Week 7 - Check Your Understanding

Which symptom suggests the presence of a hiatal hernia? A. Nausea B. Heartburn C. Diarrhea D. Abdominal cramps

B. Heartburn Individuals with hiatal hernia are predisposed to GERD and may experience symptoms such as heartburn, chest pain, and dysphagia. Nausea and abdominal cramps are not symptoms that suggest hiatal hernia. Hiatal hernia is not manifested by diarrhea.

In the United States, nearly ________ people have diabetes mellitus. A. 7 million B. 29.1 million C. 366 million D. 176 billion

B. 29.1 million In the United States, nearly 29.1 million people have diabetes. Diabetes affects much more than 7 million people in the United States. It is estimated that worldwide the number of people who have diabetes will rise to 366 million by 2015. The annual cost of diabetes to the U.S. medical care system was estimated to be $176 billion in 2007.

A patient with chronic gastritis would likely be tested for A. Helicobacter pylori. B. occult blood. C. lymphocytes. D. herpes simplex.

A. Helicobacter pylori. It is now known that H. pylori causes chronic, superficial gastritis in virtually all infected persons. Once established in the gastric mucosa, H. pylori sets up a destructive pattern of persistent inflammation. The presence of bloody stools is not generally seen in chronic gastritis. Lymphocytes are not tested in the presence of chronic gastritis. Herpes simplex is not a manifestation of chronic gastritis.

Which response to an injection of ACTH indicates a primary adrenal insufficiency? A. No change in serum glucocorticoid level B. An increase in serum glucocorticoid level C. A decrease in serum glucose level D. An increase in serum ACTH level

A. No change in serum glucocorticoid level Primary adrenal insufficiency would be indicated when the adrenal cortex fails to produce cortisol when synthetic ACTH is administered. Serum cortisol levels would increase following ACTH administration if the adrenal cortex is functioning properly. Primary adrenal insufficiency occurs when there is no change in the serum glucocorticoid level. Serum levels of cortisol are measured after synthetic ACTH is given.

What laboratory data would support a diagnosis of hemochromatosis? A. Deficient protease inhibitor B. Elevated ferritin C. Elevated urine copper D. Positive antinuclear antibody

B. Elevated ferritin Serum iron and ferritin studies are performed to diagnose hemochromatosis. Protease inhibitor is not used to diagnose hemochromatosis. Copper in the urine is not indicative of hemochromatosis. Antinuclear antibody is not diagnostic of hemochromatosis.

Acute right lower quadrant pain associated with rebound tenderness and systemic signs of inflammation are indicative of A. appendicitis. B. peritonitis. C. cholecystitis. D. gastritis.

A. appendicitis. The earliest manifestation of appendicitis is generalized periumbilical pain accompanied by nausea and, occasionally, diarrhea. The pain is often described as "migrating" or localizing to the lower right abdomen (McBurney's point) because of distention of the serosa from inflammatory edema, at which time fever usually manifests. Acute localized pain with rebound tenderness is not associated with peritonitis. Cholecystitis is not manifested by lower quadrant pain. Gastritis is not associated with symptoms of right lower quadrant pain and systemic inflammation.

Ulcerative colitis is commonly associated with A. bloody diarrhea. B. malabsorption of nutrients. C. fistula formation between loops of bowel. D. inflammation and scarring of the submucosal layer of the bowel.

A. bloody diarrhea. Ulcerative colitis (inflammation and ulceration of the colon and rectal mucosa) is manifested as bloody diarrhea and abdominal pain. Ulcerative colitis is not associated with malabsorption of nutrients. Fistula formation in the bowel is related to Crohn disease. Acute inflammation of the intestinal wall may manifest as pseudomembranous enterocolitis or necrotizing enterocolitis.

Diabetic neuropathy is thought to result from A. decreased myoinositol transport. B. elevated HbA1c. C. deficient neuronal insulin receptors. D. neuronal demyelination.

A. decreased myoinositol transport. Glucose appears to compete with myoinositol in transport into the cell. Degradation of glucose to sorbitol and fructose (the polyol pathway) occurs in the nerves in the presence of hyperglycemia and insulinopenia. Elevated HbA1c is not associated with diabetic neuropathy. Deficient neuronal insulin receptors are not responsible for neuropathy. Focal ischemic lesions of the nerves may have a role in diabetic neuropathy.

Chronic pancreatitis may lead to A. diabetes mellitus. B. Crohn disease. C. gallstones. D. celiac sprue.

A. diabetes mellitus. About 10% to 15% of patients will present not with pain, but rather with the sequelae of chronic pancreatitis, including diabetes mellitus, malabsorption, and weight loss. Chronic pancreatitis does not lead to Crohn disease. Increased incidence of gallstones is not the result of chronic pancreatitis. Celiac sprue is not related to chronic pancreatitis.

Steatohepatitis is caused by an accumulation of ________ in the liver cells. A. fat B. bile C. acetaminophen D. ferritin

A. fat Alcoholic fatty liver (alcoholic steatohepatitis) is an accumulation of fat in the liver cells. It is caused by more fat being delivered to the hepatocyte than it can normally metabolize or by a defect in fat metabolism within the cell. An accumulation of bile does not contribute to steatohepatitis. Steatohepatitis is not related to an accumulation of acetaminophen levels. Serum ferritin levels are elevated in patients with hereditary hemochromatosis.

Untreated acute cholecystitis may lead to ________ of the gallbladder wall. A. gangrene B. infection C. distention D. inflammation

A. gangrene If left untreated, the inflammatory process often escalates, and gangrene of the gallbladder wall with rupture may occur. Acute cholecystitis is defined as acute inflammation of the gallbladder wall. Distention of the gallbladder wall is not a risk factor related to untreated cholecystitis. Acute cholecystitis is defined as acute inflammation of the gallbladder wall.

The most common causes of prehepatic jaundice are ________ and ineffective erythropoiesis. A. hemolysis B. metabolism C. fibrosis D. canalicular bilirubin transport

A. hemolysis The most common causes of prehepatic jaundice are hemolysis and ineffective erythropoiesis. The reabsorption of large hematomas in patients with mild liver disease is a frequent and harmless cause of mild jaundice. Dysfunction of each of the hepatic steps in bilirubin metabolism may cause jaundice. Increased resistance from fibrosis may cause jaundice in the cholestatic pathway. At the canalicular posthepatocytic level, jaundice may occur as a result of conjugated hyperbilirubinemia.

