Quiz 9 - Part 1 - Digestive System Disorders (Ch.17)
29. What does the pathophysiology of chronic gastritis include? a. Atrophy of the gastric mucosa with decreased secretions b. Hyperchlorhydria and chronic peptic ulcers c. Frequent vomiting and diarrhea d. Episodes of acute inflammation and edema of the mucosa
a. Atrophy of the gastric mucosa with decreased secretions Chronic gastritis is a long-term condition in which the mucus lined layer of the stomach, also known as the gastric mucosa, is inflamed or irritated over a longer period of time.
87. What does the term melena mean? a. Blood in a dark-colored stool b. Occult blood in the stool c. Blood in the sputum d. Blood in vomitus
a. Blood in a dark-colored stool
76. 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
a. Continued vomiting and fluid shift into the intestine Hypovolemic shock is a life-threatening condition that results when you lose more than 20 percent (one-fifth) of your body's blood or fluid supply. This severe fluid loss makes it impossible for the heart to pump a sufficient amount of blood to your body. Hypovolemic shock can lead to organ failure.
10 - True or False: Cholesterol gallstones occur twice as often in men as women
False, this is a false statement. Cholesterol gallstones occur twice as often in women as men.
7. Which of the following is contained in pancreatic exocrine secretions? a. Bicarbonate ion b. Hydrochloric acid c. Activated digestive enzymes d. Insulin
a. Bicarbonate ion
25. What does the term periodontitis refer to? a. Erosion of the enamel tooth surface b. Bacterial damage to the teeth and surrounding alveolar bone c. Inflammation and infection of the gingivae d. Formation of calcified plaque on the tooth
b. Bacterial damage to the teeth and surrounding alveolar bone eriodontitis (gum disease) is a serious gum infection that damages the soft tissue and, without treatment, can destroy the bone that supports your teeth. Periodontitis can cause teeth to loosen or lead to tooth loss. Cause - poor oral hygiene
2 - Which of the below is a drug that could be used to treat an ulcer? a. Dramamine b. Carafate c. Imodium d. Stemetil
b. Carafate Forms a coating over ulcers, protecting the area from further injury.
36. Which of the following would a perforated gastric ulcer likely cause? a. Severe anemia b. Chemical peritonitis c. Severe gastric hemorrhage d. Pyloric obstruction
b. Chemical peritonitis A perforated ulcer is a condition in which an untreated ulcer has burned through the mucosal wall in a segment of the GI tract allowing gastric contents to leak into the abdominal cavity Perforation of gastric ulcer or duodenal ulcer into the peritoneal cavity causes initially chemical peritonitis as opposed to bacterial peritonitis, unlike more distal bowel perforation. If posterior wall gastric ulcers perforate, they leak gastric contents into the lesser sac, which tends to confine the peritonitis.
109. A viral infection of the parotid gland is commonly known as: a. tonsillitis. b. mumps. c. chickenpox. d. scarlet fever.
b. mumps.
16. Small, hidden amounts of blood in stool are referred to as: a. melena. b. occult blood. c. frank blood. d. hematemesis.
b. occult blood. Fecal occult blood refers to blood in the feces that is not visibly apparent.
60. Which of the following best describes steatorrhea? a. A light gray-colored stool b. A tarry black stool c. Bulky, fatty, foul-smelling stools d. Watery stools with mucus and blood
c. Bulky, fatty, foul-smelling stools steatorrhea (Oily, smelly stools, which often float.) - the excretion of abnormal quantities of fat with the feces owing to reduced absorption of fat by the intestine.
90. Which term refers to an inflammation usually related to infection of the bile ducts? a. Cholelithiasis b. Cholecystitis c. Cholangitis d. Choledocholithiasis
c. Cholangitis Cholangitis is an inflammation of the bile duct system Cholecystitis is inflammation of the gallbladder.
65. 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
c. Chronic blood loss in stools
86. An individual with peptic ulcer disease exhibits hematemesis. What does this probably indicate? a. Perforation b. Obstruction c. Erosion of a large blood vessel d. Development of malignancy
c. Erosion of a large blood vessel
93. 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
c. HBV and HCV HBV- and HCV-induced HCC develops in an environment of inflammation and regeneration that results from chronic liver damage, suggesting that the pathogenesis of HCC is immune mediated1
47. What is the most common type of hepatitis transmitted by blood transfusion? a. HAV b. HBV c. HCV d. HEV
c. HCV HCV - An infection caused by a virus that attacks the liver and leads to inflammation. The virus is spread by contact with contaminated blood, for example, from sharing needles or from unsterile tattoo equipment.
23. Oral candidiasis is considered to: a. be a common bacterial infection in infants and young children. b. cause painful ulcerations in the mucosa and tongue. c. cause white patches in the mucosa that cannot be scraped off. d. be an opportunistic fungal infection of the mouth.
d. be an opportunistic fungal infection of the mouth. Oral candidiasis (oral thrush) occurs in the mouth. That is, oral candidiasis is a mycosis (yeast/fungal infection) of Candida species on the mucous membranes of the mouth.
