1
Which physical assessment has good specificity for acute appendicitis?
A. Murphy’s sign B. Halo sign C. Carnett’s sign D.Rovsing’s sign
Although they are insensitive tests, the psoas, obturator, and Rovsing’s signs have
good specificity for acute appendicitis. Murphy’s sign is suggestive of cholecystitis or
gallbladder disease. Halo sign is suggestive of the presence of cerebrospinal fluid in
drainage from a head injury. Carnett’s sign distinguishes abdominal wall pain from
visceral pain.
Both hepatitis A and hepatitis B can be transmitted by which of the following modes?
A. Sneezing and coughing
B. Maternal–fetal transmission
C. Consumption of contaminated food or water
D. Sexual transmission
Hepatitis A virus is transmitted via the fecal–oral route, via person-to-person contact
(transmission within households, sexual transmission, residential institution or daycare
center transmission), contact with contaminated food or water (consumption of raw or
undercooked food or contaminated foods), blood transfusion, or illicit drug use.
Maternal–fetal transmission has not been described. Hepatitis B is transmitted through
activities that involve percutaneous (puncture through skin) or mucosal contact with
infectious blood or body fluids (e.g., semen, saliva). This includes mother-to-child
transmission, blood transfusion, sexual transmission, intravenous drug use, nosocomial
infection (via contaminated instruments or an accidental needlestick), transplant
recipients, and blood exposure to minor breaks in the skin or mucous membranes.
There is no firm evidence of hepatitis B transmission via body fluids other than blood or
semen.
A patient presents with generalized fatigue and concern for hepatitis B virus (HBV)
infection. Serology testing is significant for positive HBsAg and IgM anti-HBc. This
suggests that the patient:
A. Was previously infected B. Is immune due to vaccination
C. Is chronically infected D. Is acutely infected
Acute hepatitis B is diagnosed based on the detection of hepatitis B surface antigen
(HBsAg) and IgM hepatitis B core antibody (IgM anti-HBc). Markers of HBV replication,
hepatitis B e antigen (HBeAg) and HBV DNA are also present in the initial phase of
infection. Recovery is indicated by the disappearance of HBV DNA, HBeAg to hepatitis
B e antibody (anti-HBe) seroconversion, and HBsAG to hepatitis B surface antibody
(anti-HBs) seroconversion. Previous infection is characterized by the presence of anti-
HBs and IgG anti-HBc. Immunity after vaccination is indicated by the presence of anti-
HBs only. Chronic HBV infection is diagnosed by the persistence of HBsAg for more
than 6 months.
, 2
Patients with hepatitis D are always dually infected with hepatitis:
A. B B. A C. C D. E
Hepatitis D is closely associated with hepatitis B virus (HBV) infection. The presence of
HBV is required for complete virion assembly and secretion. Therefore, patients with
hepatitis D are always dually infected with HBV.
A patient presents with left upper quadrant pain. This area of abdominal pain suggests
which of the following disease processes?
A. Acute pancreatitis B. Acute cholecystitis
C. Hepatitis D. Splenomegaly
Left upper quadrant pain is often related to disorders of the spleen (splenomegaly,
splenic infarct, splenic abscess or rupture). Right upper quadrant pain is often due to
biliary disorders (gallstones, acute cholecystitis, acute cholangitis) and hepatic
etiologies (hepatitis, liver abscess). Epigastric pain is often a result of pancreatic and
gastric etiologies (peptic ulcer disease, gastritis).
A patient presents with right lower quadrant abdominal pain, anorexia, nausea, and
vomiting. During the physical assessment, the psoas sign is positive. This suggests
which of the following acute processes?
A. Cholecystitis B. Pancreatitis
C. Appendicitis D. Diverticulitis
The classic symptoms of appendicitis include right lower quadrant abdominal pain,
anorexia, nausea, and vomiting. The psoas sign is associated with a retrocecal
appendix. It is considered positive if right lower quadrant abdominal pain occurs with
passive right hip extension. The patient draws up the right knee to shorten the muscle
because the inflamed appendix may lie against the right psoas muscle. Cholecystitis is
associated with a positive Murphy sign. Diverticulitis often presents with pain in the left
lower quadrant. Pancreatitis often presents with severe epigastric and left upper
quadrant pain.
An older adult patient was recently hospitalized and prescribed antibiotics for
community-acquired pneumonia. The patient presents with complaints of severe watery
diarrhea, lower abdominal pain, and cramping. The patient denies both a history of
previous episodes of diarrhea and recent travel. Which of the following regimens is
indicated for initial management?
A. Metronidazole B. Fecal transplant
C. Probiotics D. Fidaxomicin
The patient is presenting with risk factors and clinical manifestations suggestive
of Clostridium difficile infection. It should be suspected in patients with acute diarrhea
(more than three loose stools in 24 hours) with associated risk factors (e.g., recent
antibiotic use, hospitalization, older age). The initial episode of non-severe C.
difficile infection should be treated with either oral fidaxomicin or oral vancomycin for 10
days. An alternative option is metronidazole; however, it is less effective for treatment of
Which physical assessment has good specificity for acute appendicitis?
