NR 509 CH. 11 EXAM WITH 100%
CORRECT ANSWERS 2025 GRADED
A+
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.
GRADED A+
,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
GRADED A+
, 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.
GRADED A+
CORRECT ANSWERS 2025 GRADED
A+
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.
GRADED A+
,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
GRADED A+
, 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.
GRADED A+