69. With acute appendicitis, localized pain and tenderness in the lower right quadrant results from: a. increased peristalsis in the adjacent colon. b. inflammation and stretching of the appendiceal wall. c. increased gas and fluid inside the appendix. d. local inflammation of the parietal peritoneum.
d. local inflammation of the parietal peritoneum. Parietal peritoneum is that portion that lines the abdominal and pelvic cavities
3 - Parietal cells: a. are found in the liver and produce glycogen. b. are present in the large intestine and assist in colonic movement. c. are in the mesentery and support the intestines. d. are found in fundus of the stomach and secrete hydrochloric acid and produce intrinsic factor.
d; Parietal cells are found in the fundus of the stomach and they secrete hydrochloric acid and produce intrinsic factor.
63. Stools that are more liquid and contain mucus and frank blood are typical of: a. diverticulitis. b. ulcerative colitis. c. Crohn's disease. d. celiac disease.
b. ulcerative colitis. Ulcerative colitis signs and symptoms include frequent watery stools (diarrhea) with presence of blood and mucus and accompanied by cramping pain. Individual can also have tenesmus which can also lead to rectal bleeding Inflammation causes your colon to contract and empty frequently, which is why you may experience frequent diarrhea and urgent bowel movements. When inflammation destroys the cells lining your colon, sores or ulcers can develop. These ulcers can bleed and produce pus, resulting in bloody diarrhea Tenesmus - a continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness
2. Which of the following is the primary site for the absorption of nutrients? a. Stomach b. Duodenum c. Ileum d. Ascending colon
c. Ileum
82. Bile pigment gallstones are more common in individuals dealing with: a. obesity. b. high cholesterol levels. c. alcoholic cirrhosis. d. use of oral contraceptives.
c. alcoholic cirrhosis.
107. "A gluten-free diet as required" for the client with celiac disease means avoiding: a. products containing lactose. b. any trans-fat. c. certain grains. d. proteins containing certain amino acids.
c. certain grains.
26. What is/are common location(s) for oral cancer? a. Floor of the mouth or tongue borders b. Mucosa lining the cheeks c. Hard and soft palate d. Gingivae near the teeth
a. Floor of the mouth or tongue borders The oral cavity is continuously, been exposed to inhaled and consumed carcinogens, and thus it is the most common site for the origin of malignant epithelial neoplasms in the head and neck region. The most common location for a malignant tumor of the oral cavity is the anterior two thirds of the tongue.
89. Which of the following frequently occurs 2 to 3 hours after meals in post-gastrectomy patients? a. Hypoglycemia b. Hypovolemia c. Abdominal cramps and distention d. Increased peristalsis and diarrhea
a. Hypoglycemia Ghrelin suppresses insulin secretion, opposes its action, and stimulates counterregulatory hormones. Its secretion is decreased after gastric bypass surgery, which may contribute to hypoglycemia.
55. 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
a. Increased aldosterone and deficit of albumin ascites - the accumulation of fluid in the peritoneal cavity, causing abdominal swelling. Hyperaldosteronism plays a major role in the pathogenesis of ascites as suggested by elevated plasma aldosterone concentrations and marked increases in both of the major aldosterone-sensitive apical transport proteins of renal tubule, namely, the thiazide-sensitive sodium chloride cotransporter and the epithelial sodium channel α subunit.
53. What is the primary cause of esophageal varices? a. Increased hydrostatic pressure in the veins b. Alcohol irritating the mucosa c. Failure to inactivate estrogen d. Poor nutritional status
a. Increased hydrostatic pressure in the veins Esophageal varices are extremely dilated sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis. Portal hypertension leads to an increase in the blood pressure inside the veins in the lower esophagus and stomach. These veins were not designed for the higher pressure, and thus they begin to expand, resulting in varices
58. How does chemical peritonitis and shock frequently result from acute pancreatitis? a. Inflammation and increased vascular permeability of the peritoneum affect fluid balance. b. Erosion in the intestinal wall causes release of bacteria. c. Fat necrosis and hypocalcemia develop. d. Secretions from the pancreas and intestine become more acidic.
a. Inflammation and increased vascular permeability of the peritoneum affect fluid balance. This 'chemical peritonitis' is characterized by peritoneal exudate and sepsis. In humans, acute pancreatitis has been associated with biliary tract disease, especially with gallstone formation and alcohol abuse. Acute cholecystitis and acute pancreatitis are also strongly associated with biliary stones. Inflammation of your pancreas (pancreatitis) complicated by infection may lead to peritonitis if the bacteria spreads outside the pancreas
18. Which of the following applies to the act of swallowing? a. It requires coordination of cranial nerves V, IX, X, and XII. b. It is entirely voluntary. c. It is controlled by a center in the hypothalamus. d. It does not affect respiration.
a. It requires coordination of cranial nerves V, IX, X, and XII.
78. What would be the likely outcome from chemical peritonitis related to a perforated gallbladder? a. Leakage of intestinal bacteria into blood and the peritoneal cavity b. Massive hemorrhage and shock c. Breakdown of the gallstones d. Increasing peristalsis with intermittent painful spasms
a. Leakage of intestinal bacteria into blood and the peritoneal cavity A gallbladder rupture is a medical condition where the gallbladder wall leaks or bursts. Ruptures are commonly caused by inflammation of the gallbladder. This inflammation can be caused by gallstones, which can get stuck inside the gallbladder. Infection can also cause inflammation that could lead to rupture.
