Pathophysiology Chapter 20

question

In the liver, amino acids are used to produce complex molecules by means of: a. glycogenesis b. anabolic processes c. catabolic processes d. autodigestion
answer

B
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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
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A
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Which of the following is the primary site for absorption of nutrients? a. stomach b. duodenum c. ileum d. ascending colon
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C
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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
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B
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Which of the following breaks protein down into peptides? a. amylase b. peptidase c. lactase d. trypsin
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D
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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
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B
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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
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B
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Which of the following is contained in pancreatic exocrine secretions? a. bicarbonate ion b. hydrochloric acid c. activated digestive enzymes d. insulin
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A
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An alkaline environment is required in the duodenum to: a. activate pepsinogen b. activate intestinal and pancreatic enzymes c. activate bile salts d. produce mucus
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B
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Which of the following processes is likely to occur in the body immediately after a meal? a. lipolysis b. ketogenesis c. gluconeogenesis d. glycogenesis
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D
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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
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C
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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
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C
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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.
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C
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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 and intestines e. covers the kidneys and bladder
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D
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The early stage of vomiting causes: a. metabolic alkalosis b. metabolic acidosis c. increased respirations d. increased excretion of hydrogen ions
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A
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Prolonged vomiting cause a state of acidosis due to: a. catabolism of proteins and lipids b. continued loss of gastric secretions c. loss of pancreatic enzymes d. retention of sodium ions and water
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A
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What is the first change in arterial blood gases with diarrhea? a. increased bicarbonate ion b. decreased bicarbonate ion c. increased carbonic acid d. increased serum pH
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B
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Dehydration causes acidosis because of increased: a. ketones produced b. CO2 retained in the lungs and kidneys c. hypovolemia and lactic acid production d. metabolic rate
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C
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Which of the following applies to the act of swallowing? a. requires coordination of cranial nerves V, IX, X, and XII b. is entirely voluntary c. is controlled by a center in the hypothalamus d. does not affect respiration
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A
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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 contraction of abdominal muscles
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C
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What is the definition of achalasia? a. a herniation of the gastric mucosa through a segment of weakened muscle b. recurrent reflux of chime into the esophagus c. absence of a connection of the esophagus to the stomach d. lack of a nerve plexus to relax the lower esophageal sphincter
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D
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What does 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
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C
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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.
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B
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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
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D
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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.
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C
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What does the term periodontitis refer to? a. erosion of the enamel tooth surface b. bacterial damage to the ligaments and bone surrounding teeth c. inflammation and infection of the gingivae d. formation of calcified plaque on the tooth
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B
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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
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A
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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
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B
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What is a common sign of acute gastritis? a. colicky right upper quadrant pain b. vomiting with epigastric tenderness c. projectile vomiting after eating d. diarrhea with abdominal distention
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B
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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
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A
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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
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C
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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
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D
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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 and hyperplasia of smooth muscle in the pylorus d. thickening of the gastric wall due to chronic inflammation
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C
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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
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D
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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/pepsinogen secreting cells d. increased epinephrine increases motility
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A
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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
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D
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Which of the following would a perforated gastric ulcer likely cause? a. severe anemia b. chemical peritonitis c. severe gastric hemorrhage d. pyloric obstruction
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B
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What is frequently the first manifestation of stress ulcers? a. abdominal discomfort between meals and at night b. nausea and diarrhea c. hematemesis and hypotension d. sharp colicky pain with food intake
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C
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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
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A
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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
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A
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Which of the following is/are (a) manifestation(s) of hemolytic jaundice? a. increased unconjugated bilirubin in the blood b. increased bleeding tendencies c. pale stool and dark urine d. elevated liver enzymes in the blood
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A
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Why does mild hyperbilirubinemia occur in newborns? a. blood incompatibility between mother and child b. there is damage to many erythrocytes during the birth process c. poor circulation and albumin transport for bilirubin d. the immature liver cannot process bilirubin quickly enough
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D
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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
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A
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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 gall bladder
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C
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Which of the following describes the supply of bile following a cholecystectomy? a. Bile is no longer available for digestion. b. Bile is stored in the liver sinusoids until a fatty meal is consumed. c. Bile is not diluted and is less effective as an emulsifier. d. Small amounts of bile are continuously secreted and flow into the duodenum.
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D
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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.
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B
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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.
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B
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What is the most common type of hepatitis transmitted by blood transfusion? a. HAV b. HBV c. HCV d. HEV
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C
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What causes elevated serum levels of AST and ALT during the preicteric stage of hepatitis? a. systemic effects of viral infection b. obstruction of bile ducts and malabsorption c. necrosis of liver cells d. ammonia toxicity
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C
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What is the likely effect of long-term exposure to a hepatotoxin? a. full recovery to normal tissue after the toxic material is 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
answer

