Patho 370: Ch 36 37 38 41

Chronic pancreatitis may lead to a. diabetes mellitus. b. gallstones. c. celiac sprue. d. Crohn disease.

A 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.

What finding should prompt further diagnostic testing in a child presenting with diarrhea? a. Blood and mucus in the stools b. Periumbilical discomfort c. Greenish, watery diarrhea d. Frequent, large-volume diarrhea

A Both ulcerative colitis and Crohn disease have their onset most commonly in childhood and young adulthood, with obviously profound implications. Stools may contain blood or mucus. Periumbilical discomfort, watery diarrhea, and frequent, large-volume diarrhea are not causes for further diagnostic testing.

Hepatitis B is usually transmitted by exposure to a. blood or semen. b. feces. c. contaminated food. d. hepatitis vaccine.

A 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.

Untreated acute cholecystitis may lead to ________ of the gallbladder wall. a. gangrene b. infection c. distention d. inflammation

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

A 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.

In the United States, nearly ________ people have diabetes mellitus. a. 29.1 million b. 176 billion c. 7 million d. 366 million

A 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.

It is true that the synthesis of thyroid hormones a. is inhibited by iodine deficiency. b. is stimulated by ACTH. c. is increased by thyrotropin-inhibiting factor. d. occurs in perifollicular C cells.

A Lack of iodine prevents production of both T 4 and T 3 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.

In type I diabetes, respiratory compensation may occur through a process of a. respiratory alkalosis. b. metabolic acidosis. c. metabolic alkalosis. d. respiratory acidosis.

A Respiratory compensation for the metabolic acidosis in the form of deep, labored respirations that are "fruity" in odor results in lowered PCO 2 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.

Elevated serum lipase and amylase levels are indicative of a. pancreatitis. b. appendicitis. c. peritonitis. d. gallbladder disease.

A 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.

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

A 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.

Ulcerative colitis is commonly associated with a. bloody diarrhea. b. fistula formation between loops of bowel. c. inflammation and scarring of the submucosal layer of the bowel. d. malabsorption of nutrients.

A 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.

An increase in ADH secretion occurs in response to a. hyponatremia. b. dehydration. c. decreased serum osmolality. d. hypervolemia.

B 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.

It is true that biliary cancer a. is most often cured by surgery. b. tend to be asymptomatic and progress insidiously. c. are identifiable and treatable when diagnosed early. d. respond well to chemotherapy.

B 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.

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

B 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.

Fecal leukocyte screening would be indicated in a patient with suspected a. lactose intolerance. b. enterocolitis. c. laxative abuse. d. giardiasis.

B 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.

What form of viral hepatitis is likely to be transmitted sexually? a. Hepatitis E b. Hepatitis B c. Hepatitis C d. Hepatitis A

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.

The breakdown of stored glycogen in the liver and muscles is called a. glycolysis. b. glycogenolysis. c. glycogenesis. d. gluconeogenesis.

B 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 type of insulin that would be most appropriate for acute management of hyperglycemia is a. Semilente. b. regular. c. Ultralente. d. NPH.

B 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.

Rupture of esophageal varices is a complication of cirrhosis with portal hypertension and carries a high ________ rate. a. insurance b. mortality c. morbidity d. cure

B 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.

A patient receiving chemotherapy may be at greater risk for development of a. gastroesophageal reflux. b. stomatitis. c. Mallory-Weiss syndrome. d. esophageal varices.

B 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.

More than half of the initial cases of pancreatitis are associated with a. high cholesterol. b. alcoholism. c. stones. d. trauma.

B 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.

Epigastric pain that is relieved by food is suggestive of a. pancreatitis. b. cardiac angina. c. gastric ulcer. d. dysphagia.

C 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.

A patient with pancreatitis may experience muscle cramps secondary to a. hypermagnesemia. b. alkalosis. c. hypocalcemia. d. hyperglycemia.

C 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.

Patients with acute pancreatitis are generally made NPO and may require continuous gastric suctioning in order to a. prevent hyperglycemia associated with loss of insulin secretion. b. prevent abdominal distention. c. remove the usual stimuli for pancreatic secretion. d. prevent mechanical obstruction of the intestine.

C Conservative management is indicated for mild to moderate cases of acute pancreatitis. In general, withholding oral feedings, providing nasogastric suction, and providing careful volume replacement with IV fluids are indicated. Gastric suctioning is not indicated for preventing abdominal distention. Hyperglycemia is not influenced by the presence of gastric suctioning. Continuous gastric suctioning may be used in the presence of a significant ileus.

Diabetes insipidus is a condition that a. is associated with anterior pituitary dysfunction. b. leads to glycosuria. c. results from inadequate ADH secretion. d. is characterized by oliguria.

C 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

Dumping syndrome is commonly seen after __________ procedures. a. appendectomy b. intestinal biopsy c. gastric bypass d. colonoscopy

C 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.

Jaundice is a common manifestation of a. malabsorption syndromes. b. anemia. c. liver disease. d. cholecystitis.

C 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.

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

C 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.

The definitive treatment for cholecystitis is a. lithotripsy of stones. b. chemical dissolution of stones. c. cholecystectomy. d. antibiotics and anti-inflammatories

C 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.

The American Diabetes Association recommends a postprandial blood glucose level of ________ mg/dL for adults with diabetes. a. 70 b. more than 180 c. less than 180 d. 130

C 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.

The most common causes of prehepatic jaundice are ________ and ineffective erythropoiesis. a. metabolism b. canalicular bilirubin transport c. hemolysis d. fibrosis

C 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.

Constipation in an elderly patient can be best treated by a. maintaining the current level of activity. b. maintaining a low-fiber diet. c. increasing fiber in the diet. d. fecal disimpaction.

C 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.

A patient who should be routinely evaluated for peptic ulcer disease is one who is a. experiencing chronic diarrhea. b. routinely drinking alcoholic beverages. c. being treated with high-dose oral glucocorticoids. d. taking six to eight tablets of acetaminophen per day

C Glucocorticoids released in response to stress may have a role in the promotion of excess acid production or the destruction of gastric mucosal defenses. Therefore, a patient taking high-dose glucocorticoids would be at higher risk of developing peptic ulcer disease. Acetaminophen is not a risk factor for development of peptic ulcer disease. Chronic diarrhea is not a symptom of peptic ulcer disease. There is little evidence of a pathogenic role for alcohol, spicy foods, and caffeine in the development of peptic ulcer disease.

The underlying pathogenic mechanism for type 1 diabetes is a. lack of insulin receptors. b. lack of exercise and chronic overeating. c. impaired glucose transport into cells. d. pancreatic β-cell destruction.

D 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.

Clinical manifestations of hypoparathyroidism a. are similar to those occurring with hypermagnesemia. b. are similar to those occurring with hypokalemia. c. result from decreased neuromuscular excitability. d. result from decreased serum ionized calcium.

D 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. second b. fourth c. first d. seventh

D 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.

Hepatic encephalopathy is associated with a. hyperuricemia. b. toxic effects of alcohol on brain cells. c. hyperbilirubinemia. d. increased blood ammonia levels.

D 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.

A tumor which results in excessive production and release of catecholamines is a. Cushing disease. b. Conn syndrome. c. goiter. d. pheochromocytoma.

D 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.

A clinical finding consistent with a diagnosis of syndrome of inappropriate ADH secretion (SIADH) is a. decreased osmolality. b. hypovolemia. c. dehydration. d. hyponatremia.

D 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.

Most gallstones are composed of a. calcium. b. bile. c. uric acid salts. d. cholesterol

D 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