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NSG 6020 Week 5 Study Guide Chapter 10. Abdomen Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. When performing abdominal assessment, t... he clinician should perform examination techniques in the following order: A. Inspection, palpation, percussion, and auscultation B. Inspection, percussion, palpation, and auscultation C. Inspection, auscultation, percussion, and palpation D. Auscultation, palpation, percussion, and inspection ____ 2. The clinician should auscultate the abdomen to listen for possible bruits of the: A. Aorta B. Renal artery C. Iliac artery D. All of the above ____ 3. On abdominal examination, which of the following is assessed using percussion? A. Liver B. Kidneys C. Pancreas D. Esophagus ____ 4. In abdominal assessment, a digital rectal examination is performed to assess for: A. Hemorrhoids B. Prostate size C. Blood in stool D. Ureteral stenosis ____ 5. Rebound tenderness of the abdomen is a sign of: A. Constipation B. Peritoneal inflammation C. Elevated venous pressure D. Peritoneal edema ____ 6. While assessing the abdomen, the clinician deeply palpates the left lower quadrant of the abdomen, and this causes pain in the patient’s right lower abdomen. This is most commonly indicative of: A. Constipation B. Diverticulitis C. Appendicitis D. Hepatitis ____ 7. Your patient complains of severe right lower quadrant abdominal pain. To assess the patient for peritoneal inflammation, the examiner should: A. Percuss the right lower quadrant of the abdomen B. Deeply palpate the right lower quadrant of the abdomen C. Auscultate the right lower quadrant for hyperactive bowel sounds D. Strike the plantar surface of the patient’s heel while the patient is supine ____ 8. Your patient is lying supine and you ask him to raise his leg while you place resistance against the thigh. The examiner is testing the patient for: A. Psoas sign B. Obturator sign C. Rovsing’s sign D. Murphys’ sign ____ 9. A patient is lying supine and the clinician deeply palpates the right upper quadrant of the abdomen while the patient inhales. The examiner is testing the patient for: A. Psoas sign B. Obturator sign C. Rovsing’s sign D. Murphys’ sign ____ 10. Your patient has abdominal pain, and it is worsened when the examiner rotates the patient’s right hip inward with the knee bent and the obturator internus muscle is stretched. This is a sign of: A. Diverticulitis B. Cholecystitis C. Appendicitis D. Mesenteric adenitis ____ 11. On abdominal examination as the clinician presses on the right upper quadrant to assess liver size, jugular vein distension becomes obvious. Hepatojugular reflux is indicative of: A. Acute hepatitis B. Right ventricular failure C. Cholecystitis D. Left ventricular failure ____ 12. Your patient demonstrates positive shifting dullness on percussion of the abdomen. This is indicative of: A. Cholecystitis B. Appendicitis C. Ascites D. Hepatitis ____ 13. Your 44-year-old female patient complains of right upper quadrant pain. Her skin and sclera are yellow, and she has hyperbilirubinemia and elevated liver enzymes. The clinician should suspect: A. Acute pancreatitis B. Biliary duct obstruction C. Acute hepatitis D. Atypical appendicitis ____ 14. The most common cause of acute pancreatitis is: A. Trauma B. Hepatitis virus A C. Hyperlipidemia D. Alcohol abuse ____ 15. Your patient with pancreatitis has a Ranson rule score of 8. The clinician should recognize that this is a risk of: A. Pleural involvement B. Alcoholism C. High mortality D. Bile duct obstruction ____ 16. Your patient complains of left upper quadrant pain, fever, extreme fatigue, and spontaneous bruising. The clinician should recognize that these symptoms are often related to: A. Hematopoetic disorders B. Hepatomegaly C. Esophageal varices D. Pleural effusion ____ 17. A 16-year-old patient presents with sore throat, cervical lymphadenopathy, fever, extreme fatigue, and left upper quadrant pain. The physical examination reveals splenomegaly. The clinician should recognize the probability of: A. Bacterial endocarditis B. Infectious mononucleosis C. Pneumonia with pleural effusion D. Pancreatic cancer ____ 18. Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The clinician needs to consider: A. Diverticulitis B. Appendicitis C. Colon cancer D. Peptic ulcer disease ____ 19. Which of the following is the most common cause of heartburn-type epigastric pain? A. Decreased lower esophageal sphincter tone B. Helicobacteria pylori infection of stomach C. Esophageal spasm D. Excess use of NSAIDs ____ 20. A 22-year-old female enters the emergency room with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of: A. Digital rectal examination B. Endoscopy C. Ultrasound D. Pelvic examination ____ 21. The major sign of ectopic pregnancy is: A. Sudden onset of severe epigastric pain B. Amenorrhea with unilateral lower quadrant pain C. Lower back and rectal pain D. Palpable abdominal mass ____ 22. When ruptured ectopic pregnancy is suspected, the following procedure is most important: A. Culdocentesis B. CT scan C. Abdominal x-ray D. Digital rectal examination ____ 23. The majority of colon cancers are located in the: A. Transverse colon B. Cecum C. Rectosigmoid region D. Ascending colon ____ 24. The following symptom(s) in the patient’s history should raise the clinician’s suspicion of colon cancer: A. Alternating constipation and diarrhea B. Narrowed caliber of stool C. Hematochezia D. All of the above ____ 25. A patient presents to the emergency department with nausea and severe, colicky back pain that radiates into the groin. When asked to locate the pain, he points to the right costovertebral angle region. His physical examination is unremarkable. Which of the following lab tests is most important for the diagnosis? A. Urinalysis B. Serum electrolyte levels C. Digital rectal exam D. Lumbar x-ray ____ 26. Your 34-year-old female patient complains of a feeling of “heaviness” in the right lower quadrant, achiness, and bloating. On pelvic examination, there is a palpable mass in the right lower quadrant. Urine and serum pregnancy tests are negative. The diagnostic tool that would be most helpful is: A. Digital rectal exam B. Transvaginal ultrasound C. Pap smear D. Urinalysis ____ 27. Your 54-year-old male patient complains of a painless “lump” in his lower left abdomen that comes and goes for the past couple of weeks. When examining the abdomen, you should have the patient: A. Lie flat and take a deep breath B. Stand and bear down against your hand C. Prepare for a digital rectal examination D. Lie in a left lateral recumbent position ____ 28. A nurse practitioner reports that your patient’s abdominal x-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in: A. Appendicitis B. Cholecystitis C. Bowel obstruction D. Diverticulitis ____ 29. A 76-year-old patient presents to the emergency department with severe left lower quadrant abdominal pain, diarrhea, and fever. On physical examination, you note the patient has a positive heel strike, and left lower abdominal rebound tenderness. These are typical signs and symptoms of which of the following conditions? A. Diverticulitis B. Salpingitis C. Inflammatory bowel disease D. Irritable bowel syndrome ____ 30. Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea? A. Viral gastroenteritis B. Staphylococcal food poisoning C. Acute hepatitis A D. E.coli gastroenteritis ____ 31. A patient presents to the emergency department with complaints of vomiting and abdominal pain. You note that the emesis contains bile. On physical examination, there is diffuse tenderness, abdominal distension, and rushing, high-pitched bowel sounds. Which of the following diagnoses would be most likely? A. Gastric outlet obstruction B. Small bowel obstruction C. Distal intestinal blockage D. Colonic obstruction ____ 32. Your 5-year-old female patient presents to the emergency department with sore throat, vomiting, ear ache, 103 degree fever, photophobia, and nuchal rigidity. She has an episode of projectile vomiting while you are examining her. The clinician should recognize that the following should be done: A. Abdominal x-ray B. Fundoscopic examination C. Lumbar puncture D. Analysis of vomitus ____ 33. A 9-year-old boy accompanied by his mother reports that since he came home from summer camp, he has had fever, nausea, vomiting, severe abdominal cramps and watery stools that contain blood and mucus. The clinician should recognize the importance of: A. Stool for ova and parasites B. Abdominal x-ray C. Stool for clostridium D. Fecal occult blood test ____ 34. A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable. It is important for the clinician to recognize the importance of: A. CBC with differential B. Stool culture and sensitivity C. Abdominal x-ray D. Colonoscopy ____ 35. A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and episodes of diarrhea. The symptoms usually occur after eating, and pain is frequently relieved with bowel movement. She is on a “celiac diet” and the episodic symptoms persist. Physical examination and