P20(a)

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  • 1. 
    In the liver, amino acids are used to produce complex molecules by means of:
    • A. 

      A. glycogenesis

    • B. 

      B. anabolic processes

    • C. 

      C. catabolic processes

    • D. 

      D. autodigestion


  • 2. 
    Which of the following cells in the gastric mucosa produce intrinsic factor and hydrochloric acid?
    • A. 

      A. parietal cells

    • B. 

      B. chief cells

    • C. 

      C. mucous cells

    • D. 

      D. gastrin cells


  • 3. 
    Which of the following is the primary site for absorption of nutrients?
    • A. 

      A. stomach

    • B. 

      B. duodenum

    • C. 

      C. ileum

    • D. 

      D. ascending colon


  • 4. 
    When highly acidic chyme enters the duodenum, which hormone stimulates the release of pancreatic secretions that contains very high bicarbonate ion content?
    • A. 

      A. gastrin

    • B. 

      B. secretin

    • C. 

      C. cholecystokinin

    • D. 

      D. histamine


  • 5. 
    Which of the following breaks protein down into peptides?
    • A. 

      A. amylase

    • B. 

      B. peptidase

    • C. 

      C. lactase

    • D. 

      D. trypsin


  • 6. 
    In which structure is oxygenated blood (arterial) mixed with unoxygenated blood (venous) so as to support the functions of the structure?
    • A. 

      A. pancreas

    • B. 

      B. liver

    • C. 

      C. small intestine

    • D. 

      D. spleen


  • 7. 
    Which of the following stimulates increased peristalsis and secretions in the digestive tract?
    • A. 

      A. sympathetic nervous system

    • B. 

      B. vagus nerve

    • C. 

      C. increased saliva

    • D. 

      D. absence of food in the system


  • 8. 
    Which of the following is contained in pancreatic exocrine secretions?
    • A. 

      A. bicarbonate ion

    • B. 

      B. hydrochloric acid

    • C. 

      C. activated digestive enzymes

    • D. 

      D. insulin


  • 9. 
    An alkaline environment is required in the duodenum to:
    • A. 

      A. activate pepsinogen

    • B. 

      B. activate intestinal and pancreatic enzymes

    • C. 

      C. activate bile salts

    • D. 

      D. produce mucus


  • 10. 
    Which of the following processes is likely to occur in the body immediately after a meal?
    • A. 

      A. lipolysis

    • B. 

      B. ketogenesis

    • C. 

      C. gluconeogenesis

    • D. 

      D. glycogenesis


  • 11. 
    What does the term gluconeogenesis refer to?
    • A. 

      A. breakdown of glycogen to produce glucose

    • B. 

      B. conversion of excess glucose into glycogen for storage

    • C. 

      C. formation of glucose from protein and fat

    • D. 

      D. breakdown of glucose into carbon dioxide and water


  • 12. 
    Normally, proteins or amino acids are required to produce all of the following EXCEPT:
    • A. 

      A. peptide hormones

    • B. 

      B. clotting factors and antibodies

    • C. 

      C. cellular energy

    • D. 

      D. hemoglobin


  • 13. 
    Which of the following statements applies to bile salts?
    • A. 

      A. They give feces the characteristic brown color.

    • B. 

      B. They are enzymes used to break down fats into free fatty acids.

    • C. 

      C. They emulsify lipids and lipid-soluble vitamins.

    • D. 

      D. They are excreted in the feces.


  • 14. 
    The visceral peritoneum:
    • A. 

      A. lines the abdominal wall

    • B. 

      B. hangs from the stomach over the loops of small intestine

    • C. 

      C. contains many pain receptors

    • D. 

      D. forms the outer covering of the stomach and intestines

    • E. 

      E. covers the kidneys and bladder


  • 15. 
    The early stage of vomiting causes:
    • A. 

      A. metabolic alkalosis

    • B. 

      B. metabolic acidosis

    • C. 

      C. increased respirations

    • D. 

      D. increased excretion of hydrogen ions


  • 16. 
    Prolonged vomiting cause a state of acidosis due to:
    • A. 

