NR 509 CH. 11 || WITH ERRORLESS ANSWERS.
1. A 52-year-old secretary comes to your office, complaining about accidentally leaking urine
when she coughs or sneezes. She says this has been going on for about a year now. She relates
that she has not had a period for 2 years. She denies any recent illness or injuries. Her past
medical history is significant for four spontaneous vaginal deliveries. She is married and has four
children. She denies alcohol, tobacco, or drug use. During her pelvic examination you note some
atrophic vaginal tissue, but the remainder of her pelvic, abdominal, and rectal examinations are
unremarkable.
Which type of urinary incontinence does she have?
A) Stress incontinence
B) Urge incontinence
C) Overflow incontinence correct answers Ans: A
Stress incontinence usually occurs when the intra-abdominal pressure goes up during coughing,
sneezing, or laughing. This is usually due to a weakness of the pelvic floor, with inadequate
muscle support of the bladder. Vaginal deliveries and pelvic surgery are often associated with
these symptoms. Usually female patients are postmenopausal when stress incontinence begins.
Kegel exercises are usually recommended to strengthen the pelvic floor muscles.
2. A 46-year-old former salesman presents to the ER, complaining of black stools for the past
few weeks. His past medical history is significant for cirrhosis. He has gained weight recently,
especially around his abdomen. He has smoked two packs of cigarettes a day for 30 years and
has drunk approximately 10 alcoholic beverages a day for 25 years. He has used IV heroin and
smoked crack in the past. He denies any recent use. He is currently unemployed and has never
been married. On examination you find a man appearing older than his stated age. His skin has a
yellowish tint and he is thin, with a prominent abdomen. You note multiple "spider angiomas" at
the base of his neck. Otherwise, his heart and lung examinations are normal. On inspection he
has dilated veins around his umbilicus. Increased bowel sounds are heard during auscultation.
Palpation reveals diffuse tenderness that is more severe in the epigastric area. correct answers
Ans: C
Varices are often found in alcoholic patients, but only when they have a diagnosis of significant
cirrhosis. This patient has symptoms of cirrhosis, including jaundice, ascites, spider
hemangiomas, and dilated veins on his abdomen (caput medusa).
, 3. A 21-year-old receptionist comes to your clinic, complaining of frequent diarrhea. She states
that the stools are very loose and there is some cramping beforehand. She states this has occurred
on and off since she was in high school. She denies any nausea, vomiting, or blood in her stool.
Occasionally she has periods of constipation, but that is rare. She thinks the diarrhea is much
worse when she is nervous. Her past medical history is not significant. She is single and a junior
in college majoring in accounting. She smokes when she drinks alcohol but denies using any
illegal drugs. Both of her parents are healthy. Her entire physical examination is unremarkable.
What is most likely the etiology of her diarrhea?
A) Secretory infections
B) Inflammatory infections
C) Irritable bowel syndrome
D) Malabsorption syndrome correct answers Ans: C
Irritable bowel syndrome will cause loose bowel movements with cramps but no systemic
symptoms of fever, weight loss, or malaise. This syndrome is more likely in young women with
alternating symptoms of loose stools and constipation. Stress usually makes the symptoms
worse, as do certain foods.
4. A 42-year-old florist comes to your office, complaining of chronic constipation for the last 6
months. She has had no nausea, vomiting, or diarrhea and no abdominal pain or cramping. She
denies any recent illnesses or injuries. She denies any changes to her diet or exercise program.
She is on no new medications. During the review of systems you note that she has felt fatigued,
had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is
significant for one vaginal delivery and two cesarean sections. She is married, has three children,
and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2
diabetes and her father has coronary artery disease. There is no family history of cancers. On
examination she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose,
throat, and neck examinations are normal. Her cardiac, lung, and abdo correct answers Ans: D
Many metabolic conditions can interfere with bowel motility. In this case the patient has many
symptoms of hypothyroidism, including cold intolerance, weight gain, fatigue, constipation, and
irregular menstrual cycles. On examination, thyromegaly and delayed reflexes can help to make
the diagnosis. Medication will usually correct these symptoms.