Myxedema coma is a severe condition associated with A. hypothyroidism. B. hyperthermia. C. acute cortisol insufficiency. D. pheochromocytoma.

A. hypothyroidism. Myxedema occurs with severe or prolonged thyroid deficiency. Individuals with myxedema usually present in an altered mental state, with alterations in thermoregulation. The accumulation of glycosaminoglycans causes the patient to have edematous skin. Pheochromocytoma is not associated with myxedema coma.

Celiac sprue is a malabsorptive disorder associated with A. inflammatory reaction to gluten-containing foods. B. megacolon at regions of autonomic denervation. C. ulceration of the distal colon and rectum. D. deficient production of pancreatic enzymes.

A. inflammatory reaction to gluten-containing foods. Celiac disease (also called celiac sprue) is characterized by intolerance of gluten, a protein in wheat and wheat products. Current research suggests that celiac sprue is an immune disorder. The main pathologic finding is villus atrophy, with a decrease in the activity and amount of surface epithelial enzymes. Celiac sprue is not associated with ulceration of the distal colon and rectum. Celiac disease is an intolerance of gluten.

The American Diabetes Association recommends a postprandial blood glucose level of ________ mg/dL for adults with diabetes. A. less than 180 B. more than 180 C. 70 D. 130

A. less than 180 The American Diabetes Association recommends a postprandial blood glucose level less than 180 mg/dL for adults with diabetes. Blood glucose levels in adults with diabetes are recommended to be less than 180 mg/dL after meals. The American Diabetes Association recommends as goals a preprandial blood glucose level between 70 and 130 mg/dL. A preprandial blood glucose level between 70 and 130 mg/dL is recommended.

A patient being treated for hepatic encephalopathy could be expected to receive a(n) ________ diet. A. low-protein and high-fiber B. high-protein and high-carbohydrate C. high-sodium D. unrestricted

A. low-protein and high-fiber Restriction of protein is indicated for chronic encephalopathy, along with enhanced elimination of toxic nitrogenous substances. High fiber intake may help decrease constipation. As ammonia levels drop, protein is reintroduced into the diet. When protein is restricted, carbohydrate levels should be at least 400 g. Excessive levels of sodium in the diet are contraindicated with renal insufficiency. Dietary restrictions are utilized in patients with hepatic encephalopathy.

Premature infants are at greater risk for developing A. necrotizing enterocolitis. B. pseudomembranous colitis. C. appendicitis. D. diverticular disease.

A. necrotizing enterocolitis. Necrotizing enterocolitis (NEC) is a disorder occurring most often in premature infants (less than 34 weeks' gestation) and infants with low birth weight (less than 5 lbs or 2.25 kg). This disorder is characterized by diffuse or patchy intestinal necrosis accompanied by sepsis. Pseudomembranous colitis is an acute inflammation and necrosis of the large intestine caused by Clostridium difficile, usually affecting the mucosa but sometimes extending to other layers. The most common cause of emergency surgery on the abdomen, appendicitis is an inflammation of the vermiform appendix. The prevalence of diverticular disease increases with age.

Type 2 diabetes mellitus is often associated with A. nonketotic hyperosmolality. B. childhood. C. autoimmune destruction of the pancreas. D. ketoacidosis.

A. nonketotic hyperosmolality. More common in type 2 diabetes mellitus, especially in older individuals, is nonketotic hyperglycemic hyperosmolar syndrome characterized by severe hyperglycemia with no or slight ketosis and striking dehydration. Type 1 diabetes is seen more in childhood than type 2. Type 2 diabetes is characterized by a lack of insulin. Ketoacidosis is found in type 1 diabetes.

The underlying pathogenic mechanism for type 1 diabetes is A. pancreatic β-cell destruction. B. lack of insulin receptors. C. lack of exercise and chronic overeating. D. impaired glucose transport into cells.

A. pancreatic β-cell destruction. By definition, type 1 diabetes is characterized by destruction of the β cells of the pancreas. Type 1 diabetes mellitus is characterized by an absolute insulin deficiency, and thus glucose cannot enter muscle and adipose tissue. Type 1 diabetes is unrelated to lack of exercise and chronic overeating. In type 1 diabetes, production of glucose by the liver is no longer opposed by insulin.

In type I diabetes, respiratory compensation may occur through a process of A. respiratory alkalosis. B. respiratory acidosis. C. metabolic acidosis. D. metabolic alkalosis.

A. respiratory alkalosis. Respiratory compensation for the metabolic acidosis in the form of deep, labored respirations that are "fruity" in odor results in lowered PCO2 values from compensatory respiratory alkalosis. Respiratory acidosis is not the mechanism of respiratory compensation. In hyperglycemia, metabolic acidosis ensues as the bicarbonate concentration decreases, and diabetic ketoacidosis results. Metabolic alkalosis is not the compensatory mechanism for hyperglycemia.

Diabetes insipidus is a condition that A. results from inadequate ADH secretion. B. is characterized by oliguria. C. is associated with anterior pituitary dysfunction. D. leads to glycosuria.

A. results from inadequate ADH secretion. Diabetes insipidus is a condition related to insufficient ADH activity. Diabetes insipidus is characterized by excessive loss of water in the urine. ADH is secreted by the posterior pituitary gland. A hallmark of DI is the presence of excessive urination and excessive drinking.

It is true that growth hormone excess in adults A. results in the condition of acromegaly. B. leads to abnormally tall stature. C. is associated with hypoglycemia. D. is usually asymptomatic.

A. results in the condition of acromegaly. Growth hormone excess in adults is known as acromegaly. Acromegaly in adults causes an increase in bone density. Acromegaly may be clinically subtle and occurs with equal frequency in men and women. Growth hormone in adults is not associated with hypoglycemia.

Clinical manifestations of Graves disease may include A. tremor. B. cold intolerance. C. lethargy. D. weight gain.

