Np Test 4: Abdominal Disorders

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Questions and Answers
  • 1. 

    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:

    • A.

      Perianl fistula

    • B.

      Anal fisure

    • C.

      External hemorrhoid

    • D.

      Crohn proctitis

    Correct Answer
    B. 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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  • 2. 

    Rectal bleeding associated with hemorrhoids is usually described as:

    • A.

      Streaks of bright red blood on the stool

    • B.

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

    • C.

      A large amount of brisk red bleeding

    • D.

      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. 

    Therapy for hemorrhoids includes all of the following except:

    • A.

      Weight control

    • B.

      Low-fat diet

    • C.

      Topical corticosteroids

    • D.

      Stool softener

    Correct Answer
    B. Low-fat diet
    Explanation
    Therapy for hemorrhoids typically includes weight control, topical corticosteroids, and stool softeners. However, a low-fat diet is not specifically mentioned as a part of hemorrhoid therapy. While maintaining a healthy diet is generally recommended for overall well-being, it may not directly impact the treatment of hemorrhoids. Hence, a low-fat diet is not included in the therapy for hemorrhoids.

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  • 4. 

    All of the following are typically noted in a young adult with the diagnosis of acute appendicitis except:

    • A.

      Epigastric pain

    • B.

      Positive obturator sign

    • C.

      Rebound tenderness

    • D.

      Marked febrile response

    Correct Answer
    D. Marked febrile response
    Explanation
    In a young adult with the diagnosis of acute appendicitis, all of the following symptoms are typically noted: epigastric pain, positive obturator sign, and rebound tenderness. However, a marked febrile response is not typically seen in acute appendicitis. This means that a high fever is not commonly associated with this condition.

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  • 5. 

    A 26-year-old man presents with acute abdominal pain. As part of the evaluation for acute appendicitis, you order a WBC with differential and anticipate the following results:

    • A.

      Total WBC - 4500 mm3; Neutrophils - 35%, Bands 2% and lymphocytes - 45%

    • B.

      Total WBC - 14,000 mm3; Neutrophils - 55%, Bands 3% and Lymphocytes - 38%

    • C.

      Total WBC - 16,500 mm3; Neutrophils - 66%, Bands - 8% and Lymphocytes - 22%

    • D.

      Total WBC - 18,100 mm3; Neutrophils - 55%, Bands - 3% and Lymphocytes - 28%

    Correct Answer
    C. Total WBC - 16,500 mm3; Neutrophils - 66%, Bands - 8% and Lymphocytes - 22%
    Explanation
    The correct answer is likely the one with a higher total WBC count (16,500 mm3) and a higher percentage of neutrophils (66%). This suggests an increase in the number of neutrophils, which is consistent with an inflammatory response seen in acute appendicitis. The presence of bands (immature neutrophils) also indicates an ongoing infection. The lower percentage of lymphocytes (22%) further supports the diagnosis, as lymphocytes are typically decreased in acute appendicitis.

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  • 6. 

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

    • A.

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

    • B.

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

    • C.

      Vomiting before onset of abdominal pain is often seen

    • D.

      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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  • 7. 

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

    • A.

      Passive extension of the hip

    • B.

      Passive flexion an internal rotation of the hip

    • C.

      Deep palpation

    • D.

      Asking the patient to cough

    Correct Answer
    A. Passive extension of the hip
    Explanation
    The psoas sign refers to abdominal pain that is elicited by passive extension of the hip. This sign is commonly used in clinical examinations to assess for inflammation or irritation of the psoas muscle, which can be caused by conditions such as appendicitis or psoas abscess. Passive extension of the hip stretches the psoas muscle, leading to pain if there is an underlying pathology. This sign is helpful in diagnosing and evaluating the severity of certain abdominal conditions.

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  • 8. 

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

    • A.

      Passive extension of the hip

    • B.

      Passive flexion of the hip

    • C.

      Deep palpation

    • D.

