Np Test 4: Abdominal Disorders

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  • 1/104 Questions

    Which of the following is likely to be reported in a patient with persistent GERD?

    • Hematemesis
    • Chronic sore throat
    • Diarrhea
    • Melena
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Np Test 4: Abdominal Disorders - Quiz
About This Quiz

NP Test 4: Abdominal Disorders explores conditions like anal fissures, hemorrhoids, and appendicitis. It assesses knowledge on symptoms, treatments, and diagnostic approaches, essential for medical students and healthcare professionals.

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  • 2. 

    Rectal bleeding associated with hemorrhoids is usually described as:

    • Streaks of bright red blood on the stool

    • Dark-brown to black in color and mixed in with normal-appearing stool

    • A large amount of brisk red bleeding

    • Significant blood clots and mucus mixed with stool

    Correct Answer
    A. Streaks of bright red blood on the stool
    Explanation
    Rectal bleeding associated with hemorrhoids is usually described as streaks of bright red blood on the stool. This is because hemorrhoids are swollen blood vessels in the rectum and anus, and when they become irritated or inflamed, they can bleed. The blood from hemorrhoids is typically bright red because it is fresh and has not had time to darken. This type of bleeding is often seen on the surface of the stool or on toilet paper after wiping. It is important to note that if the bleeding is excessive or persistent, medical attention should be sought.

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  • 3. 

    The most common source of Hep A infection is:

    • Sharing IV drug equipment

    • Cooked seafood

    • Contaminated water supplies

    • Sexual contact

    Correct Answer
    A. Contaminated water supplies
    Explanation
    Contaminated water supplies are the most common source of Hepatitis A infection. Hepatitis A is a viral infection that affects the liver and is transmitted through the ingestion of contaminated food or water. Poor sanitation and inadequate water treatment can lead to the contamination of water supplies with the virus. Consuming contaminated water can result in the spread of Hepatitis A to individuals who come into contact with it. Therefore, contaminated water supplies pose a significant risk for Hepatitis A transmission.

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  • 4. 

    Murphy's sign can be best described as abdominal pain elicited by:

    • RUQ abdominal palpation

    • Asking the patient to stand on tiptoes and then letting the body weight fall quickly onto the heels.

    • Asking the patient to cough

    • Percussion

    Correct Answer
    A. RUQ abdominal palpation
    Explanation
    Murphy's sign is a clinical finding used to diagnose gallbladder inflammation or cholecystitis. It is characterized by abdominal pain elicited by palpation of the right upper quadrant (RUQ) of the abdomen. This pain occurs when the gallbladder is inflamed and the patient experiences tenderness upon palpation in this area. The other options, such as asking the patient to stand on tiptoes and letting the body weight fall quickly onto the heels, asking the patient to cough, or percussion, are not associated with the characteristic pain experienced in Murphy's sign.

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  • 5. 

    Which of the following does not increase a patient's risk of developing colorectal cancer?

    • A family history of colorectal cancer

    • Familial polyposis

    • Personal history of neoplasm

    • Long-term aspirin use

    Correct Answer
    A. Long-term aspirin use
    Explanation
    Long-term aspirin use does not increase a patient's risk of developing colorectal cancer. While a family history of colorectal cancer, familial polyposis, and personal history of neoplasm are all risk factors for colorectal cancer, long-term aspirin use has actually been shown to reduce the risk of developing colorectal cancer. Aspirin has anti-inflammatory properties that can help prevent the formation of polyps, which can potentially develop into cancerous cells. Therefore, long-term aspirin use is not associated with an increased risk of colorectal cancer.

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  • 6. 

    Which of the following is a PPI?

    • Loperamide

    • Metoclopramide

    • Nizatidine

    • Lansoprazole

    Correct Answer
    A. Lansoprazole
    Explanation
    Lansoprazole is a proton pump inhibitor (PPI) used to reduce stomach acid production. PPIs work by blocking the enzyme that produces acid in the stomach, helping to relieve symptoms of acid reflux, heartburn, and stomach ulcers. Loperamide is an anti-diarrheal medication, Metoclopramide is a medication used to treat gastrointestinal disorders, and Nizatidine is a histamine-2 blocker used to reduce stomach acid production. Only Lansoprazole fits the category of a PPI.

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  • 7. 

    Tenesmus is defined as which of the following

    • Rectal burning with defecation

    • A sensation of incomplete bowel emptying that is distressing and sometimes painful

    • Weight loss that accompanies many bowel diseases

    • Appearance of frank blood in the stool

    Correct Answer
    A. A sensation of incomplete bowel emptying that is distressing and sometimes painful
    Explanation
    Tenesmus is a medical term used to describe a sensation of incomplete bowel emptying that can be distressing and painful. It is characterized by a persistent urge to have a bowel movement, even after passing stool. This sensation is often associated with conditions such as inflammatory bowel disease, irritable bowel syndrome, or infections. Rectal burning with defecation refers to a different symptom, while weight loss and the appearance of frank blood in the stool are not directly related to tenesmus.

