Np Test 4: Abdominal Disorders

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

Hematemesis

Chronic sore throat

Diarrhea

Melena

Persistent GERD, or gastroesophageal reflux disease, is a chronic condition characterized by the reflux of stomach acid into the esophagus. This can lead to irritation and inflammation of the esophagus, causing symptoms such as heartburn, regurgitation, and a persistent sore throat. Hematemesis (vomiting blood) and melena (black, tarry stools) are more commonly associated with gastrointestinal bleeding, which can occur in severe cases of GERD but are less likely to be reported compared to a chronic sore throat. Diarrhea is not a typical symptom of GERD and is more commonly associated with other gastrointestinal conditions.

Explanation

Persistent GERD, or gastroesophageal reflux disease, is a chronic condition characterized by the reflux of stomach acid into the esophagus. This can lead to irritation and inflammation of the esophagus, causing symptoms such as heartburn, regurgitation, and a persistent sore throat. Hematemesis (vomiting blood) and melena (black, tarry stools) are more commonly associated with gastrointestinal bleeding, which can occur in severe cases of GERD but are less likely to be reported compared to a chronic sore throat. Diarrhea is not a typical symptom of GERD and is more commonly associated with other gastrointestinal conditions.

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

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.

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.

3. The most common source of Hep A infection is:

Sharing IV drug equipment

Cooked seafood

Contaminated water supplies

Sexual contact

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.

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.

4. Which of the following is a PPI?

Loperamide

Metoclopramide

Nizatidine

Lansoprazole

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.

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.

5. 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

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.

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.

6. 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

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.

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.

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

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.

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.

8. 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

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.

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.

9. 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.

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.

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.

10. 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

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.

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.

11. 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

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.

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.

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

Epigastric

LLQ

RLQ

Suprapubic

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.

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.

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

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.

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.

14. 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

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.

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.

15. 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.

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.

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.

16. 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

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.

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.

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

Klebsiella species

Proteus mirabilis

E. coli

Staph. saprophyticus

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.

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.

18. Prevention of acute colonic diverticulitis includes:

Use of antidiarrheal agents

Avoiding gas-producing foods

High-fiber diet

Low-dose antibiotic therapy

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.

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.

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

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.

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.

20. 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

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.

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.

21. Recommended antimicrobial therapy in acute diverticulitis includes:

Amoxicillin with clarithromycin

Linezolid with daptomycin

Ciprofloxacin with metroniazole

Nitrofurantoin with doxycycline

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.

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.

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.

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.

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.

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

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.

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.

24. 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

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.

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.

25. 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

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.

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.

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

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.

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.

27. 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

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.

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.

28. 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

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.

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.

29. Risk factors for cholelithiasis include all of the following except:

Genetics

Rapid weight loss

Obesity

High-fiber diet

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.

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.

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

Hypokalemia

Hypotension

Constipation

Anemia

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.

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.

31. 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

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.

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.

32. 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

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.

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.

33. 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

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.

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.

34. 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

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.

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.

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

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.

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.

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.

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.

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.

37. The gastric parietal cells produce:

Hydrochloric acid

A protective mucus layer

Prostaglandins

Prokinetic hormones

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.

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.

38. Immune modulators are often used for intervention in:

Ulcerative colitis

Irritable bowel syndrome

Crohn disease

Ulcerative colitis and Crohn disease

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.

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.

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

Small bowel

Large intestine

Duodenum

Stomach

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.

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.

40. 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

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.

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.

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

MRI

CT

Ultrasound

Flat plate

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.

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.

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

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.

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.

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

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.

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.

44. "Skip lesions" are usually reported in:

Irritable bowel syndrome

Ulcerative colitis

Crohn disease

C. diff colitis

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.

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.

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

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.

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.

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

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.

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.

47. An example of a medication with prokinetic activity is:

Dicyclomine (Bentyl)

Metoclopramide (Reglan)

Loperamide (Imodium)

Psyllium (Metamucil)

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.

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.

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

Cimetidine

Famotidine

Nizatidine

Ranitidine

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.

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.

49. A 38-year-old man with a recent history of injection drug use presents with malaise, nausea, fatigue, and "yellow eyes" for the past week. After ordering diagnostic tests, you confirm the diagnosis of acute hepatitis B. Anticipated lab results include:

Hep B surface antibody (HBsAb)

Neutrophilia

Thrombocytosis

The presence of HBsAg

The presence of HBsAg indicates that the patient is currently infected with hepatitis B virus. HBsAg is the surface antigen of the hepatitis B virus and is present during the acute phase of infection. This finding confirms the diagnosis of acute hepatitis B in the patient. The other anticipated lab results, such as HBsAb (hepatitis B surface antibody), neutrophilia (increased neutrophil count), and thrombocytosis (increased platelet count), may also be seen in acute hepatitis B, but the presence of HBsAg is the most specific indicator of active infection.

Explanation

The presence of HBsAg indicates that the patient is currently infected with hepatitis B virus. HBsAg is the surface antigen of the hepatitis B virus and is present during the acute phase of infection. This finding confirms the diagnosis of acute hepatitis B in the patient. The other anticipated lab results, such as HBsAb (hepatitis B surface antibody), neutrophilia (increased neutrophil count), and thrombocytosis (increased platelet count), may also be seen in acute hepatitis B, but the presence of HBsAg is the most specific indicator of active infection.