      A. catabolism of proteins and lipids

    • B. 

      B. continued loss of gastric secretions

    • C. 

      C. loss of pancreatic enzymes

    • D. 

      D. retention of sodium ions and water


  • 17. 
    What is the first change in arterial blood gases with diarrhea?
    • A. 

      A. increased bicarbonate ion

    • B. 

      B. decreased bicarbonate ion

    • C. 

      C. increased carbonic acid

    • D. 

      D. increased serum pH


  • 18. 
    Dehydration causes acidosis because of increased:
    • A. 

      A. ketones produced

    • B. 

      B. CO2 retained in the lungs and kidneys

    • C. 

      C. hypovolemia and lactic acid production

    • D. 

      D. metabolic rate


  • 19. 
    Which of the following applies to the act of swallowing?
    • A. 

      A. requires coordination of cranial nerves V, IX, X, and XII

    • B. 

      B. is entirely voluntary

    • C. 

      C. is controlled by a center in the hypothalamus

    • D. 

      D. does not affect respiration


  • 20. 
    What does the defecation reflex require?
    • A. 

      A. stimulation by the sympathetic nervous system

    • B. 

      B. contraction of the internal anal sphincter

    • C. 

      C. coordination through the sacral spinal cord

    • D. 

      D. voluntary contraction of abdominal muscles


  • 21. 
    What is the definition of achalasia?
    • A. 

      A. a herniation of the gastric mucosa through a segment of weakened muscle

    • B. 

      B. recurrent reflux of chime into the esophagus

    • C. 

      C. absence of a connection of the esophagus to the stomach

    • D. 

      D. lack of a nerve plexus to relax the lower esophageal sphincter


  • 22. 
    What does esophageal atresia cause?
    • A. 

      A. direct passage of saliva and food from the mouth into the trachea

    • B. 

      B. repeated reflux of gastric secretions into the esophagus

    • C. 

      C. no fluid or food entering the stomach

    • D. 

      D. gastric distention and cramps


  • 23. 
    Which of the following applies to cleft palate?
    • A. 

      A. The mandibular processes do not fuse.

    • B. 

      B. The hard and soft palates do not fuse during the first trimester of pregnancy.

    • C. 

      C. Exposure to environmental factors in the last trimester causes the defect.

    • D. 

      D. Speech and eating are not affected.


  • 24. 
    Oral candidiasis is considered to:
    • A. 

      A. be a common bacterial infection in infants and young children

    • B. 

      B. cause painful ulcerations in the mucosa and tongue

    • C. 

      C. cause white patches in the mucosa that cannot be scraped off

    • D. 

      D. be an opportunistic fungal infection of the mouth


  • 25. 
    Why does herpes simplex infection tend to recur?
    • A. 

      A. Active infection is usually asymptomatic.

    • B. 

      B. The virus builds up a resistance.

    • C. 

      C. The virus persists in latent form in sensory nerve ganglia.

    • D. 

      D. The virus mutates; therefore, no effective immunity develops.


  • 26. 
    What does the term periodontitis refer to?
    • A. 

      A. erosion of the enamel tooth surface

    • B. 

      B. bacterial damage to the ligaments and bone surrounding teeth

    • C. 

      C. inflammation and infection of the gingivae

    • D. 

      D. formation of calcified plaque on the tooth


  • 27. 
    What is/are common location(s) for oral cancer?
    • A. 

      A. floor of the mouth or tongue borders

    • B. 

      B. mucosa lining the cheeks

    • C. 

      C. hard and soft palate

    • D. 

      D. gingivae near the teeth


  • 28. 
    What is a common cause of hiatal hernia?
    • A. 

      A. an abnormally long esophagus

    • B. 

      B. increased intra-abdominal pressure

    • C. 

      C. stenosis of the hiatus in the diaphragm

    • D. 

      D. a small fundus in the stomach


  • 29. 
    What is a common sign of acute gastritis?
    • A. 

      A. colicky right upper quadrant pain

    • B. 

      B. vomiting with epigastric tenderness

    • C. 

      C. projectile vomiting after eating

    • D. 

