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NR 509 Final week 5 Abdomen and GUTEST FINAL EXAM AND
PRACTICE EXAM 20262027 BANK 2 VERSIONS QUESTIONS
WITH DETAILED VERIFIED ANSWERS EXAM QUESTIONS
WILL COME FROM HERE (100% CORRECT ANSWERS A+
GRADED
An overweight 26-year-old public servant presents to the Emergency
Department 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 β-
human chorionic gonadotropin (β-hCG) is positive at triage. She reports
that her last period was 10 weeks ago. Her vital signs at triage are
pulse, 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen
saturation, 99%; and temperature, 37.3ºC 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 tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perf - ANSWERS--Good!
a. Ruptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive β-hCG, and findings suggestive of peritoneal
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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
β-hCG testing and her unstable vital signs make ruptured ectopic
pregnancy more likely.
2. A 63-year-old janitor 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, γ-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. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm at the midclavicular line
d. Dullness to percussion over a span of 8 cm at the midsternal line
e. Liver palpable 3 cm below the right costal margin, mid clavicular line,
on expi - ANSWERS--e. Liver palpable 3 cm below the right costal
margin, mid clavicular line, on expiration
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Rationale: The liver being palpable 3 cm below the right costal margin,
midclavicular 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 midclavicular 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.
3. A 63-year-old underweight administrative clerk with 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 years. Her vital
signs are pulse, 86; blood pressure, 148/92; respiratory rate, 16; oxygen
saturation, 95%; and temperature, 36.2ºC. Her body mass index is 17.6.
On exam, her abdominal aorta is prominent, which is concerning for an
abdominal aortic aneurysm (AAA). Which of the following is her most
significant risk factor for an AAA?
a. Female gender
b. History of smoking
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c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension - ANSWERS--b. History of smoking
Rationale: History of smoking is her most significant risk factor for an
AAA.
Male gender, not female gender, is considered as 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 age 66 years and subsequently went for a
colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found
NR 509 Final week 5 Abdomen and GUTEST FINAL EXAM AND
PRACTICE EXAM 20262027 BANK 2 VERSIONS QUESTIONS
WITH DETAILED VERIFIED ANSWERS EXAM QUESTIONS
WILL COME FROM HERE (100% CORRECT ANSWERS A+
GRADED
An overweight 26-year-old public servant presents to the Emergency
Department 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 β-
human chorionic gonadotropin (β-hCG) is positive at triage. She reports
that her last period was 10 weeks ago. Her vital signs at triage are
pulse, 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen
saturation, 99%; and temperature, 37.3ºC 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 tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perf - ANSWERS--Good!
a. Ruptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive β-hCG, and findings suggestive of peritoneal
,2|Page
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
β-hCG testing and her unstable vital signs make ruptured ectopic
pregnancy more likely.
2. A 63-year-old janitor 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, γ-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. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm at the midclavicular line
d. Dullness to percussion over a span of 8 cm at the midsternal line
e. Liver palpable 3 cm below the right costal margin, mid clavicular line,
on expi - ANSWERS--e. Liver palpable 3 cm below the right costal
margin, mid clavicular line, on expiration
,3|Page
Rationale: The liver being palpable 3 cm below the right costal margin,
midclavicular 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 midclavicular 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.
3. A 63-year-old underweight administrative clerk with 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 years. Her vital
signs are pulse, 86; blood pressure, 148/92; respiratory rate, 16; oxygen
saturation, 95%; and temperature, 36.2ºC. Her body mass index is 17.6.
On exam, her abdominal aorta is prominent, which is concerning for an
abdominal aortic aneurysm (AAA). Which of the following is her most
significant risk factor for an AAA?
a. Female gender
b. History of smoking
, 4|Page
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension - ANSWERS--b. History of smoking
Rationale: History of smoking is her most significant risk factor for an
AAA.
Male gender, not female gender, is considered as 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 age 66 years and subsequently went for a
colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found
