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RRPA History and Physical II > Chapter 18 > Flashcards

Chapter 18 Flashcards

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1
Q 
A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the 
A. Peritoneum
B. Mediastinum
C. Linea alba
D. Mesentery
E. Pleura
A

A. Peritonuem

The peritoneum is a serous membrane that lines the abdominal cavity and serves as a protective cover.

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2
Q 
What part of the small intestine forms a C-shaped curve around the head of the pancreas?
A. Duodenum
B. Ileum
C. Jejunum
D. Falciform ligament
E. Pylorus
A

A. Duodenum

The C-shaped curve around the head of the pancreas is the duodenum, the first 12 inches of the small intestine.

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3
Q 
Peristalsis of intestinal contents is under the control of 
A. Cognitive processes
B. Gravity
C. Autonomic nervous system
D. Fluid content of the stomach
E. Cerebellum
A

C. ANS

The movement of food and digestive products is regulated by the autonomic nervous system

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4
Q

The esophagus travels a route from
A. Anterior to the trachea through the mediastinal cavity
B. Lateral to the trachea through the diaphragm
C. Left of the trachea through the peritoneum
D. The anterior trachea through the cardiac orifice
E. Behind the trachea through the mediastinal cavity

A

E. Behind the trachea through the mediastinal cavity

The esophagus lies posteriorly to the trachea, descends through the mediastinal cavity and through the diaphragm, and enters into the stomach. The esophagus connects the pharynx to the stomach.

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5
Q 
Which organ is part of the alimentary tract?
A. Pancreas
B. Stomach
C. Gallbladder
D. Liver
E. Spleen
A

B. Stomach

The term alimentary tract refers to the continuous tract from the mouth, esophagus, stomach, small intestine, large intestine, and anus

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6
Q 
The superior most part of the stomach is the 
A. Body
B. Fundus
C. Pylorus
D. Cardiac orifice
E. Pyloric orifice
A

B. Fundus

The most superior aspect of the stomach is the fundus, followed by the body, and then the most distal part, the pylorus.

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7
Q

Which of the following is true regarding the stomach?
A. It lies in the lower abdominal cavity
B. It secretes gastric lipase that serves to digest protein
C. Very little absorption takes place in the stomach
D. The stomach produces most of the body’s bile
E. Pancreatic enzymes directly enter the stomach

A

C. Very little absorption takes place in the stomach

The stomach lies across the upper abdomen, secretes pepsin that digests protein and gastric lipase that emulsifies fats, and has a very small role in the absorption of nutrients. Secretions from the liver and pancreas enter the duodenum

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8
Q 
The appendix is an extension of the 
A. ileum
B. Cecum
C. Ascending colon
D. Transverse colon
E. Descending colon
A

B. Cecum

The appendix is a blind-ended tube connected to the cecum, the site of the beginning of the large intestine, located in the right lower quadrant of the abdomen. It develops embryologically from the cecum.

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9
Q 
When palpating the abdomen, you should note whether the liver is enlarged in the 
A. LUQ
B. Midepigastric region
C. Periumbilical area
D. RUQ
E. RLQ
A

D. RUQ

The liver is located in the right upper quadrant of the abdomen

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10
Q 
One major function of the liver is to 
A. Secrete pepsin
B. Emulsify fats
C. Store glycogen
D. Absorb bile
E. Produce insulin
A

C. Store glycogen

The liver plays a metabolic role; it converts glucose to glycogen, stores it, and then converts glycogen back to glucose as needed by the body.

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11
Q 
The majority of nutrient absorption takes place in the 
A. Stomach
B. Small intestine
C. Cecum
D. Transverse colon
E. Descending colon
A

B. Small intestine

Very little absorption takes place in the stomach; most absorption takes place in the small intestine. The cecum and transverse colon are part of the large intestine, and its major function is water reabsorption.

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12
Q 
The major function of the large intestine is 
A. Water absorption
B. Food digestion
C. Carbohydrate absorption
D. Mucous absorption
E. Glycogen breakdown
A

A. Water absorption

The major function of the large intestine is the absorption of water and excretion of solid waste material in the form of stool. Mucous glands secrete large quantities of alkaline mucus.

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13
Q 
Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the 
A. Spleen
B. Kidney
C. Liver
D. Pancreas
E. Gallbladder
A

C. Liver

The liver is responsible for converting fat-soluble waste to water-soluble materials so the kidneys can excrete them as well as convert ammonia to urea.

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14
Q 
Contraction of the gallbladder propels bile into the 
A. Stomach
B. Duodenum
C. Jejunum
D. Ileum
E. Cecum
A

B. Duodenum

With contraction of the gallbladder, bile is excreted into the duodenum.