diagnostic tests are negative. Colonoscopy is negative for any abnormalities. This is a history and physical consistent with: A. Inflammatory bowel disease B. Irritable bowel syndrome C. Laxative abuse D. Norovirus gastroenteritis ____ 36. A 78-year-old female patient is suffering from heart failure, GERD, diabetes, and depression. She presents with complaints of frequent episodes of constipation. Her last bowel movement was 1 week ago. Upon examination, you palpate a hard mass is the left lower quadrant of the abdomen. You review her list of medications. Which of the following of her medications cause constipation? A. Digitalis (Lanoxin) B. Amlodipine (Norvasc) C. Sertraline (Zoloft) D. Metformin (Glucophage) ____ 37. You are examining a 55-year-old female patient with a history of alcohol abuse. She complains of anorexia, nausea, pruritus, and weight loss over the last month. On physical examination, you note yellow hue of the skin and sclera. Which of the following physical examination techniques is most important? A. Scratch test B. Heel strike C. Digital rectal examination D. Pelvic examination ____ 38. You observe Charcot’s triad of sign and symptoms in a patient under your care. This is commonly seen in which of the following disorders? A. Cirrhosis B. Pancreatitis C. Cholangitis D. Portal hypertension ____ 39. A 59-year-old patient with history of alcohol abuse is admitted for hematemesis. On physical examination, you note ascites and caput medusa. A likely cause for the hematemesis is: A. Peptic ulcer disease B. Barrett’s esophagus C. Pancreatitis D. Esophageal varices ____ 40. A 16-year-old female with anorexia and bulimia is admitted for hematemesis. She admits to inducing vomiting often. On physical examination, you note pallor, BMI less than 15, and hypotension. A likely reason for hematemesis is: A. Mallory-Weiss tear B. Cirrhosis C. Peptic ulcer disease D. Esophageal varies ____ 41. An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: A. Mallory-Weiss tear B. Esophageal varices C. Gastric ulcer D. Colon cancer ____ 42. A 48-year-old male presents to the clinic with complaints of anorexia, nausea, weakness, and unintentional weight loss over the last few weeks. On physical examination, the patient has jaundice of the skin as well as sclera and a palpable mass in the epigastric region. In addition to CBC and bilirubin levels, all of the following tests would be helpful except: A. Liver enzymes B. Amylase C. Lipase D. Uric acid ____ 43. Your 66-year-old male patient complains of weakness, fatigue, chronic constipation for the last month, and dark stools. On CBC, his results show iron deficiency anemia. Colon cancer is diagnosed. Which of the following laboratory tests is used to follow progress of colon cancer? A. Alpha fetoprotein (AFP) B. Carcinogenic embryonic antigen (CEA) C. Carcinoma antigen 125 (CA-125) D. Beta-human chorionic gonadotropin (beta HCG) ____ 44. Your patient is a 33-year-old female gave birth last week. She complains of constipation, rectal pain, and itching. She reports bright red blood on the toilet tissue. The clinician should recognize the need for: A. Digital rectal exam B. CEA blood test C. Colonoscopy D. Fecal occult blood test Chapter 11 The Abdomen 1. A 52-year-old secretary comes to your office, complaining about accidentally leaking urine when she coughs or sneezes. She says this has been going on for about a year now. She relates that she has not had a period for 2 years. She denies any recent illness or injuries. Her past medical history is significant for four spontaneous vaginal deliveries. She is married and has four children. She denies alcohol, tobacco, or drug use. During her pelvic examination you note some atrophic vaginal tissue, but the remainder of her pelvic, abdominal, and rectal examinations are unremarkable. Which type of urinary incontinence does she have? A) Stress incontinence B) Urge incontinence C) Overflow incontinence 2. A 46-year-old former salesman presents to the ER, complaining of black stools for the past few weeks. His past medical history is significant for cirrhosis. He has gained weight recently, especially around his abdomen. He has smoked two packs of cigarettes a day for 30 years and has drunk approximately 10 alcoholic beverages a day for 25 years. He has used IV heroin and smoked crack in the past. He denies any recent use. He is currently unemployed and has never been married. On examination you find a man appearing older than his stated age. His skin has a yellowish tint and he is thin, with a prominent