NR509 study guide
NR509 study guide
Study online at https://quizlet.com/_jpbzcg
1. An overweight 26-year-old public servant pre- Ruptured tubal (or ectopic) pregnancy
sents to the Emergency Department with 12
hours of intense abdominal pain, light-head-
edness, and a fainting episode that finally
prompted her to seek medical attention. She
has a strong family history of gallstones and
is concerned 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 pe-
riod was 10 weeks ago. Her vital signs at triage
are pulse, 118; blood pressure, 86/68; respira-
tory rate, 20/min; oxygen saturation, 99%; and
temperature, 37.3ºC orally. The clinician per-
forms an abdominal exam prior to her pelvic
exam and, on palpation of her abdomen, finds
involuntary rigidity and rebound tenderness.
What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perf
2. A 63-year-old janitor with a history of ade- e. Liver palpable 3 cm below the right
nomatous colonic polyps presents for a well costal margin, mid clavicular line, on
visit. Electrolytes and liver enzymes were also expiration
measured. His labs are all normal expect
for moderate elevations of aspartate amino-
transferase, alanine aminotransferase, γ-glu-
tamyl transferase, and alkaline phosphatase
as well as a mildly elevated total bilirubin.
, NR509 study guide
NR509 study guide
Study online at https://quizlet.com/_jpbzcg
He presents for a follow-up appointment and
the clinician performs an abdominal exam
to assess his liver. Which of the following
findings would be most consistent with he-
patomegaly?
a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm
at the midclavicular line
d. Dullness to percussion over a span of 8 cm
at the midsternal line
e. Liver palpable 3 cm below the right costal
margin, mid clavicular line, on expiration
3. A 63-year-old underweight administrative b. History of smoking
clerk with a 50-pack-year smoking history pre-
sents with a several month history of re-
current epigastric abdominal discomfort. She
feels fairly well otherwise and denies any nau-
sea, vomiting, diarrhea, or constipation. She
reports that a first cousin died from a rup-
tured 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 in-
dex is 17.6. On exam, her abdominal aorta
is prominent, which is concerning for an ab-
dominal aortic aneurysm (AAA). Which of the
following is her most significant risk factor for
an AAA?
a. Female gender
b. History of smoking
, NR509 study guide
NR509 study guide
Study online at https://quizlet.com/_jpbzcg
c. Underweight
d. Family history of ruptured aneurysm
e. hypertension
4. A 76-year-old retired man with a history of a. Do not screen routinely
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 subsequent-
ly went for a colonoscopy. Internal hemor-
rhoids and sigmoid diverticuli were found on
colonoscopy. He has no first-degree relatives
with a history of colorectal cancer or adeno-
matous polyps. What are the U.S. Preventive
Services Task Force (USPSTF) screening rec-
ommendations 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
Submit
5. An otherwise healthy 31-year-old accountant c. Functional change in bowel move-
presents to an outpatient clinic with a 3-year ment
, NR509 study guide
NR509 study guide
Study online at https://quizlet.com/_jpbzcg
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 in-
take, 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 gradu-
ally 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
6. A 23-year-old woman comes to the respirolo- a. Tympany to percussion in the right
gy clinic for follow-up of her chronic sinusitis upper quadrant, dullness to percus-
and bronchiectasis that is associated with a sion of the left upper quadrant
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
NR509 study guide
Study online at https://quizlet.com/_jpbzcg
1. An overweight 26-year-old public servant pre- Ruptured tubal (or ectopic) pregnancy
sents to the Emergency Department with 12
hours of intense abdominal pain, light-head-
edness, and a fainting episode that finally
prompted her to seek medical attention. She
has a strong family history of gallstones and
is concerned 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 pe-
riod was 10 weeks ago. Her vital signs at triage
are pulse, 118; blood pressure, 86/68; respira-
tory rate, 20/min; oxygen saturation, 99%; and
temperature, 37.3ºC orally. The clinician per-
forms an abdominal exam prior to her pelvic
exam and, on palpation of her abdomen, finds
involuntary rigidity and rebound tenderness.
What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perf
2. A 63-year-old janitor with a history of ade- e. Liver palpable 3 cm below the right
nomatous colonic polyps presents for a well costal margin, mid clavicular line, on
visit. Electrolytes and liver enzymes were also expiration
measured. His labs are all normal expect
for moderate elevations of aspartate amino-
transferase, alanine aminotransferase, γ-glu-
tamyl transferase, and alkaline phosphatase
as well as a mildly elevated total bilirubin.
, NR509 study guide
NR509 study guide
Study online at https://quizlet.com/_jpbzcg
He presents for a follow-up appointment and
the clinician performs an abdominal exam
to assess his liver. Which of the following
findings would be most consistent with he-
patomegaly?
a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm
at the midclavicular line
d. Dullness to percussion over a span of 8 cm
at the midsternal line
e. Liver palpable 3 cm below the right costal
margin, mid clavicular line, on expiration
3. A 63-year-old underweight administrative b. History of smoking
clerk with a 50-pack-year smoking history pre-
sents with a several month history of re-
current epigastric abdominal discomfort. She
feels fairly well otherwise and denies any nau-
sea, vomiting, diarrhea, or constipation. She
reports that a first cousin died from a rup-
tured 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 in-
dex is 17.6. On exam, her abdominal aorta
is prominent, which is concerning for an ab-
dominal aortic aneurysm (AAA). Which of the
following is her most significant risk factor for
an AAA?
a. Female gender
b. History of smoking
, NR509 study guide
NR509 study guide
Study online at https://quizlet.com/_jpbzcg
c. Underweight
d. Family history of ruptured aneurysm
e. hypertension
4. A 76-year-old retired man with a history of a. Do not screen routinely
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 subsequent-
ly went for a colonoscopy. Internal hemor-
rhoids and sigmoid diverticuli were found on
colonoscopy. He has no first-degree relatives
with a history of colorectal cancer or adeno-
matous polyps. What are the U.S. Preventive
Services Task Force (USPSTF) screening rec-
ommendations 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
Submit
5. An otherwise healthy 31-year-old accountant c. Functional change in bowel move-
presents to an outpatient clinic with a 3-year ment
, NR509 study guide
NR509 study guide
Study online at https://quizlet.com/_jpbzcg
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 in-
take, 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 gradu-
ally 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
6. A 23-year-old woman comes to the respirolo- a. Tympany to percussion in the right
gy clinic for follow-up of her chronic sinusitis upper quadrant, dullness to percus-
and bronchiectasis that is associated with a sion of the left upper quadrant
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
