NSG 507 Week 5 Abdomen Test Bank

NSG 507 Week 5 Abdomen Test Bank

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University of Phoenix

NSG/507 Social Justice and Information Systems for Population Health

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Date

NSG 507 Week 5 Abdomen Test Bank

Question 1

While examining the liver by percussing the 7th right intercostal space along the midclavicular line, which percussion sound is expected?

A. Dullness
B. Tympany
C. Resonance
D. Hyperresonance

Answer: A. Dullness

Explanation:
Since the liver is a solid organ located in the right upper quadrant, percussion over it normally produces a dull sound.

Question 2

Which abdominal structure is found in the left lower quadrant (LLQ)?

A. Liver
B. Duodenum
C. Gallbladder
D. Sigmoid colon

Answer: D. Sigmoid colon

Explanation:
The sigmoid colon occupies the left lower quadrant of the abdomen.

Question 3

A patient reports difficulty swallowing both food and medications. Which term best describes this condition?

A. Aphasia
B. Dysphasia
C. Dysphagia
D. Anorexia

Answer: C. Dysphagia

Explanation:
Dysphagia refers to impaired swallowing, usually resulting from disorders affecting the throat or esophagus. Aphasia and dysphasia involve communication or language impairments, whereas anorexia refers to a loss of appetite.

Question 4

The nurse suspects urinary bladder distention. Which assessment technique is most appropriate?

A. Percuss and palpate the lumbar area.
B. Inspect and palpate the epigastric region.
C. Auscultate and percuss the inguinal region.
D. Percuss and palpate the midline just above the pubic bone.

Answer: D. Percuss and palpate the midline just above the pubic bone.

Explanation:
A distended bladder is assessed in the suprapubic (hypogastric) region, where percussion produces dullness and palpation may reveal a firm, rounded mass.

Question 5

Which age-related change commonly occurs within the gastrointestinal system?

A. Increased saliva production
B. Enlargement of the liver
C. Faster esophageal emptying
D. Reduced gastric acid secretion

Answer: D. Reduced gastric acid secretion

Explanation:
With aging, gastric acid production declines. Older adults also tend to have decreased saliva production, delayed esophageal emptying, and a reduction in liver size.

Question 6

A 22-year-old man falls from his motorcycle and strikes his left side against the handlebars. The nurse suspects splenic injury. Which statement about assessing the spleen is correct?

A. Trauma commonly causes splenic enlargement.
B. The spleen is normally palpable during routine examination.
C. If enlargement is detected, palpate thoroughly to estimate its size.
D. Avoid further palpation if the spleen is enlarged because it may rupture.

Answer: D. Avoid further palpation if the spleen is enlarged because it may rupture.

Explanation:
An enlarged spleen is fragile and susceptible to rupture. If splenomegaly is detected, additional palpation should be avoided, and the patient should be referred for further evaluation.

Question 7

The patient’s abdomen appears rounded, protruding, and stretched. How should this abdominal contour be documented?

A. Obese
B. Herniated
C. Scaphoid
D. Protuberant

Answer: D. Protuberant

Explanation:
A protuberant abdomen has a rounded, outward appearance. In contrast, a scaphoid abdomen is sunken or concave.

Question 8

How is a scaphoid abdomen best described when viewed from the side?

A. Flat
B. Convex
C. Bulging
D. Concave

Answer: D. Concave

Explanation:
A scaphoid abdomen has an inward-curving (concave) contour extending from the rib cage to the pubic area.

Question 9

During abdominal inspection, the nurse notices pulsations between the xiphoid process and the umbilicus. What is the most likely explanation?

A. Renal artery pulsations
B. Inferior vena cava pulsations
C. Normal abdominal aortic pulsations
D. Increased bowel peristalsis caused by obstruction

Answer: C. Normal abdominal aortic pulsations

Explanation:
Visible pulsation of the abdominal aorta is a normal finding, particularly in thin individuals with relaxed abdominal muscles.

Question 10

The nurse notes hypoactive bowel sounds during abdominal auscultation. Which condition is a likely cause?

