Costovertebral angle tenderness should be assessed whenever you suspect the patient may have: 2 out of 2 points Response Feedback: Pyelonephritis is characterized by flank pain and costovertebral angle tenderness. • Question 2 In older adults, overflow fecal incontinence is commonly due to: 2 out of 2 points Response Feedback: Constipation with overflow occurs when the rectum contains hard stool and soft feces above leak around the mass of stool. • Question 3 2 out of 2 points A 1-month-old boy has been vomiting for 2 weeks. How is this symptom of gastroesophageal reflux disease (GERD) and pyloric stenosis further differentiated in this child s assessment? Response Feedback: 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. • Question 4 Auscultation of borborygmi is associated with: 2 out of 2 points Response Feedback: 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. • Question 5 2 out of 2 points When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous systems? Response Feedback: Venous hum is associated with blood flow in venous collaterals found in portal hypertension. Aortic bruit occurs during systole, while a venous hum is a continuous sound and softer than a bruit. The other choices are not vascular sounds. • Question 6 Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the: 2 out of 2 points Response Feedback: The liver is responsible for converting fat-soluble waste to water-soluble materials so that the kidneys can excrete them as well as convert ammonia to urea. • Question 7 The major function of the large intestine is: 2 out of 2 points Response Feedback: 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. • Question 8 Which structure is located in the hypogastric region of the abdomen? 2 out of 2 points Response Feedback: The hypogastric (pubic) area contains the ileum, the bladder, and the pregnant uterus. • Question 9 2 out of 2 points A 45-year-old 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 examination, you review his laboratory work, anticipating a(n): Response Feedback: The patient s presenting symptoms suggest peptic ulcer disease. The supporting laboratory finding is the presence of H. pylori. • Question 10 Percussion at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the: 2 out of 2 points Response Feedback: 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. • Question 11 2 out of 2 points Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A sausage-shaped mass is palpable in his right upper quadrant. Joe s lower quadrant feels empty, and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Baby Joe s symptoms? Response Intussusception refers to the prolapse of one segment of the Feedback: intestine into another causing intestinal obstruction. A sausage-shaped mass may be palpated in the right or left upper quadrant, whereas the lower quadrant feels empty (positive Dance sign); it commonly occurs between 3 and 12 months of age.