NSG 550
EXAM 2
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
,Table of Contents
NSG 550 Exam 2 ................................................................. 2
NSG 550 Exam 2 Study Guide ............................................. 58
NSG 550 Exam 2
Question 1
A 52-year-old male presents to the emergency department with sudden onset of
severe epigastric pain that radiates to his back. He reports nausea and vomiting. The
pain is steady and worsens when he walks or lies supine. He admits to drinking
approximately 12 beers daily and consumed a large fatty meal 4 hours prior to
symptom onset. His vital signs reveal a temperature of 101.2°F, heart rate of 112
bpm, and blood pressure of 148/92 mmHg. Laboratory studies show lipase 980 U/L
(normal: 10–140), amylase 420 U/L (normal: 30–110), ALT 85 U/L, CRP 18 mg/L,
WBC 16,500/μL, and glucose 198 mg/dL.
Which diagnostic imaging study is the first choice to confirm the diagnosis?
A. Abdominal ultrasound
B. CT abdomen with contrast — CORRECT ✓
C. MRI abdomen
D. ERCP
Rationale: The patient presents with classic signs of acute pancreatitis: epigastric
pain radiating to the back, worsened by supine position and walking,
nausea/vomiting, history of alcohol abuse and heavy meal, and laboratory findings
of elevated lipase (>3× upper limit of normal), elevated amylase, elevated ALT, CRP,
WBC, and hyperglycemia. While abdominal ultrasound can visualize the pancreas,
CT abdomen is the first-choice diagnostic imaging for pancreatitis as it provides
detailed visualization of pancreatic inflammation, necrosis, and complications. ERCP
is used to evaluate bile duct patency, not as initial imaging. MRI is not first-line.
,Question 2 (SATA)
A 45-year-old female presents with RUQ pain, nausea, vomiting, and a low-grade
fever. She reports the pain began approximately 6 hours after eating fried chicken.
On physical examination, the nurse practitioner elicits a positive Murphy's sign. Her
WBC is 14,200/μL.
Which of the following diagnostic tests would be appropriate to order? Select
all that apply.
A. RUQ ultrasound — CORRECT ✓
B. HIDA scan — CORRECT ✓
C. CT abdomen
D. ERCP
E. Abdominal x-ray
Rationale: This patient has acute cholecystitis (RUQ pain after fatty meal, positive
Murphy's sign, fever, elevated WBC). The gold standard diagnostic imaging is RUQ
ultrasound (A). If the ultrasound is inconclusive, a HIDA scan (B) would be the
next appropriate test. A CT abdomen (C) is not the preferred initial test for
cholecystitis. ERCP (D) evaluates bile duct patency and is used for bile duct stones,
not gallbladder inflammation. Abdominal x-ray (E) has limited utility for
cholecystitis diagnosis.
Question 3
A 68-year-old male with a history of alcohol abuse presents with epigastric pain,
nausea, and vomiting. Laboratory studies reveal a lipase of 1,250 U/L (3× upper
limit of normal) and an amylase of 380 U/L. The nurse practitioner knows that
lipase is more sensitive and specific than amylase for pancreatitis.
Which statement about these laboratory findings is most accurate?
A. Amylase remains elevated longer than lipase and is therefore more useful for late
diagnosis.
B. Lipase remains elevated longer than amylase and is the preferred diagnostic
marker. — CORRECT ✓
,C. Both enzymes normalize within 24 hours, so serial testing is not useful.
D. ALT elevation is the most specific indicator of pancreatitis.
Rationale: Lipase remains elevated longer than amylase and is more specific for
pancreatitis, making it the preferred diagnostic marker. Amylase can be elevated in
other conditions (salivary gland disorders, intestinal obstruction) and normalizes
more quickly. While ALT may be elevated in pancreatitis (especially gallstone-
related), it is not the most specific indicator. Serial testing is useful because lipase
elevation persists.
Question 4 (SATA)
A 35-year-old male presents with periumbilical pain that has migrated to the RLQ
over the past 12 hours. He reports nausea, a low-grade fever of 100.8°F, and rebound
tenderness at McBurney's point.
Which diagnostic findings and physical examination signs are consistent with
acute appendicitis? Select all that apply.
A. Rovsing's sign — CORRECT ✓
B. Psoas sign — CORRECT ✓
C. Murphy's sign
D. McBurney's point tenderness — CORRECT ✓
E. Positive obturator sign — CORRECT ✓
Rationale: Rovsing's sign (A) is pain in the RLQ with palpation of the LLQ. Psoas
sign (B) is abdominal pain with passive extension of the thigh with knees extended.
