2026/2027
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 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?
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.
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 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?
1|Page
,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 screening may continue until age 80-85 years if benefits to doing
so outweigh risks for the individual patient; however, screening should not be routinely continued. In
general, a life expectancy >7 years is necessary for screening to be potentially beneficial. There is no
indication to repeat a colonoscopy given the absence of any cancerous or precancerous findings on his
colonoscopy 10 years ago. Sigmoidoscopy every 5 years with FOBT every 3 years is a valid screening
option, but again screening is not routinely recommended for patients age >75 years.
CHAPTER 19: Abdomen
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?
Functional change in bowel movement
Rationale: Functional change in bowel movement is characteristic of irritable bowel syndrome (IBS). IBS
is characterized by three patterns: diarrhea predominant, constipation predominant, or mixed. Other
functional causes for her constipation should be excluded prior to making this diagnosis. A large firm
fecal mass in the rectum is characteristic of fecal impaction, which is common in debilitated, bedridden
individuals. Decreased fecal bulk is characteristic of a diet low in fiber. This patient had not found that
increasing fiber helps her constipation. Spasm of the external sphincter is associated with painful anal
lesions, which this patient does not report. Impairment of autonomic innervations is characteristic of
patients with multiple sclerosis, spinal cord injuries, and Hirschsprung disease. She has no known
diagnosis that would increase suspicion of neurological impairment.
CHAPTER 19: Abdomen
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?
Tympany to percussion in the right upper quadrant, dullness to percussion of the left upper quadrant
Rationale: Situs inversus is a rare condition in which organs are reversed and is associated with
Kartagener syndrome. Thus, the stomach and gastric air bubble are on the right and liver dullness is on
the left. A protuberant abdomen with scattered areas of dullness and tympany and stool on palpation is
likely constipation. None of these findings suggest organ reversal. Liver dullness will occur in the left
upper quadrant with organ reversal. Findings given in the remaining answer choices are both associated
2|Page
,with splenomegaly with the spleen located in the left upper quadrant, which would not be the case for
sinus inversus totalis.
CHAPTER 19: Abdomen
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?
Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly produces pain
Rationale: Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly
producing pain describes rebound tenderness, which, along with guarding and rigidity, is suggestive of
peritonitis. Involuntary contraction rather than voluntary contraction of the abdominal wall that persists
over several examinations describes rigidity. Abdominal pain that increases with hip flexion is not
suggestive of peritonitis. In fact, patients with peritonitis tend to keep hips flexed to reduce stretch and
irritation of the parietal peritoneum. They often walk bent forward at the hips for this reason. Localized
pain over McBurney point is certainly suggestive of appendicitis, but not suggestive of peritonitis.
Similarly pain with internal rotation of the right hip, or a positive obturator sign, suggests irritation of
the psoas muscle due to an inflamed appendix, but not peritonitis.
CHAPTER 19: Abdomen
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?
Fibrosis of the pancreas
Rationale: Fibrosis of the pancreas is associated with chronic pancreatitis. Chronic pancreatitis leads to
fibrosis and decreased pancreatic function, which causes diarrhea from pancreatic enzyme insufficiency
and diabetes mellitus. H. pylori infection may cause peptic ulcer disease and dyspepsia, which is not
usually associated with diarrhea. Inflammation of the colonic diverticulum is diverticulitis and typically
causes left-lower-quadrant pain, fever, constipation, and sometimes diarrhea. It is typically an acute
disease. Reduced blood supply to the bowel characterizes mesenteric ischemia. It can be acute or
chronic in presentation and causes diffuse abdominal pain, vomiting, diarrhea, or constipation. It is
associated with older age and vascular risk factors such as coronary artery disease.
CHAPTER 19: Abdomen
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 after 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?
Associated right shoulder pain
3|Page
, Rationale: Pain with biliary colic can produced referred pain to the right shoulder or scapula due to
irritation of the right hemidiaphragm. Alcohol is not an exacerbating factor for biliary colic. Positive
McBurney point tenderness is associated with acute appendicitis. The Murphy sign is associated with
acute cholecystitis. Poorly localized periumbilical pain is associated with early stages of acute
appendicitis. Vomiting bile is associated with small bowel obstruction.
CHAPTER 22: Anus, Rectum, and Prostate
A 49-year-old male nurse experiences fecal incontinence after a motor vehicle accident that left him
paralyzed below the waist. He asks his rehabilitation physician about the control of this function in a
person without his injuries. Which of the following is true regarding the muscle control of the anal
sphincter?