      D. diarrhea with abdominal distention


  • 30. 
    What does the pathophysiology of chronic gastritis include?
    • A. 

      A. atrophy of the gastric mucosa with decreased secretions

    • B. 

      B. hyperchlorhydria and chronic peptic ulcers

    • C. 

      C. frequent vomiting and diarrhea

    • D. 

      D. episodes of acute inflammation and edema of the mucosa


  • 31. 
    What is a common cause of gastroenteritis due to Salmonella?
    • A. 

      A. unrefrigerated custards or salad dressings

    • B. 

      B. poorly canned foods

    • C. 

      C. raw or undercooked poultry or eggs

    • D. 

      D. contaminated water


  • 32. 
    Which of the following individuals is likely to develop acute gastritis?
    • A. 

      A. a long-term, heavy cigarette smoker

    • B. 

      B. patient with arthritis taking enteric-coated aspirin on a daily basis

    • C. 

      C. a person with an autoimmune reaction in the gastric mucosa

    • D. 

      D. an individual with an allergy to shellfish


  • 33. 
    What does congenital pyloric stenosis involve?
    • A. 

      A. absence of peristalsis in the lower section of the stomach

    • B. 

      B. failure of an opening to develop between the stomach and duodenum

    • C. 

      C. hypertrophy and hyperplasia of smooth muscle in the pylorus

    • D. 

      D. thickening of the gastric wall due to chronic inflammation


  • 34. 
    A patient with acquired pyloric stenosis would likely:
    • A. 

      A. have an increase in appetite

    • B. 

      B. have chronic diarrhea

    • C. 

      C. develop severe colicky pains

    • D. 

      D. vomit undigested food from previous meals


  • 35. 
    Prolonged or severe stress predisposes to peptic ulcer disease because:
    • A. 

      A. of reduced blood flow to the gastric wall and mucous glands

    • B. 

      B. of reduced bicarbonate content in bile and pancreatic secretions

    • C. 

      C. stress increases the number of acid/pepsinogen secreting cells

    • D. 

      D. increased epinephrine increases motility


  • 36. 
    The pathophysiology of peptic ulcer disease may involve any of the following EXCEPT:
    • A. 

      A. decreased resistance of the mucosal barrier

    • B. 

      B. increased stimulation of pepsin and acid secretions

    • C. 

      C. infection by H. pylori

    • D. 

      D. increased stimulation of mucus-producing glands


  • 37. 
    Which of the following would a perforated gastric ulcer likely cause?
    • A. 

      A. severe anemia

    • B. 

      B. chemical peritonitis

    • C. 

      C. severe gastric hemorrhage

    • D. 

      D. pyloric obstruction


  • 38. 
    What is frequently the first manifestation of stress ulcers?
    • A. 

      A. abdominal discomfort between meals and at night

    • B. 

      B. nausea and diarrhea

    • C. 

      C. hematemesis and hypotension

    • D. 

      D. sharp colicky pain with food intake


  • 39. 
    What would be the result of chronic bleeding from gastric carcinoma?
    • A. 

      A. occult blood in the stool and anemia

    • B. 

      B. hematemesis and shock

    • C. 

      C. abdominal pain and distention

    • D. 

      D. red blood on the surface of the stool


  • 40. 
     Following gastric resection, the onset of nausea, cramps, and dizziness immediately after meals indicates:
    • A. 

      A. a large volume of chyme has entered the intestines, causing distention

    • B. 

      B. severe hypoglycemia has developed

    • C. 

      C. the pylorus is restricting the flow of chyme

    • D. 

      D. bile and pancreatic secretions are irritating the small intestine


  • 41. 
    Which of the following is/are (a) manifestation(s) of hemolytic jaundice?
    • A. 

      A. increased unconjugated bilirubin in the blood

    • B. 

      B. increased bleeding tendencies

    • C. 

      C. pale stool and dark urine

    • D. 

      D. elevated liver enzymes in the blood


  • 42. 
    Why does mild hyperbilirubinemia occur in newborns?
    • A. 

      A. blood incompatibility between mother and child

    • B. 

      B. there is damage to many erythrocytes during the birth process

    • C. 