A. Diarrhea
B. Peritonitis
C. Laxative use
D. Gastroenteritis

Answer: B. Peritonitis

Explanation:
Hypoactive or absent bowel sounds indicate decreased intestinal motility, which commonly occurs with peritonitis, paralytic ileus following surgery, or advanced bowel obstruction.

Below are Questions 11–25 paraphrased while preserving the original meaning, answers, and explanations.

Question 11

A nurse observes a newly graduated nurse performing an abdominal examination. Why should auscultation be completed before percussion and palpation?

A. To identify tender areas before touching the abdomen
B. To avoid altering bowel sounds through percussion or palpation
C. To allow the patient additional time to relax before the examination
D. To prevent changes in vascular sounds caused by percussion and palpation

Answer: B. To avoid altering bowel sounds through percussion or palpation

Explanation:
Auscultation follows inspection because palpation and percussion can stimulate intestinal activity, leading to bowel sounds that do not accurately reflect the patient’s normal condition.

Question 12

While listening to bowel sounds, which description is considered normal?

A. Loud, high-pitched brushing and tinkling sounds
B. Irregular, high-pitched gurgling sounds
C. Sounds resembling leather rubbing together
D. Sounds produced by movement through the large intestine

Answer: B. Irregular, high-pitched gurgling sounds

Explanation:
Normal bowel sounds are high-pitched, gurgling, and occur irregularly about 5 to 30 times per minute. They result from the movement of air and fluid through the small intestine.

Question 13

The healthcare provider documents abdominal borborygmi. What does this finding indicate?

A. A continuous loud vascular hum
B. A peritoneal friction rub
C. Reduced bowel activity
D. Increased bowel activity

Answer: D. Increased bowel activity

Explanation:
Borborygmi refers to exaggerated intestinal sounds caused by increased peristalsis, commonly experienced as stomach growling.

Question 14

Which abdominal assessment finding is considered normal?

A. A bruit heard over the femoral artery
B. Tympany noted around the umbilical area
C. A palpable spleen between the 9th and 11th ribs
D. Dullness in the left upper quadrant at the midclavicular line

Answer: B. Tympany noted around the umbilical area

Explanation:
Tympany is the expected percussion note throughout most of the abdomen because the intestines contain air. Normally, vascular bruits are absent, the spleen is not palpable, and the left upper quadrant generally produces resonance rather than dullness.

Question 15

A pregnant patient complains of persistent heartburn. Which condition is most likely responsible?

A. Diarrhea
B. Pyrosis
C. Dysphagia
D. Constipation

Answer: B. Pyrosis

Explanation:
Pyrosis, or heartburn, commonly develops during pregnancy due to gastroesophageal reflux caused by hormonal changes and increased abdominal pressure.

Question 16

Which percussion notes may normally be heard during an abdominal examination?

A. Flatness, resonance, and dullness
B. Resonance, dullness, and tympany
C. Tympany, hyperresonance, and dullness
D. Resonance, hyperresonance, and flatness

Answer: C. Tympany, hyperresonance, and dullness

Explanation:
The abdomen is predominantly tympanic because of intestinal gas. Hyperresonance may occur when excess gas is present, whereas dullness may be heard over solid organs, fluid, adipose tissue, or a distended bladder.

NSG 507 Week 5 Abdomen Test Bank

Question 17

An older adult has been diagnosed with pernicious anemia. Which age-related gastrointestinal change is associated with this condition?

A. Increased gastric acid secretion
B. Decreased gastric acid secretion
C. Delayed gastrointestinal emptying
D. Accelerated gastrointestinal emptying

Answer: B. Decreased gastric acid secretion

Explanation:
Reduced gastric acid production in older adults can interfere with vitamin B12 absorption, contributing to pernicious anemia. It may also impair iron and calcium absorption.

Question 18

A patient reports sharp pain at the costovertebral angle. Which condition is the most likely cause?

A. Ovarian infection
B. Enlarged liver
C. Kidney inflammation
D. Enlarged spleen

Answer: C. Kidney inflammation

Explanation:
Pain at the costovertebral angle commonly indicates inflammation or infection involving the kidneys or surrounding tissues.

Question 19

A nurse notes that a patient has ascites. What does this finding indicate?

