NR 509 Final Exam
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,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?
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?
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
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
Questions Verified and
Provided with A+
Graded Answers|
Latest Updated 2026
,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?
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?
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
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
