Deck 10: Abdomen

Question 1

Your patient is lying supine and you ask him to raise his leg while you place resistance against the thigh. You are testing the patient for:

A) Psoas sign
B) Obturator sign
C) Rovsing's sign
D) Murphy's sign

Answer 1

Psoas sign

Question 2

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 from pancreatitis
D) Bile duct obstruction

Answer 2

High mortality from pancreatitis

Question 3

The most common cause of acute pancreatitis is:

A) Trauma
B) Hepatitis virus A
C) Hyperlipidemia
D) Alcohol abuse

Answer 3

Alcohol abuse

Question 4

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

Question 5

In abdominal assessment, a digital rectal exam is performed to assess for all of the following except:

A) Hemorrhoids
B) Prostate size
C) Blood in stool
D) Ureteral stenosis

Question 6

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

Question 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) Perform the heel strike test

Question 8

When performing abdominal assessment, the 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

Question 9

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) Hematopoietic disorders
B) Hepatomegaly
C) Esophageal varices
D) Pleural effusion

Question 10

Your patient demonstrates positive shifting dullness on percussion of the abdomen. This is indicative of:

A) Cholecystitis
B) Appendicitis
C) Ascites
D) Hepatitis

Question 11

The 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 stretched. This is a sign of:

A) Diverticulitis
B) Cholecystitis
C) Appendicitis
D) Mesenteric adenitis

Question 12

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

Question 13

Your patient complains of lower abdominal pain, anorexia, extreme fatigue, and unintentional weight loss of 10 pounds in the last 3 weeks. You find a positive hemoccult on digital rectal exam. Laboratory tests show iron-deficiency anemia. The clinician needs to consider:

A) Diverticulitis
B) Appendicitis
C) Colon cancer
D) Peptic ulcer disease

Question 14

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

Question 15

While assessing the abdomen, the clinician deeply palpates the left lower quadrant 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

Question 16

Rebound tenderness of the abdomen is a sign of:

A) Constipation
B) Peritoneal inflammation
C) Elevated venous pressure
D) Peritoneal edema

Question 17

The patient complains of right upper quadrant pain. With the patient lying supine on the examination table, 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) Murphy's sign

Question 18

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

Question 19

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

Question 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 exam
B) Endoscopy
C) Ultrasound
D) Pelvic examination

Question 21

You observe Charcot's triad of signs 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

Question 22

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

Question 23

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

Question 24

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

Question 25

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

Question 26

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, body mass index less than 15, and hypotension. A likely reason for hematemesis is:

A) Mallory-Weiss tear
B) Cirrhosis
C) Peptic ulcer disease
D) Esophageal varies

Question 27

A 59-year-old patient with a 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

Question 28

A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and 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

Question 29

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) Complete blood count with differential
B) Stool culture and sensitivity
C) Abdominal x-ray
D) Colonoscopy

Question 30

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 laboratory tests is most important for the diagnosis?

A) Urinalysis
B) Serum electrolyte levels
C) Digital rectal exam
D) Lumbar x-ray

Question 31

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 exam
D) Lie in a left lateral recumbent position

Question 32

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

Question 33

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

Question 34

When ruptured ectopic pregnancy is suspected, the following procedure is most important:

A) Culdocentesis
B) Computed tomography scan
C) Abdominal x-ray
D) Digital rectal exam

Question 35

The majority of colon cancers are located in the:

A) Transverse colon
B) Cecum
C) Rectosigmoid region
D) Ascending colon

Question 36

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

Question 37

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

Question 38

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 exam
D) Pelvic examination

Question 39

A 5-year-old female patient presents to the emergency department with sore throat, vomiting, ear ache, 103°F 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

Question 40

A 78-year-old female patient is suffering from heart failure, gastroesophageal reflux disease, diabetes, and depression. She presents with complaints of frequent episodes of constipation. Her last bowel movement was 1 week ago. On examination, you palpate a hard mass in the left lower quadrant of the abdomen. You review her list of medications. Which of the following of her medications causes constipation?

A) Digitalis (Lanoxin)
B) Amlodipine (Norvasc)
C) Sertraline (Zoloft)
D) Metformin (Glucophage)

Question 41

Your 66-year-old male patient complains of weakness, fatigue, chronic constipation for the last month, and dark stools. On complete blood count, 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)

Question 42

Your patient is a 33-year-old female who 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) Carcinogenic embryonic antigen blood test
C) Colonoscopy
D) Fecal occult blood test

Question 43

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 complete blood count and bilirubin levels, all of the following tests would be helpful except:

A) Liver enzymes
B) Amylase
C) Lipase
D) Uric acid