A. Accumulation of fluid within the peritoneal cavity
B. Retained fecal matter
C. Excess intestinal gas
D. Presence of uterine fibroids

Answer: A. Accumulation of fluid within the peritoneal cavity

Explanation:
Ascites refers to free fluid in the abdominal cavity and is commonly associated with conditions such as cirrhosis, portal hypertension, heart failure, hepatitis, pancreatitis, and certain cancers.

Question 20

During an abdominal examination, what is the primary purpose of deep palpation?

A. Assess bowel motility
B. Detect enlarged organs and abdominal masses
C. Evaluate superficial tenderness
D. Assess the skin and superficial muscles

Answer: B. Detect enlarged organs and abdominal masses

Explanation:
Deep palpation helps determine the size, location, consistency, mobility, and tenderness of abdominal organs and can identify enlarged organs or masses.

NSG 507 Week 5 Abdomen Test Bank

Question 21

A patient reports passing black, tarry stools. Which condition is the most likely cause?

A. Gallbladder disease
B. Excessive use of laxatives
C. Gastrointestinal bleeding
D. Bleeding from hemorrhoids or the anus

Answer: C. Gastrointestinal bleeding

Explanation:
Black, tarry stools (melena) usually result from bleeding in the upper gastrointestinal tract. Bright red blood is more often associated with bleeding near the rectum or anus.

Question 22

Light palpation causes tenderness in the right lower quadrant. Which abdominal structure is most likely involved?

A. Spleen
B. Sigmoid colon
C. Appendix
D. Gallbladder

Answer: C. Appendix

Explanation:
The appendix is located in the right lower quadrant. Inflammation of the appendix commonly produces localized tenderness in this area.

Question 23

Which statement accurately describes abdominal assessment findings in older adults?

A. Abdominal muscle tone is increased.
B. Abdominal muscles become thinner and weaker.
C. Abdominal rigidity is more pronounced during acute illness.
D. Older adults usually experience greater abdominal pain than younger adults.

Answer: B. Abdominal muscles become thinner and weaker.

Explanation:
With aging, the abdominal musculature loses thickness and tone. Older adults may show less rigidity and often report less pain despite significant abdominal disease.

Question 24

Which finding in a newborn is most characteristic of pyloric stenosis?

A. Projectile vomiting
B. Hypoactive bowel sounds
C. An olive-shaped mass in the right lower quadrant
D. Peristaltic waves moving from right to left

Answer: A. Projectile vomiting

Explanation:
Pyloric stenosis typically presents with forceful projectile vomiting after feeding. Visible peristaltic waves move from left to right, and an olive-shaped mass may be felt in the right upper quadrant.

Question 25

Which statement about an abdominal aortic aneurysm (AAA) is correct?

A. A bruit is usually absent.
B. Femoral pulses are stronger than normal.
C. A pulsating abdominal mass is commonly present.
D. Most aneurysms are located below the umbilicus.

Answer: C. A pulsating abdominal mass is commonly present.

Explanation:
An abdominal aortic aneurysm often presents as a palpable pulsatile mass in the upper abdomen, usually just left of the midline. A bruit may be heard, and femoral pulses are often diminished rather than increased.

NSG 507 Week 5 Abdomen Test Bank

Question 8

A 26-year-old sporting goods store manager visits the clinic with severe pain in the right lower abdomen that has persisted for the past 12 hours. The discomfort began the previous day as generalized abdominal pain accompanied by a decreased appetite, but it has since become localized to the right lower quadrant. He also reports nausea and vomiting but denies diarrhea, constipation, fever, or chills. His last bowel movement was normal. His medical history is unremarkable. He is engaged, drinks alcohol socially (4–6 beers per week), and denies tobacco or illicit drug use. His mother has breast cancer, and his father has coronary artery disease.

On examination, he appears ill and lies on his right side. His temperature is 100.4°F, and his pulse is 110 beats/minute. Bowel sounds are decreased. Rebound tenderness and involuntary guarding are present at McBurney’s point, approximately one-third of the distance between the anterior superior iliac spine and the umbilicus. Examination of the rectum, inguinal region, prostate, penis, and testes is normal.

