GI review questions
You examine a 59 year old man with a chief complain of new onset rectal pain after a bout of constipation. On examination, you note an ulcerated lesion on the posterior midline of the anus. This pres
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GI review questions
You examine a 59 year old man with a chief complain of new onset rectal pain after a bout of constipation. On examination, you note an ulcerated lesion on the posterior midline of the anus. This presentation is most consistent with:
A. perianal fistula
B. anal fissure
C. external hemorrhoid
D. Crohn proctitis
Rectal bleeding associated with hemorrhoids is usually described as:
A. streaks of bright red blood on the stool.
B. dark brown to black in color and mixed in with normal appearing stool.
C. a large amount of brisk red bleeding.
D. significant blood clots and mucous mixed with stool.
Therapy for hemorrhoids includes all of the following except:
A. weight control.
B. low-fat diet.
C. topical corticosteroids.
D. the use of a stool softner.
All of the following are typically noted in a young adult with the diagnosis of acute appendicitis except:
A.epigastric pain.
B. positive obturator sign.
C. rebound tenderness.
D. marked febrile response.
A 26 year old man presents with acute abdominal pain. As part of the evaluation for acute appendicitis, you order a white blood cell (WBC) count with differential and anticipate the following results:
A. total WBCs, 4500 mm3; neutrophils, 35%; bands, 2%; lymphocytes, 45%
B. total WBCs, 14,000 mm3; neutrophils, 55%; bands, 3%; lymphocytes, 38%
C. total WBCs, 16,500 mm3; neutrophils; 66%; bands, 8%; lymphocytes, 22%
D. total WBCs, 18,100 mm3; neutrophils, 55%; bands, 3%; lymphocytes, 28%
In evaluating a patient with suspected appendicitis, the clinician considers that:
A. the presentation may differ according to the anatomical location of the appendix.
B. this is a common reason for acute abdominal pain in elderly patients.
C. vomiting before the onset of abdominal pain is often seen.
D. the presentation is markedly different from the presentation of pelvic inflammatory disease.
There is no true classic presentation of acute appendicitis. Vague epigastric or periumbilical pain often heralds its beginning.The psoas sign can be best described as abdominal pain elicited by:
A. passive extension of the hip.
B. passive flexion and internal rotation of the hip.
C. deep palpation.
D. asking the patient to cough.
The obturator sign can be best described as abdominal pain elicited by:
A. passive extension of the hip.
B. passive flexion and internal rotation of the hip.
C. deep palpation.
D. asking the patient to cough.
To support the diagnosis of acute appendicitis with suspected appendiceal rupture, you consider obtaining the following abdominal imaging study:
A. magnetic resonance image.
B. computed tomography (CT) scan.
C. ultrasound.
D. flat plate.
Which of the following WBC forms is an ominous finding in the presence of severe bacterial infection?
A. neutrophil
B. lymphocyte
C. basophil
D. metamyelocyte
Myelocytes and metamyelocytes are immature neutrophil forms that are typically found in only the granulopoiesis pool. The presence of thses cells is an ominous marker of life-threatening infection, and these are occasionally found in the presence of appendiceal rupture.
Which of the following best represents the peak ages for occurrence of acute appendicitis?
A. 1 to 20 years
B. 20 to 40 years
C. 10 to 30 years
D. 30 to 50 years.
The peak age of patients with acute appendicitis is 10 to 30 years; this condition is uncommon in infants and elderly adults. At either end of the life span, a delay in diagnosis of appendicitis commonly occurs because providers do not consider appendicitis a possibility.
Clinical findings most consistent with appendiceal rupture include all of the following except:
A. abdominal discomfort less than 24 hours in duration.
B. fever greater than 102 F (> 38 C)
C. palpable abdominal mass.
D. marked leukocytosis with total WBC greater than 20,000/mm3.
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. Examination reveals marked tenderness to right upper quadrant abdominal palpation. Her most likely diagnosis is:
A. hepatoma.
B. acute chlolecystitis
C. acute hepatitis
D. cholelithiasis
White of the following is usually not seen in the diagnosis of acute cholecystitis?