50. To prevent an outbreak of Hep. D infection, a NP plans to:

Promote a campaign for clean food supplies

Immunize the population against Hep. B

Offer antiviral prophylaxis against the agent

Encourage frequent hand washing

Immunizing the population against Hep. B is the most effective way to prevent an outbreak of Hep. D infection. Hepatitis D is a liver infection caused by the Hepatitis D virus, which can only infect individuals who are already infected with Hepatitis B. By immunizing the population against Hepatitis B, the NP can prevent individuals from becoming infected with Hepatitis B and subsequently being at risk for Hepatitis D. This approach targets the root cause of Hepatitis D transmission and is therefore the best preventive measure.

Explanation

Immunizing the population against Hep. B is the most effective way to prevent an outbreak of Hep. D infection. Hepatitis D is a liver infection caused by the Hepatitis D virus, which can only infect individuals who are already infected with Hepatitis B. By immunizing the population against Hepatitis B, the NP can prevent individuals from becoming infected with Hepatitis B and subsequently being at risk for Hepatitis D. This approach targets the root cause of Hepatitis D transmission and is therefore the best preventive measure.

51. 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

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.

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.

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

Initiation of estrogen-progestin hormonal therapy

Recent weight loss

Report of melena

Evidence of H. pylori infection

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.

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.

53. Objective findings in patients with glomerulonephritis include all of the following except:

Edema

Urinary RBC casts

Proteinuria

Hypotension

Objective findings in patients with glomerulonephritis typically include edema, urinary RBC casts, and proteinuria. Hypotension, however, is not commonly associated with glomerulonephritis. Hypotension refers to abnormally low blood pressure, and while it can be seen in certain medical conditions, it is not a characteristic finding in glomerulonephritis. This suggests that hypotension is not a typical objective finding in patients with this condition.

Explanation

Objective findings in patients with glomerulonephritis typically include edema, urinary RBC casts, and proteinuria. Hypotension, however, is not commonly associated with glomerulonephritis. Hypotension refers to abnormally low blood pressure, and while it can be seen in certain medical conditions, it is not a characteristic finding in glomerulonephritis. This suggests that hypotension is not a typical objective finding in patients with this condition.

54. Diagnostic criteria for irritable bowel syndrome include abdominal pain that is associated with all of the following except:

Improvement with defecation

A change in frequency of stool

A change in stool form

Unexplained weight loss

Unexplained weight loss is not associated with irritable bowel syndrome. The other three criteria, including improvement with defecation, a change in frequency of stool, and a change in stool form, are commonly seen in individuals with irritable bowel syndrome. Weight loss without a clear explanation may indicate a different underlying condition and should be further evaluated by a healthcare professional.

Explanation

Unexplained weight loss is not associated with irritable bowel syndrome. The other three criteria, including improvement with defecation, a change in frequency of stool, and a change in stool form, are commonly seen in individuals with irritable bowel syndrome. Weight loss without a clear explanation may indicate a different underlying condition and should be further evaluated by a healthcare professional.

55. 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:

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

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

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

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

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.

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.

56. Hyperbilirubinemia can cause all of the following except:

Potential displacement of highly protein-bound drugs

Scleral icterus

Cola-colored urine

Reduction in urobilinogen

Hyperbilirubinemia is a condition characterized by elevated levels of bilirubin in the blood. Bilirubin is a yellow pigment produced during the breakdown of red blood cells. In hyperbilirubinemia, the liver is unable to properly process and excrete bilirubin, leading to its accumulation in the body. This condition can cause various symptoms, including scleral icterus (yellowing of the whites of the eyes), cola-colored urine, and potential displacement of highly protein-bound drugs. However, reduction in urobilinogen, which is a byproduct of bilirubin metabolism, is not a typical consequence of hyperbilirubinemia.

Explanation

Hyperbilirubinemia is a condition characterized by elevated levels of bilirubin in the blood. Bilirubin is a yellow pigment produced during the breakdown of red blood cells. In hyperbilirubinemia, the liver is unable to properly process and excrete bilirubin, leading to its accumulation in the body. This condition can cause various symptoms, including scleral icterus (yellowing of the whites of the eyes), cola-colored urine, and potential displacement of highly protein-bound drugs. However, reduction in urobilinogen, which is a byproduct of bilirubin metabolism, is not a typical consequence of hyperbilirubinemia.

57. Diagnostic testing in inflammatory bowel disease often reveals:

Evidence of underlying inflammation

Notation of intestinal parasites

Normal results on most testing

A characteristic intra-abdominal mass on radiological imaging.

Diagnostic testing in inflammatory bowel disease often reveals evidence of underlying inflammation. This is because inflammatory bowel disease is characterized by chronic inflammation of the gastrointestinal tract. Diagnostic tests such as blood tests, stool tests, endoscopy, and imaging studies like CT scans or MRI can detect markers of inflammation such as elevated levels of C-reactive protein or erythrocyte sedimentation rate, presence of white blood cells or fecal calprotectin in the stool, and visible signs of inflammation in the intestinal lining. These findings help confirm the diagnosis of inflammatory bowel disease and guide treatment decisions.