      Asking the patient to cough

    Correct Answer
    B. 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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  • 9. 

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

    • A.

      MRI

    • B.

      CT

    • C.

      Ultrasound

    • D.

      Flat plate

    Correct Answer
    B. 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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  • 10. 

    Which of the following WBC forms is an ominous finding in the presence of severe bacterial infection?

    • A.

      Neutrophil

    • B.

      Lymphocyte

    • C.

      Basophil

    • D.

      Metamyelocyte

    Correct Answer
    D. Metamyelocyte
    Explanation
    A metamyelocyte is an immature form of a white blood cell that is typically not seen in the bloodstream. Its presence suggests that the bone marrow is releasing immature cells in response to a severe bacterial infection. This indicates a dysfunctional or overwhelmed immune response, which can be a sign of a serious and potentially life-threatening infection.

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  • 11. 

    Which of the following best represents the peak ages for occurrence of acute appendicitis?

    • A.

      1-20 years

    • B.

      20-40 years

    • C.

      10-30 years

    • D.

      30-50 years

    Correct Answer
    C. 10-30 years
    Explanation
    The peak ages for the occurrence of acute appendicitis are typically between 10-30 years. This age range is when the appendix is most susceptible to inflammation and infection, resulting in appendicitis. It is important to note that while appendicitis can occur at any age, it is most commonly seen in this particular age group.

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  • 12. 

    Clinical findings most consistent with appendiceal rupture include all of the following except:

    • A.

      Abdominal discomfort less than 24 hours in duration

    • B.

      Fever > 102F

    • C.

      Palpable abdominal mass

    • D.

      Marked leukocytosis with total WBC greater than 20,000/ mm3

    Correct Answer
    A. Abdominal discomfort less than 24 hours in duration
    Explanation
    Clinical findings most consistent with appendiceal rupture include fever > 102F, palpable abdominal mass, and marked leukocytosis with total WBC greater than 20,000/ mm3. Appendiceal rupture is a serious condition that occurs when the appendix becomes inflamed and eventually bursts. This can lead to the spread of infection and inflammation in the abdominal cavity. The presence of fever, palpable abdominal mass, and marked leukocytosis are all indicative of a severe infection and inflammation, which are commonly seen in cases of appendiceal rupture. However, abdominal discomfort lasting less than 24 hours is not typically associated with appendiceal rupture, as the pain usually worsens over time.

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  • 13. 

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

    • A.

      Occupational exposure to textile dyes

    • B.

      Cigarette smoking

    • C.

      Occupational exposure to heavy metals

    • D.

      Long-term aspirin use

    Correct Answer
    D. 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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  • 14. 

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

    • A.

      Painful urination

    • B.

      Fever and flank pain

    • C.

      Painless frank hematuria

    • D.

      Palpable abdominal mass

    Correct Answer
    C. 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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  • 15. 

    In a person diagnosed with superficial bladder cancer without evidence of metastases, you realize that:

    • A.

      The prognosis for 2-year survival is poor

    • B.

      A cystectomy is indicated

    • C.

      Despite successful initial therapy, local recurrence is common

    • D.

      Systemic chemotherapy is the treatment of choice

    Correct Answer
    C. Despite successful initial therapy, local recurrence is common
    Explanation
    Local recurrence refers to the reappearance of cancer cells in the same area where the cancer was initially treated. In the case of superficial bladder cancer, despite successful initial therapy, local recurrence is common. This means that even if the cancer is effectively treated in the beginning, there is a high likelihood of the cancer coming back in the same area. This highlights the importance of close monitoring and follow-up after initial treatment to detect and manage any potential recurrence.

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  • 16. 

    Persistent microscopic hematuria would be the primary finding in about ______% of individuals with bladder cancer.

    • A.

      10

    • B.

      20

    • C.

      30

    • D.