      C. poor circulation and albumin transport for bilirubin

    • D. 

      D. the immature liver cannot process bilirubin quickly enough


  • 43. 
    Predisposing factors to cholelithiasis include excessive:
    • A. 

      A. bilirubin or cholesterol concentration in the bile

    • B. 

      B. water content in the bile

    • C. 

      C. bile salts in the bile

    • D. 

      D. bicarbonate ions in the bile


  • 44. 
    What is the major effect when a gallstone obstructs the cystic duct?
    • A. 

      A. intrahepatic jaundice

    • B. 

      B. acute pancreatitis

    • C. 

      C. severe colicky pain in upper right quadrant

    • D. 

      D. inflammation and infection in the gall bladder


  • 45. 
    Which of the following describes the supply of bile following a cholecystectomy?
    • A. 

      A. Bile is no longer available for digestion.

    • B. 

      B. Bile is stored in the liver sinusoids until a fatty meal is consumed.

    • C. 

      C. Bile is not diluted and is less effective as an emulsifier.

    • D. 

      D. Small amounts of bile are continuously secreted and flow into the duodenum.


  • 46. 
    Which of the following applies to hepatitis A infection?
    • A. 

      A. It is also called serum hepatitis.

    • B. 

      B. It is transmitted by the fecal-oral route.

    • C. 

      C. It contains a double strand of DNA.

    • D. 

      D. It frequently leads to chronic hepatitis.


  • 47. 
    What can be concluded if the hepatitis B antigen level remains high in the serum?
    • A. 

      A. Acute infection is present.

    • B. 

      B. Chronic infection has developed.

    • C. 

      C. Liver failure is in progress.

    • D. 

      D. The usual prolonged recovery from any viral infection is occurring.


  • 48. 
    What is the most common type of hepatitis transmitted by blood transfusion?
    • A. 

      A. HAV

    • B. 

      B. HBV

    • C. 

      C. HCV

    • D. 

      D. HEV


  • 49. 
    What causes elevated serum levels of AST and ALT during the preicteric stage of hepatitis?
    • A. 

      A. systemic effects of viral infection

    • B. 

      B. obstruction of bile ducts and malabsorption

    • C. 

      C. necrosis of liver cells

    • D. 

      D. ammonia toxicity


  • 50. 
    What is the likely effect of long-term exposure to a hepatotoxin?
    • A. 

      A. full recovery to normal tissue after the toxic material is removed

    • B. 

      B. acute onset of vomiting, steatorrhea, and jaundice

    • C. 

      C. continued mild inflammation of the liver without permanent damage

    • D. 

      D. gradual irreversible damage to the liver and cirrhosis


  • 51. 
    What indicates the presence of third-stage alcohol hepatitis?
    • A. 

      A. below normal blood levels of AST and ALT

    • B. 

      B. ULQ tenderness and dull pain

    • C. 

      C. a small, firm, nodular liver and portal hypertension

    • D. 

      D. accumulation of fat in the hepatocytes and hepatomegaly


  • 52. 
    A primary factor causing encephalopathy with cirrhosis is the elevated:
    • A. 

      A. serum urea

    • B. 

      B. conjugated bilirubin

    • C. 

      C. serum ammonia

    • D. 

      D. serum pH


  • 53. 
    In patients with cirrhosis, serum ammonia may increase when:
    • A. 

      A. ingesting excessive lipids

    • B. 

      B. bleeding occurs in the digestive tract

    • C. 

      C. an increase in unconjugated bilirubin occurs in the serum

    • D. 

      D. less bile is produced


  • 54. 
    What is the primary cause of esophageal varices?
    • A. 

      A. portal hypertension

    • B. 

      B. alcohol irritating the mucosa

    • C. 

      C. failure to inactivate estrogen

    • D. 

      D. poor nutritional status


  • 55. 
    What is the primary cause of increased bleeding tendencies associated with cirrhosis?
    • A. 

      A. anemia and leucopenia

    • B. 

      B. jaundice and pruritus

    • C. 

      C. recurrent infections

    • D. 

      D. deficit of vitamin K and prothrombin


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