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  • 8. 

    A 68-year-old man presents with suspected bladder cancer. You consider that its most common presenting sign or symptom is:

    • Painful urination

    • Fever and flank pain

    • Painless frank hematuria

    • Palpable abdominal mass

    Correct Answer
    A. Painless frank hematuria
    Explanation
    The most common presenting sign or symptom of bladder cancer is painless frank hematuria, which refers to the presence of blood in the urine that is visible to the naked eye. This symptom is significant because it may indicate the presence of tumors or abnormal growths in the bladder. It is important to note that while other symptoms such as painful urination, fever and flank pain, and palpable abdominal mass can occur in bladder cancer, painless frank hematuria is the most commonly observed sign.

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  • 9. 

    A 43-year-old woman has a 12-hour history of sudden onset of right upper quadrant abdominal pain with radiation to the shoulder, fever and chills. She has had similar, milder episodes in the past. Exam reveals marked tenderness to the right upper quadrant abdominal palpation. Her most likely diagnosis is:

    • Hepatoma

    • Acute cholecystitis

    • Acute hepatitis

    • Cholelithiasis

    Correct Answer
    A. Acute cholecystitis
    Explanation
    The patient's presentation of sudden onset right upper quadrant abdominal pain with radiation to the shoulder, fever, chills, and tenderness to palpation in the right upper quadrant is highly suggestive of acute cholecystitis. Acute cholecystitis is inflammation of the gallbladder, commonly caused by gallstones obstructing the cystic duct. This obstruction leads to increased pressure in the gallbladder, causing pain and inflammation. The patient's past history of similar, milder episodes further supports this diagnosis. Hepatoma, acute hepatitis, and cholelithiasis may cause similar symptoms but do not fit the clinical picture as well as acute cholecystitis.

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  • 10. 

    The location of discomfort with acute diverticulitis is usually in which of the following areas of the abdomen?

    • Epigastric

    • LLQ

    • RLQ

    • Suprapubic

    Correct Answer
    A. LLQ
    Explanation
    The location of discomfort with acute diverticulitis is usually in the lower left quadrant (LLQ) of the abdomen. Diverticulitis is inflammation or infection of small pouches that develop in the lining of the colon, called diverticula. When these pouches become infected or inflamed, it can cause pain and tenderness in the LLQ of the abdomen. This is because the left side of the colon is more commonly affected by diverticula.

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  • 11. 

    Which of the following is most likely to be part of the clinical presentation of an otherwise healthy woman with uncomplicated lower UTI?

    • Urinary frequency

    • Fever

    • Suprapubic tenderness

    • Lower GI upset

    Correct Answer
    A. Urinary frequency
    Explanation
    Urinary frequency is most likely to be part of the clinical presentation of an otherwise healthy woman with uncomplicated lower UTI. This symptom occurs when the woman feels the need to urinate more frequently than usual. It is a common sign of a urinary tract infection, as the infection irritates the bladder and causes increased urgency and frequency of urination. Fever and suprapubic tenderness are less likely to be present in an uncomplicated lower UTI, while lower GI upset is not typically associated with this condition.

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  • 12. 

    Concerning IBS, which of the following statements is most accurate?

    • Patients most often report chronic diarrhea as the most distressing part of the problem.

    • Weight gain is often reported

    • Pts can present with bowel issues ranging from diarrhea to constipation

    • The condition is associated with a strongly increased risk of colorectal cancer.

    Correct Answer
    A. Pts can present with bowel issues ranging from diarrhea to constipation
    Explanation
    The most accurate statement concerning IBS is that patients can present with bowel issues ranging from diarrhea to constipation. This means that individuals with IBS may experience either loose stools or difficulty passing stools. It is important to note that this condition does not necessarily cause weight gain and is not associated with an increased risk of colorectal cancer.

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  • 13. 

    Creatinine clearance usually:

    • Approximates glomerular filtration rate

    • Does not change as part of normative aging

    • Is greater in women compared with men

    • Increases with hypotension

    Correct Answer
    A. Approximates glomerular filtration rate
    Explanation
    Creatinine clearance is a measure of the rate at which the kidneys filter and remove creatinine from the blood. It is commonly used as an estimate of the glomerular filtration rate (GFR), which is the gold standard for assessing kidney function. Therefore, the statement that creatinine clearance approximates GFR is correct. The other statements are not supported by the information given, as creatinine clearance can be influenced by factors such as age, gender, and blood pressure.

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  • 14. 

    Which of the following is not a risk for bladder cancer?

