[Ex3] - C38 - AP

Question 1

38-1. Which of the following types of diarrhea would most likely occur with a bacterial GI
infection?
a. Osmotic
b. Secretory
c. Hypotonic
d. Motility

Answer 1

ANS: B
Bacterial infections lead to secretory diarrhea. A nonabsorbable substance in the intestine
leads to osmotic diarrhea. Hypotonic diarrhea is not a form of diarrhea. Food is not mixed
properly, digestion and absorption are impaired, and motility is increased, leading to motility
diarrhea.

Question 2

38-2. A 20 year old recently diagnosed with lactose intolerance eats an ice cream cone and develops
diarrhea. This diarrhea can be classified as _____ diarrhea.
a. osmotic
b. secretory
c. hypotonic
d. motility

Answer 2

ANS: A
A nonabsorbable substance in the intestine leads to osmotic diarrhea. Infections lead to
secretory diarrhea. Hypotonic diarrhea is not a form of diarrhea. Food is not mixed properly,
digestion and absorption are impaired, and motility is increased leading to motility diarrhea.

Question 3

38-3. Assuming that midline epigastric pain is caused by a stimulus acting on an abdominal organ,
the pain felt is classified as:
a. visceral.
b. somatic.
c. parietal.
d. referred.

Answer 3

ANS: A
Visceral pain arises from a stimulus (distention, inflammation, and ischemia) acting on an
abdominal organ. Somatic is a form of parietal pain. Parietal pain, from the parietal
peritoneum, is more localized and intense than visceral pain, which arises from the organs
themselves. Referred pain is visceral pain felt at some distance from a diseased or affected
organ.

Question 4

38-4. The most common disorder associated with upper GI bleeding is:
a. diverticulosis.
b. hemorrhoids.
c. esophageal varices.
d. cancer.

Answer 4

ANS: C
Esophageal varices is the most common disorder associated with upper GI bleeding.
Diverticulosis could lead to bleeding, but it would be lower GI rather than upper.
Hemorrhoids can lead to bleeding, but they would be lower GI. Cancer could lead to upper GI
bleeding, but peptic ulcers and varices are identified as more common.

Question 5

38-5. Bright red bleeding from the rectum is referred to as:
a. melena.
b. occult bleeding.
c. hematochezia.
d. hematemesis.

Answer 5

ANS: C
Bleeding from the upper GI tract can also be rapid enough to produce hematochezia (bright
red stools). Melena is a black or tarry stool. Occult bleeding is hidden bleeding. Hematemesis
is vomiting blood.

Question 6

38-6. A 50 year old is diagnosed with gastroesophageal reflux. This condition is caused by:
a. fibrosis of the lower third of the esophagus.
b. sympathetic nerve stimulation.
c. loss of muscle tone at the lower esophageal sphincter.
d. reverse peristalsis of the stomach.

Answer 6

ANS: C
Gastroesophageal reflux is due to loss of muscle tone at the lower esophageal sphincter. The
resting tone of the lower esophageal sphincter (LES) tends to be lower than normal from
either transient relaxation or weakness of the sphincter. Gastroesophageal reflux is not due to
fibrosis, stimulation of sympathetic nerves, or reverse peristalsis.

Question 7

38-7. A 45-year-old male complains of heartburn after eating and difficulty swallowing. These
symptoms support which diagnosis?
a. Pyloric stenosis
b. Gastric cancer
c. Achalasia
d. Hiatal hernia

Answer 7

ANS: D
Regurgitation, dysphagia, and epigastric discomfort after eating are common in individuals
with hiatal hernia. Pyloric stenosis is manifested by projectile vomiting. Gastric cancer is not
manifested by heartburn. Achalasia is a form of functional dysphagia caused by loss of
esophageal innervation.

Question 8

38-8. A serious complication of paraesophageal hiatal hernia is:
a. hemorrhage.
b. strangulation.
c. peritonitis.
d. ascites.

Answer 8

ANS: B
Strangulation of the hernia is a major complication. Neither hemorrhage, peritonitis, nor
ascites is associated with paraesophageal hiatal hernia complications.

