NR 509 Final Exam Study Guide
Study online at https://quizlet.com/_d31fm2
1. Chapter 19: Abdomen ...
2. An overweight 26-year-old public servant pre- a. Ruptured tubal (or ectopic)
sents to the Emergency Department with 12 pregnancy
hours of intense abdominal pain, light-headed- b. Acute cholecystitis
ness, and a fainting episode that finally prompt- c. Ruptured appendix
ed her to seek medical attention. She has a d. Perforated bowel wall
strong family history of gallstones and is con- e. Ruptured ovarian cyst
cerned 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 pri-
or to her pelvic exam and, on palpation of her
abdomen, finds involuntary rigidity and rebound
tenderness. What is the most likely diagnosis?
3. A 63-year-old janitor with a history of adenoma- a. Liver span of 11 cm at the mid-
tous colonic polyps presents for a well visit. Basic clavicular line
labs are performed to screen for diabetes mel- b. Liver span of 8 cm at the mid-
litus and dyslipidemia. Electrolytes and liver en- sternal line
zymes were also measured. His labs are all nor- c. Dullness to percussion over a
mal expect for moderate elevations of aspartate span of 11 cm at the midclavicu-
aminotransferase, alanine aminotransferase, γ-- lar line
glutamyl transferase, and alkaline phosphatase d. Dullness to percussion over a
as well as a mildly elevated total bilirubin. He pre- span of 8 cm at the midsternal
sents for a follow-up appointment and the clini- line
cian performs an abdominal exam to assess his e. Liver palpable 3 cm below the
, NR 509 Final Exam Study Guide
Study online at https://quizlet.com/_d31fm2
liver. Which of the following findings would be right costal margin, mid clavicu-
most consistent with hepatomegaly? lar line, on expiration
4. A 63-year-old underweight administrative clerk a. Female gender
with a 50-pack-year smoking history presents b. History of smoking
with a several month history of recurrent epigas- c. Underweight
tric abdominal discomfort. She feels fairly well d. Family history of ruptured
otherwise and denies any nausea, vomiting, di- aneurysm
arrhea, or constipation. She reports that a first e. Hypertension
cousin died from a ruptured aneurysm at age 68
years. Her vital signs are pulse, 86; blood pres-
sure, 148/92; respiratory rate, 16; oxygen satu-
ration, 95%; and temperature, 36.2ºC. Her body
mass index is 17.6. On exam, her abdominal aorta
is prominent, which is concerning for an abdomi-
nal aortic aneurysm (AAA). Which of the following
is her most significant risk factor for an AAA?
5. A 76-year-old retired man with a history of a. Do not screen routinely
prostate cancer and hypertension has been b. Continue annual FOBT screen-
screened annually for colon cancer using high ing until age 80 years
sensitivity fecal occult blood testing (FOBT). He c. Continue annual FOBT screen-
presents for follow-up of his hypertension, during ing until age 85 years
which the clinician scans his chart to ensure he is d. Repeat colonoscopy this year
up to date with his preventive health care. He has e. Sigmoidoscopy every 5 years
a positive FOBT on one occasion at age 66 years with FOBT every 3 years
and subsequently went for a colonoscopy. In- Submit
ternal hemorrhoids and sigmoid diverticuli were
found on colonoscopy. He has no first-degree rel-
atives with a history of colorectal cancer or adeno-
matous polyps. What are the U.S. Preventive Ser-
, NR 509 Final Exam Study Guide
Study online at https://quizlet.com/_d31fm2
vices Task Force (USPSTF) screening recommen-
dations for this patient?
6. An otherwise healthy 31-year-old accountant pre- a. A large, firm fecal mass in the
sents to an outpatient clinic with a 3-year history rectum
of recurrent crampy abdominal pain that lasts b. Decreased fecal bulk
for about 1-2 weeks each episode and is asso- c. Functional change in bowel
ciated with onset of constipation. She describes movement
infrequent, small hard stool that she finds very d. Spasm of the external sphinc-
difficult to pass. She has tried to increase dietary ter
fiber and water intake, but usually this is not suf- e. Impairment of autonomic in-
ficient and she resorts to over-the-counter lax- nervations
atives, 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?