5. A 22-year-old law student comes to your office, complaining of severe abdominal pain
radiating to his back. He states it began last night after hours of heavy drinking. He has had
abdominal pain and vomiting in the past after drinking but never as bad as this. He cannot keep
1. A 52-year-old secretary comes to your office, complaining about accidentally leaking urine
when she coughs or sneezes. She says this has been going on for about a year now. She relates
that she has not had a period for 2 years. She denies any recent illness or injuries. Her past
medical history is significant for four spontaneous vaginal deliveries. She is married and has four
children. She denies alcohol, tobacco, or drug use. During her pelvic examination you note some
atrophic vaginal tissue, but the remainder of her pelvic, abdominal, and rectal examinations are
unremarkable.
Which type of urinary incontinence does she have?
A) Stress incontinence
B) Urge incontinence
C) Overflow incontinence correct answers Ans: A
Stress incontinence usually occurs when the intra-abdominal pressure goes up during coughing,
sneezing, or laughing. This is usually due to a weakness of the pelvic floor, with inadequate
muscle support of the bladder. Vaginal deliveries and pelvic surgery are often associated with
these symptoms. Usually female patients are postmenopausal when stress incontinence begins.
Kegel exercises are usually recommended to strengthen the pelvic floor muscles.
2. A 46-year-old former salesman presents to the ER, complaining of black stools for the past
few weeks. His past medical history is significant for cirrhosis. He has gained weight recently,
especially around his abdomen. He has smoked two packs of cigarettes a day for 30 years and
has drunk approximately 10 alcoholic beverages a day for 25 years. He has used IV heroin and
smoked crack in the past. He denies any recent use. He is currently unemployed and has never
been married. On examination you find a man appearing older than his stated age. His skin has a
yellowish tint and he is thin, with a prominent abdomen. You note multiple "spider angiomas" at
the base of his neck. Otherwise, his heart and lung examinations are normal. On inspection he
has dilated veins around his umbilicus. Increased bowel sounds are heard during auscultation.
Palpation reveals diffuse tenderness that is more severe in the epigastric area. correct answers
Ans: C
Varices are often found in alcoholic patients, but only when they have a diagnosis of significant
cirrhosis. This patient has symptoms of cirrhosis, including jaundice, ascites, spider
hemangiomas, and dilated veins on his abdomen (caput medusa).
, 3. A 21-year-old receptionist comes to your clinic, complaining of frequent diarrhea. She states
that the stools are very loose and there is some cramping beforehand. She states this has occurred
on and off since she was in high school. She denies any nausea, vomiting, or blood in her stool.
Occasionally she has periods of constipation, but that is rare. She thinks the diarrhea is much
worse when she is nervous. Her past medical history is not significant. She is single and a junior
in college majoring in accounting. She smokes when she drinks alcohol but denies using any
illegal drugs. Both of her parents are healthy. Her entire physical examination is unremarkable.
What is most likely the etiology of her diarrhea?
A) Secretory infections
B) Inflammatory infections
C) Irritable bowel syndrome
D) Malabsorption syndrome correct answers Ans: C
Irritable bowel syndrome will cause loose bowel movements with cramps but no systemic
symptoms of fever, weight loss, or malaise. This syndrome is more likely in young women with
alternating symptoms of loose stools and constipation. Stress usually makes the symptoms
worse, as do certain foods.
4. A 42-year-old florist comes to your office, complaining of chronic constipation for the last 6
months. She has had no nausea, vomiting, or diarrhea and no abdominal pain or cramping. She
denies any recent illnesses or injuries. She denies any changes to her diet or exercise program.
She is on no new medications. During the review of systems you note that she has felt fatigued,
had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is
significant for one vaginal delivery and two cesarean sections. She is married, has three children,
and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2
diabetes and her father has coronary artery disease. There is no family history of cancers. On
examination she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose,
throat, and neck examinations are normal. Her cardiac, lung, and abdo correct answers Ans: D
Many metabolic conditions can interfere with bowel motility. In this case the patient has many
symptoms of hypothyroidism, including cold intolerance, weight gain, fatigue, constipation, and
irregular menstrual cycles. On examination, thyromegaly and delayed reflexes can help to make
the diagnosis. Medication will usually correct these symptoms.
5. A 22-year-old law student comes to your office, complaining of severe abdominal pain
radiating to his back. He states it began last night after hours of heavy drinking. He has had
abdominal pain and vomiting in the past after drinking but never as bad as this. He cannot keep
