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:

Accepted Answer

The psoas sign is tested by having the patient lie supine and then asking them to raise their leg against resistance, which can elicit pain in the presence of irritation of the psoas muscle, often associated with appendicitis.

Question 2

Your patient with pancreatitis has a Ranson rule score of 8. The clinician should recognize that this is a risk of:

Accepted Answer

A Ranson score of 8 in a patient with pancreatitis indicates a high risk of mortality from the condition. The Ranson criteria are used to assess the severity of pancreatitis and predict its outcome, with higher scores correlating with increased mortality risk.

Question 3

The most common cause of acute pancreatitis is:

Accepted Answer

Alcohol abuse is one of the most common causes of acute pancreatitis, along with gallstones.

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:

Accepted Answer

Hepatojugular reflux is indicative of right ventricular failure. It occurs when there is increased pressure in the right atrium and venous system, which can be observed as jugular vein distension when pressure is applied to the liver (right upper quadrant). This is not typically seen in conditions like acute hepatitis, cholecystitis, or left ventricular failure.

Question 5

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

Accepted Answer

Ureteral stenosis, a narrowing of the ureters, cannot be assessed through a digital rectal exam. This procedure is used to evaluate conditions directly related to the rectum, anus, and nearby structures such as hemorrhoids, prostate size in males, and presence of blood in the stool.

Question 6

The clinician should auscultate the abdomen to listen for possible bruits of the:

Accepted Answer

Auscultation of the abdomen can reveal bruits of the aorta, renal artery, and iliac artery, which may indicate vascular abnormalities such as stenosis or aneurysms.

Question 7

Your patient complains of severe right lower quadrant abdominal pain. To assess the patient for peritoneal inflammation, the examiner should:

Accepted Answer

The heel strike test (or heel jar test) is used to assess for peritoneal irritation. It involves striking the patient's heel to see if it causes pain in the abdomen, indicating possible peritoneal inflammation.

Question 8

When performing abdominal assessment, the clinician should perform examination techniques in the following order:

Accepted Answer

The correct order for abdominal assessment is inspection, auscultation, percussion, and palpation. This sequence is important to avoid altering bowel sounds before they are auscultated.

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:

Accepted Answer

These symptoms are indicative of hematopoietic disorders, which affect the blood-forming organs and can lead to symptoms such as fever, fatigue, pain in areas like the left upper quadrant (due to splenomegaly), and spontaneous bruising due to abnormalities in blood cell production or function.

Question 10

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

Accepted Answer

Shifting dullness on percussion of the abdomen is a physical examination finding indicative of ascites, which is the accumulation of fluid in the peritoneal cavity.

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:

Accepted Answer

This description matches the obturator sign, which is a clinical sign for irritation of the obturator internus muscle, often due to an inflamed appendix in close proximity. It is indicative of appendicitis.

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:

Accepted Answer

The symptoms described are classic for infectious mononucleosis, which is often caused by the Epstein-Barr virus. Symptoms include sore throat, fever, fatigue, cervical lymphadenopathy, and splenomegaly.

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:

Accepted Answer

The symptoms and findings, including lower abdominal pain, anorexia, fatigue, weight loss, positive hemoccult, and iron-deficiency anemia, are suggestive of colon cancer.

Question 14

Which of the following is the most common cause of heartburn-type epigastric pain?

Accepted Answer

Decreased lower esophageal sphincter (LES) tone is the most common cause of heartburn-type epigastric pain, as it allows gastric acid to reflux into the esophagus, causing irritation and the sensation of heartburn.

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:

Accepted Answer

This is a description of the Rovsing's sign, which is indicative of appendicitis. It occurs when palpation of the left lower quadrant of the abdomen results in pain in the right lower quadrant, suggesting irritation of the peritoneum.

Question 16

Rebound tenderness of the abdomen is a sign of:

Accepted Answer

Rebound tenderness is a clinical sign that indicates peritoneal inflammation. When pressure is applied to the abdomen and then quickly released, the sudden rebound of the abdominal wall causes sharp, severe pain in areas of peritoneal irritation.

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:

Accepted Answer

The described technique is used to elicit Murphy's sign, which is a test for cholecystitis (inflammation of the gallbladder). A positive Murphy's sign occurs when the patient experiences pain or stops inhaling deeply due to pain when the examiner palpates the right upper quadrant during inhalation, indicating gallbladder inflammation.

Question 18

The major sign of ectopic pregnancy is:

Accepted Answer

Ectopic pregnancy often presents with amenorrhea followed by unilateral lower quadrant pain, which is a result of the embryo implanting outside the uterine cavity, most commonly in a fallopian tube.

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:

Accepted Answer

The symptoms of right upper quadrant pain, jaundice (yellow skin and sclera), hyperbilirubinemia, and elevated liver enzymes are indicative of a biliary duct obstruction, which can cause bile to back up into the liver and bloodstream.

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:

Accepted Answer

The answer of A 22-year-old female enters the emergency room...

Quiz 10: Abdomen