67. 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
a. Lower left quadrant Diverticulitis is the infection or inflammation of pouches that can form in your intestines.
38. What would be the result of chronic bleeding from gastric carcinoma? a. Occult blood in the stool and anemia b. Hematemesis and shock c. Abdominal pain and distention d. Red blood on the surface of the stool
a. Occult blood in the stool and anemia
1. Which of the following cells in the gastric mucosa produce intrinsic factor and hydrochloric acid? a. Parietal cells b. Chief cells c. Mucous cells d. Gastrin cells
a. Parietal cells Parietal cells are epithelial cells in the stomach that secrete HCl and intrinsic factor and located in the gastric glands found in the lining of the fundus and cardia regions of the stomach.
94. Which of the following is/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
a. Pruritic skin and light-colored stools Post-hepatic jaundice refers to obstruction of biliary drainage. The bilirubin that is not excreted will have been conjugated by the liver, hence the result is a conjugated hyperbilirubinaemia. Conjugated bilirubin in urine (bilirubinuria) gives urine an abnormally dark brown color. Thus, the presence of pale stool (stercobilin absent from feces) and dark urine (conjugated bilirubin present in urine) suggest an obstructive cause of jaundice. hyperbilirubinemia - These changes occur when a blockage or other problem prevents bilirubin from being eliminated in stool, causing more bilirubin to be eliminated in urine. If bilirubin levels are high, substances formed when bile is broken down may accumulate, causing itching all over the body.
95. 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 cannot regenerate when the virus is present. d. Infection is self-limiting.
a. The liver is inflamed and enlarged.
14 - Which statement below is true? a. The most common morphology for colon cancer is adenomatous polyps. b. IBS is most commonly seen in older men. c. Celiac disease is an allergic response to wheat, corn, etc. d. Crohn's disease commonly affects the rectum and the appendix.
a. The most common morphology for colon cancer is adenomatous polyps.
39. Following gastric resection, the onset of nausea, cramps, and dizziness immediately after meals indicates: a. a large volume of chyme has entered the intestines, causing distention. b. severe hypoglycemia has developed. c. the pylorus is restricting the flow of chyme. d. bile and pancreatic secretions are irritating the small intestine.
a. a large volume of chyme has entered the intestines, causing distention. Gastric resection - removal of part of the stomach Chyme - the pulpy acidic fluid which passes from the stomach to the small intestine, consisting of gastric juices and partly digested food. Dumping Syndrome is caused when food moves too rapidly into the small intestines. They are caused when sugar and simple carbohydrates pass too rapidly into the small intestine. This pulls fluids into the intestines resulting in bloating/abdominal pain Gastric bypass surgery makes the stomach smaller and causes food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size. This reduces the amount of food you can eat at one time. Bypassing part of the intestine reduces how much food and nutrients are absorbed.
106. 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. d. in the endocrine glands of the pancreas.
a. at the head of the pancreas. The head of the pancreas is located at the juncture where the stomach meets the first part of the small intestine. This is where the stomach empties partially digested food into the intestine, and the pancreas releases digestive enzymes into these contents.
15. Yellow or greenish stained vomitus usually indicates the presence of: a. bile. b. blood. c. protein. d. bacteria.
a. bile.
42. Predisposing factors to cholelithiasis include excessive: a. bilirubin or cholesterol concentration in the bile. b. water content in the bile. c. bile salts in the bile. d. bicarbonate ions in the bile.
a. bilirubin or cholesterol concentration in the bile. cholelithiasis - formation of gallstones Cholesterol stones form when your gallbladder doesn't empty the way it should. They also form when bile has 1) Too much cholesterol 2) Too much of a yellowish pigment called bilirubin 3) Not enough bile salts
46. What can be concluded if the hepatitis B antigen level remains high in the serum? a. Acute infection is present. b. Chronic infection has developed. c. Liver failure is in progress. d. The usual prolonged recovery from any viral infection is occurring.
b. Chronic infection has developed. Hepatitis B is spread when blood, semen, or other body fluids from a person infected with the virus enters the body of someone who is not infected For people living with chronic hepatitis B, a high level can indicate liver damage since ferritin is leaked into the bloodstream as liver cells are injured by the virus.
59. Malnutrition may develop in children with celiac disease because of: a. damage to the intestinal villi. b. obstruction in the pancreatic ducts. c. acidosis, preventing activation of digestive enzymes. d. insufficient bile for absorption.
a. damage to the intestinal villi. The primary mechanism involved in celiac disease is related to an inappropriate adaptive immune response to gluten-derived peptides. When the body's immune system overreacts to gluten in food, the reaction damages the tiny, hairlike projections (villi) that line the small intestine. Villi absorb vitamins, minerals and other nutrients from the food you eat. If your villi are damaged, you can't get enough nutrients, no matter how much you eat
40. Bilirubin is a product of: a. hemolysis of red blood cells (RBCs) and breakdown of hemoglobin. b. production of excess chyme and bile. c. mixing of undigested food and gastric secretions. d. accumulation of white blood cells (WBCs) due to infection.
a. hemolysis of red blood cells (RBCs) and breakdown of hemoglobin. Bilirubin is a yellow compound that occurs in the normal catabolic pathway that breaks down heme in vertebrates. This catabolism is a necessary process in the body's clearance of waste products that arise from the destruction of aged or abnormal red blood cells.
