Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/180

Click to flip

180 Cards in this Set

  • Front
  • Back

The most common anal fissure location is:


A. posterior midline of the anus.


B. anterior anal midline.


C. anterior and posterior anal midline.


D. transversely across the anal mucosa.

A. posterior midline of the anus.

Rectal bleeding associated with anal fissure is usually described by the patient as:


A. drops of blood noticed when wiping.


B. dark brown to black in color and mixed in with normal-appearing stool.


C. a large amount of brisk red bleeding.


D. significant blood clots and mucus mixed with stool.

A. drops of blood noticed when wiping.

A 62-year-old woman who reports frequent constipation is diagnosed with an anal fissure. First-line therapy includes all of the following except:



A. stool-bulking supplements.


B. high fiber diet.


C. intraanal corticosteroids.


D. the periodic use of oral mineral oil.

C. intraanal corticosteroids.

A 54-year-old man with an anal fissure responds inadequately to dietary intervention and standard therapy during the past 2 weeks. Additional treatment options include all of the following except:


A. intraanal nitroglycerine ointment.


B. botulinum toxicum injection to the internal anal sphincter.


C. surgical sphincterotomy.


D. rubber band ligation of the lesion.

D. rubber band ligation of the lesion.

In a patient who presents with a history consistent with anal fissure but with notation of an atypical anal lesion, alternative diagnoses to consider include all of the following except:


A. condyloma acuminata.


B. Crohn’s disease.


C. anal squamous cell carcinoma.


D. C. difficile colitis.

D. C. difficile colitis.

Which of the following is the most likely patient report with anal fissure?


A. “I have anal pain that is relieved with having a bowel movement.”


B. “Even after having a bowel movement, I feel like I still need to ‘go’ more.”


C. “I have anal pain for up to 1–2 hours after I have a bowel movement.”


D. “I itch down there almost all the time.”

C. “I have anal pain for up to 1–2 hours after I have a bowel movement.”

Long term, recurrent high-dose oral use of mineral oil can lead to deficiency in:

A. iron.


B. vitamin A.


C. vitamin C.


D. vitamin B12.

B. vitamin A.

Rectal bleeding associated with hemorrhoids is usually described as:


A. streaks of bright red blood on the stool.


B. dark brown to black in color and mixed in with normal-appearing stool.


C. a large amount of brisk red bleeding.


D. significant blood clots and mucus mixed with stool.


A. streaks of bright red blood on the stool.

Therapy for hemorrhoids includes all of the following except:

A. weight control.


B. low-fat diet.


C. topical corticosteroids.


D. the use of a stool softener.

B. low-fat diet.
The NP is advising a 58-year-old woman about the benefits of a high-fiber diet. Which of the following foods provides the highest fiber content?

A. a small banana


B. 1 cup of cooked oatmeal


C. a 1/2 cup serving of brown rice


D. a medium-size blueberry muffin

B. 1 cup of cooked oatmeal

A 62-year-old man presents with a 2-month history of noting a “bit of dark blood mixed in with my stool most days.” Physical examination reveals external hemorrhoids, no rectal mass, and a small amount of dark brown stool on the examining digit. In-office fecal occult blood test is positive, and hemogram reveals amicrocytic hypochromic anemia. The next best step in his care is to:


A. perform in-office anoscopy.


B. advise the patient use sitz baths post bowel movement.


C. refer to gastroenterology practice for colonoscopy.


D. order a double contrast barium enema.

C. refer to gastroenterology practice for colonoscopy.

Risk factors for the development of hemorrhoidals symptoms include all of the following except:

A. prolonged sitting.


B. insertive partner in anal intercourse.


C. chronic diarrhea.


D. excessive alcohol use.

B. insertive partner in anal intercourse.

Which of the following best describes Grade III internal hemorrhoids?


A. The hemorrhoids do not prolapse.


B. The hemorrhoids prolapse upon defecation but reduce spontaneously.


C. The hemorrhoids prolapse upon defecation and must be reduced manually.


D. The hemorrhoids are prolapsed and cannot be reduced manually.

C. The hemorrhoids prolapse upon defecation and must be reduced manually.

Which of the following patients should be evaluated for possible surgical intervention for hemorrhoids?