Explanation

Diagnostic testing in inflammatory bowel disease often reveals evidence of underlying inflammation. This is because inflammatory bowel disease is characterized by chronic inflammation of the gastrointestinal tract. Diagnostic tests such as blood tests, stool tests, endoscopy, and imaging studies like CT scans or MRI can detect markers of inflammation such as elevated levels of C-reactive protein or erythrocyte sedimentation rate, presence of white blood cells or fecal calprotectin in the stool, and visible signs of inflammation in the intestinal lining. These findings help confirm the diagnosis of inflammatory bowel disease and guide treatment decisions.

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

Elevated lactic dehydrogenase level

Increased alkaline phosphatase level

Leukocytosis

Elevated AST level

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.

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.

59. Which of the following is true regarding Hep B. vaccine?

The vaccine contains the live Hep. B virus

The NP should consider checking postvaccination HBsAb titers only for individuals at highest risk for infection

The vaccine is contraindicated in the presence of HIV infection

Postvaccination arthralgias are often reported

The correct answer is that the NP should consider checking postvaccination HBsAb titers only for individuals at highest risk for infection. This means that it is not necessary to check the postvaccination HBsAb titers for all individuals who receive the Hep B vaccine, but only for those who are at the highest risk of infection. This is because checking the titers can help determine if the vaccine was effective in producing the necessary antibodies to protect against Hepatitis B.

Explanation

The correct answer is that the NP should consider checking postvaccination HBsAb titers only for individuals at highest risk for infection. This means that it is not necessary to check the postvaccination HBsAb titers for all individuals who receive the Hep B vaccine, but only for those who are at the highest risk of infection. This is because checking the titers can help determine if the vaccine was effective in producing the necessary antibodies to protect against Hepatitis B.

60. You see a 70-year-old woman in a walk-in center with a chief complaint of increased urinary frequency and dysuria. Urinalysis reveals pyuria and positive nitrites. She mentions she has a "bit of kidney trouble, not too bad." Recent evaluation of renal status is unavailable. In considering abx therapy for this patient, you prescribe:

Nitrofurantoin

Fosfomycin

Ciprofloxacin

Tetracycline

The correct answer is Ciprofloxacin. This is because the patient's symptoms of increased urinary frequency and dysuria, along with the findings of pyuria and positive nitrites on urinalysis, are consistent with a urinary tract infection (UTI). Ciprofloxacin is a commonly used antibiotic for treating UTIs, especially in older adults. Nitrofurantoin is another option for UTI treatment, but it may not be suitable for this patient due to her "bit of kidney trouble." Fosfomycin is generally reserved for uncomplicated UTIs, and tetracycline is not typically used for UTI treatment.

Explanation

The correct answer is Ciprofloxacin. This is because the patient's symptoms of increased urinary frequency and dysuria, along with the findings of pyuria and positive nitrites on urinalysis, are consistent with a urinary tract infection (UTI). Ciprofloxacin is a commonly used antibiotic for treating UTIs, especially in older adults. Nitrofurantoin is another option for UTI treatment, but it may not be suitable for this patient due to her "bit of kidney trouble." Fosfomycin is generally reserved for uncomplicated UTIs, and tetracycline is not typically used for UTI treatment.

61. Which of the following is true concerning colorectal cancer?

Most colorectal cancers are found during rectal exam

Rectal carcinoma is more common than cancers involving the colon

Early manifestations include abdominal pain and cramping

Later disease presentation often includes iron deficiency anemia

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.

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.

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

History of long-term naproxen use

Age younger than 50

Previous use of H2RA or antacids

Cigarette smoking

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.

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.

63. The use of which of the following medications can precipitate acute renal failure in a patient with bilateral renal artery stenosis?

Corticosteroids

Angiotensin II receptor antagonists

Beta-adrenergic antagonists

Cephalosporins

Angiotensin II receptor antagonists can precipitate acute renal failure in a patient with bilateral renal artery stenosis. This is because these medications block the action of angiotensin II, which is responsible for maintaining renal blood flow in patients with renal artery stenosis. By blocking the vasoconstrictive effects of angiotensin II, these medications can cause a sudden decrease in renal blood flow, leading to acute renal failure.

Explanation

Angiotensin II receptor antagonists can precipitate acute renal failure in a patient with bilateral renal artery stenosis. This is because these medications block the action of angiotensin II, which is responsible for maintaining renal blood flow in patients with renal artery stenosis. By blocking the vasoconstrictive effects of angiotensin II, these medications can cause a sudden decrease in renal blood flow, leading to acute renal failure.

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

Passive extension of the hip

Passive flexion an internal rotation of the hip

Deep palpation

Asking the patient to cough

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.

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.

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

Fever

Vomiting

Jaundice

Palpable gallbladder

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.

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.

66. Diagnostic testing in IBS often reveals:

Evidence of underlying inflammation

Anemia of chronic disease

Normal results on most testing

Mucosal thickening on abdominal radiologic imaging

The correct answer is "Normal results on most testing" because diagnostic testing for IBS typically does not show any abnormalities or evidence of underlying inflammation. This is because IBS is a functional disorder rather than a structural or inflammatory one. While other conditions may cause abnormalities such as anemia or mucosal thickening on imaging, these are not typically seen in IBS. Therefore, most diagnostic tests for IBS will come back as normal.