83. 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.
a. hypovolemia limits renal function. Low blood volume shock (hypovolemic shock). This is one of the most serious, and sometimes life-threatening, complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body Acute renal failure in patients with congestive heart failure occurs because of decreased renal blood flow. This decrease is due to hypovolemia from overdiuresis or hypervolemia that causes elevated filling pressures of the left ventricle and leads to decreased cardiac output
14. The early stage of vomiting causes: a. metabolic alkalosis. b. metabolic acidosis. c. increased respirations. d. increased excretion of hydrogen ions.
a. metabolic alkalosis. B/c loss of stomach acid
34. Prolonged or severe stress predisposes to peptic ulcer disease because: a. of reduced blood flow to the gastric wall and mucous glands. b. of reduced bicarbonate content in bile and pancreatic secretions. c. stress increases the number of acid- and pepsinogen-secreting cells. d. increased epinephrine increases motility.
a. of reduced blood flow to the gastric wall and mucous glands. Your digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer. Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach or small intestine. The acid can create a painful open sore that may bleed (1st part of SI, duodenum, or lining of the stomach) The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and long-term use NSAIDs
103. Gastroesophageal reflux disease involves: a. periodic flow of gastric contents into the esophagus. b. constant flow of intestinal and gastric contents into the esophagus. c. spasmodic and violent vomiting of gastric contents. d. violent spasming of the esophagus, causing choking.
a. periodic flow of gastric contents into the esophagus. Gerd is a long-term condition where acid from the stomach comes up into the esophagus This is a chronic disease that occurs when stomach acid or bile flows into the food pipe and irritates the lining.
92. Which of the following statement(s) 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
b. 4 only 4. Jaundice usually develops with hepatocellular carcinoma.
80. 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
b. Decreased bicarbonate ion, decreased PCO2, serum pH 7.35
27. What is a common cause of hiatal hernia? a. An abnormally long esophagus b. Increased intra-abdominal pressure c. Stenosis of the hiatus in the diaphragm d. A small fundus in the stomach
b. Increased intra-abdominal pressure A hiatal hernia occurs when the upper part of your stomach bulges through your diaphragm into your chest cavity. A hiatal hernia occurs when the upper part of your stomach bulges through the large muscle separating your abdomen and chest (diaphragm)
100. At what stage of alcoholic liver disease can the damage be reversed? a. It can never be reversed b. Initial stage c. Alcoholic hepatitis stage d. End-stage cirrhosis
b. Initial stage
70. How does localized peritonitis develop from acute appendicitis before rupture? a. The omentum walls off the inflamed area. b. Intestinal bacteria escape through the necrotic appendiceal wall. c. The obstructing object inside the appendix causes edema. d. Bacteria escape into the circulating blood.
b. Intestinal bacteria escape through the necrotic appendiceal wall. Peritonitis - Inflammation of the membrane lining the abdominal wall and covering the abdominal organs.
45. Which of the following applies to hepatitis A infection? a. It is also called serum hepatitis. b. It is transmitted by the fecal-oral route. c. It contains a double strand of DNA. d. It frequently leads to chronic hepatitis.
b. It is transmitted by the fecal-oral route.
5. In which structure is oxygenated blood (arterial) mixed with unoxygenated blood (venous) so as to support the functions of the structure? a. Pancreas b. Liver c. Small intestine d. Spleen
b. Liver
105. Which of the following applies to gastric cancer? a. It usually appears as polyp or protruding mass. b. Most cases involve an adenocarcinoma of the mucous glands. c. Genetics or geographical area does not affect the incidence. d. It is usually diagnosed in an early stage because of pyloric obstruction.
b. Most cases involve an adenocarcinoma of the mucous glands.
3. When highly acidic chyme enters the duodenum, which hormone stimulates the release of pancreatic secretions that contains very high bicarbonate ion content? a. Gastrin b. Secretin c. Cholecystokinin d. Histamine
b. Secretin Three main functions 1) Regulation of gastric acid 2) Regulation of pancreatic bicarbonate 3) osmoregulation. The major physiological actions of secretin are stimulation of pancreatic fluid and bicarbonate secretion. S cells in the small intestine emit secretin
22. Which of the following applies to cleft palate? a. The mandibular processes do not fuse. b. The hard and soft palates do not fuse during the first trimester of pregnancy. c. Exposure to environmental factors in the last trimester causes the defect. d. Speech and eating are not affected.
b. The hard and soft palates do not fuse during the first trimester of pregnancy. Cleft palate is an opening or split in the roof of the mouth that occurs when the tissue doesn't fuse together during development in the womb. A cleft palate often includes a split (cleft) in the upper lip (cleft lip) but can occur without affecting the lip
73. How does a volvulus cause localized gangrene in the intestine? a. Hypotension and shock cause 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.
b. The mesenteric arteries are compressed in the twisted section of intestine. volvulus - when loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction.
