Patho Chapter 36

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

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.

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

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.

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.

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.

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

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.

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

A - Duodenal ulcers occur with greater frequency than other types of peptic ulcers and are commonly caused by H. 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.

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.

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

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

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

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.

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.

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

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.

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.

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.

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

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.

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

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.

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.

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.

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

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.

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

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.

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.

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.

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

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 oriexigenic 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.

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

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.

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

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.

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

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

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

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.

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

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.

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.

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.

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

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.

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

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.

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

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.

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.

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.

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.

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.

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.

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.

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

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.

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

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.

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

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.

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.

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.

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

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.

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.

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.

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

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.

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

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

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

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.