P20b Likely2

1. What causes hypovolemic shock to develop with intestinal obstruction?

A. continued vomiting and fluid shift into the intestine

B. hemorrhage into the intestine

C. rupture of the intestinal wall

D. repeated bouts of severe diarrhea

2. Dehydration limits compensation available for an acid-base imbalance resulting from prolonged vomiting and diarrhea because:

A. hypovolemia limits renal function

B. increased respirations cannot remove more H+

C. increased ADH blocks secretion of H+

D. more sodium and potassium ions are retained

3. Pancreatic cancer may be diagnosed early if obstruction of bile or pancreatic secretions develops when the tumor is located:

A. at the head of the pancreas

B. in the body of the pancreas

C. in the tail of the pancreas

4. How does chemical peritonitis and shock frequently result from acute pancreatitis?

A. Inflammation and increased vascular permeability of the peritoneum affect fluid balance.

B. Erosions in the intestinal wall causes release of bacteria.

C. Fat necrosis and hypocalcemia develop.

D. Secretions from the pancreas and intestine become more acidic.

5. Which of the following occurs with hepatitis B?

A. The liver is inflamed and enlarged.

B. Blood clotting delays are apparent at onset.

C. Hepatocytes can not regenerate when virus is present.

D. Infection is self-limiting.

6. What pain is typical of diverticulitis?

A. lower left quadrant

B. lower right quadrant

C. sharp colicky, periumbilical

D. lower abdominal pain, radiating into the groin

7. How does a volvulus cause localized gangrene in the intestine?

A. Hypotension and shock causes ischemia.

B. The mesenteric arteries are compressed in the twisted section of intestine.

C. A section of intestine herniates between the muscles of the abdominal wall.

D. The distention of the intestinal wall causes increased permeability of the tissue.

8. Choose the significant change in arterial blood gases expected with prolonged severe vomiting:

A. increased bicarbonate ion, increased PCO2, serum pH 7.4

B. decreased bicarbonate ion, decreased PCO2, serum pH 7.35

C. increased bicarbonate ion, decreased PCO2, serum pH 7.35

D. decreased bicarbonate ion, increased PCO2, serum pH 7.45

9. Identify a major reason making it difficult to prevent the spread of hepatitis B.

A. A vaccine is not available.

B. The incubation period is too short to track contacts.

C. Infection is often asymptomatic.

D. Antibodies are not produced.

10. Stools that are more liquid and contain mucus, frank blood, and pus are typical of:

A. diverticulitis

B. ulcerative colitis

C. Crohn’s disease

D. celiac disease

11. Which of the following are related to post-hepatic jaundice?

A. pruritic skin and light-colored stools

B. dark-colored stools and urine

C. increased serum levels of unconjugated bilirubin

D. loss of all metabolic functions

12. Which of the following frequently occurs 2-3 hours after meals in post-gastrectomy patients?

A. hypoglycemia

B. hypovolemia

C. abdominal cramps and distention

D. increased peristalsis and diarrhea

13. Which of the following statements about jaundice is/are true? 1. It is often the first manifestation of hepatitis. 2. Jaundice indicates permanent liver damage. 3. Individuals with hepatitis are always jaundiced. 4. Jaundice usually develops with hepatocellular carcinoma.

A. 1 only

B. 4 only

C. 1, 3

D. 2, 4

14. Which factors contribute to ascites in patients with cirrhosis?

A. increased aldosterone and deficit of albumin

B. severe anemia and increased serum bilirubin

C. hypokalemia and increased serum ammonia

D. hyperproteinemia and persistent hypotension

15. Deficiencies of vitamins A, D, and K occur in patients with cirrhosis primarily because of decreased?

A. liver metabolism

B. production of bile for absorption

C. pancreatic secretions in the intestine

D. storage of all vitamins

16. How does iron-deficiency anemia frequently develop with ulcerative colitis?

A. loss of surface area for absorption in the ileum

B. bone marrow depression by toxic wastes

C. chronic blood loss in stools

D. insufficient hydrochloric acid for iron absorption

17. When dehydration reduces the compensation possible for acidosis resulting from prolonged diarrhea, what significant change in arterial blood gases indicates this?

Serum pH would rise above 7.45

B. serum bicarbonate levels would increase, serum pH would remain in normal range

C. serum bicarbonate levels would decrease, serum pH would drop below 7.35

D. serum PCO2 would rise, serum pH would be around 7.4

18. Which type(s) of hepatitis increase(s) the risk of hepatocellular carcinoma?

A. HBV

B. HCV

C. HBV and HCV

D. neither HBV nor HCV

19. How may a fistula form with Crohn's disease?

A. lack of peristalsis leading to dilated areas of intestine

B. fibrosis and thickening of the wall causing obstruction

C. erosion of the mucosa causing bleeding

D. recurrent inflammation, necrosis, and fibrosis forming a connection between intestinal loops

20. What are the typical changes occurring with Crohn's disease?

A. degeneration and flattening of the villi in the small intestine

B. multiple herniations of the mucosa through weak areas of the muscularis

C. a continuous area of mucosal inflammation and ulceration in the rectum and colon

D. inflamed areas of the wall of the ileum alternating with thick fibrotic or normal areas

21. What is the cause of inflammatory bowel disease?

A. physical and emotional stress

B. an autoimmune reaction

C. a combination of recessive genes

D. idiopathic

22. Which of the following is a typical indicator of an intestinal obstruction caused by paralytic ileus?

A. excessive audible bowel sounds

B. intermittent colicky pain

C. severe steady abdominal pain

D. visible peristalsis

23. What causes the characteristic rigid abdomen found in the patient with peritonitis?

A. increased fluid and gas causing abdominal distention

B. inflammation of the peritoneum and organs causing a firm mass in the abdomen

C. inflamed peritoneum resulting in reflex abdominal muscle spasm

D. the patient voluntarily contracts the abdominal muscles as a protective mechanism

24. The telescoping of one section of bowel inside another section is called:

A. volvulus

B. hernia

C. adhesion

D. intussusceptions

25. Which type of hepatitis virus requires the presence of hepatitis B virus so as to replicate?

A. HAV

B. HCV

C. HDV

D. HEV

26. Partial obstruction of the sigmoid colon resulting from diverticular disease would likely:

A. cause severe colicky pain

B. cause frequent diarrhea

C. develop very rapidly

D. result in a small, hard stool

27. How does serum bilirubin change with cirrhosis?

A. increased unconjugated bilirubin

B. increased conjugated bilirubin

C. increased conjugated and unconjugated bilirubin

D. decreased conjugated and unconjugated bilirubin

28. Which of the following is NOT usually present during the icteric stage of viral hepatitis?

A. hepatomegaly

B. elevated serum liver enzymes

C. esophageal varices

D. lighter-colored stools

29. What causes massive inflammation and necrosis in acute pancreatitis?

A. formation of multiple thrombi and ischemia

B. infection by intestinal microbes

C. immune complex reaction

D. activation and spread of proteolytic enzymes

30. Tetany may develop in patients with acute pancreatitis because:

A. digestion and absorption of calcium is impaired

B. hemorrhage and fluid shift displace calcium from the blood

C. calcium ions are used up in blood coagulation process

D. calcium ions bind with fatty acids in necrotic tissue