      40

    Correct Answer
    B. 20
    Explanation
    Persistent microscopic hematuria is a common symptom of bladder cancer, and it is estimated that approximately 20% of individuals with bladder cancer would have this as the primary finding. This means that in one-fifth of cases, the presence of blood in the urine would be the main indication of bladder cancer. It is important to note that other symptoms and diagnostic tests would also be necessary to confirm the diagnosis.

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  • 17. 

    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:

    • A.

      Hepatoma

    • B.

      Acute cholecystitis

    • C.

      Acute hepatitis

    • D.

      Cholelithiasis

    Correct Answer
    B. 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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  • 18. 

    Which of the following is usually not seen in the diagnosis of acute cholecystitis?

    • A.

      Elevated lactic dehydrogenase level

    • B.

      Increased alkaline phosphatase level

    • C.

      Leukocytosis

    • D.

      Elevated AST level

    Correct Answer
    A. Elevated lactic dehydrogenase level
    Explanation
    Elevated lactic dehydrogenase (LDH) level is usually not seen in the diagnosis of acute cholecystitis. LDH is an enzyme that is found in many tissues of the body, including the liver and gallbladder. In acute cholecystitis, the inflammation of the gallbladder, the most common laboratory findings include increased alkaline phosphatase level, leukocytosis (elevated white blood cell count), and elevated AST (aspartate aminotransferase) level. However, LDH is not typically elevated in acute cholecystitis, making it the correct answer.

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  • 19. 

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

    • A.

      RUQ abdominal palpation

    • B.

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

    • C.

      Asking the patient to cough

    • D.

      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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  • 20. 

    Risk factors for cholelithiasis include all of the following except:

    • A.

      Genetics

    • B.

      Rapid weight loss

    • C.

      Obesity

    • D.

      High-fiber diet

    Correct Answer
    D. 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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  • 21. 

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

    • A.

      MRI

    • B.

      CT

    • C.

      Ultrasound

    • D.

      Flat plate

    Correct Answer
    C. 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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  • 22. 

    Which of the following is most likely to be found in a person with acute cholecystitis?

    • A.

      Fever

    • B.

      Vomiting

    • C.

      Jaundice

    • D.

      Palpable gallbladder

    Correct Answer
    B. Vomiting
    Explanation
    Acute cholecystitis is inflammation of the gallbladder, usually caused by gallstones. It commonly presents with symptoms such as fever, vomiting, and right upper abdominal pain. However, the presence of vomiting is the most likely symptom to be found in a person with acute cholecystitis. Vomiting can occur due to the irritation and inflammation of the gallbladder, leading to nausea and subsequent vomiting.

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  • 23. 

    Which of the following is true concerning colorectal cancer?

    • A.

      Most colorectal cancers are found during rectal exam

    • B.

      Rectal carcinoma is more common than cancers involving the colon

    • C.

      Early manifestations include abdominal pain and cramping

    • D.

      Later disease presentation often includes iron deficiency anemia

    Correct Answer
    D. Later disease presentation often includes iron deficiency anemia
    Explanation
    Later disease presentation often includes iron deficiency anemia. This is because colorectal cancer can cause bleeding in the digestive tract, leading to chronic blood loss. Over time, this can result in iron deficiency anemia, as iron is necessary for the production of red blood cells. Iron deficiency anemia can cause symptoms such as fatigue, weakness, and shortness of breath. However, it is important to note that not all cases of colorectal cancer will present with iron deficiency anemia, and other symptoms and diagnostic tests are also used to detect and diagnose the disease.

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  • 24. 

    According to the American Cancer Society recommendations, which of the following is the preferred method for annual colorectal cancer screening in a 51-year-old man?

    • A.

      Digital rectal exam

    • B.

      Fecal occult blood test

    • C.

      Colonoscopy

    • D.

      Barium enema study

    Correct Answer
    B. Fecal occult blood test
    Explanation
    The preferred method for annual colorectal cancer screening in a 51-year-old man, according to the American Cancer Society recommendations, is the fecal occult blood test. This test is a simple and non-invasive way to detect hidden blood in the stool, which can be an early sign of colorectal cancer. It is recommended annually as a screening tool because it can help identify individuals who may need further diagnostic tests, such as a colonoscopy, to confirm the presence of cancer. The other options listed, such as digital rectal exam, barium enema study, are not recommended as the preferred method for annual screening.