A. tremor. Symptoms of Graves disease include restlessness, tremors, and irritability. Graves disease is associated with heat intolerance. Hyperthyroidism is associated with insomnia. Increased basal metabolic rate may result in weight loss.

Normal bile is composed of A. water, electrolytes, and organic solutes. B. proteins. C. bile acids. D. phospholipids.

A. water, electrolytes, and organic solutes. Normal bile is composed primarily of water, electrolytes, and organic solutes. Bile has a low protein content. The low amount of protein in bile contains bile acids, pigment, cholesterol, and phospholipids. Phospholipids are part of the low protein content in bile.

What form of viral hepatitis is likely to be transmitted sexually? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis E

B. Hepatitis B Hepatitis B is spread by parenteral contact with infected blood or blood products, including contaminated needles, and by sexual contact. Hepatitis A virus (HAV) is usually spread by the fecal-oral route. The mode of transmission of hepatitis C closely resembles that of HBV, although sexual and perinatal transmission is much less likely. The majority of infections were acquired through IV drug abuse. Hepatitis E is an RNA virus spread via the fecal-oral route, especially through contaminated water.

________ is the most powerful predictor of developing type 2 diabetes mellitus. A. Aging B. Obesity C. Sedentary lifestyle D. Cardiovascular disease

B. Obesity For type 2 diabetes mellitus, the most powerful predictor is obesity. Excessive abdominal fat introduces a greater threat of diabetes mellitus. Risk factors include aging and a sedentary lifestyle. Leading a sedentary lifestyle carries a greater risk of diabetes. The presence of cardiovascular disease is a risk factor in developing type 2 diabetes, but is not the primary factor.

________ disease is a rare autosomal recessive disorder in which excessive amounts of copper accumulate in the liver. A. Kayser-Fleischer B. Wilson C. Reye D. Byler

B. Wilson Wilson disease, or hepatolenticular degeneration, is a rare autosomal recessive disorder in which excessive amounts of copper accumulate in the liver and other organs. As with hereditary hemochromatosis, it has now been linked to a specific abnormal protein, ATP7B, which results in retention of copper in the liver. Clinical signs and symptoms of Wilson disease include the presence of Kayser-Fleischer rings on the cornea. Reye syndrome is characterized by fatty infiltration of the liver with severe hepatic dysfunction, including encephalopathy, coagulopathy, and elevated levels of hepatocellular enzymes. Byler syndrome is caused by a single-gene mutation and traces back to an Amish kindred.

Liver transaminase elevations in which aspartate aminotransferase (AST) is markedly greater than alanine aminotransferase (ALT) is characteristic of A. viral hepatitis. B. alcohol-induced injury. C. cirrhosis. D. acetaminophen toxicity.

B. alcohol-induced injury. Alcoholic and other toxic hepatitides virtually always show the aspartate aminotransferase (AST) markedly elevated in comparison with the alanine aminotransferase (ALT). In viral hepatitis, the alanine aminotransferase (ALT) is markedly higher than the aspartate aminotransferase (AST). Jaundice in patients with cirrhosis often shows elevations in all parameters, reflecting the widespread liver dysfunction and obstruction of the bile canals and small vessels because of scarring. Acetaminophen toxicity will cause signs of hepatic injury within 24 to 48 hours, including abnormal liver enzyme levels.

It is true that Graves disease is A. a secondary endocrine disorder. B. associated with autoantibodies to TSH receptors. C. characterized by high serum TSH levels. D. untreatable.

B. associated with autoantibodies to TSH receptors. Graves disease is an autoimmune disorder where autoantibodies cause the pituitary gland to stop producing TSH. Graves disease is an autoimmune disorder. Serum TSH levels fall to very low levels with Graves disease. Hyperthyroidism is treatable with medications, surgery, or other modalities.

Hepatitis with the presence of autoantibodies and positive antinuclear antibodies (ANA) is A. hepatitis D. B. autoimmune hepatitis. C. hepatitis A. D. hepatitis B.

B. autoimmune hepatitis. Autoimmune hepatitis is characterized by the presence of several autoantibodies as well as a polyclonal hypergammaglobulinemia. Antinuclear antibody (ANA) is generally positive at a high level. The diagnosis of hepatitis D is by anti-HDV IgM and IgG enzyme-linked immunosorbent assays. HAV infection is diagnosed through serologic testing. Presence of anti-HAV immune globulin G (IgG) indicates previous infection, and presence of immune globulin M (IgM) indicates acute infection. The serologic diagnosis for hepatitis B is complicated.

Most gallstones are composed of A. bile. B. cholesterol. C. calcium. D. uric acid salts.

B. cholesterol. The majority of gallstones among patients are cholesterol stones. Cholesterol eventually precipitates from supersaturated bile. Most gallstones are not composed of calcium. Uric acid salts are not the primary composition of gallstones.

An increase in ADH secretion occurs in response to A. decreased serum osmolality. B. dehydration. C. hypervolemia. D. hyponatremia.

B. dehydration. ADH is secreted in response to changes in blood osmolality. ADH increases membrane permeability to and reabsorption of water. An increase in serum osmolality causes an increase in ADH secretion. With insufficient amounts of ADH, urine cannot be concentrated and free water is lost, causing hyperosmolality. Not enough salt outside the cells would not cause ADH to be secreted.

Fecal leukocyte screening would be indicated in a patient with suspected A. lactose intolerance. B. enterocolitis. C. laxative abuse. D. giardiasis.

B. enterocolitis. Enterocolitis is manifested by diarrhea (often bloody), abdominal pain, fever, leukocytosis, and rarely, colonic perforation. Lactose intolerance would not be a cause of leukocytosis. Leukocyte screening would not be a factor in laxative use or abuse. Suspected giardiasis would not be a reason to screen fecal leukocytes.

A clinical finding that is consistent with a diagnosis of adrenocortical insufficiency is A. hypokalemia. B. hypoglycemia. C. hypertension. D. moon face.

B. hypoglycemia. Hypoglycemia is associated with adrenal insufficiency. Early signs of electrolyte imbalance may occur with adrenal insufficiency. Hypotension is a symptom of adrenal insufficiency. Moon face occurs with hypercortisolism.