abdomen. You note multiple “spider angiomas” at the base of his neck. Otherwise, his heart and lung examinations are normal. On inspection he has dilated veins around his umbilicus. Increased bowel sounds are heard during auscultation. Palpation reveals diffuse tenderness that is more severe in the epigastric area. His liver is small and hard to palpation and he has a positive fluid wave. He is positive for occult blood on his rectal examination. What cause of black stools most likely describes his symptoms and signs? A) Infectious diarrhea B) Mallory-Weiss tear C) Esophageal varices 3. A 21-year-old receptionist comes to your clinic, complaining of frequent diarrhea. She states that the stools are very loose and there is some cramping beforehand. She states this has occurred on and off since she was in high school. She denies any nausea, vomiting, or blood in her stool. Occasionally she has periods of constipation, but that is rare. She thinks the diarrhea is much worse when she is nervous. Her past medical history is not significant. She is single and a junior in college majoring in accounting. She smokes when she drinks alcohol but denies using any illegal drugs. Both of her parents are healthy. Her entire physical examination is unremarkable. What is most likely the etiology of her diarrhea? A) Secretory infections B) Inflammatory infections C) Irritable bowel syndrome D) Malabsorption syndrome 4. A 42-year-old florist comes to your office, complaining of chronic constipation for the last 6 months. She has had no nausea, vomiting, or diarrhea and no abdominal pain or cramping. She denies any recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new medications. During the review of systems you note that she has felt fatigued, had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary artery disease. There is no family history of cancers. On examination she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the Achilles tendons. What is the best choice for the cause of her constipation? A) Large bowel obstruction B) Irritable bowel syndrome C) Rectal cancer D) Hypothyroidism 5. A 22-year-old law student comes to your office, complaining of severe abdominal pain radiating to his back. He states it began last night after hours of heavy drinking. He has had abdominal pain and vomiting in the past after drinking but never as bad as this. He cannot keep any food or water down, and these symptoms have been going on for almost 12 hours. He has had no recent illnesses or injuries. His past medical history is unremarkable. He denies smoking or using illegal drugs but admits to drinking 6 to 10 beers per weekend night. He admits that last night he drank something like 14 drinks. On examination you find a young male appearing his stated age in some distress. He is leaning over on the examination table and holding his abdomen with his arms. His blood pressure is 90/60 and his pulse is 120. He is afebrile. His abdominal examination reveals normal bowel sounds, but he is very tender in the left upper quadrant and epigastric area. He has no Murphy's sign or tenderness in the right lower quadrant. The remainder of his abdominal examination is normal. His rectal, prostate, penile, and testicular examinations are normal. He has no inguinal hernias or tenderness with that examination. Blood work is pending. What etiology of abdominal pain is most likely causing his symptoms? A) Peptic ulcer disease B) Biliary colic C) Acute cholecystitis D) Acute pancreatitis 6. A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about 3 days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, 3 days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for over 50 years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination he appears his stated age and is in no acute distress. His temperature is 100.9 degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable and his fecal occult blood test is negative. His prostate is slightly enlarged but his testicular, penile, and inguinal examinations are all normal. Blood work is pending. What diagnosis for abdominal pain best describes his symptoms and signs? A) Acute diverticulitis B) Acute cholecystitis C) Acute appendicitis D) Mesenteric ischemia 7. A 77-year-old retired bus driver comes to your clinic for a physical examination at his wife's request. He has recently been losing weight and has felt very fatigued. He has had no chest pain, shortness of breath, nausea, vomiting, or fever. His past medical history includes colon cancer, for which he had