McBurney's point tenderness (D) is rebound tenderness at the RLQ. These are all
classic signs of acute appendicitis. Murphy's sign (C) is associated with
cholecystitis. The obturator sign (E) is also associated with appendicitis (pain with
internal rotation of the flexed right hip), though not explicitly mentioned in the
study guide.
Question 5
,A 28-year-old female presents to the clinic with LLQ pain, constipation alternating
with diarrhea, nausea, vomiting, and a low-grade fever. On examination, a palpable
mass is noted in the LLQ. Her WBC is 12,400/μL.
What is the gold standard diagnostic test for this condition?
A. Abdominal ultrasound
B. CT scan with contrast of the abdomen — CORRECT ✓
C. Colonoscopy
D. Barium enema
Rationale: This patient has diverticulitis (LLQ pain, altered bowel habits, N/V, low-
grade fever, palpable LLQ mass). The gold standard diagnostic test is CT scan
with contrast of the abdomen (B). Colonoscopy is contraindicated during acute
diverticulitis due to perforation risk. Abdominal ultrasound is not the preferred test.
Barium enema is used for colon cancer screening when colonoscopy is unavailable.
Question 6
A 62-year-old female presents with vague abdominal discomfort, fatigue, anorexia,
and weakness. She denies fever. She reports that her symptoms began after a large
family dinner 2 days ago. On physical examination, there is mild RUQ tenderness but
no rebound.
The nurse practitioner recognizes that elderly patients with cholecystitis may
present atypically. Which of the following best describes the typical elderly
presentation of cholecystitis?
A. Severe RUQ pain with fever and leukocytosis
B. Vague symptoms including anorexia, fatigue, no fever, weakness, and N/V —
CORRECT ✓
C. Acute periumbilical pain migrating to the RLQ
D. Epigastric pain radiating to the back with elevated lipase
Rationale: Elderly patients with cholecystitis often present with vague, atypical
symptoms (B): anorexia, fatigue, absence of fever, weakness, and nausea/vomiting.
They may not complain of classic RUQ pain. Option A describes the typical adult
presentation. Option C describes appendicitis. Option D describes pancreatitis.
,Question 7 (SATA)
A 55-year-old male with a history of recent antibiotic use for a sinus infection
presents with watery diarrhea (10–20 episodes per day), abdominal pain, fever, and
leukocytosis. He is immunocompromised due to chemotherapy for lymphoma.
Which of the following are appropriate steps in the diagnostic workup for C.
difficile infection? Select all that apply.
A. Stool sample should be passed within 1–2 hours of collection — CORRECT ✓
B. Collect 10–20 mL of watery, soft, or unformed stool — CORRECT ✓
C. Place stool in a clean, dry container — CORRECT ✓
D. Order a CT abdomen as the first-line diagnostic test
E. Obtain stool culture and sensitivity
Rationale: For C. difficile testing (A, B, C): stool should be passed within 1–2
hours, 10–20 mL of watery/soft/unformed stool should be collected in a clean dry
container. CT abdomen (D) is not first-line for C. diff diagnosis. While stool C&S (E)
may be ordered, the key diagnostic test is C. diff PCR or toxin assay. The patient's
recent antibiotic use, immunocompromised status, fever, leukocytosis, and
abdominal pain are all risk factors/clinical features of C. diff.
Question 8
A 50-year-old male presents with jaundice, dark urine, and pale stools. His total
bilirubin is 4.8 mg/dL. He reports yellow/brown urine.
Which condition should the nurse practitioner suspect based on these
findings?
A. Acute pancreatitis
B. Bile duct obstruction — CORRECT ✓
C. Hepatic encephalopathy
D. Viral hepatitis
Rationale: Yellow/brown urine with elevated bilirubin is concerning for bile
duct obstruction (B). Dark urine and pale stools (acholic stools) are classic signs of
extrahepatic biliary obstruction. While viral hepatitis can cause jaundice, the specific
mention of urine color points to obstruction. Hepatic encephalopathy would present
,with altered mental status and elevated ammonia. Pancreatitis would present with
epigastric pain and elevated lipase/amylase.
Question 9
A 58-year-old male with cirrhosis presents with confusion, asterixis, and lethargy.
His family reports he has been increasingly somnolent over the past 3 days.
Which laboratory test helps determine the extent of his condition?