A clinical finding consistent with a diagnosis of syndrome of inappropriate ADH secretion (SIADH) is A. hypovolemia. B. hyponatremia. C. decreased osmolality. D. dehydration.

B. hyponatremia. SIADH is characterized by hyponatremia. Clinical manifestations of SIADH are as a result of hypotonicity of body fluids. Serum osmolality is low because of dilution by reabsorbed water. Inappropriate ADH secretion is not manifested by dehydration.

A patient presenting with muscle cramps, fatigue, anxiety, depression, and prolonged Q-T intervals on EKG may be showing symptoms of A. hyperparathyroidism. B. hypoparathyroidism. C. diabetes insipidus. D. SIADH.

B. hypoparathyroidism. Clinical manifestations of hypoparathyroidism occur as a result of low serum calcium levels. The manifestations of acute hypocalcemia include muscle cramps, fatigue, hyperirritability, anxiety, depression, and prolongation of Q-T intervals on the electrocardiogram. The presentation of hyperparathyroidism is related to the level of hypercalcemia and the hyperparathyroid state. Hyperparathyroidism may present as asymptomatic hypercalcemia. Individuals are prone to kidney stones and to bone demineralization. Diabetes insipidus is manifested by polyuria and polydipsia. SIADH is characterized by hyponatremia.

The finding of hypotension, rigid abdomen, and absent bowel sounds in a patient with pancreatitis A. is an expected finding and requires no specific intervention. B. indicates peritonitis with substantial risk for sepsis and shock. C. requires immediate surgical intervention. D. is an unusual finding in pancreatitis and indicates misdiagnosis.

B. indicates peritonitis with substantial risk for sepsis and shock. In acute pancreatitis, fever is common but is usually low-grade initially. In more severe pancreatitis, hypotension, rigid abdomen, and absent bowel sounds are present. Hypotension, rigid abdomen, and absent bowel sounds are unexpected findings. Pancreatic surgery is technically challenging and risky, and generally is only considered as a last resort. Findings indicative of peritonitis do occur and should be treated promptly.

The underlying pathogenic mechanism for type 2 diabetes is A. pancreatic β-cell destruction. B. insulin resistance and β-cell dysfunction. C. lack of exercise and chronic overeating. D. impaired glucose transport into cells.

B. insulin resistance and β-cell dysfunction. Type 2 diabetes is characterized by a relative lack of insulin. The processes instrumental in producing the relative lack of insulin are insulin resistance and β-cell dysfunction. By definition, type 1 diabetes is characterized by destruction of the β cells of the pancreas. Obesity is a major risk factor for the development of type 2 diabetes. Type 2 diabetes is not caused by an impaired transport of glucose.

The formation of active vitamin D A. occurs in the skin. B. is impaired in renal failure. C. is dependent on oral intake of vitamin D. D. is necessary for normal potassium metabolism.

B. is impaired in renal failure. Vitamin D is necessary for calcium absorption from the intestine and renal tubules and is impaired in conditions such as renal failure, in which active vitamin D is deficient. Vitamin D formation does not occur in the skin. Oral intake of vitamin D is not a dependent factor in its formation. The production of vitamin D is associated with calcium absorption.

Growth hormone-deficient infants would display A. low birth length and weight. B. normal birth length and weight. C. high birth length and weight. D. normal length and low weight.

B. normal birth length and weight. GH-deficient infants usually have normal birth length and weight. A birth history of prolonged labor or breech delivery is common, but GH deficiency may also be present in children who are born with midline craniocerebral defects. The association between GH deficiency and other midline abnormalities appears to occur because the pituitary gland is developing during the same stage of fetal life as the other midline structures. GH-deficient children generally fall below the third percentile in comparison with peers.

A patient admitted with bleeding related to esophageal varices could be expected to receive a continuous intravenous infusion of A. glucose. B. octreotide acetate. C. anticoagulants. D. proton pump inhibitors.

B. octreotide acetate. Pharmacologic management is used to lower portal pressure by dilating collateral pathways and reducing splanchnic blood flow. Controlling bleeding is often accomplished using vasopressin, but side effects limit its use. Recently, octreotide acetate, a synthetic analog of the naturally occurring hormone somatostatin, has been effectively used as a replacement for vasopressin. Fluid resuscitation is carried out using normal saline. Anticoagulants are contraindicated in a patient with active bleeding. Intravenous proton pump inhibitors may be used, but not as a continuous infusion.

A tumor which results in excessive production and release of catecholamines is A. goiter. B. pheochromocytoma. C. Conn syndrome. D. Cushing disease.

B. pheochromocytoma. Pheochromocytoma is a tumor of chromaffin tissue that results in the excessive production and release of catecholamines. It is usually benign. Goiter is an enlargement of the thyroid gland. Conn syndrome is usually related to adrenal tumor. Excess cortisol production as a result of pituitary hyperstimulation of the adrenal cortex is termed Cushing disease.

Barrett esophagus is a A. gastrin-secreting lesion. B. preneoplastic lesion. C. benign condition. D. gastrin-secreting tumor.

B. preneoplastic lesion. Barrett esophagus is a complication of chronic GERD and represents columnar tissue replacing the normal squamous epithelium of the distal esophagus. It carries a significant risk for esophageal cancer. Patients with Barrett esophagus should undergo regular endoscopic screening for cancer, along with pharmacologic control of their reflux. Barrett esophagus carries a significant risk for esophageal cancer and does not secrete gastrin.

The pain associated with chronic pancreatitis is generally described as ________ in nature. A. sharp and constant B. steady and boring C. intermittent and burning D. intermittent and stabbing

B. steady and boring The pain is often accompanied by nausea and is steady and boring in nature. The pain is usually located in the upper abdomen, particularly in the epigastrium, and radiates to the back in more than half of cases. Pain associated with pancreatitis is most often steady in nature. The pain of chronic pancreatitis is often the major form of debility. Nerve fibers from the pancreas pass to the celiac plexus and then to spinal sympathetic ganglia.

A patient receiving chemotherapy may be at greater risk for development of A. gastroesophageal reflux. B. stomatitis. C. esophageal varices. D. Mallory-Weiss syndrome.

