Page 1 of 62
“ NR509 CHAMBERLAIN ADVANCED EXAM “
NEWEST UPDATED EXAM 2025 – 2026 SOLVED
QUESTIONS & ANSWERS VERIFIED 100% GRADED A+
(LATEST VERSION)
...
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. Perforated bowel wall
e. Ruptured ovarian cyst
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
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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
expiration
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
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
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?
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a. Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
Submit
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 intake, but usually this is not
sufficient and she resorts to over-the-counter laxatives, which she finds upset
her stomach but do resolve the constipation. Symptoms typically gradually
resolve with bowel movements. Which of the following is the most likely
physiological mechanism for her constipation?
a. A large, firm fecal mass in the rectum
b. Decreased fecal bulk
c. Functional change in bowel movement
d. Spasm of the external sphincter
e. Impairment of autonomic innervations
A 23-year-old woman comes to the respirology clinic for follow-up of her
chronic sinusitis and bronchiectasis that is associated with a rare congenital
condition called Kartagener syndrome. The preceptor notes that she has situs
inversus and asks for a physical exam. Which of the following descriptions
best fits with findings on the abdominal exam?
a. Tympany to percussion in the right upper quadrant, dullness to percussion
of the left upper quadrant
b. Protuberant abdomen that has scattered areas of tympany and dullness; stool is
felt on palpation
c. Liver dullness in the right upper quadrant that is displaced downward by the low
diaphragm due to chronic obstructive pulmonary disease
d. Dullness to percussion of the left lower anterior chest wall roughly at the anterior
axillary line
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e. A change in percussion from tympany to dullness in the left lower anterior chest
wall on inspiration
An otherwise healthy 28-year-old lawyer presents to the Emergency
Department with a 1-day history of severe abdominal pain. The emergency
physician suspects appendicitis and general surgery is consulted. The
resident believes the patient has signs of peritonitis on exam. Which of the
following physical exam findings supports peritonitis?
a. Voluntary contraction of the abdominal wall that persists over several
examinations
b. Pressing down onto the abdomen firmly and slowly and withdrawing the
hand quickly produces pain
c. Abdominal pain that increases with hip flexion
d. Localized pain over McBurney point, which lies 2 inches from the anterior superior
iliac spinous process on a line drawn from the umbilicus
e. Pain with internal rotation of the right hip
A 58-year-old man with a history of diabetes and alcohol addiction has been
sober for the last 10 months. He presents with a 4-month history of increasing
weakness, recurrent epigastric pain radiating to his back, chronic diarrhea
with stools 6-8 times daily, and weight loss of 18 lb over 4 months. What is the
mechanism of his most likely diagnosis?
a. Helicobacter pylori infection
b. Inflammation of the gallbladder
c. Inflammation of colonic diverticulum
d. Reduced blood supply to the bowel
e. Fibrosis of the pancreas
A 46-year-old executive who is obese and otherwise healthy presents to a
family medicine clinic with a 3-month course of recurrent severe abdominal
pain that usually resolves on its own after a few hours. Her last episode was
prolonged lasting 6 hours, and she is frustrated that she has had to leave or
miss work on three separate occasions. She would like a diagnosis and the
problem fixed. Which symptoms or signs would be most suggestive of a
diagnosis of biliary colic?
a. Exacerbating factor includes alcohol intake
“ NR509 CHAMBERLAIN ADVANCED EXAM “
NEWEST UPDATED EXAM 2025 – 2026 SOLVED
QUESTIONS & ANSWERS VERIFIED 100% GRADED A+
(LATEST VERSION)
...
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. Perforated bowel wall
e. Ruptured ovarian cyst
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
, Page 2 of 62
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
expiration
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
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
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?
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a. Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
Submit
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 intake, but usually this is not
sufficient and she resorts to over-the-counter laxatives, which she finds upset
her stomach but do resolve the constipation. Symptoms typically gradually
resolve with bowel movements. Which of the following is the most likely
physiological mechanism for her constipation?
a. A large, firm fecal mass in the rectum
b. Decreased fecal bulk
c. Functional change in bowel movement
d. Spasm of the external sphincter
e. Impairment of autonomic innervations
A 23-year-old woman comes to the respirology clinic for follow-up of her
chronic sinusitis and bronchiectasis that is associated with a rare congenital
condition called Kartagener syndrome. The preceptor notes that she has situs
inversus and asks for a physical exam. Which of the following descriptions
best fits with findings on the abdominal exam?
a. Tympany to percussion in the right upper quadrant, dullness to percussion
of the left upper quadrant
b. Protuberant abdomen that has scattered areas of tympany and dullness; stool is
felt on palpation
c. Liver dullness in the right upper quadrant that is displaced downward by the low
diaphragm due to chronic obstructive pulmonary disease
d. Dullness to percussion of the left lower anterior chest wall roughly at the anterior
axillary line
, Page 4 of 62
e. A change in percussion from tympany to dullness in the left lower anterior chest
wall on inspiration
An otherwise healthy 28-year-old lawyer presents to the Emergency
Department with a 1-day history of severe abdominal pain. The emergency
physician suspects appendicitis and general surgery is consulted. The
resident believes the patient has signs of peritonitis on exam. Which of the
following physical exam findings supports peritonitis?
a. Voluntary contraction of the abdominal wall that persists over several
examinations
b. Pressing down onto the abdomen firmly and slowly and withdrawing the
hand quickly produces pain
c. Abdominal pain that increases with hip flexion
d. Localized pain over McBurney point, which lies 2 inches from the anterior superior
iliac spinous process on a line drawn from the umbilicus
e. Pain with internal rotation of the right hip
A 58-year-old man with a history of diabetes and alcohol addiction has been
sober for the last 10 months. He presents with a 4-month history of increasing
weakness, recurrent epigastric pain radiating to his back, chronic diarrhea
with stools 6-8 times daily, and weight loss of 18 lb over 4 months. What is the
mechanism of his most likely diagnosis?
a. Helicobacter pylori infection
b. Inflammation of the gallbladder
c. Inflammation of colonic diverticulum
d. Reduced blood supply to the bowel
e. Fibrosis of the pancreas
A 46-year-old executive who is obese and otherwise healthy presents to a
family medicine clinic with a 3-month course of recurrent severe abdominal
pain that usually resolves on its own after a few hours. Her last episode was
prolonged lasting 6 hours, and she is frustrated that she has had to leave or
miss work on three separate occasions. She would like a diagnosis and the
problem fixed. Which symptoms or signs would be most suggestive of a
diagnosis of biliary colic?
a. Exacerbating factor includes alcohol intake