7. A 23-year-old woman comes to the respirology a. Tympany to percussion in the
clinic for follow-up of her chronic sinusitis and right upper quadrant, dullness
bronchiectasis that is associated with a rare con- to percussion of the left upper
genital condition called Kartagener syndrome. quadrant
The preceptor notes that she has situs inversus b. Protuberant abdomen that has
and asks for a physical exam. Which of the fol- scattered areas of tympany and
lowing descriptions best fits with findings on the dullness; stool is felt on palpa-
abdominal exam? tion
c. Liver dullness in the right up-
per quadrant that is displaced
downward by the low diaphragm
due to chronic obstructive pul-
monary disease
d. Dullness to percussion of the
, NR 509 Final Exam Study Guide
Study online at https://quizlet.com/_d31fm2
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 in-
spiration
8. An otherwise healthy 28-year-old lawyer pre- a. Voluntary contraction of the
sents to the Emergency Department with a 1-day abdominal wall that persists over
history of severe abdominal pain. The emer- several examinations
gency physician suspects appendicitis and gener- b. Pressing down onto the ab-
al surgery is consulted. The resident believes the domen firmly and slowly and
patient has signs of peritonitis on exam. Which withdrawing the hand quickly
of the following physical exam findings supports produces pain
peritonitis? c. Abdominal pain that increases
with hip flexion
d. Localized pain over McBurney
point, which lies 2 inches from
the anterior superior iliac spin-
ous process on a line drawn from
the umbilicus
e. Pain with internal rotation of
the right hip
9. A 58-year-old man with a history of diabetes and a. Helicobacter pylori infection
alcohol addiction has been sober for the last 10 b. Inflammation of the gallblad-
months. He presents with a 4-month history of der
increasing weakness, recurrent epigastric pain ra- c. Inflammation of colonic diver-
diating to his back, chronic diarrhea with stools ticulum
6-8 times daily, and weight loss of 18 lb over 4 d. Reduced blood supply to the
Study online at https://quizlet.com/_d31fm2
1. Chapter 19: Abdomen ...
2. An overweight 26-year-old public servant pre- a. Ruptured tubal (or ectopic)
sents to the Emergency Department with 12 pregnancy
hours of intense abdominal pain, light-headed- b. Acute cholecystitis
ness, and a fainting episode that finally prompt- c. Ruptured appendix
ed her to seek medical attention. She has a d. Perforated bowel wall
strong family history of gallstones and is con- e. Ruptured ovarian cyst
cerned 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 pri-
or to her pelvic exam and, on palpation of her
abdomen, finds involuntary rigidity and rebound
tenderness. What is the most likely diagnosis?
3. A 63-year-old janitor with a history of adenoma- a. Liver span of 11 cm at the mid-
tous colonic polyps presents for a well visit. Basic clavicular line
labs are performed to screen for diabetes mel- b. Liver span of 8 cm at the mid-
litus and dyslipidemia. Electrolytes and liver en- sternal line
zymes were also measured. His labs are all nor- c. Dullness to percussion over a
mal expect for moderate elevations of aspartate span of 11 cm at the midclavicu-
aminotransferase, alanine aminotransferase, γ-- lar line
glutamyl transferase, and alkaline phosphatase d. Dullness to percussion over a
as well as a mildly elevated total bilirubin. He pre- span of 8 cm at the midsternal
sents for a follow-up appointment and the clini- line
cian performs an abdominal exam to assess his e. Liver palpable 3 cm below the
, NR 509 Final Exam Study Guide
Study online at https://quizlet.com/_d31fm2
liver. Which of the following findings would be right costal margin, mid clavicu-
most consistent with hepatomegaly? lar line, on expiration
4. A 63-year-old underweight administrative clerk a. Female gender
with a 50-pack-year smoking history presents b. History of smoking
with a several month history of recurrent epigas- c. Underweight
tric abdominal discomfort. She feels fairly well d. Family history of ruptured
otherwise and denies any nausea, vomiting, di- aneurysm
arrhea, or constipation. She reports that a first e. Hypertension
cousin died from a ruptured aneurysm at age 68
years. Her vital signs are pulse, 86; blood pres-
sure, 148/92; respiratory rate, 16; oxygen satu-
ration, 95%; and temperature, 36.2ºC. Her body
mass index is 17.6. On exam, her abdominal aorta
is prominent, which is concerning for an abdomi-
nal aortic aneurysm (AAA). Which of the following
is her most significant risk factor for an AAA?