A. elevated lactic dehydrogenase level.
B. increased alkaline phosphatase level.
C. leukocytosis.
D. elevated aspartate aminotransferase (AST) level
Murphy's sign can be best described as abdominal pain elicited by:
A. right upper quadrant abdominal palpation
B. asking the patient to stand on tiptoes and then letting body weight fall quickly onto the heels.
C. asking the patient to cough.
D. percussion.
Risk factors for cholelithiasis include all of the following except:
A. genetics
B. rapid weight loss.
C. obesity.
D. high fiber diet.
.
Imaging in a patient with suspected symptomatic cholethiasis usually includes obtaining an abdominal:
A. magnetic resonance image.
B. CT scan
C. ultrasound (right upper quadrant)
D. flat plate
Which of the following is most likely to be found in a person with acute cholecystitis?
A. fever
B. vomiting
C. jaundice
D. palpable gallbladder
Which of the following is true regarding colorectal cancer?
A. Most colorectal cancers are found during rectal examination.
B. Rectal carcinoma is more common than cancers involving the colon.
C. Early manifestations include abdominal pain and cramping.
D. Later disease presentation often includes iron deficiency anemia.
According to the American Cancer Society recommendations, which of the following is the preferred method for annual colorectal cancer screening in a 51 year old man?
A. digital rectal examination
B. fecal occult blood test.
C. colonoscopy
D. barium enema study.
Which of the following is most likely to be noted in a person with colorectal cancer?
A. gross rectal bleeding.
B. weight loss.
C. few symptoms.
D. nausea and vomiting.
A person with colorectal cancer is usually asymptomatic until disease is quiet advanced.
Which of the following does not increase a patient's risk of developing colorectal cancer?
A. family history of colorectal cancer.
B. familial polyposis.
C. personal history of neoplasm.
D. long-term aspirin therapy.
Which of the following is most consistent with the presentation of a patient with colonic diverticulosis?
A. diarrhea and leukocytosis
B. constipation and fever
C. few or no symptoms
D. frank blood in the stool with reduced stool caliber.
.
Which of the following is most consistent with the presentation of a patient with acute colonic diverticulitis?
A. cramping, diarrhea, and leukocytosis.
B. constipation and fever.
C. right sided abdominal pain
D. frank blood in the stool with reduced stool caliber.
The location of discomfort with acute diverticulitis is usually in which of the following areas of the abdomen?
A. epigastrium
B. left lower quadrant.
C. right lower quadrant.
D. suprapubic.
The diverticula are inflamed causing left lower quadrant abdominal pain.
Prevention of acute colonic diverticulitis includes:
A. use of antidiarrheal agents.
B. avoiding gas-producing foods.
C. high-fiber diet.
D. low-dose antibiotic therapy.
You are seeing Mr. Lopez, a 68 year old man with suspected acute colonic diverticulitis. In choosing an appropriate imaging study to support this diagnosis, which of the following abdominal imaging studies is most appropriate?
A. flat plate.
B. ulrasound.
C. CT scan.
D. barium enema.
Recommended antimicrobial therapy in acute diverticulitis includes:
A. amoxicillin with clarithromycin.
B. linezolid with daptomycin.
C. ciprofloxacin with metronidazole.
D. nitrofurantoin with doxycycline.
.
Lower GI hemorrhage associated with diverticular disease usually manifests as:
A. a painless event.
B. a condition noted to be found with a marked febrile response.
C. a condition accompanied by crampy abdominal pain.
D. a common chronic condition.
.
The gastric parietal cells produce:
A. hydrochloric acid
B. a protective mucosal layer.
C. prostaglandins.
D. prokinetic hormones.
Gastric parietal cells secrete hydrochloric acid, mediated by histamine2-receptor sites.
Antiprostaglandin drugs cause stomach mucosal injury primarily by:
A. a direct irritative effect.
B. altering the thickness of the protective mucosal layer.
C. decreasing peristalsis.
D. modifying stomach pH level.
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 most consistent with the clinical presentation of:
A. acute gastritis
B. gastric ulcer
C. duodenal ulcer
D. cholecystitis
When choosing pharmacologic intervention to prevent recurrence of duodenal ulcer in a middle-aged man, you prescribe:
A. a proton pump inhibitor (PPI).
B. timed antacid use.
C. antimicrobial therapy.
D. a histamine2-receptor antagonist (H2RA).
The H2RA most likely to cause drug interactions with phenytoin and theophylline is:
A. cimetidine.
B. famotidine.
C. nizatidine.
D. ranitidine.
Which of the following is least likely to be found in a pt with gastric ulcer?
