NURS 5120 FOCUSED EXAM ABDOMINAL PAIN –
COMPREHENSIVE QUESTION COMPLETE WITH
VERIFIED ANSWERS
1. A 45-year-old male presents with acute onset of severe, generalized
abdominal pain, nausea, and vomiting. His abdomen is rigid and board-like on
palpation. Which of the following is the most likely diagnosis?
A. Acute cholecystitis
B. Acute pancreatitis
C. Perforated peptic ulcer
D. Renal colic
Correct Answer: C
Explanation: A rigid, board-like abdomen is a classic sign of peritoneal irritation,
most commonly from a perforated viscus such as a peptic ulcer. This causes
sudden leakage of gastric contents into the peritoneal cavity, leading to
generalized peritonitis.
2. A 32-year-old woman presents with right upper quadrant pain that radiates to
her right shoulder, worsened by fatty meals. On physical exam, she has a
positive Murphy’s sign. What is the most appropriate initial imaging study?
A. CT scan of the abdomen with contrast
B. Magnetic resonance cholangiopancreatography (MRCP)
C. Right upper quadrant ultrasound
D. Abdominal X-ray
Correct Answer: C
Explanation: Right upper quadrant ultrasound is the initial imaging study of choice
for suspected cholelithiasis or cholecystitis. It is highly sensitive for gallstones and
can assess gallbladder wall thickness and pericholecystic fluid.
,3. A 60-year-old male with a history of alcohol use disorder presents with severe
midepigastric pain radiating to the back, relieved by leaning forward. Which
laboratory finding is most characteristic of his condition?
A. Elevated alkaline phosphatase
B. Elevated serum lipase
C. Elevated serum bilirubin
D. Elevated liver transaminases
Correct Answer: B
Explanation: The presentation is classic for acute pancreatitis. Serum lipase is the
most sensitive and specific laboratory marker for acute pancreatitis, remaining
elevated longer than amylase.
4. A 28-year-old female presents with recurrent, crampy lower abdominal pain,
bloating, and alternating diarrhea and constipation over the past 6 months. She
has no weight loss or blood in stool. Which of the following is the most likely
diagnosis?
A. Irritable bowel syndrome (IBS)
B. Inflammatory bowel disease (IBD)
C. Celiac disease
D. Diverticulitis
Correct Answer: A
Explanation: IBS is a functional gastrointestinal disorder characterized by chronic
abdominal pain and altered bowel habits (diarrhea, constipation, or both) without
organic disease. The absence of weight loss, blood in stool, or systemic symptoms
supports this diagnosis.
5. A 55-year-old male with known atherosclerosis presents with sudden onset of
severe, tearing abdominal pain. On exam, he is hypertensive and has a pulsatile
abdominal mass. What is the most likely diagnosis?
A. Abdominal aortic aneurysm rupture
B. Acute mesenteric ischemia
,C. Renal infarct
D. Splenic rupture
Correct Answer: A
Explanation: A pulsatile abdominal mass in a patient with atherosclerosis and
sudden severe pain suggests an expanding or ruptured abdominal aortic aneurysm
(AAA). This is a life-threatening emergency requiring immediate surgical
evaluation.
6. A 40-year-old woman presents with right lower quadrant pain, nausea, and
low-grade fever. She has tenderness at McBurney’s point. Which of the following
is the most appropriate next step?
A. Barium enema
B. CT scan of the abdomen and pelvis
C. Upper endoscopy
D. Colonoscopy
Correct Answer: B
Explanation: CT scan of the abdomen and pelvis is the most accurate imaging
modality for diagnosing appendicitis, showing a distended appendix with wall
thickening and periappendiceal fat stranding.
7. A 70-year-old male with atrial fibrillation presents with sudden onset of
severe, diffuse abdominal pain out of proportion to physical exam. He has a
history of embolic events. What is the most likely diagnosis?
A. Acute pancreatitis
B. Acute mesenteric ischemia
C. Bowel obstruction
D. Diverticulitis
Correct Answer: B
Explanation: In a patient with atrial fibrillation, acute mesenteric ischemia is
caused by an embolus to the superior mesenteric artery. The classic finding is
severe pain with minimal abdominal findings initially.
, 8. A 25-year-old female presents with sharp, pleuritic left lower quadrant pain
and vaginal spotting. Her last menstrual period was 6 weeks ago. Which
diagnostic test should be performed first?
A. Complete blood count
B. Serum human chorionic gonadotropin (hCG)
C. Urinalysis
D. Abdominal X-ray
Correct Answer: B
Explanation: In a woman of childbearing age with pelvic pain and vaginal
bleeding, a ruptured ectopic pregnancy must be ruled out first. A serum hCG test
will confirm pregnancy status.
9. A 50-year-old male presents with right upper quadrant pain, jaundice, dark
urine, and pale stools. He has a history of gallstones. What is the most likely
underlying cause?
A. Acute cholecystitis
B. Choledocholithiasis
C. Pancreatic cancer
D. Hepatitis
Correct Answer: B
Explanation: The triad of jaundice, dark urine, and pale stools suggests biliary
obstruction. In a patient with a history of gallstones, choledocholithiasis (stone in
the common bile duct) is the most likely cause.
10. A 65-year-old female presents with constipation, abdominal distension, and
crampy pain. On exam, she has high-pitched bowel sounds. Abdominal X-ray
shows dilated loops of small bowel with air-fluid levels. What is the most likely
diagnosis?