The internal anal sphincter is under involuntary control, whereas the external anal sphincter is under
voluntary control.
Rationale: The internal anal sphincter is under involuntary control, whereas the external anal sphincter
is under voluntary control. Together, these two muscles hold the anal sphincter closed until the
individual is ready to defecate. The internal anal sphincter is under voluntary control, whereas the
external anal sphincter is under involuntary control; both internal and external anal sphincter are under
voluntary control; and both internal and external anal sphincter are under involuntary control are
incorrect because, as above, the internal anal sphincter is under involuntary control, whereas the
external anal sphincter is under voluntary control. Control of the anal sphincters is variable between
individuals is incorrect because this anatomic and neurological arrangement is not typically variable
between individuals, although these pathways may be interrupted by derangements of normal
physiology such as spinal cord injuries.
CHAPTER 18: Breasts and Axillae
A 42-year-old female website developer presents for an annual preventive examination with questions
about breast cancer screening. She is concerned about the radiation exposure associated with
mammography and is interested in magnetic resonance imaging (MRI) as a possible alternative for
routine screening. She is otherwise healthy with no family history of breast, ovarian, or colon cancer.
Which of the following is true about MRI as a screening modality for breast cancer in the general
population?
Sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity.
Sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity.
Increased sensitivity (in this case, higher-resolution imaging to pick up subtler disease) is often traded
for reduced specificity (in the form of discovering many small items of no pathological significance). This
is a core concept in designing screening tests—very sensitive tests often pick up false positives, while
very specific tests often rule out disease effectively by missing many actual cases. Balance must be
sought between these two when setting thresholds for positive and negative screens. Breast cancer
screening by MRI has been well studied in the general population is incorrect. This screening modality
has only been studied in high-risk populations. This patient is an ideal candidate for screening via breast
MRI based on current evidence is incorrect. This patient meets no known criteria for screening with
breast MRI (known BRCA mutation, history of chest radiation, etc.). Women at low lifetime risk of breast
4|Page
ASSESSMENT FINAL, PD II - LIPPINCOTT
ABDOMEN QUIZ PREP EXAM
WITH ACTUAL CORRECT QUESTIONS
AND VERIFIED DETAILED
ANSWERS|FREQUENTLY TESTED
QUESTIONS AND
SOLUTIONS|NEWEST|GUARANTEED
PASS 2026/2027
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 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?
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.
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 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?
1|Page
,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 screening may continue until age 80-85 years if benefits to doing
so outweigh risks for the individual patient; however, screening should not be routinely continued. In
general, a life expectancy >7 years is necessary for screening to be potentially beneficial. There is no
indication to repeat a colonoscopy given the absence of any cancerous or precancerous findings on his
colonoscopy 10 years ago. Sigmoidoscopy every 5 years with FOBT every 3 years is a valid screening
option, but again screening is not routinely recommended for patients age >75 years.
CHAPTER 19: Abdomen
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?
Functional change in bowel movement
Rationale: Functional change in bowel movement is characteristic of irritable bowel syndrome (IBS). IBS
is characterized by three patterns: diarrhea predominant, constipation predominant, or mixed. Other
functional causes for her constipation should be excluded prior to making this diagnosis. A large firm
fecal mass in the rectum is characteristic of fecal impaction, which is common in debilitated, bedridden
individuals. Decreased fecal bulk is characteristic of a diet low in fiber. This patient had not found that
increasing fiber helps her constipation. Spasm of the external sphincter is associated with painful anal
lesions, which this patient does not report. Impairment of autonomic innervations is characteristic of
patients with multiple sclerosis, spinal cord injuries, and Hirschsprung disease. She has no known
diagnosis that would increase suspicion of neurological impairment.
CHAPTER 19: Abdomen
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?
Tympany to percussion in the right upper quadrant, dullness to percussion of the left upper quadrant
Rationale: Situs inversus is a rare condition in which organs are reversed and is associated with
Kartagener syndrome. Thus, the stomach and gastric air bubble are on the right and liver dullness is on
the left. A protuberant abdomen with scattered areas of dullness and tympany and stool on palpation is
likely constipation. None of these findings suggest organ reversal. Liver dullness will occur in the left
upper quadrant with organ reversal. Findings given in the remaining answer choices are both associated
2|Page
,with splenomegaly with the spleen located in the left upper quadrant, which would not be the case for
sinus inversus totalis.