What is the most likely diagnosis?

A. Acute appendicitis
B. Acute mechanical intestinal obstruction
C. Acute cholecystitis
D. Mesenteric ischemia

Answer: A. Acute appendicitis

Explanation:
Appendicitis most commonly affects younger individuals. The pain usually begins around the umbilicus before shifting to the right lower quadrant, specifically at McBurney’s point. Findings such as rebound tenderness and involuntary guarding strongly support the diagnosis. Rovsing’s sign may also develop as inflammation progresses. Bowel habits generally remain unchanged.

Question 9

A 15-year-old high school student is brought to the clinic because of chronic diarrhea. His mother reports that he has experienced diarrhea after many meals for the past several years, with symptoms being especially severe after eating school lunches. The patient describes abdominal cramping, bloating, and excessive gas followed by watery diarrhea. He denies nausea, vomiting, constipation, weight loss, fatigue, recent illness, injuries, or foreign travel. His medical history is unremarkable, and he does not use tobacco, alcohol, or recreational drugs. His parents are healthy.

Physical examination is normal. His abdomen is soft, nondistended, and non-tender, with active bowel sounds. No organ enlargement, rebound tenderness, or guarding is present. Rectal examination is normal without evidence of blood. A stool specimen is collected for analysis.

What is the most likely cause of his chronic diarrhea?

A. Malabsorption syndrome
B. Osmotic diarrhea
C. Secretory diarrhea

Answer: B. Osmotic diarrhea

Explanation:
This presentation is most consistent with lactose intolerance, a common cause of osmotic diarrhea. Symptoms typically occur after consuming dairy products and include watery diarrhea, abdominal cramps, bloating, and excessive gas. Lactose intolerance is more prevalent among African American, Latino, Native American, and Asian populations.

Question 10

A 27-year-old police officer presents with severe left-sided flank pain that radiates toward her groin. The pain began suddenly during the night and awakened her from sleep. She reports discomfort in the bladder during urination but denies burning, urinary frequency, or urgency. She has noticed blood in her urine and has nausea without vomiting or fever. She denies recent illness or injury. Her medical history is unremarkable. She rarely drinks alcohol and does not smoke or use illicit drugs.

On examination, she appears to be in significant pain and remains motionless while lying on her left side. Cardiac, pulmonary, and abdominal examinations are normal. Tenderness is present just below the left costovertebral angle. A pregnancy test is negative, and urinalysis reveals hematuria.

Which type of pain is she most likely experiencing?

A. Kidney pain due to pyelonephritis
B. Ureteral pain caused by a kidney stone
C. Musculoskeletal pain
D. Ischemic bowel pain

Answer: B. Ureteral pain caused by a kidney stone

Explanation:
A ureteral stone typically causes sudden, severe, colicky pain that begins at the costovertebral angle and radiates toward the groin. Microscopic or gross hematuria is a common accompanying finding.

Question 11

Chris, a 20-year-old college student, has experienced abdominal pain for three days. Initially, the pain was centered around the umbilicus and was associated with nausea and vomiting. He found it difficult to get comfortable. Over the past day, the pain has become constant, more intense, and localized to the right lower quadrant near the iliac crest. He now avoids walking because movement significantly worsens the pain.

Which diagnosis is most likely?

A. Peptic ulcer disease
B. Cholecystitis
C. Pancreatitis
D. Appendicitis

Answer: D. Appendicitis

Explanation:
This history is characteristic of acute appendicitis. The pain begins as poorly localized visceral pain around the umbilicus and later becomes sharp and localized in the right lower quadrant as the parietal peritoneum becomes inflamed.

Question 12

Bill, a 55-year-old man, reports newly developed epigastric pain that lasts at least 30 minutes with each episode.

Which condition should be included in the differential diagnosis?

A. Peptic ulcer disease
B. Pancreatitis
C. Myocardial ischemia
D. All of the above

Answer: D. All of the above

Explanation:
Epigastric pain has numerous potential causes. Peptic ulcer disease, pancreatitis, and myocardial ischemia should all be considered. Other conditions, such as gallbladder disease and pneumonia, may also produce pain in this region. A careful history and physical examination help distinguish among these possibilities.