A. history of long term naproxen use.
B. age younger than 50 years.
C. previous use of H2RA or antacids.
D. cigarette smoking.
Nonsteroidal anti-inflammatory drug (NSAID)-induced peptic ulcer can be best limited by the use of:
A. an antacid.
B. an H2RA.
C. an appropriate antimicrobial.
D. misoprostol.
Cyclooxygenase-1 (COX-1) contributes to:
A. the inflammatory response.
B. pain transmission.
C. maintenance of gastric protective mucosal layer.
D. renal arteriole constriction.
Cyclooxygenase-2 (COX-2) contributes to:
A. the inflammatory response
B. pain transmission.
C. maintenance of gastric protective mucosal layer.
D. renal arteriole constriction.
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 OTC H2RA affords partial symptom relief. she also uses naproxen sodium on a regular basis for the control of osteoarthritis pain. Her clinical presentation is most consistent with:
A. acute gastroenteritis
B. gastric ulcer.
C. duodenal ulcer.
D. chronic cholecystitis.
The most sensitive and specific test for H. pylori infection from the following list is:
A. stool Gram stain, looking for the offending organism.
B. serological testing for antigen related to the infection.
C. organism-specific stool antigen testing.
D. fecal DNA testing.
.
Which of the following medications is a PPI?
A. loperamide
B. metoclopramide.
C. nizatidine.
D. lansoprazole. ?
A 45 year old woman complains of periodic "hearburn." Examination reveals a single altered finding of epigastric tenderness without rebound. As first-line therapy, you advise:
A. avoiding trigger foods.
B. The use of a prokinetic agent.
C. a daily dose of a PPI.
D. increased fluid intake with meals.
You see a 62 year old man diagnosed with esophageal columnar epithelial metaplasia. You realize he is at increased risk for:
A. esophageal stricture.
B. adenocarcinoma.
C. gastroesophageal reflux.
D. H. pylori colonization.
In caring for a patient with symptomatic gastroesophageal reflux, you prescribe a PPI to:
A. enhance motility.
B. increase the pH of the stomach.
C. reduce low esophageal pressure.
D. help limit H. pylori growth.
Which of the following represents the optimal dosing schedule for sucralfate (Carafate)?
A. each tablet should be taken with a snack.
B. The medication should be taken with a full meal for buffering effect.
C. To achieve maximal therapeutic effect, the drug should be taken on an empty stomach.
Which of the following is most likely to be found in a 50 year old woman with reflux esophagitis?
A. initiation of estrogen-progestin hormonal therapy.
B. recent weight loss.
C. report of melena.
D. evidence of H. pylori infection.
Which of the following is likely to be reported in a patient with persistent GERD?
A. hematemesis
B. chronic sore throat.
C. diarrhea
D. melena
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:
A. atenolol.
B. trandolapril.
C. amlodipine.
D. losartan.
You prescribe a fluroquinolone 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:
A. with the antacid.
B. separated from the antacid by 2 to 4 hours before or 4 to 6 hours after taking the fluroquinolone.
C. without regard to antacid use.
D. apart from the antacid by about 1 hour on either side of the fluroquinolone dose.
You are caring for a 45 year old woman from a developing country. She reports that she had "yellow jaundice" as a young child. Her physical exam is unremarkable. Her lab studies are as follows: AST-22 U/L (normal: 0-31 U/L); alanine aminotransferase (ALT)- 25 U/L (normal: 0-40 U/L); hepatitis A virus immunoglobulin: positive. Lab testing reveals:
A. chronic hepatitis A.
B. no evidence of prior or current hepatitis A infection.
C. resolved hepatitis A infection.
D. prodromal hepatitis A infection.
In developing countries with limited pure water, most children contract Hepatitis A by age 5.