A. Bilirubin
B. Ammonia level — CORRECT ✓
C. Lipase
D. BNP
Rationale: The ammonia test (B) is used in liver failure to help determine the
extent of hepatic encephalopathy. Elevated ammonia levels correlate with the
severity of encephalopathy. Bilirubin (A) indicates cholestasis or hemolysis. Lipase
(C) is for pancreatitis. BNP (D) is for heart failure.
Question 10 (SATA)
A 48-year-old female presents with RUQ pain after eating a high-fat meal. An
abdominal ultrasound is performed and shows gallstones but no evidence of
gallbladder wall thickening or pericholecystic fluid.
Which of the following statements are correct? Select all that apply.
A. The patient has cholelithiasis — CORRECT ✓
B. The patient has cholecystitis
C. Ultrasound is the gold standard for diagnosing gallstones — CORRECT ✓
D. If ultrasound is inconclusive, a HIDA scan should be ordered — CORRECT ✓
E. ERCP is the first-line test for gallstone diagnosis
Rationale: Cholelithiasis (A) is stones in the gallbladder without inflammation.
Cholecystitis (B) requires evidence of inflammation (wall thickening,
pericholecystic fluid, positive Murphy's sign). Ultrasound (C) is the gold standard
for diagnosing gallstones. If inconclusive, HIDA scan (D) is appropriate. ERCP (E) is
,an endoscopic procedure for bile duct evaluation, not first-line for gallstone
diagnosis.
Question 11
A 60-year-old male presents for his annual physical. He has no symptoms but his
family history is significant for colon cancer in his father at age 52. He is currently 60
years old.
Which screening approach is most appropriate for this patient?
A. Begin colonoscopy screening at age 50 and repeat every 10 years
B. Begin colonoscopy screening now due to family history and repeat every 5 years
— CORRECT ✓
C. Cologuard testing annually starting at age 45
D. Sigmoidoscopy only, as he is asymptomatic
Rationale: The patient has a family history of colon cancer (first-degree relative
diagnosed at age 52). Reasons to screen for colon cancer include family history,
age 45, and new onset fecal bleeding. Due to his family history, he should have
begun screening earlier than age 45. Colonoscopy is the gold standard and should be
performed now, with more frequent intervals (every 5 years) due to increased risk.
Cologuard is an option but colonoscopy is preferred with risk factors.
Question 12
A 42-year-old male presents with progressive dysphagia, unintentional weight loss
of 15 lbs over 2 months, and occasional hematemesis. He has a history of chronic
NSAID use for arthritis.
Which diagnostic procedure is indicated to evaluate this patient?
A. Colonoscopy
B. EGD (Esophagogastroduodenoscopy) — CORRECT ✓
C. Barium swallow
D. CT chest
Rationale: EGD (B) is indicated for dysphagia, bleeding ulcers, and H. pylori
evaluation. This patient has progressive dysphagia, weight loss, and hematemesis
, — concerning for upper GI pathology (esophageal stricture, ulcer, or malignancy).
EGD allows direct visualization of the esophagus, stomach, and duodenum.
Colonoscopy (A) evaluates the lower GI tract. Barium swallow (C) is less sensitive.
CT chest (D) does not directly visualize mucosal lesions.
Question 13
A 38-year-old female presents with severe epigastric pain, nausea, and vomiting.
Laboratory studies show lipase 1,100 U/L and amylase 350 U/L. The nurse
practitioner suspects pancreatitis.
Which of the following are risk factors for pancreatitis? Select all that apply.
A. Alcohol abuse — CORRECT ✓
B. Gallstones — CORRECT ✓
C. Heavy meal consumption — CORRECT ✓
D. Recent antibiotic use
E. Epigastric pain — CORRECT ✓
Rationale: Pancreatitis risk factors (A, B, C, E): alcohol abuse, gallstones, heavy
meal consumption (can precipitate acute attack), and epigastric pain is a
symptom/risk indicator. Recent antibiotic use (D) is a risk factor for C. difficile, not
pancreatitis. The patient's presentation with elevated lipase (>3× ULN) and
epigastric pain confirms pancreatitis.
Question 14
A 65-year-old male with a history of alcohol abuse presents with hepatomegaly on
physical examination. He denies pain but reports early satiety and abdominal
fullness.
What is the gold standard diagnostic imaging for hepatomegaly?