Question 13

Monique, a 33-year-old administrative assistant, has experienced intermittent lower abdominal pain for approximately one week each month over the past year. The episodes are unrelated to menstruation. She reports that the pain improves after bowel movements and is associated with changes in both the frequency and consistency of her stools.

What is the most likely diagnosis?

A. Colon cancer
B. Cholecystitis
C. Inflammatory bowel disease
D. Irritable bowel syndrome

Answer: D. Irritable bowel syndrome

Explanation:
The patient’s symptoms are most consistent with irritable bowel syndrome (IBS). Relief of pain after defecation, along with changes in stool frequency and form, strongly supports IBS. Colon cancer is less likely because the symptoms are intermittent without progression. Cholecystitis typically causes right upper quadrant pain, whereas inflammatory bowel disease is often accompanied by fever and bloody stools. Stress and certain foods commonly trigger IBS symptoms.

Question 14

Jim, a 60-year-old man, presents with vomiting that has persisted for two days. He denies seeing bright red blood but reports vomiting a dark, granular material that resembles coffee grounds.

What is the most likely source of the bleeding?

A. Bleeding from a diverticulum
B. Bleeding from a peptic ulcer
C. Bleeding from colon cancer
D. Bleeding related to cholecystitis

Answer: B. Bleeding from a peptic ulcer

Explanation:
Blood exposed to gastric acid often appears as coffee-ground emesis, indicating bleeding from the upper gastrointestinal tract, commonly due to a peptic ulcer. However, rapid upper gastrointestinal bleeding may produce bright red blood instead. Upper GI bleeding may also cause black, tarry stools (melena).

Question 15

A daycare employee visits the clinic because of jaundice. She denies intravenous drug use, blood transfusions, recent travel, and has not been sexually active for the past 10 months.

Which type of viral hepatitis is the most likely cause of her illness?

A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D

Answer: A. Hepatitis A

Explanation:
Because she has no significant exposure to blood or body fluids, hepatitis B, C, and D are less likely. Her occupation places her at increased risk for Hepatitis A, which is transmitted by the fecal-oral route. Individuals who work in daycare settings are encouraged to receive the Hepatitis A vaccine.

Question 16

Linda, a 29-year-old woman, develops sudden, severe pain beneath her right lower ribs. Over time, the pain travels toward her right flank and eventually settles in the right lower quadrant.

Which diagnosis best explains this pattern of pain?

A. Appendicitis
B. Dysmenorrhea
C. Ureteral stone
D. Ovarian cyst

Answer: C. Ureteral stone

Explanation:
Pain caused by a ureteral stone typically begins in the flank and progresses downward toward the groin as the stone moves through the urinary tract. Microscopic hematuria is commonly present. This characteristic migration makes the other diagnoses less likely.

Question 17

Mrs. LaFarge, a 60-year-old woman, reports episodes of urinary leakage because she cannot reach the bathroom in time after feeling a sudden urge to urinate. She has no problems with walking or mobility.

Which type of urinary incontinence is most consistent with her symptoms?

A. Stress incontinence
B. Urge incontinence
C. Overflow incontinence
D. Functional incontinence

Answer: B. Urge incontinence

Explanation:
Urge incontinence is characterized by a sudden, intense urge to urinate followed by involuntary urine loss, usually due to detrusor muscle overactivity. Stress incontinence occurs with activities that increase intra-abdominal pressure, such as coughing or sneezing. Overflow incontinence is commonly caused by urinary obstruction or neurogenic bladder, while functional incontinence results from impaired mobility or cognitive limitations.

Question 18

What is the correct sequence for performing a physical examination of the abdomen?

A. Auscultation → Inspection → Palpation → Percussion
B. Inspection → Percussion → Palpation → Auscultation
C. Inspection → Auscultation → Percussion → Palpation
D. Auscultation → Percussion → Inspection → Palpation

Answer: C. Inspection → Auscultation → Percussion → Palpation

Explanation:
Unlike examinations of most other body systems, the abdominal assessment begins with inspection, followed by auscultation. Percussion and palpation are performed afterward because they may stimulate bowel activity and alter bowel sounds, leading to inaccurate findings.