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15
Q 
Which abdominal organs also produce hormones and function as endocrine glands?
A. Kidney and liver
B. Liver and gallbladder
C. Stomach and spleen
D. Gallbladder and pancreas
E. Pancreas and kidney
A

E. Pancreas and kidney

The pancreas produces pancreatic juices as well as insulin and glucagon; the kidneys produce urine as well as the hormones rennin and erythropoietin.

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16
Q 
Which organ(s) are located in the retroperitoneal space?
A. Kidneys
B. Lungs
C. Spleen
D. Gallbladder
E. Liver
A

A. Kidneys

The kidneys are located in the retroperitoneal space, lying behind the abdominal cavity and beside the abdominal aorta.

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17
Q

Mrs. G 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 stool
B. Increased movement through the colon and increased salt taken from foods
C. Looser anal sphincter and less nutrients taken from foods
D. Tighter anal sphincter and less iron eliminated in the stool
E. Increased absorption of nutrients and water in the colon

A

A. Decreased movement through the colon and increased water absorption from stool

Constipation and flatus are more common during pregnancy because the colon is displaced, peristalsis is decreased, and water absorption is increased. The colon does not absorb nutrients, and a tighter sphincter tone is not related to pregnancy.

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18
Q

The most pronounced function change of the GI tract in older adults is
A. Decreased hydrochloric acid production
B. Increased motility
C. Decreased bile absorption
D. Decreased motility
E. Increased saliva secretion

A

D. Decreased motility

A decrease in motility of the gastrointestinal (GI) tract is the most pronounced GI change in older adults.

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19
Q

The family history of a patient with diarrhea and abdominal pain should include inquiry about cystic fibrosis because it
A. Only affects the GI tract
B. Is one cause of malabsorption syndrome
C. Is a curable condition with medical intervention
D. Is the mosts frequent cause of diarrhea in general practice
E. Is a common genetic disorder

A

B. Is one cause of malabsorption syndrome

Cystic fibrosis is an uncommon, chronic genetic disorder affecting multiple systems. In the gastrointestinal tract, it causes malabsorption syndrome because of pancreatic lipase deficiency. Steatorrhea and abdominal pain from increased gas production are frequent concerns.

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20
Q 
Infants born weighing less than 1500g are at higher risk for
A. Hepatitis A
B. Necrotizing enterocolitis
C. Urinary urgency
D. Cystic fibrosis
E. Pancreatitis
A

B. Necrotizing enterocolitis

Necrotizing enterocolitis is a gastrointestinal disease that mostly affects premature infants; it involves infection and inflammation that causes destruction of the bowel, and it becomes more apparent after feedings. Low birth weight does not relate to the development of hepatitis A, urinary urgency, cystic fibrosis, or pancreatitis.

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21
Q 
Inspection of the abdomen should begin with the patient supine and the examiner
A. Seated on the patient's right side
B. Standing at the foot of the table
C. Standing at the patient's left
D. Walking around the table
E. Seated on the patient's left side
A

A. Seated on the patient’s right side

This preferred initial position allows tangential viewing of the abdomen for improved assessment of abdominal contour.

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22
Q

Before performing an abdominal examination, the examiner should
A. Ascertain the patient’s HIV status
B. Have the patient empty his or her bladder
C. Don double gloves
D. Completely disrobe the patient
E. Uncover only the painful areas of the abdomen

A

B. Have the patient empty his or her bladder

The patient should empty the bladder to ensure an accurate examination of organs as well as to provide comfort for the patient.

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23
Q 
Which structure is located in the hypogastric region of the abdomen?
A. Bladder
B. Cecum
C. Gallbladder
D. Stomach
E. Liver
A

A. Bladder

The hypogastric (pubic) area contains the ileum, the bladder, and the pregnant uterus.

24
Q 
When examining a patient with tense abdominal musculature, a helpful technique is to have the patient 
A. Hold his/her breath
B. Sit upright
C. Flex his/her knees
D. Raise his/her head off the pillow
E. Fully extend the legs
A

C. Flex his/her knees

To help relax the abdominal musculature, it is helpful to place a small pillow under the patient’s head and under slightly flexed knees. The other choices increase muscle flexion.

25
Q 
You ask the patient to raise the head and shoulders while lying in a supine position. A midline abdominal ridge rises. You chart this observation as a(n)
A. Small inguinal hernia
B. Large epigastric hernia
C. Abdominal lipoma
D. Diastasis recti
E. Incisional hernia
A

D. Diastasis recti

A diastasis recti occurs when abdominal contents bulge between two abdominal muscles to form a midline ridge as the head is lifted. It has little clinical significance and most often occurs in repeated pregnancies and obesity.