6. Which of the following stimulates increased peristalsis and secretions in the digestive tract? a. Sympathetic nervous system b. Vagus nerve c. Increased saliva d. Absence of food in the system
b. Vagus nerve
28. What is a common sign of acute gastritis? a. Colicky right upper quadrant pain b. Vomiting and anorexia c. Projectile vomiting after eating d. Diarrhea with abdominal distention
b. Vomiting and anorexia Acute gastritis is a sudden inflammation or swelling in the lining of the stomach. Gastritis only directly affects the stomach, while gastroenteritis affects both the stomach and the intestines. The most common causes of acute gastritis are (NSAIDs) and corticosteroids
52. In patients with cirrhosis, serum ammonia may increase when: a. ingesting excessive lipids. b. bleeding occurs in the digestive tract. c. an increase in unconjugated bilirubin occurs in the serum. d. less bile is produced.
b. bleeding occurs in the digestive tract. Upper GI bleeding causes increased urea concentrations in patients with normal liver function and high ammonia concentrations in patients with impaired liver function. This ammoniagenesis may precipitate encephalopathy.
8. The presence of food in the intestine stimulates intestinal activity but inhibits gastric activity through the: a. defecation reflex. b. enterogastric reflex. c. vomiting reflex. d. autodigestive reflex.
b. enterogastric reflex. Enterogastric Reflex: is triggered by baroreceptors (arrival of chyme stretches the receptors) and chemoreceptors (pH change in the arrival of chyme) in the duodenum. The results are temporarily inhibit gastrin production, decrease stomach contractions, and increase the contraction of the pyloric sphincter.
19. What does the defecation reflex require? a. Stimulation by the sympathetic nervous system b. Contraction of the internal anal sphincter c. Coordination through the sacral spinal cord d. Voluntary relaxation of pelvic muscles
c. Coordination through the sacral spinal cord The defecation reflex occurs when the internal anal sphincter relaxes and the external anal sphincter contracts. The rectoanal inhibitory reflex (RAIR) is an involuntary internal anal sphincter relaxation in response to rectal distention
91. 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
c. Esophageal varices Esophageal varices is present in post-icteric stage
10. What does the term gluconeogenesis refer to? a. Breakdown of glycogen to produce glucose b. Conversion of excess glucose into glycogen for storage c. Formation of glucose from protein and fat d. Breakdown of glucose into carbon dioxide and water
c. Formation of glucose from protein and fat Gluconeogenesis is the metabolic process by which organisms produce sugars for catabolic reactions from non-carbohydrate precursors. Glucose is the only energy source used by the brain (with the exception of ketone bodies during times of fasting), testes, erythrocytes, and kidney medulla
102. Which factor(s) appear(s) to have a role in the etiology of inflammatory bowel diseases? a. Dietary factors b. Environmental toxins c. Genetic and immunological factors d. Chronic alcoholism
c. Genetic and immunological factors
99. Which type of hepatitis virus requires the presence of hepatitis B virus so as to replicate? a. HAV b. HCV c. HDV d. HEV
c. HDV HDV is a defective RNA virus which requires the help of HBV virus for its replication and assembly of new virions. HDV genome contains only one actively transcribed open reading frame which encodes for two isoforms of hepatitis delta antigen
37. What is frequently the first manifestation of stress ulcers? a. Abdominal discomfort between meals and at night b. Nausea and diarrhea c. Hematemesis d. Sharp colicky pain with food intake
c. Hematemesis Stress ulcers come on suddenly, usually as a result of physiological stress. Some acidic foods can make ulcers worse, as can physical stress, such as the stress of a serious injury or infection. This may be because stress increases stomach acid. Hematemesis - vomiting of stomach contents mixed with blood, or the regurgitation of blood only.
32. What does congenital pyloric stenosis involve? a. Absence of peristalsis in the lower section of the stomach b. Failure of an opening to develop between the stomach and duodenum c. Hypertrophy of smooth muscle in the pylorus d. Thickening of the gastric wall due to chronic inflammation
c. Hypertrophy of smooth muscle in the pylorus Pyloric stenosis - A condition in which the opening between the stomach and small intestine thickens Affects babies between birth and 6 months of age and causes forceful vomiting that can lead to dehydration. It is the second most common problem requiring surgery in newborns. The lower portion of the stomach that connects to the small intestine is known as the pylorus.
1 - Which statement below is true when discussing the liver? a. The digestive enzymes trypsin, chymotrypsin and amylase are found in the liver. b. In the liver glycogen is converted to glucose. c. In the liver amino acids produce complex molecules by the means of anabolic processes. d. The liver is located in the upper left quadrant in most people.
c. In the liver amino acids produce complex molecules by the means of anabolic processes.
