NR 509 Final Exam Study Guide

NR 509 Final Exam Study Gui
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1.Chapter 19: Abdomen: ... cx cx cx

2.An overweight 26-year-
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old public servant presents to the Emergency De-
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cxpartment with 12 hours of intense abdominal pain, light-
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headedness, and a fainting episode that finally prompted her to seek med
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ical attention. She has a strong family history of gallstones and is concer
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ned about this possibility. She has not had any vomiting or diarrhea. She
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had a normal bowel movement this morning. Her ²-
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human chorionic gonadotropin ( ²-
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hCG) is positive at triage. She reports that her last period was 10 weeks a
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go. Her vital signs at triage are pulse, 118; blood pressure, 86/68; respirat
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ory rate, 20/
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min; oxygen saturation, 99%; and temperature, 37.3ºC orally. The clinician
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xperforms an abdominal exam prior to her pelvic exam and, on palpation
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of her abdomen, finds invol-
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cxuntary rigidity and rebound tenderness. What is the most likely diagnosis
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?: a. cx

Ruptured tubal (or ectopic) pregnancy cx cx cx cx

b.Acute cholecystitis cx

c. Ruptured appendix cx

d.Perforated bowel wall cx cx

e. Ruptured ovarian cyst cx cx


3.A 63-year- cx

old janitor with a history of adenomatous colonic polyps presents for a we
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ll visit. Basic labs are performed to screen for diabetes mellitus and dysli
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pidemia. Electrolytes and liver enzymes were also measured. His labs are
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all normal expect for moderate elevations of aspartate aminotransferase,
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xalanine aminotransferase, - cx cx

³glutamyl transferase, and alkaline phosphatase as well as a mildly elevat
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ed total bilirubin. He presents for a follow-up appoint-
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cxment and the clinician performs an abdominal exam to assess his liver. W
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hich of the following findings would be most consistent with hepatomega
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ly?: a. cx

Liver span of 11 cm at the midclavicular line
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b.Liver span of 8 cm at the midsternal line
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c. Dullness to percussion over a span of 11 cm at the midclavicular line
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d.Dullness to percussion over a span of 8 cm at the midsternal line
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e.Liver palpable 3 cm below the right costal margin, mid clavicular line,
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n expirationcx


4.A 63-year-old underweight administrative clerk with a 50-pack-
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, NR 509 Final Exam Study Gui
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year smok- cx

ing history presents with a several month history of recurrent epigastric
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abdominal discomfort. She feels fairly well otherwise and denies any naus
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ea, vomiting, diarrhea, or constipation. She reports that a first cousin die
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d from a ruptured aneurysm at age 68 years. Her vital signs are pulse, 86
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; blood pressure, 148/92; respiratory rate, 16; oxygen saturation, 95%; an
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d temper-
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ature, 36.2ºC. Her body mass index is 17.6. On exam, her abdominal aort
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a
is prominent, which is concerning for an abdominal aortic aneurysm (AAA
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xWhich of the following is her most significant risk factor for an AAA?: a.
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, NR 509 Final Exam Study Gui
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Female gender cx

b.History of smoking cx cx

c. Underweight
d.Family history of ruptured aneurysm cx cx cx cx

e. Hypertension
5.A 76-year- cx

old retired man with a history of prostate cancer and hypertension has bee
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n screened annually for colon cancer using high sensitivity fecal occult b
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lood testing (FOBT). He presents for follow-
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up of his hypertension, during which the clinician scans his chart to ens
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ure he is up to date with his preventive health care. He has a positive F
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OBT on one occasion at age 66 years and subsequently went for a colon
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oscopy. Internal hemorrhoids and sigmoid diverticuli were found on colo
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noscopy. He has no first-degree rela- cx cx cx cx cx

cxtives with a history of colorectal cancer or adenomatous polyps. What ar
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e thecx

U.S. Preventive Services Task Force (USPSTF) screening recommendation
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s for this patient?: a. Do not screen routinely
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b.Continue annual FOBT screening until age 80 years cx cx cx cx cx cx cx

c. Continue annual FOBT screening until age 85 years cx cx cx cx cx cx cx

d.Repeat colonoscopy this year cx cx cx

e. Sigmoidoscopy every 5 years with FOBT every cx cx cx cx cx cx cx

3 years Submit
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6.An otherwise healthy 31-year-
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old accountant presents to an outpatient clinic with a 3-
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year history of recurrent crampy abdominal pain that lasts for about 1-
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2 weeks each episode and is associated with onset of constipation. She
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describes infrequent, small hard stool that she finds very difficult to pass
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. She has tried to increase dietary fiber and water intake, but usually this
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xis not sufficient and she resorts to over-the-
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counter laxatives, which she finds upset her stomach but do resolve the
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constipation. Symptoms typically gradually resolve with bowel movement
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s. Which of the following is the most likely physiological mechanism for h
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er constipation?: a. A large, firm fecal mass in the rectum
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b.Decreased fecal bulk cx cx

c. Functional change in bowel movement cx cx cx cx

d.Spasm of the external sphincter cx cx cx cx

e. Impairment of autonomic innervations cx cx cx

7.A 23-year-old woman comes to the respirology clinic for follow-
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up of her chronic sinusitis and bronchiectasis that is associated with a ra
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, NR 509 Final Exam Study Gui
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re congenital condition called Kartagener syndrome. The preceptor notes t
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hat she has situs inversus and asks for a physical exam. Which of the fol
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lowing descriptions best fits with findings on the abdominal exam?: a. Ty
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mpany to percussion in the
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4cx/
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