Ch8 The Abdomen, Rectum, And AnusExam Prep

CHAPTER 8: ADVANCED HEALTH ASSESSMENT OF THE ABDOMEN, RECTUM, AND ANUS

1. A 4-week-old patient has been vomiting “on and off” for several days in a row, particularly after feeding. The vomiting is very forceful. The parents are concerned that their child is not gaining weight. The parents state they have also not had to perform as many diaper changes. Upon examination, the clinician finds the patient dehydrated. The clinician suspects pyloric stenosis. Which finding would help confirm this supposition?

a. Sausage-shaped mass in the left lower quadrant

b. Currant jelly–like stools

c. An olive-shaped mass in the upper right quadrant

d. Bulging around the umbilicus

2. A 3-year-old patient presents with complaints of intermittent spells of crying and severe abdominal pain. With examination, the patient’s crying is inconsolable. The clinician suspects intussusception. What additional symptoms will help confirm the diagnosis? Select all that apply.

a. Bloody, mucus-filled stool

b. An olive-shaped mass near the bottom of the sternum

c. A sausage-shaped mass in the right lower quadrant

d. Rebound tenderness

e. Hepatomegaly

3. The clinician is assessing a 23-year-old patient who is developmentally the age of 5. The patient has mobility and feeding issues and has a gastrostomy tube. Which complication should the clinician include when teaching the family about possible outcomes of such tubes? Select all that apply.

a. Diarrhea

b. Infections

c. Fistula

d. Abdominal pain

e. Ulcerative colitis

4. Which factors lead to constipation in older adults? Select all that apply.

a. Increased peristalsis

b. Poor fluid intake

c. Inadequate dietary fiber

d. Decline in activity

e. Consumption of frequent, small meals

5. Symptoms of gastroesophageal reflux disease (GERD) include which of the following? Select all that apply.

a. Cough

b. Hoarseness

c. Chest pain

d. Diarrhea

e. Odynophagia

6. The clinician should expect the patient with viral hepatitis to display which of the following symptoms? Select all that apply.

a. Itching

b. Jaundice

c. Dark urine

d. Left lower quadrant tenderness

e. Clay-colored stools

7. Which symptoms should the clinician expect a patient with cholecystitis to display? Select all that apply.

a. Positive Murphy’s sign

b. Right upper quadrant pain

c. Fever

d. Dark-colored stools

e. Constipation

8. The clinician should expect a patient with peptic ulcer disease (PUD) to display which symptoms? Select all that apply.

a. Pain that occurs 2 to 4 hours after a meal

b. Pain in right or left upper quadrant

c. Burning like pain in the esophagus

d. A history of Helicobacter pylori infection

e. Jaundice

9. Which symptoms should the clinician expect a patient with appendicitis to display? Select all that apply.

a. Pain in the periumbilical region

b. Right lower quadrant pain

c. Rebound tenderness

d. Constipation

e. Fever

10. The clinician would expect which of the following symptoms in a patient with Crohn’s disease to display? Select all that apply.

a. Weight loss

b. Right lower quadrant tenderness

c. Constipation

d. Steatorrhea

e. Clay-colored stool

11. The clinician is evaluating a patient with vomiting. The patient’s amylase is elevated. What additional symptoms would the clinician anticipate with a diagnosis of pancreatitis?

a. Pain in the upper abdomen that radiates to the back

b. Rebound tenderness

c. Jaundice

d. Peripheral edema

12. The clinician is evaluating an 88-year-old patient who has complaints of perineal pain and hemorrhoids. Upon exam, the clinician notes a pink, doughnut-shaped mass extending from the rectum. What diagnosis would the clinician make?

a. Hemorrhoids have enlarged

b. Cancer

c. Vaginal atrophy

d. Rectal prolapse

13. In evaluating women who present with abdominal pain, what is the rationale for assessing menstrual history?

14. The parents of a 2-week-old child bring him in for a checkup and immunizations. During the examination, the clinician notes a “bulge” around the umbilicus. The parents state that the bulge is there sometimes but not all the time. What is the likely diagnosis?

15. Describe why assessment of abdominal pain is difficult in the elderly population.

16. Differentiate ulcerative colitis from Crohn’s disease.

Ulcerative colitis occurs most often in young adults presenting with bloody diarrhea containing mucus and pus, rectal urgency, abdominal cramping, weight loss, and anemia.

17. Outline the use of 24-hour food recall and food diaries in the patient with gastrointestinal disorders.

18. A 67-year-old patient is seen with complaints of anal pain, especially with defecation. After questions, the clinician believes the patient has an anal fissure. What factors may have led to the development of the anal fissure?

19. In addition to the traditional tests for appendicitis such as rebound tenderness, several other signs are available to assess for the disorder. Differentiate between Markle sign, McBurney’s point, Rovsing’s sign, Obturator sign, and Psoas sign.

20. The clinician is assessing a patient with complaints of flank pain. The clinician suspects pyelonephritis. Outline the process for assessing the costovertebral angle (CVA).