Explanation

The correct answer is "Normal results on most testing" because diagnostic testing for IBS typically does not show any abnormalities or evidence of underlying inflammation. This is because IBS is a functional disorder rather than a structural or inflammatory one. While other conditions may cause abnormalities such as anemia or mucosal thickening on imaging, these are not typically seen in IBS. Therefore, most diagnostic tests for IBS will come back as normal.

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

1-20 years

20-40 years

10-30 years

30-50 years

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.

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.

68. The clinical indication for the use of lubiprostone (Amitiza) is for:

The treatment of constipation that is not amenable to standard therapies

Intervention in intractable diarrhea

Control of intestinal inflammation

The relief of intestinal spasms

Lubiprostone (Amitiza) is indicated for the treatment of constipation that does not respond to standard therapies. This means that when other treatments have been tried and have not been effective in relieving constipation, lubiprostone can be used as an alternative option. It is not indicated for intervention in intractable diarrhea, control of intestinal inflammation, or relief of intestinal spasms.

Explanation

Lubiprostone (Amitiza) is indicated for the treatment of constipation that does not respond to standard therapies. This means that when other treatments have been tried and have not been effective in relieving constipation, lubiprostone can be used as an alternative option. It is not indicated for intervention in intractable diarrhea, control of intestinal inflammation, or relief of intestinal spasms.

69. Clinical findings in patients with acute Hep. B likely include all of the following except:

Abdominal rebound tenderness

Scleral icterus

A smooth, tender, palpable hepatic border

Report of myalgia

Clinical findings in patients with acute Hepatitis B typically include scleral icterus (yellowing of the whites of the eyes), a smooth, tender, palpable hepatic border (enlarged and tender liver), and myalgia (muscle pain). However, abdominal rebound tenderness is not typically associated with acute Hepatitis B. Abdominal rebound tenderness is a sign of peritonitis, which is inflammation of the lining of the abdominal cavity, and is not a characteristic finding in Hepatitis B.

Explanation

Clinical findings in patients with acute Hepatitis B typically include scleral icterus (yellowing of the whites of the eyes), a smooth, tender, palpable hepatic border (enlarged and tender liver), and myalgia (muscle pain). However, abdominal rebound tenderness is not typically associated with acute Hepatitis B. Abdominal rebound tenderness is a sign of peritonitis, which is inflammation of the lining of the abdominal cavity, and is not a characteristic finding in Hepatitis B.

70. An increase in creatinine from 1 to 2 mg/dL is typically seen with a _____ loss in renal function.

25%

50%

75%

100%

An increase in creatinine from 1 to 2 mg/dL is typically seen with a 50% loss in renal function. This is because creatinine is a waste product that is filtered out of the blood by the kidneys. When the kidneys are functioning properly, they are able to remove creatinine efficiently, resulting in a low level of creatinine in the blood. However, when there is a decrease in renal function, the kidneys are less able to filter out creatinine, leading to an increase in its concentration in the blood. A doubling of creatinine levels, from 1 to 2 mg/dL, is indicative of a 50% loss in renal function.

Explanation

An increase in creatinine from 1 to 2 mg/dL is typically seen with a 50% loss in renal function. This is because creatinine is a waste product that is filtered out of the blood by the kidneys. When the kidneys are functioning properly, they are able to remove creatinine efficiently, resulting in a low level of creatinine in the blood. However, when there is a decrease in renal function, the kidneys are less able to filter out creatinine, leading to an increase in its concentration in the blood. A doubling of creatinine levels, from 1 to 2 mg/dL, is indicative of a 50% loss in renal function.

71. An example of a 1st line therapeutic agent for the treatment of pyelonephritis is:

Amoxicillin with clavulanate

Trimethoprim-sulfamethoxazole

Ciprofloxacin

Nitrofurantoin

Ciprofloxacin is an example of a 1st line therapeutic agent for the treatment of pyelonephritis. Pyelonephritis is a bacterial infection of the kidneys, and ciprofloxacin is a fluoroquinolone antibiotic that is effective against a wide range of bacteria, including those commonly associated with pyelonephritis such as Escherichia coli. It has good tissue penetration and is often recommended as the initial treatment for uncomplicated cases of pyelonephritis. Amoxicillin with clavulanate is more commonly used for urinary tract infections, but may not be as effective against pyelonephritis. Trimethoprim-sulfamethoxazole and nitrofurantoin are also commonly used, but ciprofloxacin is considered a first-line option.

Explanation

Ciprofloxacin is an example of a 1st line therapeutic agent for the treatment of pyelonephritis. Pyelonephritis is a bacterial infection of the kidneys, and ciprofloxacin is a fluoroquinolone antibiotic that is effective against a wide range of bacteria, including those commonly associated with pyelonephritis such as Escherichia coli. It has good tissue penetration and is often recommended as the initial treatment for uncomplicated cases of pyelonephritis. Amoxicillin with clavulanate is more commonly used for urinary tract infections, but may not be as effective against pyelonephritis. Trimethoprim-sulfamethoxazole and nitrofurantoin are also commonly used, but ciprofloxacin is considered a first-line option.

72. Which of the following best describes the hemogram results in a person with anemia of chronic disease that often accompanies IBD?