A. Murphy’s sign B. Halo sign C. Carnett’s sign D.Rovsing’s sign
Although they are insensitive tests, the psoas, obturator, and Rovsing’s signs have
good specificity for acute appendicitis. Murphy’s sign is suggestive of cholecystitis or
gallbladder disease. Halo sign is suggestive of the presence of cerebrospinal fluid in
drainage from a head injury. Carnett’s sign distinguishes abdominal wall pain from
visceral pain.
Both hepatitis A and hepatitis B can be transmitted by which of the following modes?
A. Sneezing and coughing
B. Maternal–fetal transmission
C. Consumption of contaminated food or water
D. Sexual transmission
Hepatitis A virus is transmitted via the fecal–oral route, via person-to-person contact
(transmission within households, sexual transmission, residential institution or daycare
center transmission), contact with contaminated food or water (consumption of raw or
undercooked food or contaminated foods), blood transfusion, or illicit drug use.
Maternal–fetal transmission has not been described. Hepatitis B is transmitted through
activities that involve percutaneous (puncture through skin) or mucosal contact with
infectious blood or body fluids (e.g., semen, saliva). This includes mother-to-child
transmission, blood transfusion, sexual transmission, intravenous drug use, nosocomial
infection (via contaminated instruments or an accidental needlestick), transplant
recipients, and blood exposure to minor breaks in the skin or mucous membranes.
There is no firm evidence of hepatitis B transmission via body fluids other than blood or
semen.
A patient presents with generalized fatigue and concern for hepatitis B virus (HBV)
infection. Serology testing is significant for positive HBsAg and IgM anti-HBc. This
suggests that the patient:
A. Was previously infected B. Is immune due to vaccination
C. Is chronically infected D. Is acutely infected
Acute hepatitis B is diagnosed based on the detection of hepatitis B surface antigen
(HBsAg) and IgM hepatitis B core antibody (IgM anti-HBc). Markers of HBV replication,
hepatitis B e antigen (HBeAg) and HBV DNA are also present in the initial phase of
infection. Recovery is indicated by the disappearance of HBV DNA, HBeAg to hepatitis
B e antibody (anti-HBe) seroconversion, and HBsAG to hepatitis B surface antibody
(anti-HBs) seroconversion. Previous infection is characterized by the presence of anti-
HBs and IgG anti-HBc. Immunity after vaccination is indicated by the presence of anti-
HBs only. Chronic HBV infection is diagnosed by the persistence of HBsAg for more
than 6 months.
, 2
Patients with hepatitis D are always dually infected with hepatitis:
A. B B. A C. C D. E
Hepatitis D is closely associated with hepatitis B virus (HBV) infection. The presence of
HBV is required for complete virion assembly and secretion. Therefore, patients with
hepatitis D are always dually infected with HBV.
A patient presents with left upper quadrant pain. This area of abdominal pain suggests
which of the following disease processes?
A. Acute pancreatitis B. Acute cholecystitis
C. Hepatitis D. Splenomegaly
Left upper quadrant pain is often related to disorders of the spleen (splenomegaly,
splenic infarct, splenic abscess or rupture). Right upper quadrant pain is often due to
biliary disorders (gallstones, acute cholecystitis, acute cholangitis) and hepatic
etiologies (hepatitis, liver abscess). Epigastric pain is often a result of pancreatic and
gastric etiologies (peptic ulcer disease, gastritis).
A patient presents with right lower quadrant abdominal pain, anorexia, nausea, and
vomiting. During the physical assessment, the psoas sign is positive. This suggests
which of the following acute processes?
A. Cholecystitis B. Pancreatitis
C. Appendicitis D. Diverticulitis
The classic symptoms of appendicitis include right lower quadrant abdominal pain,
anorexia, nausea, and vomiting. The psoas sign is associated with a retrocecal
appendix. It is considered positive if right lower quadrant abdominal pain occurs with
passive right hip extension. The patient draws up the right knee to shorten the muscle
because the inflamed appendix may lie against the right psoas muscle. Cholecystitis is
associated with a positive Murphy sign. Diverticulitis often presents with pain in the left
lower quadrant. Pancreatitis often presents with severe epigastric and left upper
quadrant pain.
An older adult patient was recently hospitalized and prescribed antibiotics for
community-acquired pneumonia. The patient presents with complaints of severe watery
diarrhea, lower abdominal pain, and cramping. The patient denies both a history of
previous episodes of diarrhea and recent travel. Which of the following regimens is
indicated for initial management?
A. Metronidazole B. Fecal transplant
C. Probiotics D. Fidaxomicin
The patient is presenting with risk factors and clinical manifestations suggestive
of Clostridium difficile infection. It should be suspected in patients with acute diarrhea
(more than three loose stools in 24 hours) with associated risk factors (e.g., recent
antibiotic use, hospitalization, older age). The initial episode of non-severe C.
difficile infection should be treated with either oral fidaxomicin or oral vancomycin for 10
days. An alternative option is metronidazole; however, it is less effective for treatment of