98. 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
c. Increased conjugated and unconjugated bilirubin Any bilirubin that manages to become conjugated will be excreted normally, yet it is the unconjugated bilirubin that remains in the blood stream to cause the jaundice. In hepatocellular (or intrahepatic) jaundice, there is dysfunction of the hepatic cells.
96. 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.
c. Infection is often asymptomatic.
79. How does pelvic inflammatory disease frequently lead to bacterial peritonitis? a. Chemical irritation by excessive ovarian and uterine secretions causes inflammation. b. Ulceration and perforation of the uterus allow the bacteria to spread. c. Infection spreads through the fallopian tubes directly into the peritoneal cavity. d. Gangrene in the uterine wall spreads through into the pelvic cavity.
c. Infection spreads through the fallopian tubes directly into the peritoneal cavity. Pelvic inflammatory disease is an infection of a woman's reproductive organs
77. 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. Voluntary contraction of the abdominal muscles as a protective mechanism
c. Inflamed peritoneum, resulting in reflex abdominal muscle spasm If you have pain when you are touched and you tighten the muscles to guard against more pain, it is more likely caused by a physical condition inside your body
72. To which site does colon cancer usually first metastasize? a. Lungs b. Stomach c. Liver d. Spleen
c. Liver This happens in part because the blood supply from the intestines is connected directly to the liver through a large blood vessel called the portal vein.
56. Which of the following is a major cause of primary hepatocellular cancer? a. Metastatic tumors b. Acute hepatitis c. Long-term exposure to certain chemicals d. Chronic cholelithiasis
c. Long-term exposure to certain chemicals
21. What does congenital esophageal atresia cause? a. Direct passage of saliva and food from the mouth into the trachea b. Repeated reflux of gastric secretions into the esophagus c. No fluid or food entering the stomach d. Gastric distention and cramps
c. No fluid or food entering the stomach Esophageal atresia is a congenital medical condition (birth defect) that affects the alimentary tract. It causes the esophagus to end in a blind-ended pouch rather than connecting normally to the stomach.
68. What usually initiates acute appendicitis? a. Infection in the appendix b. An episode of severe diarrhea c. Obstruction of the lumen of the appendix d. Eating a low-fiber diet
c. Obstruction of the lumen of the appendix acute appendicitis - A condition in which the appendix becomes inflamed and filled with pus, causing pain.
84. Which of the following is the most frequent location of peptic ulcers? a. Lower esophagus b. Antrum of the stomach c. Proximal duodenum d. Distal duodenum
c. Proximal duodenum Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine Ulcers occur when stomach acid damages the lining of the digestive tract.
30. What is a common cause of gastroenteritis due to Salmonella? a. Unrefrigerated custards or salad dressings b. Poorly canned foods c. Raw or undercooked poultry or eggs d. Contaminated water
c. Raw or undercooked poultry or eggs Gastroenteritis is an inflammation of the lining of the intestines caused by a virus, bacteria, or parasites
81. When dehydration reduces the compensation possible for acidosis resulting from prolonged diarrhea, what significant change in arterial blood gases indicates this? a. Serum pH would rise above 7.45. b. Serum bicarbonate levels would increase, and serum pH would remain in normal range. c. Serum bicarbonate levels would decrease, and serum pH would drop below 7.35. d. Serum PCO2 would rise, and serum pH would be around 7.4.
c. Serum bicarbonate levels would decrease, and serum pH would drop below 7.35.
43. What is the major effect when a gallstone obstructs the cystic duct? a. Intrahepatic jaundice b. Acute pancreatitis c. Severe colicky pain in upper right quadrant d. Inflammation and infection in the gallbladder
c. Severe colicky pain in upper right quadrant The cystic duct is the short duct that joins the gallbladder to the common hepatic duct. It usually lies next to the cystic artery. In adults, colic is a pain, usually intestinal or urinary in nature, that comes and goes and that intensifies and then gradually eases.
74. 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
c. Severe steady abdominal pain Paralytic ileus is the occurrence of intestinal blockage in the absence of an actual physical obstruction. This type of blockage is caused by a malfunction in the nerves and muscles in the intestine that impairs digestive movement
24. Why does herpes simplex infection tend to recur? a. Active infection is usually asymptomatic. b. The virus builds up a resistance. c. The virus persists in latent form in sensory nerve ganglia. d. The virus mutates; therefore, no effective immunity develops.
c. The virus persists in latent form in sensory nerve ganglia.
12. Which of the following statements applies to bile salts? a. They give feces the characteristic brown color. b. They are enzymes used to break down fats into free fatty acids. c. They emulsify lipids and lipid-soluble vitamins. d. They are excreted in the feces.
c. They emulsify lipids and lipid-soluble vitamins. Bile salts are one of the primary components of bile. Bile is a greenish-yellow fluid made by the liver and stored in our gallbladder. Bile salts help with the digestion of fats in our bodies. They also help us to absorb fat-soluble vitamins like A, D, E, and K. aid digestion by breaking down fats help absorb fat-soluble vitamins eliminate waste products
11. Normally, proteins or amino acids are required to produce all of the following EXCEPT: a. peptide hormones. b. clotting factors and antibodies. c. cellular energy. d. hemoglobin.
c. cellular energy. Proteins are used as an energy source only if protein intake is high, or if glucose and fat sources are depleted, in which case amino acids from protein breakdown are converted into molecules that can enter the TCA Cycle.