    • Occupational exposure to textile dyes

    • Cigarette smoking

    • Occupational exposure to heavy metals

    • Long-term aspirin use

    Correct Answer
    A. Long-term aspirin use
    Explanation
    Long-term aspirin use is not a risk for bladder cancer. Bladder cancer is commonly associated with certain risk factors such as occupational exposure to textile dyes, cigarette smoking, and occupational exposure to heavy metals. However, there is no evidence to suggest that long-term aspirin use increases the risk of developing bladder cancer.

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  • 15. 

    Which of the following represents the optimal dosing schedule for sucralfate (Carafate)?

    • Each tablet should be taken with a snack

    • The medication should be taken with a full meal for buffering effect

    • To achieve maximal therapeutic effect, the drug must be taken on an empty stomach

    • Sucralfate should be taken with other prescribed meds to enhance compliance

    Correct Answer
    A. To achieve maximal therapeutic effect, the drug must be taken on an empty stomach
    Explanation
    Taking sucralfate on an empty stomach allows for maximal therapeutic effect because it ensures that the medication is able to form a protective barrier on the stomach lining without interference from food. Taking the medication with a snack or a full meal may reduce its effectiveness as the food can interfere with the formation of the protective barrier. Taking sucralfate with other prescribed medications may enhance compliance, but it does not affect the optimal dosing schedule for sucralfate.

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  • 16. 

    A 36-year-old afebrile woman with no health problems presents with dysuria and frequency of urination. Her urinalysis findings include results positive for nitrates and leukocyte esterase. You evaluate these results and consider that she likely has:

    • Purulent vulvovaginitis

    • A gram-negative UTI

    • Cystitis caused by Staph. saprophyticus

    • Urethral syndrome.

    Correct Answer
    A. A gram-negative UTI
    Explanation
    Based on the given information, the woman is presenting with dysuria and frequency of urination, along with positive results for nitrates and leukocyte esterase in her urinalysis. These findings suggest a urinary tract infection (UTI). The presence of nitrates indicates the possibility of a gram-negative bacteria causing the infection. Therefore, the correct answer is a gram-negative UTI.

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  • 17. 

    Prevention of acute colonic diverticulitis includes:

    • Use of antidiarrheal agents

    • Avoiding gas-producing foods

    • High-fiber diet

    • Low-dose antibiotic therapy

    Correct Answer
    A. High-fiber diet
    Explanation
    A high-fiber diet is recommended for the prevention of acute colonic diverticulitis. Diverticulitis occurs when small pouches in the colon become inflamed or infected, and a high-fiber diet can help prevent this by promoting regular bowel movements and reducing pressure in the colon. Fiber adds bulk to the stool, making it easier to pass and reducing the risk of inflammation or infection in the diverticula. This is why a high-fiber diet is considered a preventive measure for acute colonic diverticulitis.

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  • 18. 

    The most likely causative organism in community-acquired UTI is:

    • Klebsiella species

    • Proteus mirabilis

    • E. coli

    • Staph. saprophyticus

    Correct Answer
    A. E. coli
    Explanation
    E. coli is the most likely causative organism in community-acquired UTI. E. coli is a common bacteria found in the gastrointestinal tract and is responsible for the majority of UTIs. It has the ability to adhere to the urinary tract lining and cause infection. Klebsiella species, Proteus mirabilis, and Staph. saprophyticus can also cause UTIs, but they are less commonly associated with community-acquired infections compared to E. coli.

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  • 19. 

    A 64-year-old woman presents with a 3-month history of upper abdominal pain. She describes the discomfort as an intermittent, centrally located "burning" feeling in the upper abdomen, most often with meals and often accompanied by mild nausea. Use of an over-the-counter H2RA affords partial symptom relief. She also uses naproxen sodium on a regular basis for the control of osteoarthritis pain. Her clinical presentation is most consistent with:  

    • Acute gastroenteritis

    • Gastric Ulcer

    • Duodenal ulcer

    • Chronic cholecystitis

    Correct Answer
    A. Gastric Ulcer
    Explanation
    The patient's symptoms of upper abdominal pain that worsens with meals, accompanied by mild nausea, and partially relieved by an H2RA, are consistent with a gastric ulcer. Gastric ulcers are usually located in the stomach and can cause a burning sensation in the upper abdomen. The use of NSAIDs like naproxen sodium can increase the risk of developing gastric ulcers. Acute gastroenteritis typically presents with diarrhea and vomiting, which are not mentioned in the patient's symptoms. Duodenal ulcers usually cause pain that improves with meals, not worsens. Chronic cholecystitis presents with symptoms such as right upper quadrant pain and may be associated with gallstones, which are not mentioned in the patient's history.

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  • 20. 