A. a 28-year-old woman with symptomatic external hemorrhoids who gave birth 6 days ago


B. a 48-year-old man with Grade II internal hemorrhoids and improvement with standard medical therapy


C. a 44-year-old woman who has internal and external hemorrhoids with recurrent prolapse


D. a 58-year-old man who has Grade I internal hemorrhoids and improvement with psyllium supplements

C. a 44-year-old woman who has internal and external hemorrhoids with recurrent prolapse

All of the following are typically noted in a young adult with the diagnosis of acute appendicitis except:

A. epigastric pain.


B. positive obturator sign.


C. rebound tenderness.


D. marked febrile response.

D. marked febrile response.
A 26-year-old man presents with acute abdominal pain. As part of the evaluation for acute appendicitis, you order a white blood cell (WBC) count with differential and anticipate the following results:

A. total WBCs, 4500 mm3; neutrophils, 35%; bands, 2%;lymphocytes, 45%.


B. total WBCs, 14,000 mm3; neutrophils, 55%; bands, 3%;lymphocytes, 38%.


C. total WBCs, 16,500 mm3; neutrophils, 66%; bands, 8%;lymphocytes, 22%.


D. total WBCs, 18,100 mm3; neutrophils, 55%; bands, 3%;lymphocytes, 28%.

C. total WBCs, 16,500 mm3; neutrophils, 66%; bands, 8%; lymphocytes, 22%.
You see a 72-year-old woman who reports vomiting and abdominal cramping occurring over the past 24 hours. In evaluating a patient with suspected appendicitis, the clinician considers that:

A. the presentation can differ according to the anatomical location of the appendix.


B. this is a common reason for acute abdominal pain in elderly patients.


C. vomiting before onset of abdominal pain is oftenseen.


D. the presentation is markedly different from thepresentation of pelvic inflammatory disease.

A. the presentation can differ according to the anatomical location of the appendix.
The psoas sign can be best described as abdominal pain elicited by:

A. passive extension of the hip.


B. passive flexion and internal rotation of the hip.


C. deep palpation.


D. asking the patient to cough.

A. passive extension of the hip.
The obturator sign can be best described as abdominal pain elicited by:

A. passive extension of the hip.


B. passive flexion and internal rotation of the hip.


C. deep palpation.


D. asking the patient to cough.

B. passive flexion and internal rotation of the hip.

An 18-year-old man presents with periumbilical pain, vomiting, and abdominal cramping over the past 48 hours. Physical examination reveals rebound tenderness, and laboratory analysis shows the presence of bandemia and a total WBC of 28,000 mm3. To support the diagnosis of acute appendicitis with suspected appendices rupture, you consider obtaining the following abdominal imaging study:


A. magnetic resonance image (MRI).


B. computed tomography (CT) scan.


C. ultrasound.


D. flat plate.

B. computed tomography (CT) scan.

Which of the following WBC forms is an ominous finding in the presence of severe bacterial infection?

A. neutrophil


B. lymphocyte


C. basophil


D. metamyelocyte

D. metamyelocyte

Which of the following best represents the peak ages for occurrence of acute appendicitis?


A. 1 to 20 years


B. 20 to 40 years


C. 10 to 30 years


D. 30 to 50 years

C. 10 to 30 years

Clinical findings most consistent with appediceal rupture include all of the following except:


A. abdominal discomfort less than 48 hours in duration.


B. fever greater than 102°F (>38°C).


C. palpable abdominal mass.


D. marked leukocytosis with total WBC greater than20,000/mm3.

A. abdominal discomfort less than 48 hours in duration.

Which of the following imaging studies potentially exposes the patient being evaluated for abdominal pain to the lowest ionizing radiation burden?

A. ultrasound


B. barium enema


C. CT scan


D. abdominal flat plate

A. ultrasound
Commonly encountered diagnoses other than acute appendicitis can include which of the following in a 28-year-old with a 2-day history of lower abdominal pain and with right-sided pain slightly worse than left? (More than one can apply.)

A. constipation


B. pelvic inflammatory disease


C. ectopic pregnancy


D. splenetic infarct

A. constipation

B. pelvic inflammatory disease


C. ectopic pregnancy

Rebound tenderness is best described as abdominal pain that worsens with:

A. light palpation at the site of the discomfort.


B. release of deep palpation at the site of the discomfort.


C. palpation on the contralateral side of the abdomen.


D. deep palpation at the site of the discomfort.

B. release of deep palpation at the site of the discomfort.
Abdominal palpation that yields rebound tenderness is also known as a positive _______ sign.