Microcytic, hypochromic

Macrocytic, normochromic

Normocytic, normochromic

Hyperproliferative

Anemia of chronic disease is a type of anemia that often accompanies inflammatory bowel disease (IBD). In this condition, the hemogram results typically show normocytic red blood cells, which means that the size of the red blood cells is normal. Additionally, the hemoglobin content of the red blood cells is also normal, resulting in a normochromic appearance. This is different from other types of anemia where the red blood cells may be either smaller (microcytic) or larger (macrocytic) than normal, and the hemoglobin content may be lower (hypochromic) or higher (hyperproliferative) than normal.

Explanation

Anemia of chronic disease is a type of anemia that often accompanies inflammatory bowel disease (IBD). In this condition, the hemogram results typically show normocytic red blood cells, which means that the size of the red blood cells is normal. Additionally, the hemoglobin content of the red blood cells is also normal, resulting in a normochromic appearance. This is different from other types of anemia where the red blood cells may be either smaller (microcytic) or larger (macrocytic) than normal, and the hemoglobin content may be lower (hypochromic) or higher (hyperproliferative) than normal.

73. Therapy for hemorrhoids includes all of the following except:

Weight control

Low-fat diet

Topical corticosteroids

Stool softener

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.

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.

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

Diarrhea and leukocytosis

Constipation and fever

Few or no symptoms

Frank blood in the stool with reduced stool calibur

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.

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.

75. Cyclooxygenase-2 (COX-2) contributes to:

The inflammatory response

Pain transmission inhibition

Maintenance of gastric protective mucosal layer

Renal arteriole constriction

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.

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.

76. A 58-year-old man recently began taking an antihypertensive medication and reports that his "heartburn" has become much worse. He is most likely taking:

Atenolol

Trandolapril

Amlodipine

Losartan

Amlodipine is a calcium channel blocker commonly used as an antihypertensive medication. It works by relaxing the blood vessels, which helps to lower blood pressure. However, one of the side effects of amlodipine is heartburn or gastroesophageal reflux disease (GERD). This occurs because amlodipine can relax the lower esophageal sphincter, allowing stomach acid to flow back up into the esophagus, causing heartburn symptoms. Therefore, it is likely that the 58-year-old man's worsening heartburn is due to the amlodipine medication he is taking.

Explanation

Amlodipine is a calcium channel blocker commonly used as an antihypertensive medication. It works by relaxing the blood vessels, which helps to lower blood pressure. However, one of the side effects of amlodipine is heartburn or gastroesophageal reflux disease (GERD). This occurs because amlodipine can relax the lower esophageal sphincter, allowing stomach acid to flow back up into the esophagus, causing heartburn symptoms. Therefore, it is likely that the 58-year-old man's worsening heartburn is due to the amlodipine medication he is taking.

77. 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?

Digital rectal exam

Fecal occult blood test

Colonoscopy

Barium enema study

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.

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.

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

The prognosis for 2-year survival is poor

A cystectomy is indicated

Despite successful initial therapy, local recurrence is common

Systemic chemotherapy is the treatment of choice

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.

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.

79. In addition to the lab work described (normal AST and ALT), results reveal the following for the resolved Hep. A patient: Hep B surface antigen (HBsAg) positive. These findings are most consistent with:

No evidence of Hep B infection

Resolved Hep B infection

Chronic Hep. B

Evidence of effective Hep B immunization.

The patient's positive Hep B surface antigen (HBsAg) indicates the presence of the Hep B virus in their body. Since the patient has already resolved their Hep A infection, it is unlikely that the positive HBsAg result is due to a recent Hep B infection. Therefore, the most consistent explanation is that the patient has chronic Hep B, meaning they have been infected with the virus for a prolonged period of time.

Explanation

The patient's positive Hep B surface antigen (HBsAg) indicates the presence of the Hep B virus in their body. Since the patient has already resolved their Hep A infection, it is unlikely that the positive HBsAg result is due to a recent Hep B infection. Therefore, the most consistent explanation is that the patient has chronic Hep B, meaning they have been infected with the virus for a prolonged period of time.

80. Which of the following is not a gram-negative organism?

E. coli

K. pneumoniae

P. mirabilis

S. saprophyticus

S. saprophyticus is not a gram-negative organism because it is a gram-positive bacterium. Gram-negative organisms have a thin peptidoglycan layer in their cell walls, which allows them to retain the counterstain (safranin) and appear pink or red under a microscope. In contrast, gram-positive bacteria have a thick peptidoglycan layer that retains the crystal violet stain, causing them to appear purple or blue. Therefore, S. saprophyticus does not fit the criteria of a gram-negative organism.

Explanation

S. saprophyticus is not a gram-negative organism because it is a gram-positive bacterium. Gram-negative organisms have a thin peptidoglycan layer in their cell walls, which allows them to retain the counterstain (safranin) and appear pink or red under a microscope. In contrast, gram-positive bacteria have a thick peptidoglycan layer that retains the crystal violet stain, causing them to appear purple or blue. Therefore, S. saprophyticus does not fit the criteria of a gram-negative organism.

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

An antacid

H2RA

An Appropriate antimicrobial

Misoprostol

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.

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.

82. Cyclooxygenase-1 (COX-1) contributes to:

The inflammatory response

Pain transmission

Maintenance of gastric protective mucosal layer

Renal arteriole constriction

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.