A. CT abdomen
B. MRI abdomen
C. Ultrasound — CORRECT ✓
D. Nuclear medicine scan
EXAM 2
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
,Table of Contents
NSG 550 Exam 2 ................................................................. 2
NSG 550 Exam 2 Study Guide ............................................. 58
NSG 550 Exam 2
Question 1
A 52-year-old male presents to the emergency department with sudden onset of
severe epigastric pain that radiates to his back. He reports nausea and vomiting. The
pain is steady and worsens when he walks or lies supine. He admits to drinking
approximately 12 beers daily and consumed a large fatty meal 4 hours prior to
symptom onset. His vital signs reveal a temperature of 101.2°F, heart rate of 112
bpm, and blood pressure of 148/92 mmHg. Laboratory studies show lipase 980 U/L
(normal: 10–140), amylase 420 U/L (normal: 30–110), ALT 85 U/L, CRP 18 mg/L,
WBC 16,500/μL, and glucose 198 mg/dL.
Which diagnostic imaging study is the first choice to confirm the diagnosis?
A. Abdominal ultrasound
B. CT abdomen with contrast — CORRECT ✓
C. MRI abdomen
D. ERCP
Rationale: The patient presents with classic signs of acute pancreatitis: epigastric
pain radiating to the back, worsened by supine position and walking,
nausea/vomiting, history of alcohol abuse and heavy meal, and laboratory findings
of elevated lipase (>3× upper limit of normal), elevated amylase, elevated ALT, CRP,
WBC, and hyperglycemia. While abdominal ultrasound can visualize the pancreas,
CT abdomen is the first-choice diagnostic imaging for pancreatitis as it provides
detailed visualization of pancreatic inflammation, necrosis, and complications. ERCP
is used to evaluate bile duct patency, not as initial imaging. MRI is not first-line.
,Question 2 (SATA)
A 45-year-old female presents with RUQ pain, nausea, vomiting, and a low-grade
fever. She reports the pain began approximately 6 hours after eating fried chicken.
On physical examination, the nurse practitioner elicits a positive Murphy's sign. Her
WBC is 14,200/μL.
Which of the following diagnostic tests would be appropriate to order? Select
all that apply.
A. RUQ ultrasound — CORRECT ✓
B. HIDA scan — CORRECT ✓
C. CT abdomen
D. ERCP
E. Abdominal x-ray
Rationale: This patient has acute cholecystitis (RUQ pain after fatty meal, positive
Murphy's sign, fever, elevated WBC). The gold standard diagnostic imaging is RUQ
ultrasound (A). If the ultrasound is inconclusive, a HIDA scan (B) would be the
next appropriate test. A CT abdomen (C) is not the preferred initial test for
cholecystitis. ERCP (D) evaluates bile duct patency and is used for bile duct stones,
not gallbladder inflammation. Abdominal x-ray (E) has limited utility for
cholecystitis diagnosis.
Question 3
A 68-year-old male with a history of alcohol abuse presents with epigastric pain,
nausea, and vomiting. Laboratory studies reveal a lipase of 1,250 U/L (3× upper
limit of normal) and an amylase of 380 U/L. The nurse practitioner knows that
lipase is more sensitive and specific than amylase for pancreatitis.
Which statement about these laboratory findings is most accurate?
A. Amylase remains elevated longer than lipase and is therefore more useful for late
diagnosis.
B. Lipase remains elevated longer than amylase and is the preferred diagnostic
marker. — CORRECT ✓
,C. Both enzymes normalize within 24 hours, so serial testing is not useful.
D. ALT elevation is the most specific indicator of pancreatitis.
Rationale: Lipase remains elevated longer than amylase and is more specific for
pancreatitis, making it the preferred diagnostic marker. Amylase can be elevated in
other conditions (salivary gland disorders, intestinal obstruction) and normalizes
more quickly. While ALT may be elevated in pancreatitis (especially gallstone-
related), it is not the most specific indicator. Serial testing is useful because lipase
elevation persists.
Question 4 (SATA)
A 35-year-old male presents with periumbilical pain that has migrated to the RLQ
over the past 12 hours. He reports nausea, a low-grade fever of 100.8°F, and rebound
tenderness at McBurney's point.
Which diagnostic findings and physical examination signs are consistent with
acute appendicitis? Select all that apply.
A. Rovsing's sign — CORRECT ✓
B. Psoas sign — CORRECT ✓
C. Murphy's sign
D. McBurney's point tenderness — CORRECT ✓
E. Positive obturator sign — CORRECT ✓
Rationale: Rovsing's sign (A) is pain in the RLQ with palpation of the LLQ. Psoas
sign (B) is abdominal pain with passive extension of the thigh with knees extended.
