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TEST BANK Bates' Guide to Physical Examination & History
Taking 12th Edition By Bickley
Bates’ Guide to Physical Examination and History Taking, 12th Edition
Chapter 11: The Abdomen
Multiple Choice
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
Ans: A
Chapter: 11
Feedback: Stress incontinence usually occurs when the intra-abdominal pressure goes up
during coughing, sneezing, or laughing. This is usually due to a weakness of the pelvic floor,
with inadequate muscle support of the bladder. Vaginal deliveries and pelvic surgery are often
associated with these symptoms. Usually female patients are postmenopausal when stress
incontinence begins. Kegel exercises are usually recommended to strengthen the pelvic floor
muscles.
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
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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
Ans: C
Chapter: 11
Feedback: Varices are often found in alcoholic patients, but only when they have a diagnosis of
significant cirrhosis. This patient has symptoms of cirrhosis, including jaundice, ascites, spider
hemangiomas, and dilated veins on his abdomen (caput medusa).
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 m NeUdRicSalIhNisGtoTrB
y.isCnO
otMsignificant. 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
Ans: C
Chapter: 11
Feedback: Irritable bowel syndrome will cause loose bowel movements with cramps but no
systemic symptoms of fever, weight loss, or malaise. This syndrome is more likely in young
women with alternating symptoms of loose stools and constipation. Stress usually makes the
symptoms worse, as do certain foods.
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.
TEST BANK Bates' Guide to Physical Examination & History
Taking 12th Edition By Bickley
Bates’ Guide to Physical Examination and History Taking, 12th Edition
Chapter 11: The Abdomen
Multiple Choice
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
Ans: A
Chapter: 11
Feedback: Stress incontinence usually occurs when the intra-abdominal pressure goes up
during coughing, sneezing, or laughing. This is usually due to a weakness of the pelvic floor,
with inadequate muscle support of the bladder. Vaginal deliveries and pelvic surgery are often
associated with these symptoms. Usually female patients are postmenopausal when stress
incontinence begins. Kegel exercises are usually recommended to strengthen the pelvic floor
muscles.
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
, Latest Updated Solutions
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
Ans: C
Chapter: 11
Feedback: Varices are often found in alcoholic patients, but only when they have a diagnosis of
significant cirrhosis. This patient has symptoms of cirrhosis, including jaundice, ascites, spider
hemangiomas, and dilated veins on his abdomen (caput medusa).
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 m NeUdRicSalIhNisGtoTrB
y.isCnO
otMsignificant. 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
Ans: C
Chapter: 11
Feedback: Irritable bowel syndrome will cause loose bowel movements with cramps but no
systemic symptoms of fever, weight loss, or malaise. This syndrome is more likely in young
women with alternating symptoms of loose stools and constipation. Stress usually makes the
symptoms worse, as do certain foods.
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.