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.

83. With fluoroquinolone use, length of antimicrobial therapy during uncomplicated pyelonephritis is typically:

5 days

1 week

2 weeks

3 weeks

The length of antimicrobial therapy during uncomplicated pyelonephritis with fluoroquinolone use is typically 1 week. This is because fluoroquinolones are highly effective in treating uncomplicated pyelonephritis and a shorter duration of therapy can help reduce the risk of antibiotic resistance and side effects associated with prolonged use.

Explanation

The length of antimicrobial therapy during uncomplicated pyelonephritis with fluoroquinolone use is typically 1 week. This is because fluoroquinolones are highly effective in treating uncomplicated pyelonephritis and a shorter duration of therapy can help reduce the risk of antibiotic resistance and side effects associated with prolonged use.

84. A 68-year-old woman with heart failure presents with tachycardia, S3 heart sound and basilar cracles bilaterally. BP is 90/68 mmHg; BUN is 58 mg/dL (20.7 mmol/L); creatinine level is 2.4 mg/dL. This clinical presentation is most consistent with:

Prerenal azotemia

Acute glomerulonephritis

Tubular necrosis

Postrenal azotemia

The clinical presentation of a 68-year-old woman with heart failure, tachycardia, S3 heart sound, basilar crackles bilaterally, and low blood pressure suggests that there is decreased blood flow to the kidneys. This can lead to prerenal azotemia, which is characterized by elevated BUN and creatinine levels due to decreased renal perfusion. In prerenal azotemia, the kidneys are not receiving enough blood flow, leading to impaired filtration and reabsorption. Acute glomerulonephritis and tubular necrosis would have different clinical findings and would not be consistent with the given presentation. Postrenal azotemia, caused by obstruction of the urinary tract, would typically present with different symptoms and signs.

Explanation

The clinical presentation of a 68-year-old woman with heart failure, tachycardia, S3 heart sound, basilar crackles bilaterally, and low blood pressure suggests that there is decreased blood flow to the kidneys. This can lead to prerenal azotemia, which is characterized by elevated BUN and creatinine levels due to decreased renal perfusion. In prerenal azotemia, the kidneys are not receiving enough blood flow, leading to impaired filtration and reabsorption. Acute glomerulonephritis and tubular necrosis would have different clinical findings and would not be consistent with the given presentation. Postrenal azotemia, caused by obstruction of the urinary tract, would typically present with different symptoms and signs.

85. Which of the following is found early in the development of chronic renal failure?

Persistent proteinuria

Elevated creatinine level

Acute uremia

Hyperkalemia

Persistent proteinuria is found early in the development of chronic renal failure. Proteinuria refers to the presence of excess protein in the urine, indicating damage to the kidneys' filtering units. In chronic renal failure, the kidneys gradually lose their ability to filter waste products and excess fluid from the blood. This leads to the leakage of proteins into the urine. Elevated creatinine levels and hyperkalemia are usually seen in later stages of chronic renal failure, while acute uremia is a condition that occurs when the kidneys suddenly stop functioning properly.

Explanation

Persistent proteinuria is found early in the development of chronic renal failure. Proteinuria refers to the presence of excess protein in the urine, indicating damage to the kidneys' filtering units. In chronic renal failure, the kidneys gradually lose their ability to filter waste products and excess fluid from the blood. This leads to the leakage of proteins into the urine. Elevated creatinine levels and hyperkalemia are usually seen in later stages of chronic renal failure, while acute uremia is a condition that occurs when the kidneys suddenly stop functioning properly.

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

Gross rectal bleeding

Weight loss

Few symptoms

Nausea and vomiting

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.

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.

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

Stool Gram stain, looking for the offending organism

Serological testing for antigen related to the infection

Organism-specific stool antigen testing

Fecal DNA testing

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.

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.

88. When answering questions about Hep. A vaccine, you consider that all of the following are true except:

It does not contain a live virus

It should be offered to individuals who frequently travel to developing countries

It is a recommended immunization for healthcare workers

It is given as a single dose

The given correct answer is "It is given as a single dose." This means that all of the statements about Hep. A vaccine are true except for the fact that it is given as a single dose. The Hep. A vaccine is actually given in two doses, with the second dose administered 6 to 18 months after the first dose.

Explanation

The given correct answer is "It is given as a single dose." This means that all of the statements about Hep. A vaccine are true except for the fact that it is given as a single dose. The Hep. A vaccine is actually given in two doses, with the second dose administered 6 to 18 months after the first dose.

89. Monitoring for hepatoma in a patient with chronic hep B or C often includes periodic evaluation of:

Erythrocyte sedimentation rate

HBsAb

Alpha-fetoprotein

Urobilinogen

Monitoring for hepatoma in a patient with chronic hepatitis B or C often includes periodic evaluation of alpha-fetoprotein (AFP). AFP is a tumor marker that is commonly elevated in patients with hepatocellular carcinoma (HCC), the most common type of liver cancer. Regular monitoring of AFP levels can help detect the development of HCC at an early stage, allowing for timely intervention and treatment. Therefore, periodic evaluation of AFP is an important component of monitoring for hepatoma in patients with chronic hepatitis B or C.

