NR 509/ NR509 Final Exam Advanced Physical
Assessment (Latest 2025/ 2026)Questions with
Verified Answers - Chamberlain
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 - - correct answer✨✔✔ b. 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.
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 - - correct answer✨✔✔ a. 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.
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 - - correct answer✨✔✔ c. 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 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 -
- correct answer✨✔✔ a. 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 lef
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?
a. Voluntary contraction of the abdominal wall that persists over several examinations
b. Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly produces pain
c. Abdominal pain that increases with hip flexion
d. Localized pain over McBurney point, which lies 2 inches from the anterior superior iliac spinous
process on a line drawn from the umbilicus
e. Pain with internal rotation of the right hip - - correct answer✨✔✔ b. 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
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?
, a. Helicobacter pylori infection
b. Inflammation of the gallbladder
c. Inflammation of colonic diverticulum
d. Reduced blood supply to the bowel
e. Fibrosis of the pancreas - - correct answer✨✔✔ e. 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
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?
a. Exacerbating factor includes alcohol intake
b. Positive McBurney point tenderness
c. Poorly localized periumbilical pain
d. Vomiting of bile
e. Associated right shoulder pain - - correct answer✨✔✔ e. Associated right shoulder pain
Rationale: Pain with biliary colic can produced referred pain to the right shoulder or scapula due to
irritation of the right hemidiaphragm.
A 67-year-old electronics technician with a history of hypertension and type 2 diabetes presents for his
yearly physical examination and complains of progressively worsening erectile dysfunction (ED). While
counseling him, the clinician mentions that multiple processes must take place to achieve an erection.
Which of the following structures would be most affected by vascular deficiencies related to his
preexisting medical conditions and is likely contributing to his symptoms?
a. Corpora cavernosa
b. Ejaculatory duct
c. Epididymis
Assessment (Latest 2025/ 2026)Questions with
Verified Answers - Chamberlain
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 - - correct answer✨✔✔ b. 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.
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 - - correct answer✨✔✔ a. 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.
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 - - correct answer✨✔✔ c. 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 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 -
- correct answer✨✔✔ a. 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 lef
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?
a. Voluntary contraction of the abdominal wall that persists over several examinations
b. Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly produces pain
c. Abdominal pain that increases with hip flexion
d. Localized pain over McBurney point, which lies 2 inches from the anterior superior iliac spinous
process on a line drawn from the umbilicus
e. Pain with internal rotation of the right hip - - correct answer✨✔✔ b. 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
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?
, a. Helicobacter pylori infection
b. Inflammation of the gallbladder
c. Inflammation of colonic diverticulum
d. Reduced blood supply to the bowel
e. Fibrosis of the pancreas - - correct answer✨✔✔ e. 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
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?
a. Exacerbating factor includes alcohol intake
b. Positive McBurney point tenderness
c. Poorly localized periumbilical pain
d. Vomiting of bile
e. Associated right shoulder pain - - correct answer✨✔✔ e. Associated right shoulder pain
Rationale: Pain with biliary colic can produced referred pain to the right shoulder or scapula due to
irritation of the right hemidiaphragm.
A 67-year-old electronics technician with a history of hypertension and type 2 diabetes presents for his
yearly physical examination and complains of progressively worsening erectile dysfunction (ED). While
counseling him, the clinician mentions that multiple processes must take place to achieve an erection.
Which of the following structures would be most affected by vascular deficiencies related to his
preexisting medical conditions and is likely contributing to his symptoms?
a. Corpora cavernosa
b. Ejaculatory duct
c. Epididymis