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  • 25. 

    Which of the following is most likely to be noted in a person with colorectal cancer?

    • A.

      Gross rectal bleeding

    • B.

      Weight loss

    • C.

      Few symptoms

    • D.

      Nausea and vomiting

    Correct Answer
    C. Few symptoms
    Explanation
    Colorectal cancer is often asymptomatic in its early stages, which means that it may not cause noticeable symptoms. As a result, it is likely that a person with colorectal cancer will have few symptoms. This can make it challenging to detect the disease early on, as individuals may not seek medical attention until the cancer has progressed. Therefore, the presence of few symptoms is a characteristic that is commonly noted in individuals with colorectal cancer.

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  • 26. 

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

    • A.

      A family history of colorectal cancer

    • B.

      Familial polyposis

    • C.

      Personal history of neoplasm

    • D.

      Long-term aspirin use

    Correct Answer
    D. 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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  • 27. 

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

    • A.

      Diarrhea and leukocytosis

    • B.

      Constipation and fever

    • C.

      Few or no symptoms

    • D.

      Frank blood in the stool with reduced stool calibur

    Correct Answer
    C. Few or no symptoms
    Explanation
    Colonic diverticulosis is a condition characterized by the presence of small pouches or diverticula in the colon. In many cases, individuals with colonic diverticulosis may not experience any symptoms, hence the answer "Few or no symptoms" is most consistent with this condition. While diarrhea and leukocytosis, constipation and fever, and frank blood in the stool with reduced stool caliber can be associated with other gastrointestinal conditions, they are not typically seen in patients with colonic diverticulosis.

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  • 28. 

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

    • A.

      Cramping, diarrhea, and leukocytosis

    • B.

      Constipation and fever

    • C.

      Right-sided abdominal pain

    • D.

      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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  • 29. 

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

    • A.

      Epigastric

    • B.

      LLQ

    • C.

      RLQ

    • D.

      Suprapubic

    Correct Answer
    B. 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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  • 30. 

    Prevention of acute colonic diverticulitis includes:

    • A.

      Use of antidiarrheal agents

    • B.

      Avoiding gas-producing foods

    • C.

      High-fiber diet

    • D.

      Low-dose antibiotic therapy

    Correct Answer
    C. 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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  • 31. 

    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?

    • A.

      Flat plate

    • B.

      Ultrasound

    • C.

      CT

    • D.

      Barium enema

    Correct Answer
    C. 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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  • 32. 

    Recommended antimicrobial therapy in acute diverticulitis includes:

    • A.

      Amoxicillin with clarithromycin

    • B.

      Linezolid with daptomycin

    • C.

      Ciprofloxacin with metroniazole

    • D.

      Nitrofurantoin with doxycycline

    Correct Answer
    C. 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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  • 33. 

    Lower GI hemorrhage associated with diverticular disease usually manifests as:

    • A.

      A painless event

    • B.

      A condition noted to be found with a marked febrile response

    • C.

      A condition accompanied by crampy abdominal pain

    • D.

      A common chronic condition

    Correct Answer
    A. A painless event
    Explanation
    Lower GI hemorrhage associated with diverticular disease usually manifests as a painless event. This means that individuals experiencing this condition may not feel any pain or discomfort during the bleeding. This is because the bleeding usually occurs from small blood vessels in the diverticula, which are small pouches that can form in the colon. The blood is often mixed with the stool and may be noticed as bright red or maroon-colored blood. However, it is important to note that if the bleeding is severe or persistent, it may lead to other symptoms such as abdominal pain, fever, or anemia.

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  • 34. 

    The gastric parietal cells produce:

    • A.

      Hydrochloric acid

    • B.

      A protective mucus layer

    • C.