    Recommended antimicrobial therapy in acute diverticulitis includes:

    • Amoxicillin with clarithromycin

    • Linezolid with daptomycin

    • Ciprofloxacin with metroniazole

    • Nitrofurantoin with doxycycline

    Correct Answer
    A. Ciprofloxacin with metroniazole
    Explanation
    The recommended antimicrobial therapy in acute diverticulitis includes ciprofloxacin with metronidazole. This combination is effective in treating the infection caused by diverticulitis. Ciprofloxacin is a fluoroquinolone antibiotic that targets a wide range of bacteria, including those commonly associated with diverticulitis. Metronidazole, on the other hand, is an antibiotic that specifically targets anaerobic bacteria, which are commonly found in the colon and can contribute to the development of diverticulitis. Therefore, the combination of ciprofloxacin and metronidazole provides broad-spectrum coverage against the bacteria that cause acute diverticulitis.

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  • 21. 

    A 45-year-old woman complains of periodic "heartburn." Examination reveals a single altered finding of epigastric tenderness without rebound. As first-line therapy, you advise:

    • Avoiding trigger foods

    • The use of a prokinetic agent

    • A daily dose PPI

    • Increased fluid intake with meals

    Correct Answer
    A. Avoiding trigger foods
    Explanation
    Avoiding trigger foods is the correct answer because the patient is experiencing periodic heartburn, which is a common symptom of gastroesophageal reflux disease (GERD). Trigger foods such as spicy or acidic foods can worsen symptoms and avoiding them can help alleviate the heartburn. The other options, such as the use of a prokinetic agent or a daily dose of PPI, may be considered if the symptoms persist despite lifestyle modifications. Increased fluid intake with meals may not directly address the underlying cause of heartburn.

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  • 22. 

    You prescribe a fluoroquinolone antibiotic to a 54-year-old woman who has occasional GERD symptoms that she treats with an antacid. When discussing appropriate medication use, you advise that she should take the antimicrobial:

    • With the antacid

    • Separated from the antacid use by 2-4 hours before or 4-6 hours after taking the fluoroquinolone.

    • Without regard to antacid use

    • Apart from the antacid by about 1 hour on either side of the fluroquinolone.

    Correct Answer
    A. Separated from the antacid use by 2-4 hours before or 4-6 hours after taking the fluoroquinolone.
    Explanation
    Fluoroquinolone antibiotics can bind to certain minerals and form insoluble complexes, reducing their absorption and effectiveness. Antacids contain minerals such as aluminum, calcium, magnesium, and iron, which can interfere with the absorption of fluoroquinolones. Therefore, it is recommended to separate the antacid use from the fluoroquinolone by 2-4 hours before or 4-6 hours after taking the antibiotic to avoid any interaction and ensure optimal absorption of the medication.

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  • 23. 

    Which of the following characteristics is predictive of severity of chronic liver disease in a patient with chronic hepatitis C?

    • Female gender, age younger than 30

    • Co-infection with Hep B, daily ETOH use

    • Acquisition of virus through IV drug use

    • Frequent use of aspirin, nutritional status

    Correct Answer
    A. Co-infection with Hep B, daily ETOH use
    Explanation
    Co-infection with Hep B and daily ETOH use are predictive of severity of chronic liver disease in a patient with chronic hepatitis C. Hepatitis B co-infection can lead to more aggressive liver disease progression and poorer outcomes. Daily alcohol consumption can exacerbate liver damage and increase the risk of developing cirrhosis. Therefore, the presence of both Hepatitis B co-infection and daily alcohol use suggests a higher likelihood of severe liver disease in a patient with chronic hepatitis C.

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  • 24. 

    Which of the following is most consistent with the presentation of a patient with acute colonic diverticulitis?

    • Cramping, diarrhea, and leukocytosis

    • Constipation and fever

    • Right-sided abdominal pain

    • Frank blood in the stool with reduced stool caliber

    Correct Answer
    A. Cramping, diarrhea, and leukocytosis
    Explanation
    The presentation of a patient with acute colonic diverticulitis typically includes symptoms such as cramping, diarrhea, and leukocytosis. Cramping is a common symptom due to inflammation and infection in the colon. Diarrhea can occur as a result of the inflammation and disruption of normal bowel movements. Leukocytosis, an increase in white blood cell count, is often seen in response to the infection. Therefore, the combination of cramping, diarrhea, and leukocytosis is most consistent with acute colonic diverticulitis.

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  • 25. 