surgery, and arthritis. He has been married for over 40 years. He denies any tobacco or drug use and has not drunk alcohol in over 40 years. His parents both died of cancer in their 60s. On examination his vital signs are normal. His head, cardiac, and pulmonary examinations are unremarkable. On abdominal examination you hear normal bowel sounds, but when you palpate his liver it is abnormal. His rectal examination is positive for occult blood. What further abnormality of the liver was likely found on examination? A) Smooth, large, nontender liver B) Irregular, large liver C) Smooth, large, tender liver 8. A 26-year-old sports store manager comes to your clinic, complaining of severe right-sided abdominal pain for 12 hours. He began having a stomachache yesterday, with a decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea and vomiting but no constipation or diarrhea. His last bowel movement was last night and was normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six beers per week. His mother has breast cancer and his father has coronary artery disease. On examination he appears ill and is lying on his right side. His temperature is 100.4 and his heart rate is 110. His bowel sounds are decreased and he has rebound and involuntary guarding, one third of the way between the anterior superior iliac spine and the umbilicus in the right lower quadrant. His rectal, inguinal, prostate, penile, and testicular examinations are normal. What is the most likely cause of his pain? A) Acute appendicitis B) Acute mechanical intestinal obstruction C) Acute cholecystitis D) Mesenteric ischemia 9. A 15-year-old high school freshman is brought to the clinic by his mother because of chronic diarrhea. The mother states that for the past couple of years her son has had diarrhea after many meals. The patient states that the diarrhea seems the absolute worst after his school lunches. He describes his symptoms as cramping abdominal pain and gas followed by diarrhea. His stools are watery with no specific smell. He denies any nausea, vomiting, constipation, weight loss, or fatigue. He has had no recent illness, injuries, or foreign travel. His past medical history is unremarkable. He denies tobacco, alcohol, or drug use. His parents are both healthy. On examination you see a relaxed young man breathing comfortably. His vital signs are normal and his head, eyes, ears, throat, neck, cardiac, and pulmonary examinations are normal. His abdomen is soft and nondistended. His bowel sounds are active and he has no tenderness, no enlarged organs, and no rebound or guarding. His rectal examination is nontender with no blood on the glove. You collect a stool sample for further study. What is the most likely explanation for this patient's chronic diarrhea? A) Malabsorption syndrome B) Osmotic diarrhea C) Secretory diarrhea 10. A 27-year-old policewoman comes to your clinic, complaining of severe left-sided back pain radiating down into her groin. It began in the middle of the night and woke her up suddenly. It hurts in her bladder to urinate but she has no burning on the outside. She has had no frequency or urgency with urination but she has seen blood in her urine. She has had nausea with the pain but no vomiting or fever. She denies any other recent illness or injuries. Her past medical history is unremarkable. She denies tobacco or drug use and drinks alcohol rarely. Her mother has high blood pressure and her father is healthy. On examination she looks her stated age and is in obvious pain. She is lying on her left side trying to remain very still. Her cardiac, pulmonary, and abdominal examinations are unremarkable. She has tenderness just inferior to the left costovertebral angle. Her urine pregnancy test is negative and her urine analysis shows red blood cells. What type of urinary tract pain is she most likely to have? A) Kidney pain (from pyelonephritis) B) Ureteral pain (from a kidney stone) C) Musculoskeletal pain D) Ischemic bowel pain 11. Chris is a 20-year-old college student who has had abdominal pain for 3 days. It started at his umbilicus and was associated with nausea and vomiting. He was unable to find a comfortable position. Yesterday, the pain became more severe and constant. Now, he hesitates to walk, because any motion makes the pain much worse. It is localized just medial and inferior to his iliac crest on the right. Which of the following is most likely? A) Peptic ulcer B) Cholecystitis C) Pancreatitis D) Appendicitis 12. Bill, a 55-year-old man, presents with pain in his epigastrium which lasts for 30 minutes or more at a time and has started recently. Which of the following should be considered? A) Peptic ulcer B) Pancreatitis C) Myocardial ischemia D) All of the above 13. Monique is a 33-year-old administrative assistant who has had intermittent lower abdominal pain approximately one week a month for the past year. It is not related to her menses. She notes relief with defecation, and a change in form and frequency of her bowel movements with these episodes. Which of the following is most likely? A) Colon cancer B) Cholecystitis C) Inflammatory bowel disease D) Irritable bowel syndrome 14. Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for 2 days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect? A) Bleeding from a diverticulum B) Bleeding from a peptic ulcer C) Bleeding from a colon cancer D) Bleeding from cholecystitis 15. A daycare worker presents to your office with jaundice. She denies IV drug use, blood transfusion, and travel and has not been sexually active for the past 10 months. Which type of hepatitis is most likely? A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Hepatitis D 16. Linda is a 29-year-old who had excruciating pain which started under her lower ribs on the right side. The pain eventually moved to her lateral abdomen and then into her right lower quadrant. Which is most likely, given this presentation? A) Appendicitis B) Dysmenorrhea C) Ureteral stone D) Ovarian cyst 17. Mrs. LaFarge is a 60-year-old who presents with urinary incontinence. She is unable to get to the bathroom quickly enough when she senses the need to urinate. She has normal mobility. Which of the following is most likely? A) Stress incontinence B) Urge incontinence C) Overflow incontinence D) Functional incontinence Ans: B 18. Which is the proper sequence of examination for the abdomen? A) Auscultation, inspection, palpation, percussion B) Inspection, percussion, palpation, auscultation C) Inspection, auscultation, percussion, palpation D) Auscultation, percussion, inspection, palpation 19. A 62-year-old woman has been followed by you for 3 years and has had recent onset of hypertension. She is still not at goal despite three antihypertensive medicines, and you strongly doubt nonadherence. Her father died of a heart attack at age 58. Today her pressure is 168/94 and pressure on the other arm is similar. What would you do next? A) Add a fourth medicine B) Refer to nephrology C) Get a CT scan D) Listen closely to her abdomen to listen with the diaphragm for a very soft, high-pitched sound with systole. It may also help to simultaneously feel the patient's pulse (a bruit with both a systolic and diastolic component is very specific for a significant blockage, while a lone systolic bruit may not be abnormal). Obtaining a CT scan is not likely to be useful, and you may save the delay, expense, and inconvenience of a nephrology referral if you can hear a bruit. 20. Mr. Patel is a 64-year-old man who was told by another care provider that his liver is enlarged. Although he is a life-long smoker, he has never used drugs or alcohol and has no knowledge of liver disease. Indeed, on examination, a liver edge is palpable 4 centimeters below the costal arch. Which of the following would you do next? A) Check an ultrasound of the liver B) Obtain a hepatitis panel C) Determine liver span by percussion D) Adopt a “watchful waiting” approach 21. Cody is a teenager with a history of leukemia and an enlarged spleen. Today he presents with fairly significant left upper quadrant pain. On examination of this area a rough grating noise is heard. What is this sound? A) It is a splenic rub. B) It is a variant of bowel noise. C) It represents borborygmi. D) It is a vascular noise. 22. You are palpating the abdomen and feel a small mass. Which of the following would you do next? A) Ultrasound B) Examination with the abdominal muscles tensed C) Surgery referral D) Determine size by percussion 23. Josh is a 14-year-old boy who presents with a sore throat. On examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate? A) His spleen is definitely enlarged and further workup is warranted. B) His spleen is possibly enlarged and close attention should be paid to further examination. C) His spleen is possibly enlarged and further workup is warranted. D) His spleen is definitely normal. 