Chapter 18: Abdomen

Question 1

1. Mrs. James is 7 months’ pregnant and states that she has developed a problem with constipation. She eats a well-balanced diet and is usually regular. You should explain that constipation is common during pregnancy because of changes in the colorectal areas, such as
   a. decreased movement through the colon and increased water absorption from the stool.
   b. increased movement through the colon and increased salt taken from foods.
   c. looser anal sphincter and fewer nutrients taken from foods.
   d. tighter anal sphincter and less iron eliminated in the stool.

Answer 1

a. decreased movement through the colon and increased water absorption from the
stool.

Question 2

2. The family history of a patient with diarrhea and abdominal pain should include inquiry about cystic fibrosis because it is
   a. a common genetic disorder.
   b. one cause of malabsorption syndrome.
   c. a curable condition with medical intervention.
   d. the most frequent cause of diarrhea in general practice.

Answer 2

b. one cause of malabsorption syndrome.

Question 3

3. When assessing abdominal pain in a college-age woman, one must include
   a. history of interstate travel.
   b. food likes and dislikes.
   c. age at completion of toilet training.
   d. the first day of the last menstrual period.

Answer 3

d. the first day of the last menstrual period.

Question 4

4. Infants born weighing less than 1500 g are at higher risk for
   a. hepatitis A.
   b. necrotizing enterocolitis.
   c. urinary urgency.
   d. pancreatitis.

Answer 4

b. necrotizing enterocolitis.

Question 5

5. You are completing a general physical examination on Mr. Rock, a 39-year-old man with complaints of constipation. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient
   a. hold his or her breath.
   b. sit upright.
   c. flex his or her knees.
   d. raise his or her head off the pillow.

Answer 5

c. flex his or her knees.

Question 6

6. Mrs. Little is a 44-year-old patient who presents to the office with abdominal pain and fever. During your examination, you ask the patient to raise her head and shoulders while she lies in a supine position. A midline abdominal ridge rises. You document this observation as a(n)
   a. small inguinal hernia.
   b. large epigastric hernia.
   c. abdominal lipoma.
   d. diastasis recti.

Answer 6

d. diastasis recti.

Question 7

7. Mr. Robins is a 45-year-old man who presents to the emergency department with a complaint of constipation. During auscultation, you note borborygmi sounds. This is associated with
   a. gastroenteritis.
   b. peritonitis.
   c. satiety.
   d. paralytic ileus.

Answer 7

a. gastroenteritis.

Question 8

8. To document absent bowel sounds correctly, one must listen continuously for
   a. 30 seconds.
   b. 1 minute.
   c. 3 minutes.
   d. 5 minutes.

Answer 8

d. 5 minutes.

Question 9

9. Percussion of the abdomen begins with establishing
   a. liver dullness.
   b. spleen dullness.
   c. gastric bubble tympany.
   d. overall dullness and tympany in all quadrants.

Answer 9

d. overall dullness and tympany in all quadrants.

Question 10

10. When percussing a spleen, Traube space is a
    a. semilunar region.
    b. splenic percussion sign.
    c. left-sided pleural effusion.
    d. solid mass.

Answer 10

a. semilunar region.

Question 11

11. Your patient is complaining of acute, intense, sharp epigastric pain that radiates to the back and left scapula, with nausea and vomiting. Based on this history, your prioritized physical examination should be to
    a. percuss for ascites.
    b. assess for rebound tenderness.
    c. inspect for ecchymosis of the flank.
    d. auscultate for abdominal bruits.

Answer 11

c. inspect for ecchymosis of the flank.

Question 12

12. To assess for liver enlargement in the obese person, you should
    a. use the hook method.
    b. have the patient lean over at the waist.
    c. auscultate using the scratch technique.
    d. attempt palpation during deep exhalation.

Answer 12

c. auscultate using the scratch technique.

Question 13

13. An umbilical assessment in the newborn that is of concern is a. a thick cord.
    b. umbilical hernia.
    c. one umbilical artery and two veins.
    d. pulsations superior to the umbilicus.

Answer 13

c. one umbilical artery and two veins.

Question 14

14. Your patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition?
    a. Positive psoas sign
    b. Positive McBurney sign
    c. Consistent right lower quadrant (RLQ) pain
    d. Rebound tenderness

Answer 14

c. Consistent right lower quadrant (RLQ) pain

Question 15

15. When using the bimanual technique for palpating the abdomen, you should
    a. push down with the bottom hand and the other hand on top.
    b. push down with the top hand and concentrate on sensation with the bottom hand.
    c. place the hands side by side and push equally.
    d. place one hand anteriorly and the other hand posteriorly, squeezing the hands
    together.

Answer 15

b. push down with the top hand and concentrate on sensation with the bottom hand.

Question 16

16. Flatulence, diarrhea, dysuria, and tenderness with abdominal palpation are findings usually associated with
    a. diverticulitis.
    b. pancreatitis.
    c. ruptured ovarian cyst.
    d. splenic rupture.

Answer 16

a. diverticulitis.

Question 17

17. A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to
    a. use a topical, over-the-counter hemorrhoid treatment for 1 week.
    b. exercise and eat more fiber.
    c. come to the laboratory for a stool guaiac test.
    d. eat six small meals a day.

Answer 17

c. come to the laboratory for a stool guaiac test.

Question 18

18. Costovertebral angle tenderness should be assessed whenever you suspect that the patient may have
    a. cholecystitis.
    b. pancreatitis.
    c. pyelonephritis.
    d. ulcerative colitis.

Answer 18

c. pyelonephritis.

Question 19

19. A mother brings her 2-year-old child for you to assess. The mother feels a lump whenever she fastens the child’s diaper. Nephroblastoma is a likely diagnosis for this child when your physical examination of the abdomen reveals a(n)
    a. fixed mass palpated in the hypogastric area.
    b. tender, midline abdominal mass.
    c. olive-sized mass of the right upper quadrant.
    d. nontender, slightly movable, flank mass.

Answer 19

d. nontender, slightly movable, flank mass.

Question 20

20. In older adults, overflow fecal incontinence is commonly caused by
    a. malabsorption.
    b. parasitic diarrhea.
    c. fecal impaction.
    d. fistula formation.

Answer 20

c. fecal impaction.

Question 21

1. Your patient is a 48-year-old woman with complaints of severe cramping pain in the abdomen and right flank. Her past medical history includes a history of bladder calculi. You diagnose her with renal calculi at this time. Which of the following symptoms would you expect with her diagnosis? (Select all that apply.)
   a. Abdominal pain on palpation
   b. Blumberg sign
   c. Cullen sign
   d. CVA tenderness
   e. Fever
   f. Grey Turner sign
   g. Hematuria
   h. Nausea

Answer 21

ANS: A, D, E, G
a. Abdominal pain on palpation
d. CVA tenderness
e. Fever
g. Hematuria

Question 22

2. Your patient returns to the office with multiple complaints regarding her abdomen. Which of the following are objective findings? (Select all that apply.)
   a. Nausea
   b. Dullness on percussion
   c. Rebound tenderness
   d. Vomiting
   e. Diarrhea
   f. Burning pain in epigastrium

Answer 22

ANS: B, C, E, F
b. Dullness on percussion
c. Rebound tenderness
e. Diarrhea
f. Burning pain in epigastrium