    IBD is a term usually used to describe:

    • Ulcerative colitis and IBS

    • C. Diff colitis and Crohn's disease

    • Crohns disease and ulcerative colitis

    • Inflammatory colitis and ileitis

    Correct Answer
    A. Crohns disease and ulcerative colitis
    Explanation
    IBD, or inflammatory bowel disease, is a term used to describe Crohn's disease and ulcerative colitis. These are both chronic inflammatory conditions that affect the digestive tract. Crohn's disease can cause inflammation anywhere in the digestive tract, while ulcerative colitis specifically affects the colon and rectum. Both conditions can cause symptoms such as abdominal pain, diarrhea, and weight loss. Treatment for IBD typically involves medication to reduce inflammation and manage symptoms, as well as lifestyle changes and sometimes surgery.

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  • 26. 

    To support the diagnosis of acute appendicitis with suspected appendiceal rupture, you consider obtaining the following abdominal imaging study:

    • MRI

    • CT

    • Ultrasound

    • Flat plate

    Correct Answer
    A. CT
    Explanation
    CT (Computed Tomography) is the preferred abdominal imaging study to support the diagnosis of acute appendicitis with suspected appendiceal rupture. CT scans provide detailed cross-sectional images of the abdomen, allowing for the visualization of the appendix and surrounding structures. It can help identify signs of inflammation, abscess formation, or perforation, which are important in diagnosing and managing appendicitis. CT scans have a high sensitivity and specificity for detecting appendiceal pathology and are considered more accurate than other imaging modalities such as MRI or ultrasound in this context. Flat plate imaging is not commonly used for diagnosing appendicitis and may not provide sufficient information.

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  • 27. 

    Risk factors for cholelithiasis include all of the following except:

    • Genetics

    • Rapid weight loss

    • Obesity

    • High-fiber diet

    Correct Answer
    A. High-fiber diet
    Explanation
    A high-fiber diet is not a risk factor for cholelithiasis. Cholelithiasis, also known as gallstones, is commonly caused by the accumulation of cholesterol or bilirubin in the gallbladder. Genetics, rapid weight loss, and obesity are known risk factors for developing gallstones. However, a high-fiber diet is actually beneficial for preventing gallstones as it helps to regulate cholesterol levels and promote healthy digestion.

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  • 28. 

    You see a 62-year-old man diagnosed with esophageal columnar epithelial metaplasia. You realize he is at increased risk for:

    • Esophageal stricture

    • Adenocarcinoma

    • GERD

    • H. Pylori colonization

    Correct Answer
    A. Adenocarcinoma
    Explanation
    The 62-year-old man diagnosed with esophageal columnar epithelial metaplasia is at increased risk for adenocarcinoma. Esophageal columnar epithelial metaplasia is a condition where the normal squamous epithelium in the esophagus is replaced by columnar epithelium, which is more prone to developing adenocarcinoma. Adenocarcinoma is a type of cancer that arises from glandular cells and can occur in various organs, including the esophagus. Therefore, the patient's diagnosis puts him at a higher risk for developing adenocarcinoma.

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  • 29. 

    You see a woman who has been sexually involved with a man newly diagnosed with acute Hep. B. She has not received the Hep. B immunization. You advise her to:

    • Start the Hep B immunization series

    • Limit the number of sexual partners

    • Be tested for the HBsAb

    • Receive the Hep B immune globulin and start Hep B. series

    Correct Answer
    A. Receive the Hep B immune globulin and start Hep B. series
    Explanation
    The correct answer is to receive the Hep B immune globulin and start the Hep B series. Hepatitis B is a viral infection that can be transmitted through sexual contact. The woman in this scenario has been sexually involved with a man who has been diagnosed with acute Hepatitis B. Since she has not received the Hepatitis B immunization, the best course of action is to receive the Hepatitis B immune globulin, which provides immediate protection against the virus, and start the Hepatitis B immunization series to ensure long-term protection. This combination of immune globulin and immunization is recommended for individuals who have been exposed to Hepatitis B.

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  • 30. 

    Which of the following is an expected finding in a patient with chronic renal failure?

    • Hypokalemia

    • Hypotension

    • Constipation

    • Anemia

    Correct Answer
    A. Anemia
    Explanation
    Anemia is an expected finding in a patient with chronic renal failure. This is because the kidneys are responsible for producing erythropoietin, a hormone that stimulates the production of red blood cells. In chronic renal failure, the kidneys are unable to produce enough erythropoietin, leading to a decrease in red blood cell production and subsequently causing anemia. Anemia in chronic renal failure is often characterized by low hemoglobin levels, fatigue, and shortness of breath.

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  • 31. 

    The obturator sign can be best described as abdominal pain elicited by:

    • Passive extension of the hip

    • Passive flexion of the hip

    • Deep palpation

    • Asking the patient to cough

    Correct Answer
    A. Passive flexion of the hip
    Explanation
    The obturator sign refers to abdominal pain that is elicited by passive flexion of the hip. This sign is suggestive of inflammation or irritation of the obturator muscle or its surrounding structures, such as the obturator nerve. Passive extension of the hip, deep palpation, and asking the patient to cough do not specifically elicit pain related to the obturator muscle or nerve.