B. stomatitis. Stomatitis is defined as an ulcerative inflammation of the oral mucosa that may extend to the buccal mucosa, lips, and palate. Among its many causes are pathogenic organisms, including bacteria and viruses; mechanical trauma; exposure to such irritants as alcohol, tobacco, and other chemical substances; certain medications, particularly chemotherapeutic agents. Gastroesophageal reflux disease is not related to chemotherapy. Patients taking chemotherapy are not at greater risk for developing esophageal varices. Chemotherapy is not a risk factor for Mallory-Weiss syndrome.

What clinical finding would suggest an esophageal cause of a client's report of dysphagia? A. Nasal regurgitation B. Airway obstruction with swallowing C. Chest pain during meals D. Coughing when swallowing

C. Chest pain during meals Two types of pain occur in the esophagus: (1) heartburn (also called pyrosis) and (2) pain located in the middle of the chest, which may mimic the pain of angina pectoris. Heartburn is caused by the reflux of gastric contents into the esophagus and is a substernal burning sensation that may radiate to the neck or throat. A person experiencing pharyngeal contractions may cough and expel the ingested food or fluids through their mouth and nose or aspirate when they attempt to swallow. Airway obstruction with swallowing would be an oropharyngeal cause of dysphagia. A person experiencing pharyngeal contractions may cough and expel the ingested food or fluids through his or her mouth and nose or aspirate when he or she attempts to swallow.

What indicator is most helpful in evaluating long-term blood glucose management in patients with diabetes mellitus? A. Blood glucose levels B. Urine glucose levels C. Glycosylated hemoglobin levels (HbA1c) D. Clinical manifestations of hyperglycemia

C. Glycosylated hemoglobin levels (HbA1c) HbA1c values are used clinically to estimate long-term control and to set and evaluate therapeutic goals. Monitoring of blood glucose levels is useful for monitoring short-term glycemic control. The blood glucose level at which glucose is measurable in the urine, the glycemic threshold, varies from individual to individual, is usually unacceptably high, and cannot be used to establish the presence of hypoglycemia. Clinical manifestations of hyperglycemia are not a useful method of evaluating long-term glucose management.

An early indicator of colon cancer is A. rectal pain. B. bloody diarrhea. C. a change in bowel habits. D. jaundice.

C. a change in bowel habits. The manifestations of colon cancer depend on the anatomic location and function of the bowel segment containing the tumor. Early manifestations may include a change in bowel habits. Later in the progression of tumor growth, a sensation of rectal fullness and a dull ache may be felt in the rectum or sacral region. Although no signs of obstruction are present, black, tarry stools, which signify bleeding into the intestinal lumen, are a significant finding. Jaundice is not an early indicator of colon cancer.

An urgent surgical consult is indicated for the patient with acute abdominal pain and A. vomiting. B. CVA tenderness. C. absent bowel sounds. D. borborygmi.

C. absent bowel sounds. Functional bowel obstructions are characterized by the absence of bowel sounds. Uncorrected obstruction may lead to intestinal wall edema, ischemia, and necrosis. Vomiting with abdominal pain is not a cause for urgent surgical consult. CVA tenderness in the presence of abdominal pain is not an indicator for urgent surgical consult. Acute abdominal pain with hyperactive bowel sounds does not indicate the need for an urgent surgical consultation.

The most common cause of mechanical bowel obstruction is A. volvulus. B. intussusception. C. adhesions. D. fecal impaction.

C. adhesions. The most frequent contributing factors for bowel obstructions are previous abdominal surgery with adhesions and congenital abnormalities of the bowel. Intestinal obstruction can be caused by volvulus. Intussusception can be related to bowel obstruction, but the most common cause is surgical adhesions. Mechanical bowel obstructions can be related to fecal impaction, but this is not the most common cause.

More than half of the initial cases of pancreatitis are associated with A. trauma. B. stones. C. alcoholism. D. high cholesterol.

C. alcoholism. Up to 66% of first cases of pancreatitis are associated with alcoholism. Trauma is a possible mechanism for acinar cell injury. A prominent factor in pancreatitis is obstruction of the pancreatic duct by a stone. Hypertriglyceridemia is a predisposing factor for pancreatitis in the United States.

Hepatitis B is usually transmitted by exposure to A. hepatitis vaccine. B. feces. C. blood or semen. D. contaminated food.

C. blood or semen. Hepatitis B virus is highly prevalent worldwide. It is spread by parenteral contact with infected blood or blood products, including contaminated needles. HBV vaccine is a recombinant vaccine that is highly immunogenic. After the full course, the antibody response rate is 95% for normal hosts. Hepatitis A is spread by the fecal-oral route. Hepatitis E is spread through contaminated water.

Epigastric pain that is relieved by food is suggestive of A. pancreatitis. B. cardiac angina. C. gastric ulcer. D. dysphagia.

C. gastric ulcer. Manifestations of peptic ulcer disease include epigastric burning pain that is usually relieved by the intake of food (especially dairy products) or antacids. Pancreatitis is not manifested by epigastric pain. Epigastric pain is not a symptom of cardiac angina. Dysphagia is not associated with epigastric pain relieved by food.

The breakdown of stored glycogen in the liver and muscles is called A. glycolysis. B. glycogenesis. C. glycogenolysis. D. gluconeogenesis.

C. glycogenolysis. In the fasting state, glucose is produced by glycogenolysis (breakdown of stored glycogen) in the liver and muscles. Glycolysis is the process of oxidization for the energy needs of the cell. Glycogenesis is the production of glycogen in the muscle and liver. Gluconeogenesis is the production of glucose from amino acids and other substrates in the liver.

A thyroid gland that grows larger than normal is known as A. cretinism. B. myxedema. C. goiter. D. colloidosis.

C. goiter. An enlarged thyroid that continues to grow larger is known as goiter. Cretinism is a congenital hypothyroidism. Myxedema is a condition in which severe or prolonged thyroid deficiency results in generalized edema. Colloidosis is not a condition associated with an enlarged thyroid gland.

The signs and symptoms of adrenocortical hormone excess may occur from either a primary or secondary disorder. A symptom associated with primary Cushing syndrome is A. hyperpigmentation. B. hypotension. C. hyperglycemia. D. hyperkalemia.