The most common source of hepatitis A infection is:
A. sharing IV drug equipment.
B. cooked seafood.
C. contaminated water supplies.
D. sexual contact.
In addition to the lab work described, results reveal the following for the above mentioned patient: hepatitis B surface antigen (HBsAg) positive. These findings are most consistent with:
A. no evidence of hepatitis B infection.
B. resolved hepatitis B infection.
C. chronic hepatitis B.
D. evidence of effective hepatitis B immunization.
.
A 38 year old man with 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:
A. hepatitis B surface antibody (HBsAb).
B. neurophilia.
C. thrombocytosis.
D. the presence of HBsAg.
Clinical findings in patients with acute hepatitis B likely include all of the following except:
A. abdominal rebound tenderness.
B. scleral icterus.
C. a smooth, tender, palpable hepatic border.
D. repot of myalgia.
You see a woman who has been sexually involved with a man newly diagnosed with acute hepatitis B. She has not received hepatitis B immunization. You advise her to:
A. start hepatitis B immunization series.
B. limit the number of sexual partners.
C. be tested for HBsAb.
D. receive hepatitis B immune globulin and start hepatitis B immunization series.
Testing for HIV, other sexually transmitted infections, and hepatitis A and C should also be offered where applicable.
Which of the following statements is true concerning hepatitis C infection?
A. It usually manifests with jaundice, fever, and significant hepatomegaly.
B. Among healthcare workers, it is most commonly found in nurses.
C. More than 50% of persons with acute hepatitis C go on to develop chronic infection.
D. Interferon therapy is consistently curative.
Which of the following characteristics is predicitive of severity of chronic liver disease in a patient with chronic hepatitis C?
A. female gender, age younger than 30.
B. co-infection with hepatitis B, daily alcohol use.
C. acquisition of the virus through IV drug use, history of hepatitis A infection.
D. frequent use of aspirin, nutritional status.
When answering questions about hepatitis A vaccine, you consider that all of the following are true except:
A. it does not contain live virus.
B. it should be offered to individuals who frequently travel to developing countries.
C. it is a recommended immunization for healthcare workers.
D. it is given as a single dose.
To prevent an outbreak of hepatitis D infection, a NP plans to:
A. promote a campaign for clean food supplies.
B. immunize the population against hepatitis B.
C. offer antiviral prophylaxis against the agent.
D. encourage frequent handwashing.
Which of the following is true concerning hepatitis B vaccine?
A. the vaccine containes live hepatitis B virus.
B. the NP should consider checking postvaccination HBsAb titers only for individuals at high risk for infection.
C. the vaccination is contraindicated in the presence of HIV infection.
D. Postvaccination athralgias are often reported.
Hyperbilirubinemia can cause all of the following except:
A. potential displacement of highly protein bound drugs.
B. scleral icterus.
C. cola-colored urine.
D. reduction in urobilirubin.
Monitoring for hepatoma in a patient with chronic hepatitis B or C often includes periodic evaluation of:
A. erythrocyte sedimentation rate.
B. HBsAb.
C. alpha-fetoprotein.
D. urobilinogen.
Which of the following is an expected lab result in a patient with acute hepatitis A infection (normal values: AST: 0-31; ALT- 0-40)?
A. AST-55, ALT-50
B. AST-320, ALT-190
C. AST-320, ALT-120
D. AST-440, ALT-870
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)?
A. AST-41, ALT-28
B. AST- 320, ALT-190
C. AST-32, ALT-120
D. AST-440, ALT-670
When discussing the use of immunoglobulin (IG) with a 60 year old woman who was recently exposed to the hepatitis virus, you consider that:
A. IG is derived from pooled donated blood.
B. the product must be used within 1 week of exposure to provide protection.
C. its use in this situation constitutes an example of active immunization.
D. a short, intense flu-like often occurs after its use.
You see a 48 year old woman with nonalocholic fatty liver disease. Evaluation of infectious hepatitis includes the following:
Anti-HAV IgG negative
Anti-HBs-negative
Anti-HCV-negative
When considering her overall health status, you advise receiving which of the following vaccines?
A. immunization against hepatitis A and B as based on her lifestyle risk factors.
B. immunization against hepatitis B and C.
C. immunization against hepatitis A and B.
D. immunization against hepatitis A, B, and C.
Which of the following hepatitis forms is most effectively transmitted from the man to the woman via heterosexual vaginal intercourse?