Question 19

A 62-year-old woman with hypertension has been under your care for three years. Despite taking three antihypertensive medications, her blood pressure remains poorly controlled. You believe medication nonadherence is unlikely. Today, her blood pressure measures 168/94 mmHg in both arms. Her father died of a myocardial infarction at age 58.

What should be your next step?

A. Prescribe a fourth antihypertensive medication
B. Refer her to a nephrologist
C. Order a CT scan
D. Carefully auscultate her abdomen

Answer: D. Carefully auscultate her abdomen

Explanation:
Resistant hypertension raises concern for secondary hypertension, particularly renal artery stenosis. The abdomen should be carefully auscultated for renal artery bruits, which are typically heard in the upper abdominal quadrants. A systolic-diastolic bruit strongly suggests significant renal artery narrowing. Detecting a bruit may guide further evaluation before ordering imaging studies or specialist referral.

Question 20

Mr. Patel, a 64-year-old lifelong smoker, has been told that his liver is enlarged. He has never consumed alcohol or used illicit drugs and has no known liver disease. On examination, the liver edge is palpable 4 cm below the right costal margin.

Which assessment should be performed next?

A. Order a liver ultrasound
B. Request hepatitis serology
C. Measure liver span by percussion
D. Observe without further evaluation

Answer: C. Measure liver span by percussion

Explanation:
A palpable liver edge does not necessarily indicate hepatomegaly. In patients with emphysema, a flattened diaphragm can push a normal-sized liver downward, making it easier to palpate. Measuring the liver span by percussion is the appropriate next step to determine whether the liver is truly enlarged. A normal liver span in the midclavicular line is approximately 6–12 cm.

Question 21

Cody, a teenager with a history of leukemia and splenomegaly, presents with significant pain in the left upper quadrant. During examination, a rough, grating sound is heard over the spleen.

What does this sound represent?

A. Splenic friction rub
B. A variation of bowel sounds
C. Borborygmi
D. A vascular bruit

Answer: A. Splenic friction rub

Explanation:
A splenic friction rub is a coarse, grating sound heard over the spleen and may occur with splenic infarction or inflammation of the splenic capsule. Similar friction rubs may also be heard over the liver, pleura, or pericardium when these structures become inflamed.

Question 22

While performing abdominal palpation, you detect a small abdominal mass.

What should you do next?

A. Order an abdominal ultrasound.
B. Repeat the examination with the patient’s abdominal muscles contracted.
C. Refer the patient for surgery.
D. Estimate the size of the mass by percussion.

Answer: B. Repeat the examination with the patient’s abdominal muscles contracted.

Explanation:
Contracting the abdominal muscles helps determine whether the mass is located within the abdominal wall or inside the abdominal cavity. This can be done by asking the patient to lift the head or shoulders while lying supine. Masses arising from the abdominal wall typically remain palpable, whereas intra-abdominal masses may become less apparent and often require further evaluation.

Question 23

Josh, a 14-year-old boy, presents with a sore throat. During the abdominal examination, percussion reveals dullness in the lowest left intercostal space along the anterior axillary line during deep inspiration.

What is the significance of this finding?

A. It confirms splenic enlargement and requires immediate investigation.
B. It suggests possible splenic enlargement, warranting careful further assessment.
C. It confirms splenomegaly and indicates the need for diagnostic testing.
D. It indicates that the spleen is normal.

Answer: B. It suggests possible splenic enlargement, warranting careful further assessment.

Explanation:
This finding may occur in infectious mononucleosis, where splenic enlargement is common. Although inspiratory dullness can also be present in healthy individuals, it should prompt a more detailed evaluation of the spleen.

Question 24

A young patient is found to have a mass in the left upper quadrant of the abdomen.

Which finding would favor an enlarged kidney rather than an enlarged spleen?

A. A palpable notch along the border of the mass
B. Inability to insert the fingers between the mass and the costal margin
C. Tympany remains present over the mass
D. Ability to palpate medial and deep to the mass

Answer: C. Tympany remains present over the mass.