C. hyperglycemia. In Cushing syndrome, cortisol increases tissue resistance to the effects of insulin and may contribute to glucose intolerance or hyperglycemia. Hyperpigmentation is related to Addison disease. Hypertension may develop as a consequence of the salt-retaining activity of cortisol and of the increased blood volume. A reduction in serum potassium is commonly found in Cushing syndrome.

A patient with pancreatitis may experience muscle cramps secondary to A. alkalosis. B. hyperglycemia. C. hypocalcemia. D. hypermagnesemia.

C. hypocalcemia. Associated laboratory findings of acute pancreatitis include leukocytosis, hyperlipidemia, and hypocalcemia. Alkalosis is not associated with pancreatitis. Hyperglycemia would not be a cause for muscle cramps. Hypermagnesemia is not generally related to pancreatitis.

A laboratory finding that would help confirm the diagnosis of hyperaldosteronism is A. hypernatremia. B. hyperkalemia. C. hypokalemia. D. hyperglycemia.

C. hypokalemia. Hyperkalemia is a manifestation of primary adrenocortical insufficiency. Hypernatremia is not a manifestation of aldosterone deficiency. Aldosterone deficiency is manifested by hyperkalemia. Hypoglycemia is one of the manifestations of aldosterone deficiency.

Brain injury secondary to high serum bilirubin is called A. hepatic encephalopathy. B. hepatic meningitis. C. kernicterus. D. encephalitis.

C. kernicterus. Kernicterus refers to brain injury as a result of hyperbilirubinemia. It is a serious complication of the neonatal period, generally occurring in the setting of premature birth, neonatal jaundice, and especially hemolytic disease of the newborn. Hepatic encephalopathy is typically characterized by high ammonia levels in the blood. Meningitis is not associated with high serum bilirubin levels. Encephalitis may accompany viral hepatitis in children, but is not related to high serum bilirubin levels.

Jaundice is a common manifestation of A. malabsorption syndromes. B. anemia. C. liver disease. D. cholecystitis.

C. liver disease. Jaundice results from impaired bilirubin metabolism and is one of the most characteristic signs of liver disease. Malabsorption syndromes are not manifested by jaundice. Anemia is not manifested by jaundice. Jaundice is not a common manifestation of cholecystitis.

Elevated serum lipase and amylase levels are indicative of A. gallbladder disease. B. appendicitis. C. pancreatitis. D. peritonitis.

C. pancreatitis. The laboratory evaluation of acute pancreatitis begins with measurements of serum pancreatic enzymes. Serum lipase and amylase levels rise more or less in tandem. Elevated serum lipase and amylase levels are not indicative of gallbladder disease. Appendicitis is not related to lipase and amylase levels. Peritonitis is not caused by elevated serum lipase or amylase levels.

Esophageal varices represent a complication of ________ hypertension. A. primary B. pregnancy-induced C. portal D. secondary

C. portal Esophageal varices represent a complication of portal hypertension, which in Western society is generally the result of cirrhosis as a result of alcoholism or viral hepatitis. Primary hypertension is not manifested by esophageal varices. Pregnancy-induced hypertension is unrelated to esophageal varices. Esophageal varices are not a complication of secondary hypertension.

A type of insulin that would be most appropriate for acute management of hyperglycemia is A. NPH. B. Semilente. C. regular. D. Ultralente.

C. regular. Regular insulin is short-acting and would be used for acute hyperglycemia. NPH insulin is an intermediate-acting agent which would not be useful in acute hyperglycemia. Acute management of hyperglycemia is not accomplished with Semilente insulin. Ultralente insulin is not the most appropriate treatment for acute hyperglycemia.

Narcotic administration should be administered carefully in patients with acute pancreatitis related to potential for A. respiratory depression. B. narcotic dependency. C. sphincter of Oddi dysfunction. D. allergic reaction.

C. sphincter of Oddi dysfunction. All narcotics should be used carefully because of the potential of sphincter of Oddi dysfunction, although recent studies show that no single agent is contraindicated. Respiratory failure related to adult respiratory distress syndrome is a risk factor with severe pancreatitis. Narcotic dependency should not be a concern with acute pancreatitis. While patients should always be assessed for allergies, this is not the primary concern.

A clinical finding consistent with a hypoglycemic reaction is A. acetone breath. B. warm, dry skin. C. tremors. D. hyperventilation.

C. tremors. Tremors are a sign of hypoglycemia. Acetone breath is not a sign of hypoglycemia. Diaphoresis (excessive sweating) is a sign of hypoglycemia. Hyperventilation does not indicate hypoglycemia.

Antidiuretic hormone (ADH) increases A. sodium reabsorption in the distal tubule of the kidney. B. potassium secretion in the distal tubule of the kidney. C. water reabsorption in the collecting tubule of the kidney. D. urinary output.

C. water reabsorption in the collecting tubule of the kidney. ADH acts directly on the renal collecting ducts and distal tubules, increasing membrane permeability to and reabsorption of water. Hypernatremia would be related to insufficient amounts of ADH. ADH increases water reabsorption in the tubule of the kidney. With insufficient amounts of ADH, urine cannot be concentrated.

A biliary cause of acute pancreatitis is suggested by an elevation in which serum laboratory results? A. Lipase B. Amylase C. Glucose D. Alkaline phosphatase

D. Alkaline phosphatase Marked elevation of the alkaline phosphatase and bilirubin levels suggest the possibility of biliary disease or obstruction, particularly by gallstones. Elevated serum lipase levels and elevated glucose levels do not suggest a biliary cause of pancreatitis. Acute pancreatitis is evidenced by elevated serum amylase and lipase levels, but does not indicate biliary disease.

What finding would rule out a diagnosis of irritable bowel syndrome in a patient with chronic diarrhea? A. Negative stool leukocytes B. Intermittent constipation C. Abdominal pain and distention D. Bloody stools

D. Bloody stools Bloody stools are not a symptom of irritable bowel syndrome. A person with irritable bowel syndrome would have negative stool leukocytes. The manifestations of IBS may vary greatly, with some persons experiencing only diarrhea or constipation and others experiencing an alternating pattern of both. In addition to cramping abdominal pain, manifestations such as nausea and mucus in the stool may also be present.

