Question 1

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?

Accepted Answer

Charcot's triad, which consists of fever, jaundice, and right upper quadrant pain, is most commonly associated with cholangitis, an inflammation of the bile duct system.

Question 2

The following symptom(s) in the patient's history should raise the clinician's suspicion of colon cancer:

Accepted Answer

All of the listed symptoms can be indicative of colon cancer. Alternating constipation and diarrhea, narrowed caliber of stool, and hematochezia (bright red blood in stool) are all potential signs of colon cancer and warrant further investigation.

Question 3

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?

Accepted Answer

Small bowel obstruction is most likely given the symptoms of vomiting (especially with bile, indicating obstruction distal to the stomach), abdominal pain, distension, and high-pitched bowel sounds, which are classic signs of small bowel obstruction.

Question 4

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?

Accepted Answer

Diverticulitis typically presents with severe left lower quadrant abdominal pain, fever, and changes in bowel habits, such as diarrhea, which matches the symptoms described in the patient. The presence of rebound tenderness and a positive heel strike test (indicative of peritoneal irritation) further supports this diagnosis.

Question 5

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:

Accepted Answer

Transvaginal ultrasound is the most helpful diagnostic tool in this scenario because it allows for detailed visualization of the pelvic organs, which can help identify the cause of the palpable mass in the right lower quadrant.

Question 6

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:

Accepted Answer

Mallory-Weiss tears are lacerations of the mucosa at the junction of the stomach and esophagus, which are often caused by severe vomiting. Given the patient's history of inducing vomiting frequently, this is the most likely cause of her hematemesis.

Question 7

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:

Accepted Answer

The presence of ascites and caput medusa in a patient with a history of alcohol abuse suggests portal hypertension, which is commonly associated with esophageal varices. Esophageal varices can rupture and lead to hematemesis.

Question 8

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:

Accepted Answer

Irritable bowel syndrome (IBS) is characterized by symptoms of abdominal discomfort, bloating, and diarrhea that are often relieved by bowel movements, with no identifiable physical or diagnostic abnormalities, fitting the description provided.

Question 9

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:

Accepted Answer

Colonoscopy is crucial in this scenario as the symptoms suggest the possibility of colorectal cancer or other significant colon pathologies, which are best diagnosed through direct visualization and biopsy if necessary.

Question 10

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?

Accepted Answer

Urinalysis is the most important initial laboratory test for a patient presenting with symptoms suggestive of kidney stones, such as severe, colicky back pain radiating into the groin and pain in the costovertebral angle region. It can detect hematuria, which is common in kidney stones, along with other abnormalities.

Question 11

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:

Accepted Answer

Standing and bearing down, or performing the Valsalva maneuver, helps in the examination of hernias, which could be the cause of a painless, intermittent lump in the lower abdomen.

Question 12

Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea?

Accepted Answer

Viral gastroenteritis, often caused by norovirus or rotavirus, is the most common cause of nausea, vomiting, and diarrhea worldwide, affecting people of all ages.

Question 13

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:

Accepted Answer

The patient's symptoms of epigastric pain, weakness, dark tarry stools (melena), and a positive fecal occult blood test, combined with her history of chronic use of NSAIDs (ibuprofen, naprosyn) and aspirin, strongly suggest a gastric ulcer as the likely etiology of her problem. NSAIDs and aspirin can cause gastric mucosal damage leading to ulcers.

Question 14

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

Accepted Answer

Culdocentesis is the most important procedure when a ruptured ectopic pregnancy is suspected because it can help in identifying the presence of blood in the peritoneal cavity, which is a sign of internal bleeding often associated with a ruptured ectopic pregnancy.

Question 15

The majority of colon cancers are located in the:

Accepted Answer

The majority of colon cancers are found in the rectosigmoid region, which includes the last part of the colon and the rectum. This area is a common site for the development of colorectal cancer.

Question 16

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:

Accepted Answer

Multiple air-fluid levels in the bowel seen on an abdominal x-ray are indicative of a bowel obstruction. This finding occurs because the bowel is blocked, leading to accumulation of gas and fluid at different levels within the intestines.

Question 17

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:

Accepted Answer

Stool for ova and parasites is important because the symptoms described are consistent with giardiasis, which is caused by a parasite that can be identified in stool samples.

Question 18

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?

Accepted Answer

The yellow hue of the skin and sclera indicates jaundice, which is a sign of liver dysfunction often associated with alcohol abuse. The scratch test is a technique used to assess the presence of ascites, which can occur in advanced liver disease, making it the most relevant physical examination technique in this context.

Question 19

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:

Accepted Answer

The symptoms suggest meningitis, and a lumbar puncture is necessary to confirm the diagnosis by analyzing the cerebrospinal fluid.

Question 20

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?

Accepted Answer

Amlodipine, a calcium channel blocker, is known to cause constipation as a side effect.

Quiz 10: Abdomen