Explanation

Monitoring for hepatoma in a patient with chronic hepatitis B or C often includes periodic evaluation of alpha-fetoprotein (AFP). AFP is a tumor marker that is commonly elevated in patients with hepatocellular carcinoma (HCC), the most common type of liver cancer. Regular monitoring of AFP levels can help detect the development of HCC at an early stage, allowing for timely intervention and treatment. Therefore, periodic evaluation of AFP is an important component of monitoring for hepatoma in patients with chronic hepatitis B or C.

90. Altering the gut pain threshold in IBS is a possible therapeutic outcome with the use of:

Loperamide (Imodium)

Dicyclomine (Bentyl)

Bismuth subsalicylate (Pepto-bismol)

Amitriptyline (Elavil)

Amitriptyline (Elavil) is a tricyclic antidepressant that is commonly used to treat irritable bowel syndrome (IBS). It has been found to be effective in altering the gut pain threshold in individuals with IBS. By modulating the levels of certain neurotransmitters in the brain, such as serotonin and norepinephrine, amitriptyline can help reduce the sensitivity of the gut to pain signals. This can lead to a decrease in abdominal pain and discomfort experienced by individuals with IBS. Loperamide, dicyclomine, and bismuth subsalicylate are not typically used for altering the gut pain threshold in IBS.

Explanation

Amitriptyline (Elavil) is a tricyclic antidepressant that is commonly used to treat irritable bowel syndrome (IBS). It has been found to be effective in altering the gut pain threshold in individuals with IBS. By modulating the levels of certain neurotransmitters in the brain, such as serotonin and norepinephrine, amitriptyline can help reduce the sensitivity of the gut to pain signals. This can lead to a decrease in abdominal pain and discomfort experienced by individuals with IBS. Loperamide, dicyclomine, and bismuth subsalicylate are not typically used for altering the gut pain threshold in IBS.

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

Epigastric pain

Positive obturator sign

Rebound tenderness

Marked febrile response

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.

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.

92. When discussing the use of immunoglobulin (IG) with a 60-year-old woman who was recently exposed to the Hep. A virus, you consider that:

IG is derived from pooled donated blood

The product must be used within a week of exposure to provide protection

Its use in this situation constitutes an example of active immunization

A short, intense flu-like illness often occurs after its use.

Immunoglobulin (IG) is derived from pooled donated blood. This means that it is made from combining blood donations from multiple individuals. The use of IG in this situation is not an example of active immunization, as active immunization involves stimulating the body's immune system to produce its own antibodies. IG provides passive immunity, meaning that it provides immediate protection against the Hepatitis A virus by introducing pre-formed antibodies into the body. However, it is important to note that the given information does not mention anything about the timeframe for using IG or the occurrence of a flu-like illness after its use.

Explanation

Immunoglobulin (IG) is derived from pooled donated blood. This means that it is made from combining blood donations from multiple individuals. The use of IG in this situation is not an example of active immunization, as active immunization involves stimulating the body's immune system to produce its own antibodies. IG provides passive immunity, meaning that it provides immediate protection against the Hepatitis A virus by introducing pre-formed antibodies into the body. However, it is important to note that the given information does not mention anything about the timeframe for using IG or the occurrence of a flu-like illness after its use.

93. A 78-year-old man presents with fatigue and difficulty with bladder emptying. Examination reveals a distended bladder, but otherwise unremarkable. The BUN legel is 88 mg/dL (31.4 mmol/L); the creatinine level is 2.8 mg/dL (247.5 mic.mol/L). This clinical assessment is most consistent with:

Prerenal azotemia

Acute glomerulonephritis

Acute tubular necrosis

Postrenal azotemia

The patient's presentation of fatigue and difficulty with bladder emptying, along with a distended bladder on examination, suggests an obstruction in the urinary tract. The elevated BUN and creatinine levels indicate impaired kidney function. Postrenal azotemia is the most likely cause in this case, as it occurs when there is a blockage in the urinary tract that prevents urine from being excreted, leading to the build-up of waste products in the blood. This is supported by the findings of a distended bladder and the elevated BUN and creatinine levels.

Explanation

The patient's presentation of fatigue and difficulty with bladder emptying, along with a distended bladder on examination, suggests an obstruction in the urinary tract. The elevated BUN and creatinine levels indicate impaired kidney function. Postrenal azotemia is the most likely cause in this case, as it occurs when there is a blockage in the urinary tract that prevents urine from being excreted, leading to the build-up of waste products in the blood. This is supported by the findings of a distended bladder and the elevated BUN and creatinine levels.

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

Neutrophil

Lymphocyte

Basophil

Metamyelocyte

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.

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.

95. Lower GI hemorrhage associated with diverticular disease usually manifests as:

A painless event

A condition noted to be found with a marked febrile response

A condition accompanied by crampy abdominal pain

A common chronic condition

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.

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.

96. Creatinine is best described as:

A substance produced by the kidney

A product related to skeletal muscle metabolism

Produced by the liver and filtered by the kidney

A by-product of protein metabolism

Creatinine is best described as a product related to skeletal muscle metabolism. It is a waste product that is produced by the breakdown of creatine phosphate in muscle. It is then filtered out of the blood by the kidneys and excreted in urine. The level of creatinine in the blood is commonly used as a marker of kidney function, as the kidneys are responsible for removing it from the body.

