WEEK 8 NR 509 ADVANCED HEALTH
ASSESSMENT FINAL EXAM WITH
CORRECT QUESTIONS AND ANSWERS
2025
CHAPTER 19: Abdomen
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 periterm-12od 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? - CORRECT-
ANSWERSRuptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia, hypotension,
positive β-hCG, and findings suggestive of peritoneal 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.
CHAPTER 19: Abdomen
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? - CORRECT-ANSWERSLiver palpable 3 cm below the right costal
margin, mid clavicular line, on expiration
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.
CHAPTER 19: Abdomen
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? - CORRECT-
ANSWERSHistory 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.
CHAPTER 19: Abdomen
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 on colonoscopy. He has no first-degree
relatives with a history of colorectal cancer or adenomatous polyps. What are the U.S.
Preventive Services Task Force (USPSTF) screening recommendations for this patient? -
CORRECT-ANSWERSDo not screen routinely
Rationale: The USPSTF recommends not screening routinely. For most adults ages 76-85
years, the gain in life years is small compared to colonoscopy risks. It is advised to
discuss individualized risks and benefits with the patient. Annual FOBT screening may
continue until age 80-85 years if benefits to doing so outweigh risks for the individual
patient; however, screening should not be routinely continued. In general, a life
expectancy >7 years is necessary for screening to be potentially beneficial. There is no
indication to repeat a colonoscopy given the absence of any cancerous or precancerous
findings on his colonoscopy 10 years ago. Sigmoidoscopy every 5 years with FOBT
every 3 years is a valid screening option, but again screening is not routinely
recommended for patients age >75 years.
CHAPTER 19: Abdomen
An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a 3-
year history of recurrent crampy abdominal pain that lasts for about 1-2 weeks each
episode and is associated with onset of constipation. She describes infrequent, small hard
stool that she finds very difficult to pass. She has tried to increase dietary fiber and water
ASSESSMENT FINAL EXAM WITH
CORRECT QUESTIONS AND ANSWERS
2025
CHAPTER 19: Abdomen
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 periterm-12od 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? - CORRECT-
ANSWERSRuptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia, hypotension,
positive β-hCG, and findings suggestive of peritoneal 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.
CHAPTER 19: Abdomen
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? - CORRECT-ANSWERSLiver palpable 3 cm below the right costal
margin, mid clavicular line, on expiration
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.
CHAPTER 19: Abdomen
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? - CORRECT-
ANSWERSHistory 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.
CHAPTER 19: Abdomen
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 on colonoscopy. He has no first-degree
relatives with a history of colorectal cancer or adenomatous polyps. What are the U.S.
Preventive Services Task Force (USPSTF) screening recommendations for this patient? -
CORRECT-ANSWERSDo not screen routinely
Rationale: The USPSTF recommends not screening routinely. For most adults ages 76-85
years, the gain in life years is small compared to colonoscopy risks. It is advised to
discuss individualized risks and benefits with the patient. Annual FOBT screening may
continue until age 80-85 years if benefits to doing so outweigh risks for the individual
patient; however, screening should not be routinely continued. In general, a life
expectancy >7 years is necessary for screening to be potentially beneficial. There is no
indication to repeat a colonoscopy given the absence of any cancerous or precancerous
findings on his colonoscopy 10 years ago. Sigmoidoscopy every 5 years with FOBT
every 3 years is a valid screening option, but again screening is not routinely
recommended for patients age >75 years.
CHAPTER 19: Abdomen
An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a 3-
year history of recurrent crampy abdominal pain that lasts for about 1-2 weeks each
episode and is associated with onset of constipation. She describes infrequent, small hard
stool that she finds very difficult to pass. She has tried to increase dietary fiber and water