Question 9

38-9. Tests reveal narrowing of the opening between the stomach and the duodenum. This condition
is referred to as:
a. ileocecal obstruction.
b. hiatal hernia.
c. pyloric obstruction.
d. hiatal obstruction.

Answer 9

ANS: C
The pylorus is the opening between the esophagus and the duodenum; the obstruction is
pyloric. Ileocecal obstruction is in the small intestine. Hiatal hernia is related to the
esophagus. Hiatal obstruction is related to the esophagus.

Question 10

38-10. The symptoms and signs of large bowel obstruction are:
a. abdominal distention and hypogastric pain.
b. diarrhea and excessive thirst.
c. dehydration and epigastric pain.
d. abdominal pain and rectal bleeding.

Answer 10

ANS: A
Large intestine obstruction usually presents with hypogastric pain and abdominal distention.
Neither diarrhea, epigastric pain, nor rectal bleeding occurs.

Question 11

38-11. Chronic gastritis is classified according to the:
a. severity.
b. location of lesions.
c. patient’s age.
d. signs and symptoms.

Answer 11

ANS: B
Chronic gastritis is classified as type A (fundal) or type B (antral), depending on the
pathogenesis and location of the lesions. Gastritis is not classified by severity, age, or
symptoms, but by location.

Question 12

38-12. Gastroscopy reveals degeneration of the gastric mucosa in the body and fundus of the
stomach. This condition increases the risk for the development of:
a. pernicious anemia.
b. osmotic diarrhea.
c. increased acid secretion.
d. decreased gastrin secretion.

Answer 12

ANS: A
Pernicious anemia can develop because the damage to the mucosa makes the intrinsic factor
less available to facilitate vitamin B12 absorption in the ileum. None of the other options
would result from this damage.

Question 13

38-13. What is the cause of peptic ulcer disease?
a. Hereditary hormonal imbalances with high gastrin levels.
b. Breaks in the mucosa and presence of corrosive secretions.
c. Decreased vagal activity and vascular engorgement.
d. Gastric erosions related to high ammonia levels and bile reflux.

Answer 13

ANS: B

Peptic ulcer disease is caused by breaks in the mucosa and the presence of corrosive
substances. High gastrin occurs, but the disease is due to breaks in the mucosa. Vagal activity
increases. Gastric erosions occur, but they are not due to high ammonia.

Question 14

38-14. A 39 year old is diagnosed with a duodenal ulcer. Which of the following behaviors may have
contributed to the development of the ulcer?
a. Regular NSAID use
b. Drinking caffeinated beverages
c. Consuming limited fiber
d. Antacid consumption

Answer 14

ANS: A
Duodenal ulcers occur with greater frequency than other types of peptic ulcers and are
commonly caused by Helicobacter pylori infection and NSAID use. Neither antacids nor
caffeinated beverages contribute to ulcer formation. Fiber is important, but consuming limited
fiber will not contribute to ulcer formation.

Question 15

38-15. A 22 year old underwent brain surgery to remove a tumor. Following surgery, the patient
experienced a peptic ulcer. This ulcer is referred to as a(n) _____ ulcer.
a. infectious
b. Cushing
c. H. pylori
d. Curling

Answer 15

ANS: B
A Cushing ulcer is a stress ulcer associated with severe head trauma or brain surgery that
results from decreased mucosal blood flow and hypersecretion of acid caused by
overstimulation of the vagal nerve. Cushing ulcers are not associated with infections or H.
pylori. Curling ulcers develop secondary to burns.

Question 16

38-16. What is the primary clinical manifestation of a stress ulcer?
a. Bowel obstruction
b. Bleeding
c. Pulmonary embolism
d. Hepatomegaly

Answer 16

ANS: B
The primary clinical manifestation of stress-related mucosal disease is bleeding, which is
uncommon, but occurs more readily with the presence of coagulopathy and more than 48
hours of mechanical ventilation. None of the other options is associated with stress ulcers.