A. Markel’s


B. Murphy’s


C. Blumberg’s


D. Nikolsky’s

C. Blumberg’s

Which of the following findings would you expect to encounter in a 33-year-old man with appendices abscess?


A. leukopenia with lymphocytosis


B. positive Cullen’s sign


C. protracted nausea and vomiting


D. dullness to percussion in the abdominal right lower quadrant



D. dullness to percussion in the abdominal right lower quadrant

A 43-year-old woman has a 12-hour history of sudden onset of right upper quadrant abdominal pain with radiation to the shoulder, fever, and chills. She has had similar, milder episodes in the past. Examination reveals marked tenderness to right upper quadrant abdominal palpation. Her most likely diagnosis is:


A. hepatoma.


B. acute cholecystitis.


C. acute hepatitis.


D. cholelithiasis.

B. acute cholecystitis.

Which of the following is usually not seen in the diagnosis of acute cholecystitis?


A. elevated serum creatinine


B. increased alkaline phosphatase level


C. leukocytosis


D. elevated aspartate aminotransferase (AST) level

A. elevated serum creatinine

Murphy’s sign can be best described as abdominal pain elicited by:

A. right upper quadrant abdominal palpation.


B. asking the patient to stand on tiptoes and thenletting body weight fall quickly onto the heels.


C. asking the patient to cough.


D. percussion.

A. right upper quadrant abdominal palpation.
Which of the following is the most common serious complication of cholecystitis?

A. adenocarcinoma of the gallbladder


B. gallbladder empyema


C. hepatic failure


D. pancreatitis

D. pancreatitis

A 58-year-old man reports intermittent right upper quadrant abdominal pain. He is obese and being actively treated for hyperlipidemia. Imaging in a patient with suspected symptomatic cholelithiasis usually includes obtaining an abdominal:


A. magnetic resonance image (MRI).


B. CT scan.


C. ultrasound of the right upper quadrant.


D. flat plate.

C. ultrasound of the right upper quadrant.

Which of the following is most likely to be found in a person with acute cholecystitis?

A. fever


B. vomiting


C. jaundice


D. palpable gallbladder

B. vomiting
Risk factors for the development of cholelithiasis include all of the following except:

A. rapid weight loss.


B. male gender.


C. obesity.


D. Native American ancestry.

B. male gender.

A gallstone that is not visualized on standard x-ray is said to be:


A. radiopaque.


B. radiolucent.


C. calcified.


D. unclassified.

B. radiolucent.
Which of the following is true concerning colorectal cancer?

A. Most colorectal cancers are found during rectalexamination.


B. Rectal carcinoma is more common than cancersinvolving the colon.


C. Early manifestations include abdominal pain andcramping.


D. Later disease presentation often includes iron-deficiency anemia.

D. Later disease presentation often includes iron- deficiency anemia.

According to the American Cancer Society recommendations, which of the following is the preferred method for annual colorectal cancer screening in a 51-year-old man?


A. digital rectal examination


B. fecal occult blood test


C. colonoscopy


D. barium enema study

B. fecal occult blood test

Which of the following is most likely to be noted in a person with colorectal cancer?

A. gross rectal bleeding


B. weight loss


C. few symptoms


D. nausea and vomiting

C. few symptoms
Which of the following does not increase a patient’s risk of developing colorectal cancer?

A. family history of colorectal cancer


B. familial polyposis


C. personal history of neoplasm


D. long-term aspirin therapy

D. long-term aspirin therapy
According to current American Cancer Society data, colorectal cancer is the number _______ cause of cancer death in men and women.

A. 1


B. 3


C. 5


D. 7

B. 3
Colonic diverticulosis most commonly occurs in the walls of the:

A. ascending colon.


B. descending colon.


C. transverse colon.


D. sigmoid colon.

D. sigmoid colon.
Approximately what percent of the population will develop diverticulosis by the time they reach 50 years of age?

A. 10%


B. 20%


C. 33%


D. 50%

C. 33%


Which of the following is most consistent with the presentation of a patient with colonic diverticulosis?

A. diarrhea and leukocytosis


B. constipation and fever


C. few or no symptoms


D. frank blood in the stool with reduced stool caliber

C. few or no symptoms
Which of the following is most consistent with the presentation of a patient with acute colonic diverticulitis?

