AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentMedium
A 68-year-old male presents for a routine physical examination. He denies any current symptoms. His past medical history includes hypertension and hyperlipidemia, both well-controlled with medication. He has a 40-pack-year smoking history but quit 5 years ago. On abdominal palpation, the FNP notes a pulsatile mass superior to the umbilicus. Which of the following diagnostic tests is most appropriate for initial evaluation?
- AAbdominal ultrasound.
- BCT angiography.
- CMagnetic resonance angiography (MRA).
- DAbdominal X-ray.
Show answer & explanationAnswer & explanation
Correct answer: A. Abdominal ultrasound.
A pulsatile abdominal mass in an elderly male with a significant smoking history is highly suspicious for an abdominal aortic aneurysm (AAA). Abdominal ultrasound is the most appropriate initial diagnostic test due to its non-invasiveness, low cost, and high accuracy in detecting and measuring AAA. It is also the recommended screening tool for AAA.
Why the other options are wrong
- B. CT angiography is more invasive (radiation, contrast) and typically reserved for surgical planning or when ultrasound is inconclusive, not for initial screening/diagnosis.
- C. MRA is also more complex, expensive, and typically reserved for specific situations or when CT is contraindicated, not for initial evaluation.
- D. An abdominal X-ray may show calcification of the aorta but is not sensitive or specific enough to diagnose or measure an AAA.
Abdominal Aortic Aneurysm (AAA) Screening
Screening for AAA involves identifying asymptomatic individuals at risk for aortic dilation, often using abdominal ultrasound.
- Risk factors: male, age >65, smoking history, family history.
- Pulsatile abdominal mass is a classic sign.
- Abdominal ultrasound is the preferred initial diagnostic and screening tool.
Memory trick: Smoker's Aorta: Ultrasound First Look