CHAPTER 19: Abdomen
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?
Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly produces pain
Rationale: Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly
producing pain describes rebound tenderness, which, along with guarding and rigidity, is suggestive of
peritonitis. Involuntary contraction rather than voluntary contraction of the abdominal wall that persists
over several examinations describes rigidity. Abdominal pain that increases with hip flexion is not
suggestive of peritonitis. In fact, patients with peritonitis tend to keep hips flexed to reduce stretch and
irritation of the parietal peritoneum. They often walk bent forward at the hips for this reason. Localized
pain over McBurney point is certainly suggestive of appendicitis, but not suggestive of peritonitis.
Similarly pain with internal rotation of the right hip, or a positive obturator sign, suggests irritation of
the psoas muscle due to an inflamed appendix, but not peritonitis.
CHAPTER 19: Abdomen
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?
Fibrosis of the pancreas
Rationale: Fibrosis of the pancreas is associated with chronic pancreatitis. Chronic pancreatitis leads to
fibrosis and decreased pancreatic function, which causes diarrhea from pancreatic enzyme insufficiency
and diabetes mellitus. H. pylori infection may cause peptic ulcer disease and dyspepsia, which is not
usually associated with diarrhea. Inflammation of the colonic diverticulum is diverticulitis and typically
causes left-lower-quadrant pain, fever, constipation, and sometimes diarrhea. It is typically an acute
disease. Reduced blood supply to the bowel characterizes mesenteric ischemia. It can be acute or
chronic in presentation and causes diffuse abdominal pain, vomiting, diarrhea, or constipation. It is
associated with older age and vascular risk factors such as coronary artery disease.
CHAPTER 19: Abdomen
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 after 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?
Associated right shoulder pain
3|Page
, Rationale: Pain with biliary colic can produced referred pain to the right shoulder or scapula due to
irritation of the right hemidiaphragm. Alcohol is not an exacerbating factor for biliary colic. Positive
McBurney point tenderness is associated with acute appendicitis. The Murphy sign is associated with
acute cholecystitis. Poorly localized periumbilical pain is associated with early stages of acute
appendicitis. Vomiting bile is associated with small bowel obstruction.
CHAPTER 22: Anus, Rectum, and Prostate
A 49-year-old male nurse experiences fecal incontinence after a motor vehicle accident that left him
paralyzed below the waist. He asks his rehabilitation physician about the control of this function in a
person without his injuries. Which of the following is true regarding the muscle control of the anal
sphincter?
The internal anal sphincter is under involuntary control, whereas the external anal sphincter is under
voluntary control.
Rationale: The internal anal sphincter is under involuntary control, whereas the external anal sphincter
is under voluntary control. Together, these two muscles hold the anal sphincter closed until the
individual is ready to defecate. The internal anal sphincter is under voluntary control, whereas the
external anal sphincter is under involuntary control; both internal and external anal sphincter are under
voluntary control; and both internal and external anal sphincter are under involuntary control are
incorrect because, as above, the internal anal sphincter is under involuntary control, whereas the
external anal sphincter is under voluntary control. Control of the anal sphincters is variable between
individuals is incorrect because this anatomic and neurological arrangement is not typically variable
between individuals, although these pathways may be interrupted by derangements of normal
physiology such as spinal cord injuries.
CHAPTER 18: Breasts and Axillae
A 42-year-old female website developer presents for an annual preventive examination with questions
about breast cancer screening. She is concerned about the radiation exposure associated with
mammography and is interested in magnetic resonance imaging (MRI) as a possible alternative for
routine screening. She is otherwise healthy with no family history of breast, ovarian, or colon cancer.
Which of the following is true about MRI as a screening modality for breast cancer in the general
population?
Sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity.
Sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity.
Increased sensitivity (in this case, higher-resolution imaging to pick up subtler disease) is often traded
for reduced specificity (in the form of discovering many small items of no pathological significance). This
is a core concept in designing screening tests—very sensitive tests often pick up false positives, while
very specific tests often rule out disease effectively by missing many actual cases. Balance must be
sought between these two when setting thresholds for positive and negative screens. Breast cancer
screening by MRI has been well studied in the general population is incorrect. This screening modality
has only been studied in high-risk populations. This patient is an ideal candidate for screening via breast
MRI based on current evidence is incorrect. This patient meets no known criteria for screening with
breast MRI (known BRCA mutation, history of chest radiation, etc.). Women at low lifetime risk of breast
4|Page