A. cramping, diarrhea, and leukocytosis


B. constipation and fever


C. right-sided abdominal pain


D. frank blood in the stool with reduced stool caliber

A. cramping, diarrhea, and leukocytosis
Major risk factors for diverticulosis include all of the following except:

A. low-fiber diet.


B. family history of the condition.


C. older age.


D. select connective tissue disorders (e.g., Marfansyndrome).

A. low-fiber diet.


To avoid the development of acute diverticulitis, treatment of diverticulosis can include:

A. avoiding foods with seeds.


B. the use of fiber supplements.


C. ceasing cigarette smoking.


D. limiting alcohol intake.

B. the use of fiber supplements.
The location of discomfort with acute diverticulitis isusually in which of the following areas of the abdomen?

A. epigastrium


B. left lower quadrant


C. right lower quadrant


D. suprapubic

B. left lower quadrant


Which of the following best describes colonic diverticulosis?

A. bulging pockets in the intestinal wall


B. poorly contracting intestinal walls


C. strictures of the intestinal lumen


D. flaccidity of the small intestine

A. bulging pockets in the intestinal wall

You are seeing Mr. Lopez, a 68-year-old man with suspected acute colonic diverticulitis. In choosing an appropriate imaging study to support this diagnosis, which of the following abdominal imaging studies is most appropriate?


A. flat plate


B. ultrasound


C. CT scan with contrast


D. barium enema

C. CT scan with contrast

In the evaluation of acute diverticulitis, the most appropriate diagnostic approach to rule out free air in the abdomen includes:

A. barium enema.


B. plain abdominal film.


C. abdominal ultrasound.


D. lower endoscopy.

B. plain abdominal film.
A 56-year-old woman is diagnosed with mild diverticulitis. In addition to counseling her about increased fluid intake and adequate rest, you recommend antimicrobial treatment with:

A. amoxicillin with clarithromycin.


B. linezolid with daptomycin.


C. ciprofloxacin with metronidazole.


D. nitrofurantoin with doxycycline.

C. ciprofloxacin with metronidazole.

Lower gastrointestinal (GI) hemorrhage associated with diverticular disease usually manifests as:


A. a painless event.


B. a condition noted to be found with a marked febrile response.


C. a condition accompanied by severe cramp-like abdominal pain.


D. a common chronic condition.

A. a painless event.

Measures to prevent colonic diverticulosis and diverticulitis include all of the following except:

A. increased whole grain intake.


B. regular aerobic exercise.


C. adequate hydration.


D. refraining from excessive alcohol intake.

D. refraining from excessive alcohol intake
The gastric parietal cells produce:

A. hydrochloric acid.


B. a protective mucosal layer.


C. prostaglandins.


D. prokinetic hormones.

A. hydrochloric acid.

Antiprostaglandin drugs cause stomach mucosal injury primarily by:


A. a direct irritative effect.


B. altering the thickness of the protective mucosallayer.


C. decreasing peristalsis.


D. modifying stomach pH level.

B. altering the thickness of the protective mucosal layer.

A 24-year-old man presents with a 3-month historyof upper abdominal pain. He describes it as an intermittent, centrally located “burning” feeling in his upper abdomen, most often occurring 2 to 3 hoursafter meals. His presentation is most consistent withthe clinical presentation of:


A. acute gastritis.


B. gastric ulcer.


C. duodenal ulcer.


D. cholecystitis.

C. duodenal ulcer.

When choosing pharmacological intervention to prevent recurrence of duodenal ulcer in a middle-aged man, you prescribe:


A. a proton pump inhibitor (PPI).


B. timed antacid use.


C. antimicrobial therapy.


D. a histamine 2-receptor antagonist (H2RA).

C. antimicrobial therapy.

The H2RA most likely to cause drug interactions with phenytoin and theophylline is:


A. cimetidine.


B. famotidine.


C. nizatidine.


D. ranitidine.

A. cimetidine.

Which of the following is least likely to be found in a patient with gastric ulcer?


