A 26-year-old woman comes to your clinic, complaining of leakage of stool despite generally normal, pain-free bowel movements. She denies any blood in her stool or on the toilet paper. She has had no recent episodes of diarrhea. Her past medical history includes a spontaneous vaginal delivery 3 months ago. She had a fourth-degree tear of the perineal area (from the vagina through the rectum) that was surgically repaired after delivery. A few days later the patient developed an abscess in the anal area that had to be incised and drained. She denies using any tobacco, alcohol, or illegal drugs. Her mother and father are both in good health. She denies any weight gain, weight loss, fever, or night sweats. She is still breast-feeding without any problems. On examination you visualize a small opening anterior to the anus with some surrounding erythema. There is not a mass or other inflammation on inspection. Digital rectal examination reveals smooth rectal walls with no blood. She has no pain during the rectal examination. Bimanual vaginal examination is also normal. What anal or rectal disorder is the most likely cause of her symptom?- Skildor

Question 1 of 5

A 26-year-old woman comes to your clinic, complaining of leakage of stool despite generally normal, pain-free bowel movements. She denies any blood in her stool or on the toilet paper. She has had no recent episodes of diarrhea. Her past medical history includes a spontaneous vaginal delivery 3 months ago. She had a fourth-degree tear of the perineal area (from the vagina through the rectum) that was surgically repaired after delivery. A few days later the patient developed an abscess in the anal area that had to be incised and drained. She denies using any tobacco, alcohol, or illegal drugs. Her mother and father are both in good health. She denies any weight gain, weight loss, fever, or night sweats. She is still breast-feeding without any problems. On examination you visualize a small opening anterior to the anus with some surrounding erythema. There is not a mass or other inflammation on inspection. Digital rectal examination reveals smooth rectal walls with no blood. She has no pain during the rectal examination. Bimanual vaginal examination is also normal. What anal or rectal disorder is the most likely cause of her symptom?

A. Anal fissure B. External hemorrhoids C. Internal hemorrhoids D. Anorectal fistula

Correct Answer: D

Rationale: The most likely cause of the woman's symptom of stool leakage despite normal bowel movements is an anorectal fistula. An anorectal fistula is an abnormal, tunnel-like connection between the anal canal or rectum and the skin around the anus. In this case, the small opening anterior to the anus with surrounding erythema on examination suggests the presence of a fistula.

Question 2 of 5

On a very busy day in the office, Mrs. Donelan, who is 81 years old, comes for her usual visit for her blood pressure. She is on a low-dose diuretic chronically and denies any side effects. Her blood pressure is 118/78 today, which is well-controlled. As you are writing her script, she mentions that it is hard not having her husband Bill around anymore. What would you do next?

A. Hand her the script and make sure she has a 3-month follow-up appointment. B. Make sure she understands the script. C. Ask why Bill is not there. D. Explain that you will have more time at the next visit to discuss this.

Correct Answer: C

Rationale: It is important to show empathy and address Mrs. Donelan's feelings about missing her husband. By asking why Bill is not there, you are opening the door for her to talk about her emotions and potentially offer support or resources. This can help build a stronger patient-provider relationship and address any underlying emotional concerns she may have. It is important to prioritize the patient's emotional well-being along with their physical health during the visit.

Question 3 of 5

A patient with hearing loss by whisper test is further examined with a tuning fork, using the Weber and Rinne maneuvers. The abnormal results are as follows: bone conduction is greater than air on the left, and the patient hears the sound of the tuning fork better on the left. Which of the following is most likely?

A. Otosclerosis of the left ear B. Exposure to chronic loud noise of the right ear C. Otitis media of the right ear D. Perforation of the right eardrum

Correct Answer: A

Rationale: Otosclerosis is a condition characterized by abnormal bone growth in the middle ear, specifically around the stapes bone. In cases of otosclerosis, the bone conduction is greater than air conduction on the affected side, which is seen in the scenario described. The Weber test localizes to the affected ear, meaning the patient hears the sound of the tuning fork better in the left ear in this case. This is because the abnormal bone growth can restrict the movement of the ossicles, leading to a conductive hearing loss. Otosclerosis typically affects one ear, and its presentation aligns with the results of the hearing tests performed in this case.

Question 4 of 5

A 56-year-old homosexual man presents with itching, anorectal pain, and tenesmus of 1 week's duration. Rectal examination reveals generalized tenderness without frank prostate abnormalities. Which of the following is most likely?

A. Acute prostatitis B. External hemorrhoid C. Proctitis D. Colon cancer

Correct Answer: C

Rationale: Given the patient's presentation of itching, anorectal pain, and tenesmus, along with rectal examination findings of generalized tenderness without prostate abnormalities, proctitis is the most likely diagnosis. Proctitis is inflammation of the rectal lining and is commonly associated with symptoms such as rectal pain, itching, tenesmus (feeling of incomplete defecation), and sometimes rectal bleeding. It can have various causes, including sexually transmitted infections (such as gonorrhea, chlamydia), inflammatory bowel disease, radiation therapy, or trauma.

Question 5 of 5

Which of the following represents metrorrhagia?

A. Fewer than 21 days between menses B. Excessive flow C. Infrequent bleeding D. Bleeding between periods

Correct Answer: D

Rationale: Metrorrhagia refers to abnormal bleeding between menstrual periods. This can manifest as spotting or heavier bleeding outside of the regular menstrual cycle. It is important to differentiate metrorrhagia from other types of abnormal bleeding such as menorrhagia (excessive flow), oligomenorrhea (infrequent bleeding), and polymenorrhea (fewer than 21 days between menses) in order to address and diagnose the underlying cause accurately.

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Which of the following represents metrorrhagia?

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The components of the health history include all of the following except which one?

A 26-year-old woman comes to your clinic, complaining of leakage of stool despite generally normal, pain-free bowel movements. She denies any blood in her stool or on the toilet paper. She has had no recent episodes of diarrhea. Her past medical history includes a spontaneous vaginal delivery 3 months ago. She had a fourth-degree tear of the perineal area (from the vagina through the rectum) that was surgically repaired after delivery. A few days later the patient developed an abscess in the anal area that had to be incised and drained. She denies using any tobacco, alcohol, or illegal drugs. Her mother and father are both in good health. She denies any weight gain, weight loss, fever, or night sweats. She is still breast-feeding without any problems. On examination you visualize a small opening anterior to the anus with some surrounding erythema. There is not a mass or other inflammation on inspection. Digital rectal examination reveals smooth rectal walls with no blood. She has no pain during the rectal examination. Bimanual vaginal examination is also normal. What anal or rectal disorder is the most likely cause of her symptom?

His head, eyes, ears, nose, and throat examinations are unremarkable. His lungs have normal breath sounds and there are no abnormalities with percussion and palpation of the chest. His heart has a normal S and S and no S or S . Further workup is pending. 1 2 3 4 Which disorder of the chest best describes these symptoms?

NCLEX Practice Questions Physical Assessment

Skildor

ATI RN