17. Severe vomiting can lead to metabolic acidosis because of increased: a. ketones produced. b. CO2 retained in the lungs and kidneys. c. hypovolemia and lactic acid production. d. metabolic rate.
c. hypovolemia and lactic acid production. Vomiting --> loss of Hcl --> decrease serum bicarb --> increase lactic acid production --> metabolic acidosis Hypovolemia - A condition in which the liquid portion of the blood (plasma) is too low. Lactic acidosis - the buildup of lactate in the body, with formation of an excessively low pH in the bloodstream. Hyperchloremic acidosis results from a loss of sodium bicarbonate. This base helps to keep the blood neutral. Both diarrhea and vomiting can cause this type of acidosis.
48. During the course of a hepatitis B infection, the onset of jaundice occurs in the: a. incubation period. b. preicteric stage. c. icteric stage. d. posticteric stage.
c. icteric stage. Three stages of hepatitis 1) Preicteric - ausea / vomiting, decreased appetite / weight loss, fever, fatigue, headache and joint pain, rt upper quadrant abdominal pain, enlarged spleen/liver/lymph nodes and rash and itching of the skin (urticaria) 2) Icteric - Jaundice (yellowing of the skin and whites of the eyes) develops. 3) Posticteric - cessation of the above noted symptoms, liver enlargement and continued fatigue Remarkable progress has been made in our understanding of the four natural stages of chronic hepatitis B (CHB): 1) immune tolerance stage 2) immune clearance stage 3) inactive HBsAg carrier stage 4) reactivation stage.
51. A factor that may precipitate encephalopathy with cirrhosis is the elevated: a. serum urea. b. conjugated bilirubin. c. serum ammonia. d. serum pH.
c. serum ammonia. Encephalopathy - damage to the brain Ammonia is mostly cleared by the liver and there is some extrahepatic metabolism in muscle tissue. Hepatic encephalopathy is thought to be caused by accumulation of unmetabolized ammonia resulting in neuropsychiatric toxicity and encephalopathy.
104. When a portion of the proximal stomach and the paraesophageal junction move above the diaphragm, this is called a: a. dysphagia. b. rolling hernia. c. sliding hernia. d. pyloric stenosis.
c. sliding hernia. Sliding hiatal hernias are those in which the junction of the esophagus and stomach, referred to as the gastro- esophageal junction, and part of the stomach protrude into the chest.
97. What is the initial pathological change in alcoholic liver disease? a. Formation of nodules with shrinkage of the liver b. Inflammation with necrosis c. Development of fibrous bands of tissue d. Accumulation of fat in hepatocytes with hepatomegaly
d. Accumulation of fat in hepatocytes with hepatomegaly hepatic steatosis - fatty liver hepatomegaly - enlarged liver
31. Which of the following individuals is likely to develop acute gastritis? a. A long-term, heavy cigarette smoker b. Patient with arthritis taking enteric-coated aspirin on a daily basis c. A person with an autoimmune reaction in the gastric mucosa d. An individual with an allergy to shellfish
d. An individual with an allergy to shellfish Acute gastritis is a sudden inflammation or swelling in the lining of the stomach.
88. Which of the following is NOT a common predisposing factor to gastric carcinoma? a. Ingestion of smoked foods b. Genetic factors c. Ingestion of foods preserved with nitrates d. Anti-inflammatory medications such as ASA
d. Anti-inflammatory medications such as ASA
57. 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. Autodigestion of tissue by pancreatic enzymes
d. Autodigestion of tissue by pancreatic enzymes Acute pancreatitis is sudden inflammation of the pancreas that may be mild or life threatening but usually subsides. Gallstones and alcohol abuse are the main causes of acute pancreatitis Autodigestion describes a process whereby pancreatic enzymes destroy its own tissue leading to inflammation. The inflammation may be sudden (acute) or ongoing (chronic).
50. What indicates the presence of third-stage alcohol hepatitis? a. Below normal blood levels of AST and ALT b. Upper left quadrant tenderness and dull pain c. A small, firm, nodular liver and portal hypertension d. Decreased production of blood clotting factors
d. Decreased production of blood clotting factors 1st stage - fatty liver 2nd stage - liver fibrosis 3rd stage - cirrhosis
85. In peptic ulcer disease, which of the following does NOT decrease the resistance of the mucosal barrier? a. Prolonged vasoconstriction b. Excessive glucocorticoid intake c. Proteases and cytotoxins from H. pylori d. Decreased vagal stimulation
d. Decreased vagal stimulation
54. What is the primary cause of increased bleeding tendencies associated with cirrhosis? a. Anemia and leucopenia b. Jaundice and pruritus c. Recurrent infections d. Deficit of vitamin K and prothrombin
d. Deficit of vitamin K and prothrombin Nutritional deficiency is common in patients with cirrhosis, especially those with coexisting biliary disease. The ensuing reduction in bile production and flow leads to decreased intraluminal concentrations of biliary salts. This results in the decreased absorption of fat-soluble vitamins, including vitamin K.