A. history of long-term naproxen use


B. age younger than 50 years


C. previous use of H2RA or antacids


D. cigarette smoking

B. age younger than 50 years

Nonsteroidal antiinflammatory drug (NSAID)-induced peptic ulcer can be best limited by the use of:


A. timed antacid doses.


B. an H2RA.


C. an appropriate antimicrobial.


D. misoprostol.

D. misoprostol.

Cyclooxygenase-1 (COX-1) contributes to:

A. the inflammatory response.


B. pain transmission.


C. maintenance of gastric protective mucosal layer.


D. renal arteriole constriction.

C. maintenance of gastric protective mucosal layer.
Cyclooxygenase-2 (COX-2) contributes to:

A. the inflammatory response.


B. pain transmission inhibition.


C. maintenance of gastric protective mucosal layer.


D. renal arteriole dilation.

A. the inflammatory response.
You see a 48-year-old woman who has been taking a cyclooxygenase-2 (COX-2) inhibitor for the past 3 years. In counseling her, you mention that long-term use of COX-2 inhibitors is associated with all of the following except:

A. hepatic dysfunction.


B. gastropathy.


C. cardiovascular events.


D. cerebrovascular events.

A. hepatic dysfunction.

A 64-year-old woman presents with a 3-month history of upper abdominal pain. She describes the discomforts an intermittent, centrally located “burning” feeling in the upper abdomen, most often with meals and often accompanied by mild nausea. Use of an over-the-counter HR2 affords partial symptom relief. She also uses diclofenac on a regular basis for the control of osteoarthritis pain. Her clinical presentation is most consistent with:


A. acute gastroenteritis.


B. gastric ulcer.


C. duodenal ulcer.


D. chronic cholecystitis.

B. gastric ulcer.

Which of the following statements about Helicobacter pylori is false?


A. H. pylori is a gram-negative, spiral-shaped bacterium.


B. Infection with H. pylori is the most potent risk factor for duodenal ulcer.


C. The organism is often resistant due to the production of beta-lactamase.


D. H. pylori is transmitted via the oral-fecal or oral-oral route.

C. The organism is often resistant due to the production of beta-lactamase.

The most sensitive and specific test for H. pylori infection from the following list is:


A. stool Gram stain, looking for the offending organism.


B. serological testing for antigen related to the infection.


C. organism-specific stool antigen testing.


D. fecal DNA testing.

C. organism-specific stool antigen testing.

Which of the following medications is a PPI?

A. loperamide


B. metoclopramide


C. nizatidine


D. lansoprazole

D. lansoprazole

Peptic ulcer disease can occur in any of the following locations except:


A. duodenum.


B. stomach.


C. esophagus.


D. large intestine.

D. large intestine.

An ulcer that is noted to be located in the region below the lower esophageal sphincter and before the pylorus's usually referred to as a(n) ________ ulcer.

A. duodenal


B. esophageal


C. gastric


D. stomach

C. gastric
A 56-year-old man with a 60 pack-year cigarette smoking history, recent 5-lb unintended weight loss, and a 3-month history of new-onset symptoms of peptic disease presents for care. He is taking no medications on a regular basis and reports drinking approximately six 12-oz beers per week with no more than 3 beers per day. Physical examination is unremarkable except for mild pharyngeal erythema and moderate epigastric tenderness without rebound. The most helpful diagnostic test at this point in his evaluation is a:

A. upper endoscopy.


B. barium swallow.


C. evaluation of H. pylori status.


D. esophageal pH monitoring.

A. upper endoscopy.
Which of the following medications is a prostaglandin analog?

A. sucralfate


B. misoprostol


C. esomeprazole


D. metoclopramide

B. misoprostol
Long-term PPI use is associated with all of the following except:

A. increased risk of pneumonia in hospitalizedpatients.


B. increased risk of C. difficult colitis in hospitalizedpatients.


C. reduced absorption of calcium and magnesium.


D. reduced absorption of dietary carbohydrates.

D. reduced absorption of dietary carbohydrates.

To avoid rebound gastric hyperacidity following discontinuation of long-term PPI use, all of the following methods can be used except:


A. gradually tapering the PPI dose with supplemental antacid.


B. switch to every-other-day dosing of PPI with supplemental antacid.


C. switch to a low-dose H2RA therapy with supplemental antacid.


D. empiric H. pylori therapy.

D. empiric H. pylori therapy.

A 35-year-old woman complains of a 6-month history of periodic “heartburn” primarily after eating tomato-based sauces. Her weight is unchanged and examination reveals a single altered finding of epigastric tenderness without rebound. As first-line therapy, you advise:

A. avoiding trigger foods.


B. the use of a pro kinetic agent.


C. addition of sucralfate with meals.


D. increased fluid intake with food intake.

A. avoiding trigger foods.
You see a 62-year-old man diagnosed with esophageal columnar epithelial metaplasia. You realize he is at increased risk for:

A. esophageal stricture.


B. esophageal adenocarcinoma.


C. gastroesophageal reflux.


D. H. pylori colonization.

B. esophageal adenocarcinoma.

In caring for a patient with symptomatic gastroesophageal reflux, you prescribe a PPI to:


A. enhance motility


B. increase the pH of the stomach


C. reduce lower esophageal pressure


D. help limit H. pylori growth

B. increase the pH of the stomach

A 38-year-old nonsmoking man presents with signs and symptoms consistent of GERD. He has self-treated with over-the-counter antacids and acid suppression therapy with effect. His weight is stable, and he denies nausea, vomiting, diarrhea, or melena. Which of the following represents the most appropriate diagnostic plan for this patient?