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  • 32. 

    You are seeing Mr. Lopez, a 68-year-old man with suspected acute colonic diverticulitis. In choosing an appropriate imaging study to support this diagnosis, which of the following abdominal imaging studies is most appropriate?

    • Flat plate

    • Ultrasound

    • CT

    • Barium enema

    Correct Answer
    A. CT
    Explanation
    CT (computed tomography) is the most appropriate abdominal imaging study to support the diagnosis of acute colonic diverticulitis. CT scans provide detailed images of the colon and surrounding structures, allowing for accurate diagnosis and assessment of the severity of diverticulitis. It can detect complications such as abscesses or perforations, which may require immediate medical intervention. Other imaging studies like flat plate, ultrasound, or barium enema may have limited sensitivity or specificity in diagnosing diverticulitis compared to CT.

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  • 33. 

    In caring for a patient with symptomatic GERD, you prescribe a PPI to:

    • Enhance motility

    • Increase the pH of the stomach

    • Reduce lower esophageal pressure

    • Help limit the H. pylori growth

    Correct Answer
    A. Increase the pH of the stomach
    Explanation
    The correct answer is "Increase the pH of the stomach." Proton pump inhibitors (PPIs) work by reducing the production of stomach acid, which in turn increases the pH of the stomach. This helps to alleviate symptoms of GERD (gastroesophageal reflux disease) by reducing the amount of acid that can flow back into the esophagus and cause discomfort. PPIs are commonly prescribed for patients with symptomatic GERD to provide relief and promote healing of the esophageal lining.

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  • 34. 

    Which of the following hepatitis forms is most effectively transmitted from the man to the woman via heterosexual vaginal intercourse?

    • Hep. A

    • Hep. B

    • Hep. C

    • Hep. D

    Correct Answer
    A. Hep. B
    Explanation
    Hepatitis B is the most effectively transmitted form of hepatitis from a man to a woman through heterosexual vaginal intercourse. This is because Hepatitis B is primarily transmitted through contact with infected blood, semen, or other body fluids. During vaginal intercourse, there is a higher risk of exchange of these fluids, increasing the likelihood of transmission. Hepatitis A and C are mainly transmitted through contaminated food or water, while Hepatitis D requires the presence of Hepatitis B to cause an infection.

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  • 35. 

    Antiprostaglandin drugs cause stomach mucosal injury primarily by:

    • A direct irritative effect

    • Altering the thickness of the protective mucosal layer

    • Decreasing the peristalsis

    • Modifying the pH level

    Correct Answer
    A. Altering the thickness of the protective mucosal layer
    Explanation
    Antiprostaglandin drugs cause stomach mucosal injury primarily by altering the thickness of the protective mucosal layer. These drugs inhibit the production of prostaglandins, which play a crucial role in maintaining the integrity of the stomach lining. By reducing the production of prostaglandins, the protective mucosal layer becomes thinner and more susceptible to injury from stomach acid and other irritants. This can lead to the development of ulcers and other forms of stomach mucosal damage.

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  • 36. 

    Which of the following is most accurate information in caring for a 40-year-old man with cystitis?

    • This is a common condition in men of this age

    • A gram-positive organism is the likely causative pathogen

    • A urological evaluation should be considered

    • Pyruia is rarely found.

    Correct Answer
    A. A urological evaluation should be considered
    Explanation
    Cystitis is inflammation of the bladder, which can be caused by various factors including infection. In a 40-year-old man with cystitis, a urological evaluation should be considered because men are less likely to develop cystitis compared to women. This is because cystitis in men is often associated with underlying urological conditions such as urinary tract obstruction or prostate problems. Therefore, it is important to rule out any underlying urological issues in order to provide appropriate care and treatment for the patient.

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  • 37. 

    You examine a 59-year-old man with a chief complaint of new onset of rectal pain after a bout of constipation. On exam, you not an ulcerated lesion on the posterior midline of the anus. This presentation is most consistent with:

    • Perianl fistula

    • Anal fisure

    • External hemorrhoid

    • Crohn proctitis

    Correct Answer
    A. Anal fisure
    Explanation
    The correct answer is Anal fissure. An anal fissure is a small tear in the lining of the anus, commonly caused by passing hard or large stools. The symptom of rectal pain after constipation and the presence of an ulcerated lesion on the posterior midline of the anus are classic findings of an anal fissure. Perianal fistula is characterized by a painful, purulent discharge near the anus, while external hemorrhoids present as swollen veins in the anal area. Crohn's proctitis is a form of inflammatory bowel disease that affects the rectum and presents with symptoms such as rectal bleeding and diarrhea.

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  • 38. 