20. What is the definition of dysphagia? a. A herniation of the gastric mucosa through a segment of weakened muscle b. Recurrent reflux of chyme into the esophagus c. Absence of a connection of the esophagus to the stomach d. Difficulty in swallowing
d. Difficulty in swallowing
61. What is the dietary requirement for a child with celiac disease? a. Low sodium, high fat b. High carbohydrate, low protein c. High calorie with vitamin supplements d. Gluten-free
d. Gluten-free
9. Which of the following processes is likely to occur in the body immediately after a meal? a. Lipolysis b. Ketogenesis c. Gluconeogenesis d. Glycogenesis
d. Glycogenesis Glycogenesis is the process of glycogen synthesis, in which glucose molecules are added to chains of glycogen for storage. This process is activated during rest periods following the Cori cycle, in the liver, and also activated by insulin in response to high glucose levels.
49. What is the likely effect of long-term exposure to a hepatotoxin? a. Full recovery to normal tissue after the toxic material has been removed b. Acute onset of vomiting, steatorrhea, and jaundice c. Continued mild inflammation of the liver without permanent damage d. Gradual irreversible damage to the liver and cirrhosis
d. Gradual irreversible damage to the liver and cirrhosis
75. A congenital condition in which parasympathetic innervation is missing from a section of the colon, impairing motility is referred to as: a. diverticulitis. b. Crohn's disease. c. irritable bowel syndrome. d. Hirschsprung's disease.
d. Hirschsprung's disease. A condition of the large intestine (colon) that causes difficulty passing stool. Hirschsprung's disease involves missing nerve cells in the muscles of part or all of the large intestine (colon). Present at birth, it causes difficulty passing stool.
66. 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
d. Idiopathic
41. Why does mild hyperbilirubinemia occur in newborns? a. Blood incompatibility between mother and child b. Damage to many erythrocytes during the birth process c. Poor circulation and albumin transport for bilirubin d. Immature liver cannot process bilirubin quickly enough
d. Immature liver cannot process bilirubin quickly enough Hyperbilirubinemia - jaudice
62. 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
d. Inflamed areas of the wall of the ileum alternating with thick fibrotic or normal areas Crohn's disease is a type of inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people.
71. What is a typical early sign of cancer in the ascending colon? a. Change in shape of the stool b. Incomplete emptying c. Mild but persistent pain in the lower left quadrant d. Occult blood in the stool
d. Occult blood in the stool ascending colon ends where the colon bends, just below the liver and gallbladder (on right side going up)
64. 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
d. Recurrent inflammation, necrosis, and fibrosis, forming a connection between intestinal loops Fistula - A fistula is an abnormal connection between two body parts, such as an organ or blood vessel and another structure.
4. Which of the following breaks protein down into peptides? a. Amylase b. Peptidase c. Lactase d. Trypsin
d. Trypsin Trypsin is an enzyme that helps us digest protein. In the small intestine, trypsin breaks down proteins, continuing the process of digestion that began in the stomach. It may also be referred to as a proteolytic enzyme, or proteinase. Trypsin is produced by the pancreas in an inactive form called trypsinogen.
44. Obstruction of the biliary tract by gallstones is referred to as: a. cholelithiasis. b. cholecystitis. c. cholangitis. d. choledocholithiasis.
d. choledocholithiasis. Choledocholithiasis (also called bile duct stones or gallstones in the bile duct) is the presence of a gallstone in the common bile duct. Gallstones usually form in your gallbladder. The bile duct is the small tube that carries bile from the gallbladder to the intestine.
13. The visceral peritoneum: a. lines the abdominal wall. b. hangs from the stomach over the loops of small intestine. c. contains many pain receptors. d. forms the outer covering of the stomach.
d. forms the outer covering of the stomach. Visceral peritoneum covers the external surfaces of most abdominal organs, including the intestinal tract.
101. Although many factors may precipitate pancreatitis, the two major causes are: a. obesity and smoking. b. high-fat diet and hypertension. c. congenital defects and drug abuse. d. gallstones and alcohol abuse.
d. gallstones and alcohol abuse.
35. The pathophysiology of peptic ulcer disease may involve any of the following EXCEPT: a. decreased resistance of the mucosal barrier. b. increased stimulation of pepsin and acid secretions. c. infection by H. pylori. d. increased stimulation of mucus-producing glands.
d. increased stimulation of mucus-producing glands. It decreases
108. The telescoping of one section of bowel inside another section is called: a. volvulus. b. hernia. c. adhesion. d. intussusceptions.
d. intussusceptions.
33. A patient with acquired pyloric stenosis would likely: a. have an increase in appetite. b. have chronic diarrhea. c. develop severe colicky pains. d. vomit undigested food from previous meals.
d. vomit undigested food from previous meals. In pyloric stenosis, this muscle thickens causing the obstruction. Babies usually develop problems from pyloric stenosis before they are six months old. When a baby eats but cannot digest the food past the stomach, the baby vomits. Because the baby cannot absorb the food he stays hungry and wants more food.