A patient reporting vision changes, photophobia, and lid lag may be exhibiting signs of A. Addison disease. B. Cushing syndrome. C. myxedema. D. Graves disease.

D. Graves disease. Individuals with Graves disease may have spasm and retraction of the eyelids, lid lag, and other eye complaints such as vision changes and photophobia. Changes associated with the eyes are not related to Addison disease. Cushing syndrome is not manifested by changes in the eyes. Myxedema is associated with generalized non-pitting edema.

What effect would adrenocortical insufficiency have on an individual's response to surgical stress? A. More prone to hyperglycemia B. Decreased sensitivity to anesthesia C. More susceptible to hypertensive crisis D. More prone to hypotension

D. More prone to hypotension Adrenal insufficiency may be associated with hypotension. If an individual experiences surgical stress, the adrenal gland will be unable to produce cortisol and the patient would be more prone to hypotension. The patient may be more prone to hypoglycemia, more sensitive to anesthesia, and more susceptible to hypotension.

A viral hepatitis screen with positive hepatitis B surface antigen (HBsAg) should be interpreted as ________ hepatitis B. A. recovered from B. immunity to C. chronic active D. acute

D. acute With acute infection HBV core antigen (HBcAg) appears first, followed by seroconversion to core antibody (HBcAb). Presence of HBV surface antigen (HBsAg) indicates active infection. Conversion from surface antigen to surface antibody positivity can take as long as 1 year after acute infection. Development of surface antibody (HBsAb) points to resolution and immunity. In chronic infection, hepatitis B e antigen (HBeAg) is associated with viral replication and infectivity.

Aldosterone secretion is regulated by the presence of ________ in the circulation. A. progesterone B. corticoglobulin C. ACTH D. angiotensin II

D. angiotensin II Aldosterone secretion is not regulated by the hypothalamic-pituitary system and is instead regulated by the presence of angiotensin II in the circulation. Aldosterone secretion is not regulated by progesterone. Corticoglubulin does not secrete aldosterone. ACTH does not regulate the secretion of aldosterone into the circulation.

Congenital adrenal hyperplasia (adrenogenital syndrome) results from A. cortisol excess. B. testosterone-secreting tumor. C. exogenous androgens. D. blocked cortisol production.

D. blocked cortisol production. The syndrome of congenital adrenal hyperplasia is because of enzymatic defects in the biosynthesis of cortisol. A cortisol reduction would occur with adrenogenital syndrome. The lack of negative feedback results in overproduction of ACTH. The overproduction of ACTH leads to hyperplasia of the adrenal glands and excessive androgen secretion.

An infusion of mannitol would be prescribed to treat A. varices. B. encephalopathy. C. peritonitis. D. cerebral edema.

D. cerebral edema. Cerebral edema is managed primarily by the intravenous infusion of mannitol, which by increasing serum osmolarity draws water from the brain and thus reduces the swelling. Octreotide acetate is used in the management of varices. Hepatic encephalopathy would be treated with lactulose. Peritonitis is managed with the use of antimicrobial agents.

The definitive treatment for cholecystitis is A. lithotripsy of stones. B. chemical dissolution of stones. C. antibiotics and anti-inflammatories. D. cholecystectomy.

D. cholecystectomy. Surgical removal of the gallbladder is the definitive treatment for cholecystitis. Laparoscopic cholecystectomy is now the treatment of choice for symptomatic gallstones. Extracorporeal shock wave lithotripsy (ESWL), which involves the breaking up of gallstones using shock waves, is a nonsurgical approach which could lead to recurrence of stones. Chemodissolution of stones has a low overall efficacy. Antibiotics are generally used with acute cholecystitis if infection is involved.

A silent abdomen 3 hours after bowel surgery most likely indicates A. peritonitis. B. mechanical bowel obstruction. C. perforated bowel. D. functional bowel obstruction.

D. functional bowel obstruction. Functional obstruction or ileus refers to the loss of propulsive ability by the bowel and may occur after abdominal surgery or in association with hypokalemia, peritonitis, severe trauma, spinal fractures, ureteral distention, and the administration of medications such as narcotics. Peritonitis may be associated with functional obstruction. Mechanical obstructions are because of adhesions, hernia, tumors, impacted feces, volvulus (twisting), or intussusception (telescoping). Perforated bowel is a rare condition sometimes associated with Crohn disease.

Dumping syndrome is commonly seen after __________ procedures. A. appendectomy B. intestinal biopsy C. colonoscopy D. gastric bypass

D. gastric bypass Dumping syndrome is a term used to describe the literal dumping of stomach contents into the proximal portion of the small intestine because of impaired gastric emptying. Interestingly, dumping seems to occur only with Roux-en-Y gastric bypass procedures. Dumping syndrome is not related to procedures involving appendectomy. Intestinal biopsies do not produce a dumping effect. Colonoscopies are not related to dumping syndrome.

A patient with a history of alcoholism presents with hematemesis and profound anemia. The expected diagnosis is A. ascites. B. cerebral edema. C. hepatic encephalopathy. D. gastroesophageal varices.

D. gastroesophageal varices. Esophageal varices primarily result from portal hypertension because of chronic alcoholism or hepatitis. Initial symptoms are bleeding, anemia, and shock. Ascites is an accumulation of fluid in the abdominal cavity. Cerebral edema is swelling of the brain related to hepatic encephalopathy. Hepatic encephalopathy does not cause symptoms related to bleeding.

An increased urine bilirubin is associated with A. an increased indirect serum bilirubin. B. hemolytic reactions. C. Gilbert syndrome. D. hepatitis.

D. hepatitis. In the presence of liver disease, the hepatic fraction of bilirubin decreases and the urinary fraction increases, thus accounting for a rise in urinary urobilinogen seen with liver dysfunction and hepatitis. An increase in indirect serum bilirubin is a sign of liver disease. Hemolytic reactions do not cause an increase in urine bilirubin. Disorders of the bile acid transport will cause an increase in serum bilirubin.

Hepatic encephalopathy is associated with A. hyperbilirubinemia. B. hyperuricemia. C. toxic effects of alcohol on brain cells. D. increased blood ammonia levels.