24. A young patient presents with a left-sided mass in her abdomen. You confirm that it is present in the left upper quadrant. Which of the following would support that this represents an enlarged kidney rather than her spleen? A) A palpable “notch” along its edge B) The inability to push your fingers between the mass and the costal margin C) The presence of normal tympany over this area D) The ability to push your fingers medial and deep to the mass Feedback: A left upper quadrant mass is more likely to be a kidney if there is no palpable “notch,” you can push your fingers between the mass and the costal margin, there is normal tympany over this area, and you cannot push your fingers medial and deep to the mass. These findings are very difficult to appreciate in an obese patient. 25. Mr. Kruger is an 84-year-old who presents with a smooth lower abdominal mass in the midline which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent? A) Sigmoid mass B) Tumor in the abdominal wall C) Hernia D) Enlarged bladder Feedback: It is possible that this represents a sigmoid colon mass, but this is less likely than an enlarged bladder. Prostatic hypertrophy is very common in this age group and can frequently cause partial urinary obstruction with bladder enlargement. If the mass resolves with catheterization, this is a likely cause. Other forms of urinary obstruction such as neurogenic bladder, urethral stricture, and side effects of drugs can also be contributing to the problem. A hernia would most likely not be dull to percussion. Midline abdominal wall tumors of this size would be unusual but could be discerned by having the patient tense his abdominal muscles. 26. Mr. Martin is a 72-year-old smoker who comes to you for his hypertension visit. You note that with deep palpation you feel a pulsatile mass which is about 4 centimeters in diameter. What should you do next? A) Obtain abdominal ultrasound B) Reassess by examination in 6 months C) Reassess by examination in 3 months D) Refer to a vascular surgeon Feedback: A pulsatile mass in this man should be followed up with ultrasound as soon as possible. His risk of aortic rupture is at least 15 times greater if his aorta measures more than 4 centimeters. It would be inappropriate to recheck him at a later time without taking action. Likewise, referral to a vascular surgeon before ultrasound may be premature. 27. Mr. Maxwell has noticed that he is gaining weight and has increasing girth. Which of the following would argue for the presence of ascites? A) Bilateral flank tympany B) Dullness which remains despite change in position C) Dullness centrally when the patient is supine D) Tympany which changes location with patient position Feedback: A diagnosis of ascites is supported by findings that are consistent with movement of fluid and gas with changes in position. Gas-filled loops of bowel tend to float so that dullness when supine would argue against this. Likewise, because fluid gathers in dependent areas, the flanks should ordinarily be dull with ascites. Tympany which changes location with patient position (“shifting dullness”) would support the presence of ascites. A fluid wave and edema would support this diagnosis as well. 28. Which of the following is consistent with obturator sign? A) Pain distant from the site used to check rebound tenderness B) Right hypogastric pain with the right hip and knee flexed and the hip internally rotated C) Pain with extension of the right thigh while the patient is on her left side or while pressing her knee against your hand with thigh flexion D) Pain that stops inhalation in the right upper quadrant Feedback: Obturator sign is seen in appendicitis. It is pain with the stretching of the internal obturator muscle because of inflammation. Pain distant from the site used to check rebound tenderness is Rovsing's sign and is a reliable sign of peritonitis. Answer “C” describes psoas sign, which is also seen in appendicitis. Palpation in the right upper quadrant that causes pain severe enough to stop inhalation is consistent with inflammation of the gallbladder and is called Murphy's sign. 29. An elderly woman with a history of coronary bypass comes in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect? A) Malingering B) Neuropathy C) Ischemia D) Physical abuse Feedback: Ischemic pain can be severe but is not made worse with palpation. The history of bypass could be a clue that there is vascular narrowing elsewhere. Malingering is less likely, and neuropathic pain, as seen in herpes zoster, would worsen with touch. You are to be commended if you considered elder abuse, because this is frequently missed. Ordinarily, this pain would be worse with examination because of the preceding tr [Show More]