A. fecal testing for H. pylori antigen


B. upper GI endoscopy


C. barium swallow


D. no specific diagnostic testing is needed

D. no specific diagnostic testing is needed
Which of the following is most likely to be found in a 50-year-old woman with new-onset reflux esophagitis?

A. recent initiation of estrogen-progestin hormonal therapy


B. recent weight loss


C. report of melena


D. evidence of H. pylori infection

A. recent initiation of estrogen-progestin hormonal therapy
Which of the following is likely to be reported in a patient with persistent GERD?

A. hematemesis


B. chronic sore throat


C. diarrhea


D. melena

B. chronic sore throat
A 58-year-old man recently began taking an antihypertensive medication and reports that his “heartburn” has become much worse. He is most likely taking:

A. atenolol.


B. trandolapril.


C. amlodipine.


D. losartan.

C. amlodipine.

You prescribe a fluoroquinolone antibiotic to a 54-year-old woman who has occasional GERD symptoms that she treats with an antacid. When discussing appropriate medication use, you advise that she should take the antimicrobial:


A. with the antacid.


B. separated from the antacid use by 2 to 4 hours beforeor 4 to 6 hours after taking the fluoroquinolone.


C. without regard to antacid use.


D. apart from the antacid by about 1 hour on either side of the fluoroquinolone dose.

B. separated from the antacid use by 2 to 4 hours before or 4 to 6 hours after taking the fluoroquinolone.

A 48-year-old man with obesity and a 1-year history of classic GERD symptoms has been on the consistent use of a therapeutic dose of a PPI for the past 6 months. He states he is “really no better with the medicine and I have cut out most of the food that bothers my stomach. I even cut out all alcohol and soda.” Physical examination reveals stable weight, mildly erythematous pharynx, and epigastric tenderness without rebound. Next step options include:


A. obtaining an upper GI series.


B. referral for GERD surgery.


C. further evaluation with upper GI endoscopy.


D. obtaining FOBT testing.

C. further evaluation with upper GI endoscopy.

Which of the following is not an “alarm” finding in the person with GERD symptoms?

A. weight gain


B. dysphagia


C. odynophagia


D. iron-deficiency anemia

A. weight gain
Risk factors for Barrett esophagus include all of the following except:

A. history of cigarette smoking.


B. older than 50 years of age.


C. male gender.


D. African American ethnicity.

D. African American ethnicity.
A 57-year-old male is in need of evaluation for Barrettesophagus. You recommend:

A. H. pylori testing.


B. CT scan.


C. upper GI endoscopy with biopsy.


D. barium swallow.

C. upper GI endoscopy with biopsy.
A 64-year-old male with diagnosed Barrett esophagus has shown no sign of dysplasia in two consecutive evaluations within the past year. You recommend additional surveillance testing should be conducted every:

A. 6 months.


B. 12 months.


C. 2 years.


D. 3 years.

D. 3 years.
The most common form of esophageal cancer in the United States is:

A. squamous cell cancer.


B. adenocarcinoma.


C. basal cell carcinoma.


D. melanoma.

B. adenocarcinoma.
Esophageal adenocarcinoma is usually located:

A. in the upper esophagus.


B. near the upper esophageal sphincter.


C. at the junction of the esophagus and stomach.


D. in the lower esophagus.

C. at the junction of the esophagus and stomach.

Esophageal squamous cell cancer is usually located:


A. in the upper esophagus.


B. near the upper esophageal sphincter.


C. at the junction of the esophagus and stomach.


D. in the lower esophagus.

A. in the upper esophagus.

Which of the following is at greatest risk of esophageal cancer?