Explanation:
An enlarged left kidney is more likely when there is no palpable splenic notch, the examiner can place fingers between the mass and the costal margin, and percussion over the area remains tympanic because bowel lies in front of the kidney. These distinctions may be difficult to appreciate in obese patients.

Question 25

Mr. Kruger, an 84-year-old man, presents with a smooth, mildly tender midline lower abdominal mass. Percussion reveals dullness extending approximately 6 cm above the symphysis pubis.

What is the most likely diagnosis?

A. Sigmoid colon mass
B. Abdominal wall tumor
C. Hernia
D. Distended urinary bladder

Answer: D. Distended urinary bladder

Explanation:
A distended bladder is the most likely explanation for a smooth, dull, midline suprapubic mass in an older man. Benign prostatic hyperplasia commonly causes urinary outflow obstruction in this age group. If the mass disappears after catheterization, bladder distention is confirmed. Other possible causes include urethral stricture, neurogenic bladder, or medication-induced urinary retention.

Question 26

Mr. Martin, a 72-year-old smoker being evaluated for hypertension, is found to have a 4-cm pulsatile abdominal mass on deep palpation.

What is the most appropriate next step?

A. Arrange an abdominal ultrasound.
B. Repeat the examination in six months.
C. Repeat the examination in three months.
D. Refer immediately to a vascular surgeon.

Answer: A. Arrange an abdominal ultrasound.

Explanation:
A palpable pulsatile abdominal mass raises suspicion for an abdominal aortic aneurysm (AAA). An abdominal ultrasound should be performed promptly to determine the size of the aneurysm. A diameter greater than 4 cm significantly increases the risk of rupture. Observation without imaging is inappropriate, and surgical referral is generally based on imaging findings.

Question 27

Mr. Maxwell reports increasing abdominal size and weight gain.

Which examination finding is most consistent with ascites?

A. Tympany over both flanks
B. Persistent dullness that does not shift with position changes
C. Central abdominal dullness while lying supine
D. Tympany that shifts when the patient’s position changes

Answer: D. Tympany that shifts when the patient’s position changes.

Explanation:
Ascites is suggested by findings that demonstrate movement of fluid within the abdomen. As the patient changes position, intestinal gas rises while fluid settles in dependent areas, producing shifting dullness. Additional findings that support ascites include a positive fluid wave and peripheral edema.

Question 28

Which description correctly defines the obturator sign?

A. Pain felt away from the site of rebound tenderness testing
B. Right lower abdominal pain when the right hip and knee are flexed and the hip is internally rotated
C. Pain produced by extending the right thigh or resisting hip flexion
D. Right upper quadrant pain that causes the patient to stop inhaling

Answer: B. Right lower abdominal pain when the right hip and knee are flexed and the hip is internally rotated.

Explanation:
The obturator sign is a clinical test for appendicitis. Internal rotation of the flexed right hip stretches the obturator internus muscle, causing pain when the muscle is inflamed by an irritated appendix. Option A describes Rovsing’s sign, option C describes the psoas sign, and option D describes Murphy’s sign, which is associated with acute cholecystitis.

Question 29

An elderly woman with a history of coronary artery bypass surgery presents with severe, diffuse abdominal pain. Surprisingly, palpation of the abdomen does not worsen her discomfort.

Which diagnosis should be strongly suspected?

A. Malingering
B. Neuropathic pain
C. Mesenteric ischemia
D. Physical abuse

Answer: C. Mesenteric ischemia

Explanation:
Mesenteric ischemia classically presents with severe abdominal pain that is disproportionate to the physical examination findings. Patients often have intense pain despite minimal abdominal tenderness. A history of significant cardiovascular disease increases the likelihood of vascular insufficiency involving the intestines. Neuropathic pain generally worsens with touch, while trauma-related pain from physical abuse is usually associated with tenderness on examination.

Chapter 19

Question 6

A 23-year-old woman with Kartagener syndrome, a congenital disorder associated with chronic sinusitis, bronchiectasis, and situs inversus, returns to the respiratory clinic for follow-up. During the visit, her preceptor asks for an abdominal examination.