26
Q 
What condition is associated with striae that remain purplish?
A. Cushing disease
B. Diastasis recti
C. Liver cirrhosis
D. Reent pregnancy
E. Intraabdominal bleeding
A

A. Cushing disease

Striae from pregnancy or obesity begin as a pink or purple color then turn silvery white; striae associated with Cushing disease stay purplish.

27
Q 
Visible intestinal peristalsis may indicate
A. Normal digestion
B. Intestinal obstruction
C. Increased pulse pressure of aorta
D. Aortic aneurysm
E. Paralytic ileus
A

B. Intestinal obstruction

Peristalsis is not usually visible and when detected may indicate an intestinal obstruction.

28
Q 
After thorough inspection of the abdomen, the next assessment step is to 
A. Percuss
B. Palpate non painful areas
C. Auscultate
D. Perform a rectal examination
E. Palpate painful areas
A

C. Auscultate

Assessment of the abdomen begins with inspection followed by auscultation. This break from the usual system examination sequence is because palpation and percussion can alter the frequency as well as the intensity of bowel sounds. Therefore, auscultation is done first.

29
Q 
Auscultation of borborygmi is associated with
A. Gastroenteritis
B. Peritonitis
C. Satiety
D. Paralytic ileum
E. Stenotic arteries
A

A. Gastroenteritis

Borborygmi are prolonged loud gurgles that occur with gastroenteritis, early intestinal obstruction, or hunger. Peritonitis and paralytic ileus result in hypoactive bowel sounds. Food satiety does not stimulate growling sounds as hunger does. Vascular bruits are not associated with borborygmi.

30
Q 
Peritonitis often produces bowel sounds that are 
A. Decreased 
B. Increased
C. High pitched
D. Absent 
E. Accentuated
A

A. Decreased

Decreased bowel sounds occur with peritonitis and paralytic ileus.

31
Q 
A patient is complaining of abdominal pain, nausea with vomiting, malaise, and a low-grade fever attributed to eating some "bad food" 4 hours ago. The abdomen is soft and rounded, with hypoactive bowel sounds after 5 minutes of auscultation to each quadrant. Which assessment finding is inconsistent with gastroenteritis?
A. Malaise
B. Low-grade fever
C. Hypoactive bowel sounds
D. Soft, rounded abdomen
E. Abdominal pain
A

C. Hypoactive bowel sounds

Gastroenteritis is more consistent with findings of crampy abdominal pain, borborygmi, nausea and vomiting, diarrhea, fever, and no abdominal distention. Hypoactive bowel sounds are not expected with gastroenteritis. A firm, distended abdomen suggests an obstruction.

32
Q

An examiner can recognize a friction rub in the liver by a sound that is
A. Clicking, gurgling, and irregular
B. High pitched and associated with respirations
C. Loud, prolonged and gurgling
D. Soft, low-pitched and continuous
E. Low pitched, tinkling, and unrelated to respirations

A

B. High pitched and associated with respirations

An abdominal friction rub is rare and can be identified when high-pitched sounds are auscultated in association with respirations.

33
Q 
To correctly document absent bowel sounds, one must listen continuously for 
A. 30 seconds
B. 1 minute
C. 3 minutes
D. 5 minutes
E. 10 minutes
A

D. 5 minutes

Absent bowel sounds are confirmed after listening to each quadrant for 5 minutes.

34
Q 
Percussion at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the 
A. Descending aorta
B. Lower liver border
C. Medial border of the spleen
D. Upper right kidney ridge
E. Stomach
A

B. Lower liver border

Percussing along the right midclavicular line upward from the umbilicus determines the lower border of the liver. A liver border more than 2 to 3 cm signifies hepatomegaly.

35
Q 
When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous systems?
A. Arterial bruit
B. Gastric rumbling
C. Renal hyperresonance
D. Borborygmi
E. Venous hum
A

E. Venous hum

Venous hum is associated with blood flow in venous collaterals found in portal hypertension. Aortic bruit occurs during systole, and a venous hum is a continuous sound and softer than a bruit. The other choices are not vascular sounds.

36
Q

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
E. Bladder fullness

A

D. Overall dullness and tympany in all quadrants

Percussion begins with a general establishment over all quadrants for areas of dullness and tympany and then proceeds to specific target organs.