McBurney's point tenderness (D) is rebound tenderness at the RLQ. These are all
classic signs of acute appendicitis. Murphy's sign (C) is associated with
cholecystitis. The obturator sign (E) is also associated with appendicitis (pain with
internal rotation of the flexed right hip), though not explicitly mentioned in the
study guide.
Question 5
,A 28-year-old female presents to the clinic with LLQ pain, constipation alternating
with diarrhea, nausea, vomiting, and a low-grade fever. On examination, a palpable
mass is noted in the LLQ. Her WBC is 12,400/μL.
What is the gold standard diagnostic test for this condition?
A. Abdominal ultrasound
B. CT scan with contrast of the abdomen — CORRECT ✓
C. Colonoscopy
D. Barium enema
Rationale: This patient has diverticulitis (LLQ pain, altered bowel habits, N/V, low-
grade fever, palpable LLQ mass). The gold standard diagnostic test is CT scan
with contrast of the abdomen (B). Colonoscopy is contraindicated during acute
diverticulitis due to perforation risk. Abdominal ultrasound is not the preferred test.
Barium enema is used for colon cancer screening when colonoscopy is unavailable.
Question 6
A 62-year-old female presents with vague abdominal discomfort, fatigue, anorexia,
and weakness. She denies fever. She reports that her symptoms began after a large
family dinner 2 days ago. On physical examination, there is mild RUQ tenderness but
no rebound.
The nurse practitioner recognizes that elderly patients with cholecystitis may
present atypically. Which of the following best describes the typical elderly
presentation of cholecystitis?
A. Severe RUQ pain with fever and leukocytosis
B. Vague symptoms including anorexia, fatigue, no fever, weakness, and N/V —
CORRECT ✓
C. Acute periumbilical pain migrating to the RLQ
D. Epigastric pain radiating to the back with elevated lipase
Rationale: Elderly patients with cholecystitis often present with vague, atypical
symptoms (B): anorexia, fatigue, absence of fever, weakness, and nausea/vomiting.
They may not complain of classic RUQ pain. Option A describes the typical adult
presentation. Option C describes appendicitis. Option D describes pancreatitis.
,Question 7 (SATA)
A 55-year-old male with a history of recent antibiotic use for a sinus infection
presents with watery diarrhea (10–20 episodes per day), abdominal pain, fever, and
leukocytosis. He is immunocompromised due to chemotherapy for lymphoma.
Which of the following are appropriate steps in the diagnostic workup for C.
difficile infection? Select all that apply.
A. Stool sample should be passed within 1–2 hours of collection — CORRECT ✓
B. Collect 10–20 mL of watery, soft, or unformed stool — CORRECT ✓
C. Place stool in a clean, dry container — CORRECT ✓
D. Order a CT abdomen as the first-line diagnostic test
E. Obtain stool culture and sensitivity
Rationale: For C. difficile testing (A, B, C): stool should be passed within 1–2
hours, 10–20 mL of watery/soft/unformed stool should be collected in a clean dry
container. CT abdomen (D) is not first-line for C. diff diagnosis. While stool C&S (E)
may be ordered, the key diagnostic test is C. diff PCR or toxin assay. The patient's
recent antibiotic use, immunocompromised status, fever, leukocytosis, and
abdominal pain are all risk factors/clinical features of C. diff.
Question 8
A 50-year-old male presents with jaundice, dark urine, and pale stools. His total
bilirubin is 4.8 mg/dL. He reports yellow/brown urine.
Which condition should the nurse practitioner suspect based on these
findings?
A. Acute pancreatitis
B. Bile duct obstruction — CORRECT ✓
C. Hepatic encephalopathy
D. Viral hepatitis
Rationale: Yellow/brown urine with elevated bilirubin is concerning for bile
duct obstruction (B). Dark urine and pale stools (acholic stools) are classic signs of
extrahepatic biliary obstruction. While viral hepatitis can cause jaundice, the specific
mention of urine color points to obstruction. Hepatic encephalopathy would present
,with altered mental status and elevated ammonia. Pancreatitis would present with
epigastric pain and elevated lipase/amylase.
Question 9
A 58-year-old male with cirrhosis presents with confusion, asterixis, and lethargy.
His family reports he has been increasingly somnolent over the past 3 days.
Which laboratory test helps determine the extent of his condition?