Question 17

38-17. Clinical manifestations of bile salt deficiencies are related to poor absorption of:
a. fats and fat-soluble vitamins.
b. water-soluble vitamins.
c. proteins.
d. minerals.

Answer 17

ANS: A

Clinical manifestations of bile salt deficiency are related to poor intestinal absorption of fat
and fat-soluble vitamins (A, D, E, and K). Neither water-soluble vitamins nor minerals require
bile salts for absorption; thus, they are not affected. Protein breakdown is facilitated by bile,
but its absorption is not dependent upon it.

Question 18

38-18. Which complication is associated with gastric resection surgery?
a. Constipation
b. Acid reflux gastritis
c. Anemia
d. Hiccups

Answer 18

ANS: C
One of the complications is anemia due to iron malabsorption, which may result from
decreased acid secretion. Diarrhea, not constipation, occurs. The reflux would be alkaline, not
acidic. Hiccups are not associated with gastrectomy.

Question 19

38-19. A 50-year-old male reports episodes of frequently recurring cramping abdominal pain, diarrhea,
and bloody stools. A possible diagnosis would be:
a. ulcerative colitis.
b. hiatal hernia.
c. pyloric obstruction.
d. achalasia.

Answer 19

ANS: A
Ulcerative colitis is characterized by abdominal pain, fever, elevated pulse rate, frequent
diarrhea (10-20 stools/day), urgency, obviously bloody stools, and continuous, crampy pain.
Hiatal hernia is most often asymptomatic and would not be manifested by abdominal pain.
Pyloric obstruction would be manifested by forceful or projectile vomiting. Achalasia would
be manifested by difficulty or uncomfortable swallowing.

Question 20

38-20. Pancreatic insufficiency is manifested by deficient production of:
a. insulin.
b. amylase.
c. lipase.
d. bile.

Answer 20

ANS: C
Pancreatic insufficiency is the deficient production of lipase by the pancreas. Pancreatic
insufficiency is not associated with the deficient production of insulin, amylase, or bile.

Question 21

38-21. A 19 year old presents with abdominal pain in the right lower quadrant. Physical examination
reveals rebound tenderness and a low-grade fever. A possible diagnosis would be:
a. colon cancer.
b. pancreatitis.
c. appendicitis.
d. hepatitis.

Answer 21

ANS: C

Appendicitis is manifested originally with periumbilical pain that then migrates to the right
lower quadrant pain with rebound tenderness. A low-grade fever is common. Colon cancer
may be asymptomatic, followed by bleeding. Pancreatitis is manifested by vomiting. Hepatitis
would be manifested by upper abdominal pain, not lower.

Question 22

38-22. A common cause of chronic mesenteric ischemia among the elderly is:
a. anemia.
b. aneurysm.
c. lack of nutrition in gut lumen.
d. atherosclerosis.

Answer 22

ANS: D
The most common cause of chronic mesenteric ischemia is atherosclerosis. Neither poor
nutrition nor anemia leads to vascular insufficiency. An aneurysm would lead to acute
vascular insufficiency.

Question 23

38-23. Which of the following characteristics is associated with an acute occlusion of mesenteric
blood flow to the small intestine?
a. Often precipitated by an embolism.
b. Commonly associated with disease such as pancreatitis and gallstones.
c. Caused by chronic malnutrition and mucosal atrophy.
d. Often a complication of hypovolemic shock.

Answer 23

ANS: A
Occlusion of blood flow is often precipitated by embolism. This type of occlusion is not
associated with pancreatitis, chronic malnutrition, or hypovolemic shock.

Question 24

38-24. The risk of hypovolemic shock is high with acute mesenteric arterial insufficiency because:
a. the resulting liver failure causes a deficit of plasma proteins and a loss of oncotic
pressure.
b. ischemia alters mucosal membrane permeability, and fluid loss occurs.
c. massive bleeding occurs in the GI tract.
d. overstimulation of the parasympathetic nervous system results in ischemic injury
to the intestinal wall.