A. Paralytic ileus
COMPREHENSIVE QUESTION COMPLETE WITH
VERIFIED ANSWERS
1. A 45-year-old male presents with acute onset of severe, generalized
abdominal pain, nausea, and vomiting. His abdomen is rigid and board-like on
palpation. Which of the following is the most likely diagnosis?
A. Acute cholecystitis
B. Acute pancreatitis
C. Perforated peptic ulcer
D. Renal colic
Correct Answer: C
Explanation: A rigid, board-like abdomen is a classic sign of peritoneal irritation,
most commonly from a perforated viscus such as a peptic ulcer. This causes
sudden leakage of gastric contents into the peritoneal cavity, leading to
generalized peritonitis.
2. A 32-year-old woman presents with right upper quadrant pain that radiates to
her right shoulder, worsened by fatty meals. On physical exam, she has a
positive Murphy’s sign. What is the most appropriate initial imaging study?
A. CT scan of the abdomen with contrast
B. Magnetic resonance cholangiopancreatography (MRCP)
C. Right upper quadrant ultrasound
D. Abdominal X-ray
Correct Answer: C
Explanation: Right upper quadrant ultrasound is the initial imaging study of choice
for suspected cholelithiasis or cholecystitis. It is highly sensitive for gallstones and
can assess gallbladder wall thickness and pericholecystic fluid.
,3. A 60-year-old male with a history of alcohol use disorder presents with severe
midepigastric pain radiating to the back, relieved by leaning forward. Which
laboratory finding is most characteristic of his condition?
A. Elevated alkaline phosphatase
B. Elevated serum lipase
C. Elevated serum bilirubin
D. Elevated liver transaminases
Correct Answer: B
Explanation: The presentation is classic for acute pancreatitis. Serum lipase is the
most sensitive and specific laboratory marker for acute pancreatitis, remaining
elevated longer than amylase.
4. A 28-year-old female presents with recurrent, crampy lower abdominal pain,
bloating, and alternating diarrhea and constipation over the past 6 months. She
has no weight loss or blood in stool. Which of the following is the most likely
diagnosis?
A. Irritable bowel syndrome (IBS)
B. Inflammatory bowel disease (IBD)
C. Celiac disease
D. Diverticulitis
Correct Answer: A
Explanation: IBS is a functional gastrointestinal disorder characterized by chronic
abdominal pain and altered bowel habits (diarrhea, constipation, or both) without
organic disease. The absence of weight loss, blood in stool, or systemic symptoms
supports this diagnosis.
5. A 55-year-old male with known atherosclerosis presents with sudden onset of
severe, tearing abdominal pain. On exam, he is hypertensive and has a pulsatile
abdominal mass. What is the most likely diagnosis?
A. Abdominal aortic aneurysm rupture
B. Acute mesenteric ischemia
,C. Renal infarct
D. Splenic rupture
Correct Answer: A
Explanation: A pulsatile abdominal mass in a patient with atherosclerosis and
sudden severe pain suggests an expanding or ruptured abdominal aortic aneurysm
(AAA). This is a life-threatening emergency requiring immediate surgical
evaluation.
6. A 40-year-old woman presents with right lower quadrant pain, nausea, and
low-grade fever. She has tenderness at McBurney’s point. Which of the following
is the most appropriate next step?
A. Barium enema
B. CT scan of the abdomen and pelvis
C. Upper endoscopy
D. Colonoscopy
Correct Answer: B
Explanation: CT scan of the abdomen and pelvis is the most accurate imaging
modality for diagnosing appendicitis, showing a distended appendix with wall
thickening and periappendiceal fat stranding.
7. A 70-year-old male with atrial fibrillation presents with sudden onset of
severe, diffuse abdominal pain out of proportion to physical exam. He has a
history of embolic events. What is the most likely diagnosis?
A. Acute pancreatitis
B. Acute mesenteric ischemia
C. Bowel obstruction
D. Diverticulitis
Correct Answer: B
Explanation: In a patient with atrial fibrillation, acute mesenteric ischemia is
caused by an embolus to the superior mesenteric artery. The classic finding is
severe pain with minimal abdominal findings initially.
, 8. A 25-year-old female presents with sharp, pleuritic left lower quadrant pain
and vaginal spotting. Her last menstrual period was 6 weeks ago. Which
diagnostic test should be performed first?
A. Complete blood count
B. Serum human chorionic gonadotropin (hCG)
C. Urinalysis
D. Abdominal X-ray
Correct Answer: B
Explanation: In a woman of childbearing age with pelvic pain and vaginal
bleeding, a ruptured ectopic pregnancy must be ruled out first. A serum hCG test
will confirm pregnancy status.
9. A 50-year-old male presents with right upper quadrant pain, jaundice, dark
urine, and pale stools. He has a history of gallstones. What is the most likely
underlying cause?
A. Acute cholecystitis
B. Choledocholithiasis
C. Pancreatic cancer
D. Hepatitis
Correct Answer: B
Explanation: The triad of jaundice, dark urine, and pale stools suggests biliary
obstruction. In a patient with a history of gallstones, choledocholithiasis (stone in
the common bile duct) is the most likely cause.
10. A 65-year-old female presents with constipation, abdominal distension, and
crampy pain. On exam, she has high-pitched bowel sounds. Abdominal X-ray
shows dilated loops of small bowel with air-fluid levels. What is the most likely
diagnosis?
A. Paralytic ileus