    Imaging in a patient with suspected symptomatic cholelithiasis usually includes obtaining an abdominal:

    • MRI

    • CT

    • Ultrasound

    • Flat plate

    Correct Answer
    A. Ultrasound
    Explanation
    Ultrasound is the preferred imaging modality for evaluating patients with suspected symptomatic cholelithiasis. It is non-invasive, widely available, and does not involve the use of ionizing radiation. Ultrasound can effectively visualize the gallbladder and detect the presence of gallstones. It can also assess for complications such as inflammation or obstruction. MRI and CT are alternative imaging options but are typically reserved for specific indications such as evaluating biliary anatomy or assessing for complications. A flat plate is not commonly used for imaging cholelithiasis.

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  • 39. 

    The gastric parietal cells produce:

    • Hydrochloric acid

    • A protective mucus layer

    • Prostaglandins

    • Prokinetic hormones

    Correct Answer
    A. Hydrochloric acid
    Explanation
    Gastric parietal cells are responsible for producing hydrochloric acid in the stomach. This acid plays a crucial role in the digestion process by breaking down food and killing harmful bacteria that may enter the stomach. It also helps in the absorption of certain nutrients. The production of hydrochloric acid is tightly regulated to maintain the pH balance in the stomach.

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  • 40. 

    Immune modulators are often used for intervention in:

    • Ulcerative colitis

    • Irritable bowel syndrome

    • Crohn disease

    • Ulcerative colitis and Crohn disease

    Correct Answer
    A. Ulcerative colitis and Crohn disease
    Explanation
    Immune modulators are often used for intervention in ulcerative colitis and Crohn's disease. Both of these conditions are chronic inflammatory bowel diseases that involve abnormal immune responses in the gastrointestinal tract. Immune modulators help to regulate and suppress the immune system, reducing inflammation and preventing further damage to the intestines. They are an important part of the treatment plan for individuals with ulcerative colitis and Crohn's disease to control symptoms and maintain remission. Immune modulators are not typically used for intervention in irritable bowel syndrome, as it is a functional disorder rather than an inflammatory condition.

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  • 41. 

    After a decade of disease, a person with ulcerative colitis is at increased risk of malignancy involving the:

    • Small bowel

    • Large intestine

    • Duodenum

    • Stomach

    Correct Answer
    A. Large intestine
    Explanation
    After a decade of disease, a person with ulcerative colitis is at increased risk of malignancy involving the large intestine. Ulcerative colitis is a chronic inflammatory disease that primarily affects the large intestine. Prolonged inflammation in the colon can lead to the development of dysplasia, which is a precancerous condition. Over time, dysplasia can progress to colorectal cancer. Therefore, individuals with ulcerative colitis have a higher risk of malignancy in the large intestine compared to other parts of the digestive system.

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  • 42. 

    Angiotensin-converting enzyme inhibitors can limit the progression of some forms of renal disease by:

    • Increasing intraglomerular pressure

    • Reducing efferent arteriolar resistance

    • Enhancing afferent arteriolar tone

    • Increasing urinary protein excretion

    Correct Answer
    A. Reducing efferent arteriolar resistance
    Explanation
    Angiotensin-converting enzyme inhibitors work by inhibiting the enzyme responsible for converting angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor that causes constriction of the efferent arterioles in the kidneys, leading to increased intraglomerular pressure. By reducing efferent arteriolar resistance, angiotensin-converting enzyme inhibitors can counteract this effect of angiotensin II and help to maintain normal intraglomerular pressure. This can limit the progression of renal disease by preventing further damage to the glomeruli and preserving kidney function.

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  • 43. 

    You are caring for a 45-year-old woman from a developing country. She reports that she has had "yellow jaundice" as a young child. Her PE is unremarkable. Her labs are as follows: AST, 22 U/L (normal, 0 to 31 U/L); alanine aminotransferase (ALT), 25 U/L (normal, 0 to 40 U/L); Hepatitis A virus immunoglobulin G (HAV IgG) positive. Lab testing reveals:

    • Chronic Hep. A

    • No evidence of prior or current Hep. A infection.

    • Resolved Hep. A infection

    • Prodromal Hep. A

    Correct Answer
    A. Resolved Hep. A infection
    Explanation
    The patient's history of "yellow jaundice" as a young child, along with the positive HAV IgG result, indicates that she had a past infection with Hepatitis A. The normal levels of AST and ALT suggest that there is no ongoing liver damage or inflammation. Therefore, the correct answer is "Resolved Hep. A infection," indicating that the patient had a previous infection with Hepatitis A but has now recovered from it.

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  • 44. 