A. Bilirubin
B. Ammonia level — CORRECT ✓
C. Lipase
D. BNP
Rationale: The ammonia test (B) is used in liver failure to help determine the
extent of hepatic encephalopathy. Elevated ammonia levels correlate with the
severity of encephalopathy. Bilirubin (A) indicates cholestasis or hemolysis. Lipase
(C) is for pancreatitis. BNP (D) is for heart failure.
Question 10 (SATA)
A 48-year-old female presents with RUQ pain after eating a high-fat meal. An
abdominal ultrasound is performed and shows gallstones but no evidence of
gallbladder wall thickening or pericholecystic fluid.
Which of the following statements are correct? Select all that apply.
A. The patient has cholelithiasis — CORRECT ✓
B. The patient has cholecystitis
C. Ultrasound is the gold standard for diagnosing gallstones — CORRECT ✓
D. If ultrasound is inconclusive, a HIDA scan should be ordered — CORRECT ✓
E. ERCP is the first-line test for gallstone diagnosis
Rationale: Cholelithiasis (A) is stones in the gallbladder without inflammation.
Cholecystitis (B) requires evidence of inflammation (wall thickening,
pericholecystic fluid, positive Murphy's sign). Ultrasound (C) is the gold standard
for diagnosing gallstones. If inconclusive, HIDA scan (D) is appropriate. ERCP (E) is
,an endoscopic procedure for bile duct evaluation, not first-line for gallstone
diagnosis.
Question 11
A 60-year-old male presents for his annual physical. He has no symptoms but his
family history is significant for colon cancer in his father at age 52. He is currently 60
years old.
Which screening approach is most appropriate for this patient?
A. Begin colonoscopy screening at age 50 and repeat every 10 years
B. Begin colonoscopy screening now due to family history and repeat every 5 years
— CORRECT ✓
C. Cologuard testing annually starting at age 45
D. Sigmoidoscopy only, as he is asymptomatic
Rationale: The patient has a family history of colon cancer (first-degree relative
diagnosed at age 52). Reasons to screen for colon cancer include family history,
age 45, and new onset fecal bleeding. Due to his family history, he should have
begun screening earlier than age 45. Colonoscopy is the gold standard and should be
performed now, with more frequent intervals (every 5 years) due to increased risk.
Cologuard is an option but colonoscopy is preferred with risk factors.
Question 12
A 42-year-old male presents with progressive dysphagia, unintentional weight loss
of 15 lbs over 2 months, and occasional hematemesis. He has a history of chronic
NSAID use for arthritis.
Which diagnostic procedure is indicated to evaluate this patient?
A. Colonoscopy
B. EGD (Esophagogastroduodenoscopy) — CORRECT ✓
C. Barium swallow
D. CT chest
Rationale: EGD (B) is indicated for dysphagia, bleeding ulcers, and H. pylori
evaluation. This patient has progressive dysphagia, weight loss, and hematemesis
, — concerning for upper GI pathology (esophageal stricture, ulcer, or malignancy).
EGD allows direct visualization of the esophagus, stomach, and duodenum.
Colonoscopy (A) evaluates the lower GI tract. Barium swallow (C) is less sensitive.
CT chest (D) does not directly visualize mucosal lesions.
Question 13
A 38-year-old female presents with severe epigastric pain, nausea, and vomiting.
Laboratory studies show lipase 1,100 U/L and amylase 350 U/L. The nurse
practitioner suspects pancreatitis.
Which of the following are risk factors for pancreatitis? Select all that apply.
A. Alcohol abuse — CORRECT ✓
B. Gallstones — CORRECT ✓
C. Heavy meal consumption — CORRECT ✓
D. Recent antibiotic use
E. Epigastric pain — CORRECT ✓
Rationale: Pancreatitis risk factors (A, B, C, E): alcohol abuse, gallstones, heavy
meal consumption (can precipitate acute attack), and epigastric pain is a
symptom/risk indicator. Recent antibiotic use (D) is a risk factor for C. difficile, not
pancreatitis. The patient's presentation with elevated lipase (>3× ULN) and
epigastric pain confirms pancreatitis.
Question 14
A 65-year-old male with a history of alcohol abuse presents with hepatomegaly on
physical examination. He denies pain but reports early satiety and abdominal
fullness.
What is the gold standard diagnostic imaging for hepatomegaly?
A. CT abdomen
B. MRI abdomen
C. Ultrasound — CORRECT ✓
D. Nuclear medicine scan