5. A 76-year-old retired man with a history of a. Do not screen routinely
prostate cancer and hypertension has been b. Continue annual FOBT screen-
screened annually for colon cancer using high ing until age 80 years
sensitivity fecal occult blood testing (FOBT). He c. Continue annual FOBT screen-
presents for follow-up of his hypertension, during ing until age 85 years
which the clinician scans his chart to ensure he is d. Repeat colonoscopy this year
up to date with his preventive health care. He has e. Sigmoidoscopy every 5 years
a positive FOBT on one occasion at age 66 years with FOBT every 3 years
and subsequently went for a colonoscopy. In- Submit
ternal hemorrhoids and sigmoid diverticuli were
found on colonoscopy. He has no first-degree rel-
atives with a history of colorectal cancer or adeno-
matous polyps. What are the U.S. Preventive Ser-
, NR 509 Final Exam Study Guide
Study online at https://quizlet.com/_d31fm2
vices Task Force (USPSTF) screening recommen-
dations for this patient?
6. An otherwise healthy 31-year-old accountant pre- a. A large, firm fecal mass in the
sents to an outpatient clinic with a 3-year history rectum
of recurrent crampy abdominal pain that lasts b. Decreased fecal bulk
for about 1-2 weeks each episode and is asso- c. Functional change in bowel
ciated with onset of constipation. She describes movement
infrequent, small hard stool that she finds very d. Spasm of the external sphinc-
difficult to pass. She has tried to increase dietary ter
fiber and water intake, but usually this is not suf- e. Impairment of autonomic in-
ficient and she resorts to over-the-counter lax- nervations
atives, 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?
7. A 23-year-old woman comes to the respirology a. Tympany to percussion in the
clinic for follow-up of her chronic sinusitis and right upper quadrant, dullness
bronchiectasis that is associated with a rare con- to percussion of the left upper
genital condition called Kartagener syndrome. quadrant
The preceptor notes that she has situs inversus b. Protuberant abdomen that has
and asks for a physical exam. Which of the fol- scattered areas of tympany and
lowing descriptions best fits with findings on the dullness; stool is felt on palpa-
abdominal exam? tion
c. Liver dullness in the right up-
per quadrant that is displaced
downward by the low diaphragm
due to chronic obstructive pul-
monary disease
d. Dullness to percussion of the
, NR 509 Final Exam Study Guide
Study online at https://quizlet.com/_d31fm2
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 in-
spiration
8. An otherwise healthy 28-year-old lawyer pre- a. Voluntary contraction of the
sents to the Emergency Department with a 1-day abdominal wall that persists over
history of severe abdominal pain. The emer- several examinations
gency physician suspects appendicitis and gener- b. Pressing down onto the ab-
al surgery is consulted. The resident believes the domen firmly and slowly and
patient has signs of peritonitis on exam. Which withdrawing the hand quickly
of the following physical exam findings supports produces pain
peritonitis? c. Abdominal pain that increases
with hip flexion
d. Localized pain over McBurney
point, which lies 2 inches from
the anterior superior iliac spin-
ous process on a line drawn from
the umbilicus
e. Pain with internal rotation of
the right hip
9. A 58-year-old man with a history of diabetes and a. Helicobacter pylori infection
alcohol addiction has been sober for the last 10 b. Inflammation of the gallblad-
months. He presents with a 4-month history of der
increasing weakness, recurrent epigastric pain ra- c. Inflammation of colonic diver-
diating to his back, chronic diarrhea with stools ticulum
6-8 times daily, and weight loss of 18 lb over 4 d. Reduced blood supply to the