    "Skip lesions" are usually reported in:

    • Irritable bowel syndrome

    • Ulcerative colitis

    • Crohn disease

    • C. diff colitis

    Correct Answer
    A. Crohn disease
    Explanation
    Skip lesions are usually reported in Crohn's disease. This is because Crohn's disease is a type of inflammatory bowel disease that can affect any part of the gastrointestinal tract, from the mouth to the anus. It is characterized by the presence of skip lesions, which are areas of inflammation that are separated by normal or unaffected areas of the intestine. This pattern of involvement is unique to Crohn's disease and helps to differentiate it from other conditions such as ulcerative colitis or irritable bowel syndrome. C. diff colitis is caused by a bacterial infection and does not typically present with skip lesions.

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  • 45. 

    A 24-year-old man presents with a 3-month history of upper abdominal pain. He describes it as an intermittent, centrally located "burning" feeling in his upper abdomen, most often occurring  2-3 hours after meals. His presentation is mosts consistent with the clinical presentation of:

    • Acute gastritis

    • Gastric ulcer

    • Duodenal ulcer

    • Cholecystitis

    Correct Answer
    A. Duodenal ulcer
    Explanation
    The patient's clinical presentation of intermittent, centrally located "burning" pain in the upper abdomen that occurs 2-3 hours after meals is most consistent with the clinical presentation of a duodenal ulcer. Duodenal ulcers are commonly associated with increased acid production and occur in the first part of the small intestine (duodenum). The pain is often relieved by eating or taking antacids, which is consistent with the patient's description. Acute gastritis, gastric ulcer, and cholecystitis would have different clinical presentations and are less likely based on the given information.

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  • 46. 

    Which of the following statements is true regarding the Hep. C infection?

    • It usually manifests with jaundice, fever, and significany hepatomegaly

    • Among health-care workers, it is most commonly found in nurses

    • More than 50% of persons with acute hepatitis C go on to develop chronic infection

    • Interferon therapy is consistently curative

    Correct Answer
    A. More than 50% of persons with acute hepatitis C go on to develop chronic infection
    Explanation
    More than 50% of persons with acute hepatitis C go on to develop chronic infection. This means that a significant number of individuals who are initially infected with hepatitis C will continue to have the infection for a long period of time. It suggests that acute hepatitis C does not always resolve on its own and can progress to a chronic condition. This highlights the importance of early detection and treatment to prevent the development of chronic hepatitis C infection.

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  • 47. 

    An example of a medication with prokinetic activity is:

    • Dicyclomine (Bentyl)

    • Metoclopramide (Reglan)

    • Loperamide (Imodium)

    • Psyllium (Metamucil)

    Correct Answer
    A. Metoclopramide (Reglan)
    Explanation
    Metoclopramide (Reglan) is an example of a medication with prokinetic activity. Prokinetic medications enhance the movement of the gastrointestinal tract, promoting the forward flow of contents. Metoclopramide acts by increasing the release of acetylcholine, a neurotransmitter that stimulates muscle contractions in the stomach and intestines. This helps to improve gastric emptying and intestinal motility. Therefore, Metoclopramide is the correct answer as it is specifically designed to enhance gastrointestinal motility.

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  • 48. 

    In evaluating a patient with suspected appendicitis, the clinician considers that:

    • The presentation may differ according to the anatomical location of the appendix

    • This is a common reason for acute abdominal pain in elderly patients

    • Vomiting before onset of abdominal pain is often seen

    • The presentation is markedly different from the presentation of pelvic inflammatory disease

    Correct Answer
    A. The presentation may differ according to the anatomical location of the appendix
    Explanation
    The correct answer states that the presentation of appendicitis may differ depending on the anatomical location of the appendix. This means that the symptoms and signs of appendicitis can vary depending on where the appendix is located in the body. For example, if the appendix is located in a retrocecal position, the pain may be felt more in the flank or back rather than the lower right quadrant of the abdomen. This knowledge is important for clinicians to consider when evaluating a patient with suspected appendicitis, as it can help guide their diagnostic approach and interpretation of symptoms.

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  • 49. 

    The H2RA most likely to cause drug interactions with phenytoin and theophylline is:

    • Cimetidine

    • Famotidine

    • Nizatidine

    • Ranitidine

    Correct Answer
    A. Cimetidine
    Explanation
    Cimetidine is the H2RA most likely to cause drug interactions with phenytoin and theophylline. This is because cimetidine inhibits the cytochrome P450 enzyme system, which is responsible for the metabolism of these drugs. By inhibiting this enzyme system, cimetidine can increase the levels of phenytoin and theophylline in the body, leading to potential toxicity. Famotidine, nizatidine, and ranitidine are also H2RAs, but they have a lower likelihood of causing drug interactions with phenytoin and theophylline compared to cimetidine.

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Quiz Review Timeline (Updated): Apr 19, 2024 +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Apr 19, 2024
    Quiz Edited by
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  • Nov 13, 2010
    Quiz Created by
    Ctichy84

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