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Walden University - NURS 6512 Week 5 Study (Latest 2021) Exam Test Questions and Answers

Walden University - NURS 6512 Week 5 Study (Latest 2021) Exam Test Questions and Answers

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 Health Care> QUESTIONS & ANSWERS > Walden University NURS 6512 Week 5 Study (Latest 2021) Questions With Complete Solutions And Answers (All)

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Walden University NURS 6512 Week 5 Study (Latest 2021) Questions With Complete Solutions And Answers

Walden University NURS 6512 Week 5 Study (Latest 2021) Questions With Complete Solutions And Answers

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 *NURSING> QUESTIONS & ANSWERS > Walden University - NURS 6512 Week 5 Study (Latest 2021) Questions With Complete Solutions And Answers. (All)

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Walden University - NURS 6512 Week 5 Study (Latest 2021) Questions With Complete Solutions And Answers.

Walden University - NURS 6512 Week 5 Study (Latest 2021) Questions With Complete Solutions And Answers. 1.0 Bleeding into the periosteum during birth is known as: A.caput succedaneum. B.craniosynos...

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 *NURSING> QUESTIONS & ANSWERS > latest of South University, Savannah - NSG 6020Cardiovascular Disorders Q&A. (All)

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latest of South University, Savannah - NSG 6020Cardiovascular Disorders Q&A.

1. In order to bring the ventricular apex closer to the chest wall when assessing the point of maximal impulse (PMI), ask the patient to: turn to the left side 2. The tonsillar, submandibular, and s...

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 *NURSING> QUESTIONS & ANSWERS > Walden University - NURS 6512 Week 5 Study (Latest 2021) 100% Correct Study Guide, Download to Score A (All)

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Walden University - NURS 6512 Week 5 Study (Latest 2021) 100% Correct Study Guide, Download to Score A

Walden University - NURS 6512 Week 5 Study (Latest 2021) 100% Correct Study Guide, Download to Score A

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 *NURSING> QUESTIONS & ANSWERS > South University - NSG 6020/nsg 6420 Midterm Exam With Answers. (All)

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South University - NSG 6020/nsg 6420 Midterm Exam With Answers.

Question 1 (2 points) The first step in the genomic assessment of a patient is obtaining information regarding: Question 1 options: a) Family history b) Environmental exposures c) Lifestyle and b...

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 Business> QUESTIONS & ANSWERS > [Solved] South University NSG5003 Week 5 Study guide Ch 3 34 36 rtf (All)

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[Solved] South University NSG5003 Week 5 Study guide Ch 3 34 36 rtf

Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids and Bases MULTIPLE CHOICE 1. Infants are most susceptible to significant losses in total...

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 *NURSING> QUESTIONS & ANSWERS > NR283 Patho Quiz Week 5 complete solved solution graded A 2020 docs (All)

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NR283 Patho Quiz Week 5 complete solved solution graded A 2020 docs

NR283 Patho Quiz Week 5 complete solved solution graded A 2020 docs • Question 1 1 out of 1 points A newborn baby is severely cyanotic. An echocardiogram reveals transposition of the great ar...

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 *NURSING> QUESTIONS & ANSWERS > NSG 6020 APEA CARDIAC – QUESTION AND ANSWERS South University, Savannah - NSG 6020APEA Cardiac2 Exam. Graded A+ (All)

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NSG 6020 APEA CARDIAC – QUESTION AND ANSWERS South University, Savannah - NSG 6020APEA Cardiac2 Exam. Graded A+

In order to bring the ventricular apex closer to the chest wall when assessing the point of maximal impulse (PMI), ask the pt to: The tonsillar, submandibular, and submental nodes drain the lymphatic...

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