37
Q

To assess for liver enlargement in an obese person, you should
A. Use the hook method
B. Test for cutaneous hypersensitivity
C. Auscultate using the scratch technique
D. Attempt palpation during deep exhalation
E. Have the patient lean over at the waist

A

C. Auscultate using the scratch technique

If the abdomen is obese or distended or if the abdominal muscles are tight, you should plan on auscultating the liver using the scratch method to estimate the lower border of the liver. Cutaneous hypersensitivity is a sign of peritonitis and does not contribute to determining liver size.

38
Q

An umbilical assessment in the newborn that is of concern is
A. A thick cord
B. An umbilical hernia
C. One umbilical artery and two veins
D. Pulsations superior to the umbilicus
E. Visible non distended superficial veins

A

C. One umbilical artery and two veins

What is expected is two arteries and one vein. A single umbilical artery indicates the possibility of congenital anomalies. A thick cord suggests a well-nourished fetus, an umbilical hernia will generally spontaneously close by 2 years, and pulsations to the abdomen in the epigastric area are common. Nondistended superficial veins are usually visible in thin infants.

39
Q 
Failure to pass meconium stool in the first 24 hours after birth along with abdominal dissension is ofter the first sign of
A. Meckel diverticulum
B. Cystic fibrosis
C. Biliary atresia
D. Hydramnios
E. Wilms tumor
A

B. Cystic fibrosis

Meconium ileus is often the first manifestation of cystic fibrosis or Hirschsprung disease.

40
Q 
When palpating the aorta, a prominent lateral pulsation suggests
A. Aortic aneurysm
B. Normal pulsation
C. Renal artery fistula
D. Vena cava varicosity
E. Coarctation
A

A. Aortic aneurysm

Anterior pulsations of the aorta are within normal limits; lateral pulsations suggest an aortic aneurysm.

41
Q 
A patient present with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course?
A. Positive psoas sign
B. Positive McBurney sign
C. History or periumbilical pain
D. Rebound tenderness
E. Obturator muscle test
A

E. Obturator muscle test

Psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the right lower quadrant are signs of appendicitis. Conditions that cause irritation of the obturator muscle are late findings usually associated with a ruptured appendix or pelvic abscess.

42
Q

When using the bimanual technique for palpating the abdomen, you should
A. Push down with the bottom hand and the other atop
B. Push down with the top hand and the other atop
C. Place hands side by side and push equally
D. Place one hand anteriorly and the other posteriorly squeezing the hands together
E. Make a fist with the top hand and strike the bottom hand

A

B. Push down with the top hand and the other atop

The bimanual technique uses one hand on top of the other with the top hand pushing down while the bottom hand against the abdomen is used for sensing.

43
Q

A 23y/o man comes to the urgent care clinic with intense left flank and LLQ pain. One patient response to history of present illness questions that further supports a tentative diagnosis of renal calculi is
A. “My urine has been bright yellow”
B. “I have had fever and chills for 2 days”
C. “I also have a headache and neck ache”
D. “My left testicle and shoulder hurt as well”
E. “I have had flatulence and foul-smelling urine”

A

D. “My left testicle and shoulder hurt as well”

Renal calculi present with hematuria, intermittent flank pain that radiates to the groin and genitals, and a positive Kehr sign (pain radiating to the left shoulder).

44
Q 
Flatulence, diarrhea, dysuria, and tenderness with abdominal palpation are findings most associated with 
A. Peptic ulcer disease
B. Pancreatitis
C. Ruptured ovarian cyst
D. Splenic rupture
E. Diverticulitis
A

E. Diverticulitis

No choice other than diverticulitis has all of these presenting symptoms.

45
Q 
A 45y/o man relates a several-week history of severe intermittent abdominal burning sensations. He relates that the pain is relieved with small amounts of food. Before starting the physical exam, you review his labs, anticipating a(n)
A. Elevated WBC
B. Decreased potassium level
C. Positive H. pylori result
D. Increased urine specific gravity
E. Folate deficiency
A

C. Positive H. pylori result

The patient’s presenting symptoms suggest peptic ulcer disease. The supporting laboratory finding is the presence of H. pylori.

46
Q

A 51y/o woman calls with concerns of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to
A. Use topical OTC hemorrhoid treatment for 1 week
B. Exercise and eat more fiber
C. Come to the lab for a stool guaiac test
D. Eat six small meals a day
E. Go to the ER for a barium enema

A

C. Come to the lab for a stool guaiac test

Blood in the stools is an abnormal finding that should never be ignored even if it can be explained by conditions other than colon cancer. She should have her stool checked for blood now as well as annually because she is older than 50 years.

