Np Test 4: Abdominal Disorders
- 1.You examine a 59-year-old man with a chief complaint of new onset of rectal pain after a bout of constipation. On exam, you not an ulcerated lesion on the posterior midline of the anus. This presentation is most consistent with:
- A.
Perianl fistula
- B.
Anal fisure
- C.
External hemorrhoid
- D.
Crohn proctitis
- 2.Rectal bleeding associated with hemorrhoids is usually described as:
- A.
Streaks of bright red blood on the stool
- B.
Dark-brown to black in color and mixed in with normal-appearing stool
- C.
A large amount of brisk red bleeding
- D.
Significant blood clots and mucus mixed with stool
- 3.Therapy for hemorrhoids includes all of the following except:
- A.
Weight control
- B.
Low-fat diet
- C.
Topical corticosteroids
- D.
Stool softener
- 4.All of the following are typically noted in a young adult with the diagnosis of acute appendicitis except:
- A.
Epigastric pain
- B.
Positive obturator sign
- C.
Rebound tenderness
- D.
Marked febrile response
- 5.A 26-year-old man presents with acute abdominal pain. As part of the evaluation for acute appendicitis, you order a WBC with differential and anticipate the following results:
- A.
Total WBC - 4500 mm3; Neutrophils - 35%, Bands 2% and lymphocytes - 45%
- B.
Total WBC - 14,000 mm3; Neutrophils - 55%, Bands 3% and Lymphocytes - 38%
- C.
Total WBC - 16,500 mm3; Neutrophils - 66%, Bands - 8% and Lymphocytes - 22%
- D.
Total WBC - 18,100 mm3; Neutrophils - 55%, Bands - 3% and Lymphocytes - 28%
- 6.In evaluating a patient with suspected appendicitis, the clinician considers that:
- A.
The presentation may differ according to the anatomical location of the appendix
- B.
This is a common reason for acute abdominal pain in elderly patients
- C.
Vomiting before onset of abdominal pain is often seen
- D.
The presentation is markedly different from the presentation of pelvic inflammatory disease
- 7.The psoas sign can be best described as abdominal pain elicited by:
- A.
Passive extension of the hip
- B.
Passive flexion an internal rotation of the hip
- C.
Deep palpation
- D.
Asking the patient to cough
- 8.The obturator sign can be best described as abdominal pain elicited by:
- A.
Passive extension of the hip
- B.
Passive flexion of the hip
- C.
Deep palpation
- D.
Asking the patient to cough
- 9.To support the diagnosis of acute appendicitis with suspected appendiceal rupture, you consider obtaining the following abdominal imaging study:
- A.
MRI
- B.
CT
- C.
Ultrasound
- D.
Flat plate
- 10.Which of the following WBC forms is an ominous finding in the presence of severe bacterial infection?
- A.
Neutrophil
- B.
Lymphocyte
- C.
Basophil
- D.
Metamyelocyte
- 11.Which of the following best represents the peak ages for occurrence of acute appendicitis?
- A.
1-20 years
- B.
20-40 years
- C.
10-30 years
- D.
30-50 years
- 12.Clinical findings most consistent with appendiceal rupture include all of the following except:
- A.
Abdominal discomfort less than 24 hours in duration
- B.
Fever > 102F
- C.
Palpable abdominal mass
- D.
Marked leukocytosis with total WBC greater than 20,000/ mm3
- 13.Which of the following is not a risk for bladder cancer?
- A.
Occupational exposure to textile dyes
- B.
Cigarette smoking
- C.
Occupational exposure to heavy metals
- D.
Long-term aspirin use
- 14.A 68-year-old man presents with suspected bladder cancer. You consider that its most common presenting sign or symptom is:
- A.
Painful urination
- B.
Fever and flank pain
- C.
Painless frank hematuria
- D.
Palpable abdominal mass
- 15.In a person diagnosed with superficial bladder cancer without evidence of metastases, you realize that:
- A.
The prognosis for 2-year survival is poor
- B.
A cystectomy is indicated
- C.
Despite successful initial therapy, local recurrence is common
- D.
Systemic chemotherapy is the treatment of choice
- 16.Persistent microscopic hematuria would be the primary finding in about ______% of individuals with bladder cancer.
- A.
10
- B.
20
- C.
30
- D.
40
- 17.A 43-year-old woman has a 12-hour history of sudden onset of right upper quadrant abdominal pain with radiation to the shoulder, fever and chills. She has had similar, milder episodes in the past. Exam reveals marked tenderness to the right upper quadrant abdominal palpation. Her most likely diagnosis is:
- A.
Hepatoma
- B.
Acute cholecystitis
- C.
Acute hepatitis
- D.
Cholelithiasis
- 18.Which of the following is usually not seen in the diagnosis of acute cholecystitis?
- A.
Elevated lactic dehydrogenase level
- B.
Increased alkaline phosphatase level
- C.
Leukocytosis
- D.
Elevated AST level
- 19.Murphy's sign can be best described as abdominal pain elicited by:
- A.
RUQ abdominal palpation
- B.
Asking the patient to stand on tiptoes and then letting the body weight fall quickly onto the heels.
- C.
Asking the patient to cough
- D.
Percussion
- 20.Risk factors for cholelithiasis include all of the following except:
- A.
Genetics
- B.
Rapid weight loss
- C.
Obesity
- D.
High-fiber diet
- 21.Imaging in a patient with suspected symptomatic cholelithiasis usually includes obtaining an abdominal:
- A.
MRI
- B.
CT
- C.
Ultrasound
- D.
Flat plate
- 22.Which of the following is most likely to be found in a person with acute cholecystitis?
- A.
Fever
- B.
Vomiting
- C.
Jaundice
- D.
Palpable gallbladder
- 23.Which of the following is true concerning colorectal cancer?
- A.
Most colorectal cancers are found during rectal exam
- B.
Rectal carcinoma is more common than cancers involving the colon
- C.
Early manifestations include abdominal pain and cramping
- D.
Later disease presentation often includes iron deficiency anemia
- 24.According to the American Cancer Society recommendations, which of the following is the preferred method for annual colorectal cancer screening in a 51-year-old man?
- A.
Digital rectal exam
- B.
Fecal occult blood test
- C.
Colonoscopy
- D.
Barium enema study
- 25.Which of the following is most likely to be noted in a person with colorectal cancer?
- A.
Gross rectal bleeding
- B.
Weight loss
- C.
Few symptoms
- D.
Nausea and vomiting
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