Answer 24

ANS: B
Ischemia and necrosis (intestinal infarction) alter membrane permeability. Initially, there is
increased motility, nausea, and vomiting. Mucosal alteration causes fluid to move from the
blood vessels into the bowel wall and peritoneum. Fluid loss causes hypovolemia. Arterial
insufficiency is not related to liver failure. Bleeding may occur, but hypovolemia is related to
fluid shifts. Fluid shifts lead to hypovolemia; it is not due to overstimulation of the
parasympathetic nerves.

Question 25

38-25. Which of the following conditions is thought to contribute to the development of obesity?
a. Insulin excess
b. Leptin resistance
c. Adipocyte failure
d. Malabsorption

Answer 25

ANS: B

Leptin, a product of the obesity gene (Ob gene), acts on the hypothalamus to suppress appetite
and functions to regulate body weight within a fairly narrow range. Leptin levels increase as
the number of adipocytes increases; however, for unknown reasons, high leptin levels are
ineffective at decreasing appetite and energy expenditure, a condition known as leptin
resistance. Leptin resistance fails to inhibit orexigenic hypothalamic satiety signaling and
promotes overeating and excessive weight gain. Insulin becomes resistant, not present in
excess. Leptin resistance, not adipocyte failure, leads to obesity. Malabsorption does not lead
to obesity, but primarily to weight loss.

Question 26

38-26. A 54 year old reports vomiting blood. Tests reveal portal hypertension. Which of the
following is the most likely cause of this condition?
a. Thrombosis in the spleen
b. Cirrhosis of the liver
c. Left ventricular failure
d. Renal stenosis

Answer 26

ANS: B
Portal hypertension occurs secondarily to cirrhosis of the liver. Portal hypertension is not
associated with thrombosis of the spleen, left ventricular failure, or renal stenosis.

Question 27

38-27. The most common clinical manifestation of portal hypertension is _____ bleeding.
a. rectal
b. duodenal
c. esophageal
d. intestinal

Answer 27

ANS: C
Vomiting of blood from bleeding esophageal varices is the most common clinical
manifestation of portal hypertension. Neither rectal, duodenal, nor intestinal bleeding is a
common clinical manifestation of portal hypertension.

Question 28

38-28. Manifestations associated with hepatic encephalopathy from chronic liver disease are the
result of:
a. hyperbilirubinemia and jaundice.
b. fluid and electrolyte imbalances.
c. impaired ammonia metabolism.
d. decreased cerebral blood flow.

Answer 28

ANS: C
Hepatic encephalopathy effect on the liver prevents end products of intestinal protein
digestion, particularly ammonia, from being converted to urea by the diseased liver. Impaired
ammonia metabolism leads to the symptoms of hepatic encephalopathy. Symptoms are
primarily neurologic, not jaundice oriented. Manifestations associated with hepatic
encephalopathy are not associated with hyperbilirubinemia and jaundice, fluid, and electrolyte
imbalances or decreased cerebral blood flow.

Question 29

38-29. An increase in the rate of red blood cell breakdown causes which form of jaundice?
a. Obstructive
b. Hemolytic
c. Hepatocellular
d. Metabolic

Answer 29

ANS: B
Excessive hemolysis (breakdown) of red blood cells can cause hemolytic jaundice (prehepatic
jaundice). Red blood cell breakdown is not associated with the other forms of jaundice.

Question 30

38-30. The icteric phase of hepatitis is characterized by which clinical manifestations?
a. Fatigue, malaise, vomiting
b. Jaundice, dark urine, enlarged liver
c. Resolution of jaundice, liver function returns to normal
d. Fulminant liver failure, hepatorenal syndrome

Answer 30

ANS: B
The icteric phase is manifested by jaundice, dark urine, and clay-colored stools. The liver is
enlarged, smooth, and tender, and percussion causes pain. Fatigue and vomiting occur during
the prodromal stage. Resolution occurs in the recovery phase. Fulminant liver failure does not
involve icterus.