Which physical examination finding is most consistent with situs inversus?

A. Tympany on percussion in the right upper quadrant and liver dullness in the left upper quadrant
B. A protuberant abdomen with scattered areas of tympany and dullness; stool is palpable on examination
C. Liver dullness in the right upper quadrant displaced downward because of chronic obstructive pulmonary disease
D. Dullness to percussion over the left lower anterior chest near the anterior axillary line
E. A change from tympany to dullness with inspiration over the left lower anterior chest

Answer: A. Tympany on percussion in the right upper quadrant and liver dullness in the left upper quadrant

Explanation:
In situs inversus, the abdominal organs are arranged as a mirror image of their normal positions. Consequently, the stomach and gastric air bubble are found on the right side, producing tympany in the right upper quadrant, while the liver is located on the left, resulting in percussion dullness there. The remaining options describe findings associated with constipation, chronic lung disease, or splenic enlargement rather than reversed organ placement.

Question 7

An otherwise healthy 28-year-old lawyer presents to the emergency department with severe abdominal pain that began one day ago. The emergency physician suspects acute appendicitis, and the surgical team is consulted.

Which physical examination finding most strongly supports the diagnosis?

A. Voluntary tightening of the abdominal muscles that persists during repeated examinations
B. Pain produced when the abdomen is pressed slowly and deeply, followed by sudden release of pressure
C. Increased abdominal pain with hip flexion
D. Localized tenderness at McBurney’s point, located approximately two-thirds of the distance from the umbilicus to the anterior superior iliac spine
E. Pain elicited by internal rotation of the right hip

Answer: B. Pain produced when the abdomen is pressed slowly and deeply, followed by sudden release of pressure

Explanation:
Pain that occurs when pressure is suddenly released after deep palpation is known as rebound tenderness, a classic sign of peritoneal irritation. Rebound tenderness, together with guarding and rigidity, supports the presence of peritonitis, which may occur with appendicitis. Persistent involuntary muscle contraction is termed rigidity, whereas tenderness at McBurney’s point and a positive obturator sign are suggestive of appendicitis but are less specific for peritoneal inflammation.

Question 8

A 58-year-old man with a history of type 2 diabetes mellitus and chronic alcohol use (abstinent for the past 10 months) reports progressive weakness, recurrent epigastric pain radiating to the back, chronic diarrhea occurring 6–8 times daily, and an 18-pound weight loss over four months.

Which underlying pathological process best explains his condition?

A. Helicobacter pylori infection
B. Inflammation of the gallbladder
C. Inflammation of colonic diverticula
D. Decreased blood flow to the intestines
E. Fibrosis of the pancreas

Answer: E. Fibrosis of the pancreas

Explanation:
These findings are most consistent with chronic pancreatitis, in which repeated inflammation causes fibrosis of the pancreas. Progressive loss of pancreatic exocrine function results in malabsorption and chronic diarrhea, while endocrine dysfunction contributes to diabetes mellitus. Chronic alcohol use is a major risk factor. The other conditions do not typically produce this combination of chronic diarrhea, weight loss, diabetes, and persistent epigastric pain radiating to the back.

Question 9

A 46-year-old obese executive presents with a three-month history of intermittent episodes of severe abdominal pain. Each episode usually resolves spontaneously within several hours, but the most recent attack lasted more than six hours. Because the pain has repeatedly interfered with her work, she would like a diagnosis and definitive treatment.

Which symptom or physical finding is most suggestive of biliary colic?

A. Pain worsened by alcohol consumption
B. Tenderness at McBurney’s point
C. Poorly localized pain around the umbilicus
D. Vomiting bile
E. Pain radiating to the right shoulder

Answer: E. Pain radiating to the right shoulder

Explanation:
Biliary colic commonly causes referred pain to the right shoulder or scapular region due to irritation of the diaphragm and the phrenic nerve. Alcohol is not a typical trigger. McBurney’s point tenderness is associated with appendicitis, whereas diffuse periumbilical pain is characteristic of the early stages of appendicitis. Bilious vomiting is more commonly seen with small bowel obstruction rather than biliary colic.