Explanation

Creatinine is best described as a product related to skeletal muscle metabolism. It is a waste product that is produced by the breakdown of creatine phosphate in muscle. It is then filtered out of the blood by the kidneys and excreted in urine. The level of creatinine in the blood is commonly used as a marker of kidney function, as the kidneys are responsible for removing it from the body.

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

10

20

30

40

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.

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.

98. You see a 48-year-old woman with nonalcoholic fatty liver disease. Evaluation of infectious hepatitis includes the following:
Anti-HAV IgG - negativeAnti-HBs - negativeAnti-HCV - negative
When considering her overall health status, you advise receiving which of the following vaccines?

Hep. A and B based on lifestyle risk factors

Hep. B and C

Hep. A and B

Hep. A, B and C

The correct answer is Hep. A and B. This is because the patient has nonalcoholic fatty liver disease, which puts her at risk for developing liver complications. Hepatitis A and B vaccines are recommended for individuals with liver disease to prevent further damage to the liver.

Explanation

The correct answer is Hep. A and B. This is because the patient has nonalcoholic fatty liver disease, which puts her at risk for developing liver complications. Hepatitis A and B vaccines are recommended for individuals with liver disease to prevent further damage to the liver.

99. Which of the following is an expected lab result in a patient with acute Hep. A infection (normal values: AST, 0 to 31 U/L; ALT, 0 to 40 U/L)?

AST, 55 U/L; ALT, 50 U/L

AST, 320 U/L, ALT, 190 U/L

AST 320 U/L, ALT, 300 U/L

AST, 640 U/L, ALT, 870 U/L

The correct answer is AST, 640 U/L, ALT, 870 U/L. In a patient with acute Hep. A infection, liver enzymes such as AST and ALT are expected to be significantly elevated. The normal values for AST and ALT are much lower than the values provided in the answer options. Therefore, the answer with the highest values for both AST and ALT (AST, 640 U/L, ALT, 870 U/L) is the most likely lab result in a patient with acute Hep. A infection.

Explanation

The correct answer is AST, 640 U/L, ALT, 870 U/L. In a patient with acute Hep. A infection, liver enzymes such as AST and ALT are expected to be significantly elevated. The normal values for AST and ALT are much lower than the values provided in the answer options. Therefore, the answer with the highest values for both AST and ALT (AST, 640 U/L, ALT, 870 U/L) is the most likely lab result in a patient with acute Hep. A infection.

100. Which of the following is most likely to be reported in a patient taking a 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin)?

AST, 41 U/L, ALT, 28 U/L

AST, 320 U/L, ALT, 190 U/L

AST, 32 U/L, ALT, 120 U/L

AST, 440 U/L, ALT, 670 U/L

The correct answer is AST, 41 U/L, ALT, 28 U/L. This is the most likely result in a patient taking a statin because statins can cause mild elevations in liver enzymes, such as AST and ALT. The levels reported are within the normal range, indicating that the patient's liver function is not significantly affected by the statin medication.

Explanation

The correct answer is AST, 41 U/L, ALT, 28 U/L. This is the most likely result in a patient taking a statin because statins can cause mild elevations in liver enzymes, such as AST and ALT. The levels reported are within the normal range, indicating that the patient's liver function is not significantly affected by the statin medication.

101. A 44-year-old woman presents with pyelonephritis. The report of her UA is least likely to include:

WBC casts

Positive nitrates

3+ protein

Rare RBCs

In pyelonephritis, the inflammation of the kidney usually causes an increase in white blood cells (WBCs) in the urine, which may be seen as WBC casts. Positive nitrates in the urine indicate the presence of bacteria, suggesting a urinary tract infection. Rare red blood cells (RBCs) may also be observed due to inflammation or damage to the renal tissue. However, 3+ protein in the urine is less likely to be seen in pyelonephritis as it is more commonly associated with conditions like glomerulonephritis or nephrotic syndrome.

Explanation

In pyelonephritis, the inflammation of the kidney usually causes an increase in white blood cells (WBCs) in the urine, which may be seen as WBC casts. Positive nitrates in the urine indicate the presence of bacteria, suggesting a urinary tract infection. Rare red blood cells (RBCs) may also be observed due to inflammation or damage to the renal tissue. However, 3+ protein in the urine is less likely to be seen in pyelonephritis as it is more commonly associated with conditions like glomerulonephritis or nephrotic syndrome.

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

Abdominal discomfort less than 24 hours in duration

Fever > 102F

Palpable abdominal mass

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

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.

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.

103. Risk factors for UTI in women include:

Postvoid wiping back to front

Low lactobacilli colonization

Hot tub use

None of the above

Risk factors for urinary tract infection (UTI) in women indeed include the practice of wiping from back to front after voiding. This method can transfer bacteria from the anal region toward the urethra, increasing the risk of introducing pathogens like E. coli that can cause infections.

Explanation

Risk factors for urinary tract infection (UTI) in women indeed include the practice of wiping from back to front after voiding. This method can transfer bacteria from the anal region toward the urethra, increasing the risk of introducing pathogens like E. coli that can cause infections.

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

A proton pump inhibitor (PPI)

Timed antacid use

Antimicrobial therapy

A histamine-2 receptor blocker

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.

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.