47
Q 
Patients presenting with ascites, jaundice, cutaneous spider veins, and non palpable liver exhibit signs of 
A. Cholecystitis
B. Pancreatitis
C. Inflammatory bowel disease
D. Diverticulitis
E. Cirrhosis
A

E. Cirrhosis

Jaundice is a result of excessive bilirubin that can result from cholecystitis, pancreatitis, or liver problems. Cirrhosis presents with additional symptoms of ascites, cutaneous spider veins, and a nonpalpable liver as scarring progresses.

48
Q 
A patient presents to the ER after a motor vehicle accident. The patient sustained blunt trauma to the abdomen and complains of pain in the LUQ that radiates to the left shoulder. What organ is most likely injured?
A. Gallbladder
B. Liver
C. Spleen
D. Stomach
E. Colon
A

C. Spleen

Spleen laceration or rupture is always suspected with abdominal injury because of its anatomic location. The patient’s presenting symptoms confirm this suspicion.

49
Q 
Costovertebral angle tenderness should be assessed whenever you suspect the patient may have 
A. Cholecystitis
B. Pancreatitis
C. Pyelonephritis
D. Ulcerative colitis
E. Intussesception
A

C. Pyelonephritis

Pyelonephritis is characterized by flank pain and costovertebral angle tenderness.

50
Q 
Imaging studies reveal that a patient has dilation of the renal pelvis from an obstruction in the ureter. What condition will be documented in this patient/s health record?
A. Glomerulonephritis
B. Hydronephrosis
C. Pyelonephritis 
D. Renal abscess
E. Renal artery emboli
A

B. Hydronephrosis

Hydronephrosis is the dilation of the renal pelvis from back pressure of urine that cannot flow past an obstruction in the ureter.

51
Q 
The most common congenital anomaly of the GI tract is 
A. Biliary atresia
B. Meconium ileus
C. Intussusception
D. Meckel diverticulum
E. Pyloric stenosis
A

D. Meckel diverticulum

Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract.

52
Q 
Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A sausage-shaped mass is palpable in his RUQ. Joe's lower quadrant feels empty, and a positive Dance sign is noted in his record. Which of the following conditions is consistent with Baby Joe's symptoms?
A. Intussusception
B. Kidney stones
C. Meconium ileus
D. Pyloric stenosis
E. Necrotizing enterocolitis
A

A. Intussusception

Intussusception refers to the prolapse of one segment of the intestine into another causing intestinal obstruction. Whereas a sausage-shaped mass may be palpated in the right or left upper quadrant, the lower quadrant feels empty (positive Dance sign); it commonly occurs between 3 and 12 months of age.

53
Q

A mother brings her 2y/o child for you to assess. The mother feels a lump whenever she fastens the child’s diaper. Nephroblastoma is likely for this child when your physical exam 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 RUQ
D. Nontender, slightly moveable, flank mass
E. Sausage-shaped mass in the LUQ

A

D. Nontender, slightly moveable, flank mass

A Wilms tumor (nephroblastoma) is the most common intraabdominal tumor of childhood. It presents with hypertension; fever; malaise; and a firm, nontender mass deep within the flank that is only slightly movable and is usually unilateral.

54
Q

A 1mo boy has been vomiting for 2 weeks. How is this symptom of GERD and pyloric stenosis further differentiated in this child’s assessment?
A. Vomiting becomes projectile with GERD
B. The infant has regurgitation with pyloric stenosis
C. An olive-sized mass of the RUQ occurs with GERD
D. Normal stools are expected with pyloric stenosis
E. The fontanel becomes sunken with pyloric stenosis

A

B. The infant has regurgitation with pyloric stenosis

With pyloric stenosis, vomiting becomes projectile, and a small olive-sized mass is palpable in the RUQ; the infant is usually hungry again soon after vomiting, and because little or no food is reaching the intestines, the infant has fewer, smaller stools. The child fails to thrive and has signs of dehydration. These signs are not associated with GERD. Regurgitation can be present with either disease.

55
Q 
Urinary incontinence that occurs from the inability to hold urine when the stimulus to urinate is perceived is called \_\_\_\_\_\_\_ incontinence.
A. Paralytic
B. Urge
C. Overflow
D. Functional
E. Stress
A

B. Urge

Urge incontinence is the inability to delay urination when the urge to void occurs.

56
Q 
In older adults, overflow fecal incontinence is commonly caused by 
A. Malabsorption
B. Parasitic diarrhea
C. Meckel diverticulum
D. Fistula formation
E. Fecal impaction
A

E. Fecal impaction

Constipation with overflow occurs when the rectum contains hard stool and soft feces above leak around the mass of stool.

RRPA History and Physical II (11 decks)

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