D. increased blood ammonia levels. Hepatic encephalopathy is associated with liver failure or liver disease. It is positively correlated with elevated arterial ammonia levels. Hyperbilirubinemia is not related to hepatic encephalopathy but is associated with hypokalemia, hyponatremia, alkalosis, hypoxia, and hypercarbia. Hyperuricemia is not associated with hepatic encephalopathy. Hepatic encephalopathy is a complex neuropsychiatric syndrome characterized by symptoms ranging from mild confusion and lethargy to stupor and coma.

Constipation in an elderly patient can be best treated by A. maintaining a low-fiber diet. B. maintaining the current level of activity. C. fecal disimpaction. D. increasing fiber in the diet.

D. increasing fiber in the diet. The presence of cellulose, the carbohydrate component of dietary fiber that is indigestible in the human intestine, may be effective in promoting regular peristaltic movement in the GI tract by forming bulk within the intestinal lumen to stimulate propulsion. Dietary factors, particularly a diet low in fiber, have been shown to contribute to constipation. In elderly persons, the slowed rate of peristalsis that occurs with the aging process, coupled with a decreased level of physical activity, may promote chronic constipation. These factors may eventually contribute to the development of fecal impaction, a condition in which a firm, immovable mass of stool becomes stationary in the lower GI tract.

Propylthiouracil may be used to treat hyperthyroidism, because it A. destroys thyroid gland cells. B. inhibits the release of TSH. C. suppresses production of autoantibodies. D. inhibits thyroid hormone synthesis.

D. inhibits thyroid hormone synthesis. Antithyroid drugs called thionamides (propylthiouracil, methimazole) block the activities of the enzyme thyroid peroxidase and inhibit thyroid hormone production by follicular cells. Antithyroid drugs do not destroy thyroid gland cells. Antithyroid drugs are used to inhibit release of T3 and T4. Treatment of hyperthyroidism is not aimed at suppression of autoantibodies.

It is true that the synthesis of thyroid hormones A. is increased by thyrotropin-inhibiting factor. B. occurs in perifollicular C cells. C. is stimulated by ACTH. D. is inhibited by iodine deficiency.

D. is inhibited by iodine deficiency. Lack of iodine prevents production of both T4 and T3 but does not stop the formation of thyroglobulin. Thyroid hormone synthesis is not associated with thyrotropin-inhibiting factor. Perifollicular C cells are not responsible for thyroid hormone synthesis. Synthesis of thyroid hormones does not occur through stimulation of ACTH.

Rupture of esophageal varices is a complication of cirrhosis with portal hypertension and carries a high ________ rate. A. cure B. morbidity C. insurance D. mortality

D. mortality Rupture of esophageal varices is a dreaded complication of cirrhosis with portal hypertension and carries a high mortality rate. Rupture of esophageal varices does not carry a high cure rate. Varices will affect more than half of cirrhotic patients, and approximately 30% of them experience an episode of variceal hemorrhage within 2 years of the diagnosis of varices. Insurance is not a factor in the rupture of esophageal varices.

Calcitonin is produced by thyroid parafollicular cells and increases bone formation by A. homeostasis. B. osteoclasts. C. reabsorption. D. osteoblasts.

D. osteoblasts. Calcitonin increases bone formation by osteoblasts. The role of calcitonin in homeostasis is not clear, calcitonin tends to decrease blood calcium levels and promote conservation of hard bone matrix. Calcitonin inhibits bone breakdown by osteoclasts. Bone reabsorption is increased with hyperparathyroidism.

The most challenging aspect of treatment for chronic pancreatitis is A. pancreatectomy. B. strict dietary avoidance of fats. C. abstinence from alcohol. D. pain control.

D. pain control. The treatment for chronic pancreatitis is directed toward pain control, exocrine and endocrine insufficiency, and management of complications. By far the most challenging is the management of pain. If endoscopic management fails or is not appropriate in a given patient, surgery may be indicated. Management of exocrine insufficiency can usually be accomplished with low-fat diets. Absolute abstention from alcohol is paramount to prevent worsening of symptoms.

Pathophysiologically, esophageal varices can be attributed to A. elevated bilirubin. B. diminished protein metabolism. C. fluid accumulation. D. portal hypertension.

D. portal hypertension. Esophageal varices result mainly from portal hypertension, which in Western society is generally the result of cirrhosis because of the chronic effects of alcoholism or viral hepatitis. Elevated bilirubin is not attributed to esophageal varices. Diminished protein metabolism does not contribute to esophageal varices. Increased vascular resistance in the liver plays a prominent role in the formation of variceal esophageal veins.

Clinical manifestations of hypoparathyroidism A. are similar to those occurring with hypermagnesemia. B. result from decreased neuromuscular excitability. C. are similar to those occurring with hypokalemia. D. result from decreased serum ionized calcium.

D. result from decreased serum ionized calcium. Clinical manifestations of hypoparathyroidism occur as a result of low serum calcium levels. Manifestations of hypoparathyroidism are not similar to those with hypermagnesemia. The manifestations of acute hypocalcemia may include paresthesias of the distal extremities. Non-specific EKG changes may occur in patients with hypoparathyroidism.

Diabetes mellitus is the ________ leading cause of death and a major cause of disability in the United States. A. first B. second C. fourth D. seventh

D. seventh Diabetes mellitus is the seventh leading cause of death and a major cause of disability in the United States. Diabetes is not the leading cause of death in the United States at this time. The second leading cause of death in the United States is not diabetes. The fourth leading cause of death in the United States is not related to diabetes.

It is true that biliary cancer A. is most often cured by surgery. B. respond well to chemotherapy. C. are identifiable and treatable when diagnosed early. D. tend to be asymptomatic and progress insidiously.

D. tend to be asymptomatic and progress insidiously. Biliary cancers tend to be asymptomatic and progress insidiously until well advanced. Surgery for cure is a treatment option in fewer than 10% of cases. Chemotherapy and radiation therapy are indicted for palliation, and certain patients may benefit from stenting and other procedures to alleviate biliary obstruction. Cancers of the biliary system are relatively rare, accounting for only 1 to 2 cases per 100,000 per year. Unfortunately, they tend to be asymptomatic and progress insidiously until well advanced.