D
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What indicates the presence of third-stage alcohol hepatitis? a. below normal blood levels of AST and ALT b. ULQ tenderness and dull pain c. a small, firm, nodular liver and portal hypertension d. accumulation of fat in the hepatocytes and hepatomegaly
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D
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A primary factor causing encephalopathy with cirrhosis is the elevated: a. serum urea b. conjugated bilirubin c. serum ammonia d. serum pH
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C
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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
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B
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What is the primary cause of esophageal varices? a. portal hypertension b. alcohol irritating the mucosa c. failure to inactivate estrogen d. poor nutritional status
answer

A
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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
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D
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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
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A
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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
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C
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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. activation and spread of proteolytic enzymes
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D
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How does chemical peritonitis and shock frequently result from acute pancreatitis? a. Inflammation and increased vascular permeability of the peritoneum affect fluid balance. b. Erosions in the intestinal wall causes release of bacteria. c. Fat necrosis and hypocalcemia develop. d. Secretions from the pancreas and intestine become more acidic.
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A
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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
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A
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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
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C
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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
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D
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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
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D
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Stools that are more liquid and contain mucus, frank blood, and pus are typical of: a. diverticulitis b. ulcerative colitis c. Crohn’s disease d. celiac disease
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B
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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
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D
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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
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C
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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
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D
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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
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A
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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
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C
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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
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D
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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 perforates the wall. d. Bacteria escape into the circulating blood.
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B
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What is a typical early sign of cancer in the ascending colon? a. change in shape of the stool b. bleeding with defecation c. mild but persistent pain in the lower left quadrant d. occult blood in the stool
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D
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To which site does colon cancer usually first metastasize? a. lungs b. stomach c. liver d. spleen
answer

C
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How does a volvulus cause localized gangrene in the intestine? a. Hypotension and shock causes 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.
answer

B
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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
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C
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Partial obstruction of the sigmoid colon resulting from diverticular disease would likely: a. cause severe colicky pain b. cause frequent diarrhea c. develop very rapidly d. result in a small, hard stool
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D
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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
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A
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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. the patient voluntarily contracts the abdominal muscles as a protective mechanism
answer

C
question

What would be the likely outcome from chemical peritonitis related to a perforated gall bladder? 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
answer

A
question

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 allows 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.
answer

C
question

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
answer

B
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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, serum pH would remain in normal range c. serum bicarbonate levels would decrease, serum pH would drop below 7.35 d. serum PCO2 would rise, serum pH would be around 7.4
answer

C
question

How do body defenses respond immediately after the gall bladder ruptures? a. A localized inflammatory response occurs. b. The omentum and peritoneum seal off the area. c. Blood clots seal the perforation. d. a and b e. a and c
answer

C
question

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
answer

A
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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
answer

C
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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
answer

D
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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
answer

C
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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
answer

A
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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
answer

D
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Which of the following frequently occurs 2-3 hours after meals in post-gastrectomy patients? a. hypoglycemia b. hypovolemia c. abdominal cramps and distention d. increased peristalsis and diarrhea
answer

A
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Which term refers to obstruction of the biliary tract by gallstones? a. cholelithiasis b. cholecystitis c. cholangitis d. choledocholithiasis
answer

D
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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
answer

C
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Which of the following statements 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
answer

B
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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
answer

C
question

Which of the following 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
answer

A
question

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 can not regenerate when virus is present. d. Infection is self-limiting.
answer

A
question

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.
answer

C
question

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
answer

D
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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
answer

C
question

Which type of hepatitis virus requires the presence of hepatitis B virus so as to replicate? a. HAV b. HCV c. HDV d. HEV
answer

C

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