      Prostaglandins

    • D.

      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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  • 35. 

    Antiprostaglandin drugs cause stomach mucosal injury primarily by:

    • A.

      A direct irritative effect

    • B.

      Altering the thickness of the protective mucosal layer

    • C.

      Decreasing the peristalsis

    • D.

      Modifying the pH level

    Correct Answer
    B. 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. 

    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:

    • A.

      Acute gastritis

    • B.

      Gastric ulcer

    • C.

      Duodenal ulcer

    • D.

      Cholecystitis

    Correct Answer
    C. 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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  • 37. 

    When choosing pharmacologic intervention to prevent recurrence of duodenal ulcer in a middle-aged man, you prescribe:

    • A.

      A proton pump inhibitor (PPI)

    • B.

      Timed antacid use

    • C.

      Antimicrobial therapy

    • D.

      A histamine-2 receptor blocker

    Correct Answer
    C. Antimicrobial therapy
    Explanation
    Antimicrobial therapy is the correct choice for preventing the recurrence of duodenal ulcers in a middle-aged man. Duodenal ulcers are often caused by the presence of Helicobacter pylori bacteria in the stomach, and antimicrobial therapy is effective in eradicating this bacteria. Proton pump inhibitors (PPIs), timed antacid use, and histamine-2 receptor blockers may help relieve symptoms, but they do not address the underlying cause of the ulcer. Therefore, antimicrobial therapy is the most appropriate intervention to prevent recurrence.

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  • 38. 

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

    • A.

      Cimetidine

    • B.

      Famotidine

    • C.

      Nizatidine

    • D.

      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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  • 39. 

    Which of the following is least likely to be found in a patient with gastric ulcer?

    • A.

      History of long-term naproxen use

    • B.

      Age younger than 50

    • C.

      Previous use of H2RA or antacids

    • D.

      Cigarette smoking

    Correct Answer
    B. Age younger than 50
    Explanation
    Patients with gastric ulcers are more likely to be older than 50 years of age. Age younger than 50 is least likely to be found in a patient with gastric ulcer.

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  • 40. 

    NSAID-induced peptic ulcer can be best limited by the use of:

    • A.

      An antacid

    • B.

      H2RA

    • C.

      An Appropriate antimicrobial

    • D.

      Misoprostol

    Correct Answer
    D. Misoprostol
    Explanation
    Misoprostol is the best option for limiting NSAID-induced peptic ulcers because it is a prostaglandin analog that helps to protect the lining of the stomach and prevent ulcers. NSAIDs can cause damage to the stomach lining by inhibiting the production of prostaglandins, which are important for maintaining the integrity of the mucosal barrier. Misoprostol works by replacing these prostaglandins and reducing the risk of ulcers. Antacids can provide temporary relief from symptoms but do not address the underlying issue of mucosal damage. H2RA (histamine-2 receptor antagonist) helps to reduce acid production but may not be as effective as misoprostol in preventing ulcers. An appropriate antimicrobial may be used if there is evidence of an infection, but it does not directly address the issue of NSAID-induced ulcers.

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  • 41. 

    Cyclooxygenase-1 (COX-1) contributes to:

    • A.

      The inflammatory response

    • B.

      Pain transmission

    • C.

      Maintenance of gastric protective mucosal layer

    • D.

      Renal arteriole constriction

    Correct Answer
    C. Maintenance of gastric protective mucosal layer
    Explanation
    COX-1, also known as cyclooxygenase-1, plays a role in maintaining the gastric protective mucosal layer. This layer helps to protect the stomach lining from damage caused by stomach acid and digestive enzymes. COX-1 is responsible for producing prostaglandins, which promote the production of mucus and bicarbonate in the stomach, both of which contribute to the maintenance of the mucosal layer. Inhibition of COX-1 can lead to a decrease in mucus and bicarbonate production, increasing the risk of gastric ulcers and damage to the stomach lining.

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  • 42. 