Question 31

38-31. The autopsy of a 55 year old revealed an enlarged liver, testicular atrophy, and mild jaundice
secondary to cirrhosis. What is the most likely cause of this condition?
a. Bacterial infection
b. Viral infection
c. Alcoholic steatohepatitis
d. Drug overdose

Answer 31

ANS: C
The clinical manifestations of alcoholic steatohepatitis include jaundice, hepatomegaly, and
testicular atrophy. These symptoms are not a result of a bacterial or viral infection, or a drug
overdose.

Question 32

38-32. In alcoholic cirrhosis, hepatocellular damage is caused by:
a. acetaldehyde accumulation.
b. bile toxicity.
c. acidosis.
d. fatty infiltrations.

Answer 32

ANS: A
Alcoholic cirrhosis is caused by the toxic effects of alcohol metabolism on the liver. Alcohol
is transformed to acetaldehyde, and excessive amounts significantly alter hepatocyte function
and activate hepatic stellate cells, a primary cell involved in liver fibrosis. Bile toxicity does
not cause alcoholic cirrhosis. Acidosis does not cause alcoholic cirrhosis. Fatty infiltrations do
not cause alcoholic cirrhosis.

Question 33

38-33. An analysis of most gallstones would reveal a high concentration of:
a. phosphate.
b. bilirubin.
c. urate.
d. cholesterol.

Answer 33

ANS: D
The majority of gallstones are composed of cholesterol. The other options are not found in
high quantities.

Question 34

38-34. A 55 year old is diagnosed with extrahepatic obstructive jaundice that is a result of the
obstruction of the:
a. intrahepatic bile canaliculi.
b. gallbladder.
c. cystic duct.
d. common bile duct.

Answer 34

ANS: D
Jaundice is due to obstruction of the common bile duct. This form of jaundice is not due to
obstruction of the intrahepatic canaliculi, gallbladder, or the cystic duct.

Question 35

38-35. Cholecystitis is inflammation of the gallbladder wall usually caused by:
a. accumulation of bile in the hepatic duct.
b. obstruction of the cystic duct by a gallstone.
c. accumulation of fat in the wall of the gallbladder.
d. viral infection of the gallbladder.

Answer 35

ANS: B
Cholecystitis can be acute or chronic, but both forms are almost always caused by a gallstone
lodged in the cystic duct. Accumulation of bile in the hepatic duct would not lead to
cholecystitis. Neither the accumulation of fat nor a viral infection leads to cholecystitis.

Question 36

38-36. Tissue damage in pancreatitis is initially triggered by:
a. insulin toxicity.
b. autoimmune destruction of the pancreas.
c. backup of pancreatic enzymes.
d. hydrochloric acid reflux into the pancreatic duct.

Answer 36

ANS: C
In pancreatitis, there is backup of pancreatic secretions and activation and release of enzymes
(activated trypsin activates chymotrypsin, lipase, and elastase) within the pancreatic acinar
cells. The enzymes become activated, triggering the resulting autodigestion, inflammation,
and oxidative stress. The tissue damage associated with pancreatitis is not due to insulin
toxicity or to hydrochloric acid reflux.

Question 37

38-37. Acute pancreatitis often manifests with pain to which of the following regions?
a. Right lower quadrant
b. Right upper quadrant
c. Epigastric
d. Suprapubic

Answer 37

ANS: C
Epigastric or midabdominal pain ranging from mild abdominal discomfort to severe,
incapacitating pain is one of the manifestations of pancreatitis. Right lower pain would be a
symptom of appendicitis. Right upper quadrant pain would be manifestation of liver
inflammation. Suprapubic pain would be related to full bladder or colon problems.

Question 38

38-38. A 60-year-old male is diagnosed with adenocarcinoma of the esophagus. Which of the
following factors most likely contributed to his disease?
a. Reflux esophagitis
b. Intestinal parasites
c. Ingestion of salty foods
d. Frequent use of antacids

Answer 38

ANS: A
Adenocarcinomas are more prevalent in males and are associated with cigarette smoking,
obesity, and gastroesophageal reflux disease (GERD). Intestinal parasites, ingestion of salty
foods, or the use of antacids does not lead to adenocarcinoma of the esophagus.