NR 509 ABDOMEN EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
An overweight 26-year-old presents to the Emergency Department
... [Show More] with 12 hours of intense abdominal pain, light- headedness, 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 B-human chorionic gonadotropin (B-hCG) is positive at triage. She reports that her last period was 10 weeks ago. Her vital signs at triage are pulse - 118, BP - 86/68, RR - 20/min, O2 sat - 99%, and temp 37.3
orally. The clinician performs 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 appendix
b.) acute cholecystitis
c.) ruptured ovarian cysts
d.) ruptured tubal (or ectopic) pregnancy
e.) perforated bowel wall
d.) ruptured tubal (or ectopic) pregnancy
Explanation: The constellation of abdominal pain, syncope, tachycardia, hypotension, positive B-hCG, and findings suggestive of peritoneal
inflammation/irritation strongly suggest a ruptured ectopic pregnancy with significant intra-abdominal bleeding leading to peritoneal signs. This case is
emergent and requires immediate treatment of her hypotension and presumed blood loss as well as gynecological consult for emergent surgery. Ruptured
ectopic pregnancies can lead to life-threatening intra-abdominal bleeding. Although acute cholecystitis, ruptured appendix, bowel wall perforation, and ruptured ovarian cyst are all possibilities, the positive B-hCG testing and her unstable vital signs make ruptured ectopic pregnancy more likely.
A 63-year-old with a history of
adenomatous colonic polyps presents for a well visit. Basic labs are performed to
screen for diabetes mellitus and dyslipidemia. Electrolytes and liver
enzymes were also measured. HIs labs are all normal expect for moderate
elevations of aspartate aminotransferase, alanine aminotransferase, y-glutamyl
transferase, and alkaline phosphatase as well as a mildly elevated total bilirubin. 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
hepatomegaly?
a.) Dullness to percussion over a span of 8 cm at the midsternal line
b.) Liver palpable 3 cm below the right costal margin, mid-clavicular, on
expiration
c.) Liver span of 11 cm at the mid- clavicular
d.) Dullness to percussion over a span of 11 cm at the mid-clavicular line
e.) Liver span of 8 cm at the midsternal line b.) Liver palpable 3 cm below the right costal margin, mid-clavicular, on expiration
Explanation: The liver being palpable 3 cm below the right costal margin, mid- clavicular line, would be considered normal on inspiration when the liver is
pushed down into the abdominal cavity on inspiration, but is abnormal on
expiration. Findings to support hepatomegaly would be more convincing if, by percussion, the liver span was >12 cm at the mid-clavicular line. For patients with obstructive lung disease, air trapping in the lungs may displace the liver downwards into the abdominal cavity. The liver span and dullness to percussion refer to the same measurement. Measurements of 6-12 cm at the mid-clavicular line and 4-8 cm at the midsternal line are considered normal.
A 63-year-old underweight administrative clerk w a 50-pack-year smoking history
presents with a several month history of recurrent epigastric abdominal
discomfort. She feels fairly well otherwise and denies any nausea, vomiting,
diarrhea, or constipation. She reports that a first cousin died from a ruptured
aneurysm at age 68. Her vital signs are
pulse - 86, BP - 148/92, RR - 16, O2 -95%,
and temp - 36.2. Her body mass index is
17.6. On exam, her abdominal aorta is prominent, which is concerning for an
AAA. Which of the following is her most significant risk factor for AAA?
a.) Family history of ruptured aneurysm
b.) History of smoking
c.) Female gender
d.) Hypertension
e.) Underweight b.) History of smoking
Explanation: History of smoking is her most significant risk factor for an AAA. Male gender, not female gender, is considered a risk factor. Underweight is not a risk factor for AAA. Family history of ruptured aneurysm is vague and could be a
cerebral aneurysm. Further, her family history is in a first-degree cousin not a first- degree relative (biologic parents, siblings, and children). Hypertension could
contribute to atherosclerosis, which is a risk factor. Further, a diagnosis of hypertension is not based on one elevated blood pressure reading.
A 76 -year-old retired man with a history of 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 66 and subsequently went for a
colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found on
colonoscopy. He has no first-degree relatives with a history of colorectal
cancer or adenomatous polyps. What are the USPSTF screening recommendations for this patient?
a.) Repeat colonoscopy this year
b.) Continue annual FOBT screening until age 80
c.) Continue annual FOBT screening until age 85.
d.) Sigmoidoscopy every 5 years with FOBT every 3 years
e.) Do not screen routinely. e.) Do not screen routinely.
Explanation: The USPSTF recommends not screening routinely. For most adults ages 76-85, the gain in life years is small compared to colonoscopy risks. It is advised to discuss individualized risks and benefits with the patient. [Show Less]