    Cyclooxygenase-2 (COX-2) contributes to:

    • A.

      The inflammatory response

    • B.

      Pain transmission inhibition

    • C.

      Maintenance of gastric protective mucosal layer

    • D.

      Renal arteriole constriction

    Correct Answer
    A. The inflammatory response
    Explanation
    Cyclooxygenase-2 (COX-2) is an enzyme that plays a key role in the production of prostaglandins, which are lipid molecules involved in various physiological processes. One of the main functions of COX-2 is to promote the inflammatory response. When tissues are damaged or infected, COX-2 is upregulated, leading to the production of prostaglandins that cause inflammation. This response helps to recruit immune cells and initiate the healing process. Therefore, COX-2 contributes to the inflammatory response.

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  • 43. 

    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:  

    • A.

      Acute gastroenteritis

    • B.

      Gastric Ulcer

    • C.

      Duodenal ulcer

    • D.

      Chronic cholecystitis

    Correct Answer
    B. 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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  • 44. 

    The most sensitive and specific test for H. pylori infection from the following list is:

    • A.

      Stool Gram stain, looking for the offending organism

    • B.

      Serological testing for antigen related to the infection

    • C.

      Organism-specific stool antigen testing

    • D.

      Fecal DNA testing

    Correct Answer
    C. Organism-specific stool antigen testing
    Explanation
    Organism-specific stool antigen testing is the most sensitive and specific test for H. pylori infection. This test directly detects the presence of H. pylori antigens in the stool, providing a reliable indication of an active infection. Stool Gram stain may not be as accurate as it relies on visual identification of the organism, which can be challenging. Serological testing for antigen related to the infection may not accurately differentiate between current and past infections. Fecal DNA testing may have lower sensitivity and specificity compared to the organism-specific stool antigen testing.

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  • 45. 

    Which of the following is a PPI?

    • A.

      Loperamide

    • B.

      Metoclopramide

    • C.

      Nizatidine

    • D.

      Lansoprazole

    Correct Answer
    D. 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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  • 46. 

    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:

    • A.

      Avoiding trigger foods

    • B.

      The use of a prokinetic agent

    • C.

      A daily dose PPI

    • D.

      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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  • 47. 

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

    • A.

      Esophageal stricture

    • B.

      Adenocarcinoma

    • C.

      GERD

    • D.

      H. Pylori colonization

    Correct Answer
    B. 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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  • 48. 

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

    • A.

      Enhance motility

    • B.

      Increase the pH of the stomach

    • C.

      Reduce lower esophageal pressure

    • D.

      Help limit the H. pylori growth

    Correct Answer
    B. 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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  • 49. 

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

    • A.

      Each tablet should be taken with a snack

    • B.

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

    • C.

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

    • D.

      Sucralfate should be taken with other prescribed meds to enhance compliance

    Correct Answer
    C. 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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  • 50. 

    Which of the following is most likely to be found in a 50-year-old woman with new-onset reflux esophagitis?

    • A.

      Initiation of estrogen-progestin hormonal therapy

    • B.

      Recent weight loss

    • C.

      Report of melena

    • D.

      Evidence of H. pylori infection

    Correct Answer
    A. Initiation of estrogen-progestin hormonal therapy
    Explanation
    A 50-year-old woman with new-onset reflux esophagitis is most likely to have initiated estrogen-progestin hormonal therapy. Reflux esophagitis is commonly associated with decreased levels of estrogen, which can lead to relaxation of the lower esophageal sphincter and increased risk of gastroesophageal reflux disease. Hormone replacement therapy, such as estrogen-progestin therapy, is often prescribed to alleviate symptoms of menopause and can contribute to the development of reflux esophagitis in susceptible individuals. The other options, recent weight loss, report of melena, and evidence of H. pylori infection, are not directly associated with the development of reflux esophagitis in this context.

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Quiz Review Timeline +

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
    ProProfs Editorial Team
  • Nov 13, 2010
    Quiz Created by
    Ctichy84
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