A. hepatitis A
B. hepatitis B.
C. hepatitis C.
D. hepatitis D.
Diagnostic criteria for irritable bowel syndrome (IBS) include abdominal pain that is associated with all of the following except:
A. improvement with defecation
B. a change in the frequency of stool.
C. A change of stool form.
D. unexplained weight loss.
Altering the gut pain threshold in IBS is a possible therapeutic outcome with the use of:
A. loperamide (Immodium).
B. dicyclomide (Bentyl).
C. bismuth subsalicylate (Pepto Bismol)
D. amitriptyline (Elavil)
Tenesmus is defined as which of the following:
A. rectal burning with defecation.
B. a sensation of incomplete bowel emptying that is distressing and sometimes painful.
C. weight loss that accompanies many bowel diseases.
D. appearance of frank blood in the stool.
Concerning IBS, which of the following statements is most accurate?
A. Patients most often report chronic diarrhea as the most distressing part of the problems.
B. Weight gain is often reported.
C. Patient's can present with bowel issues ranging from diarrhea to constipation.
D. The condition is associated with a strongly increased risk of colorectal cancer.
An example of medication with prokinetic activity is:
A. dicyclomine (Bentyl).
B. metoclopramide (Reglan).
C. loperamide (Imodium)
D. psyllium (Metamucil)
Prokinetic or promotility agents have been used for patients with constipation-dominant
Diagnostic testing in IBS often reveals:
A. evidence of underlying inflammation.
B. anemia of chronic disease.
C. normal results on most testing.
D. mucosal thickening on abdominal radiologic imaging.
The clinical indication for the use of lubiprostone (Amitiza) is for:
A. the treatment of constipation that is not amenable to standard therapies.
B. intervention in intractable diarrhea.
C. control of intestinal inflammation.
D. the relief of intestinal spasms.
Diagnostic testing in inflammatory bowel disease (IBD) often reveals:
A. evidence of underlying inflammation.
B. notation of intestinal parasites.
C. normal results on most testing.
D. a characteristic intra-abdominal mass on radiologic imaging
Which of the following best describes the hemogram results in a person with anemia of chronic disease that often accompanies IBD?
A. microcytic, hypochromic
B. macrocytic, normochromic
C. normocytic, normochromic
D. hyperproliferative
Anemia is a common problem in IBD. Anemia of chronic disease, a normocytic, normochromic anemia, is a result of inflammation of IBD.
IBD is a term usually used to describe:
A. ulcerative colitis and irritable bowel syndrome.
B. C difficile adn Crohn disease.
C. Crohn disease and ulcerative colitis.
D. inflammatory colitis.
"Skip lesions" are usually reported in:
A. irritable bowel syndrome
B. ulcerative colitis
C. Crohn disease
D. C. Difficile colitis
Immune modulators are often used for intervention in:
A. ulcerative colitis
B. irritable bowel syndrome.
C. Crohn disease
D. ulcerative colitis and Crohn disease.
Other immune modulators such as methotrexate and cyclosporine have been used with some success.
After a decade of disease, a person with ulcerative colitis is at an increased risk of malignancy involving the:
A. small bowel
B. large intestine.
C. duodenum
D. stomach
With UC, colorectal cancer is greatly increased after about a decade of disease; as a result, surveillance colonoscopy is recommended every 2 years after 8-10 years of disease.
Onset of symptoms is before age 30-40 years in most cases.
IBD/IBS
The patient population is predominantly female.
IBS
The condition is often referred to as spastic colon by the general population.
IBS
Extraintestinal manifestations occasionally include nondestructive arthritis and renal calculi.
IBD.
This is a potentially life threatening condition.
IBD
The etiology likely involves an autoimmune response to the GI tract.
IBD
Patients should be advised to avoid trigger foods.
IBS/IBD
Involvement can be limited to intestinal mucosa only, or the full thickness of the intestinal wall can be involved.
IBD
The etiology is considered to be an alteration in small and large bowel motility.
IBS
Potential complications include fistula formation and perineal disease.
IBD
Potential complications include increased risk for colonic malignancy.
IBD
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