A. 34-year-old male who eats a high-fat diet


B. 76-year-old male who stopped smoking15 years ago


C. 45-year-old woman with a history of 6 full-termpregnancies


D. 58-year-old female vegetarian

B. 76-year-old male who stopped smoking 15 years ago
The presence of esophageal cancer is commonly associated with:

A. renal impairment.


B. chronic bronchitis.


C. iron-deficiency anemia.


D. unexplained weight gain.

C. iron-deficiency anemia.
A 36-year-old man complains of nausea, fever, malaise, and abdominal pain. He shows signs of jaundice and reports darkly-colored urine. Diagnostic results show elevated serum aminotransferase less than 10 times upper limits of normal (ULN). His most likely diagnosis is:

A. GERD.


B. viral hepatitis.


C. Crohn’s disease.


D. Barrett esophagus.

B. viral hepatitis.
A serological marker for acute hepatitis A virus (HAV) infection is:

A. HAV IgM.


B. HAV viral RNA.


C. TNF-α.


D. IL-10.

A. HAV IgM.

You are caring for a 45-year-old woman from a developing country. She reports that she had “yellow jaundice” as a young child. Her physical examination is unremarkable. Her laboratory studies are as follows:


AST, 22 U/L (normal, 0 to 31 U/L); alanine amino-transferase (ALT), 25 U/L (normal, 0 to 40 U/L); hepatitis A virus immunoglobulin G (HAV IgG) positive.


Laboratory testing reveals:


A. chronic hepatitis A.


B. no evidence of prior or current hepatitis A infection.


C. resolved hepatitis A infection.


D. prodromal hepatitis A.

C. resolved hepatitis A infection.

The most common source of hepatitis A infection is:

A. sharing intravenous drug equipment.


B. cooked seafood.


C. contaminated water supplies.


D. sexual contact.

C. contaminated water supplies.
In addition to the laboratory work described, results reveal the following for the above-mentioned patient: hepatitis B surface antigen (HBsAg) positive. These findings are most consistent with:

A. no evidence of hepatitis B infection.


B. resolved hepatitis B infection.


C. chronic hepatitis B.


D. evidence of effective hepatitis B immunization.

C. chronic hepatitis B.
The average incubation time for HAV is approximately:

A. 10 days.


B. 28 days.


C. 60 days.


D. 6 months.

B. 28 days.

Current vaccine guidelines recommend administering the immunization against HAV to:


A. those living in or traveling to areas endemic for the disease.


B. food handlers and day-care providers.


C. military personnel.


D. any person who wishes to receive the vaccine.

D. any person who wishes to receive the vaccine

All of the following are effective methods to kill the hepatitis A virus except:


A. heating food to more than 185°F (85°C) for at least 1 minute.


B. adequately chlorinating water.


C. cleaning surfaces with a 1:100 bleach solution.


D. freezing food for at least 1 hour.

D. freezing food for at least 1 hour.

You see a 27-year-old man who says he ate at restaurant last week that was later reported to have a worker identified with hepatitis A. He is healthy and shows no sign of infection but is concerned about contracting HAV infection. You recommend:

A. HAV vaccine.


B. HAV immune globulin.


C. HAV vaccine plus immune globulin.


D. no intervention at this time and wait untilsymptoms manifest.

A. HAV vaccine.

A 54-year-old man has been recently diagnosed with HAV infection. You recommend all of the following except:


A. eating smaller, more frequent meals to help combat nausea.


B. avoiding consumption of any alcohol.


C. reviewing current medication use for consideration of discontinuation.


D. taking daily acetaminophen to alleviate joint pains.

D. taking daily acetaminophen to alleviate joint pains.

A 38-year-old man with a recent history of injection drug use presents with malaise, nausea, fatigue, and “yellow eyes” for the past week. After ordering diagnostic tests, you confirm the diagnosis of acute hepatitis B. Anticipated laboratory results include:

A. the presence of hepatitis B surface antibody(HBsAb).


B. neutrophilia.


C. thrombocytosis.


D. the presence of HBsAg.

D. the presence of HBsAg.
Clinical findings in patients with acute hepatitis B likely include all of the following except:

A. abdominal rebound tenderness.


B. scleral icterus.


C. a smooth, tender, palpable hepatic border.


D. report of myalgia.

A. abdominal rebound tenderness.

Risk factors for hepatitis B virus (HBV) infection include all of the following except:


A. having multiple sexual partners.


B. having an occupation that exposes you to human blood.


C. injection drug user.


D. eating food prepared by a person with an HBVinfection.

D. eating food prepared by a person with an HBV infection.

You see a woman who has been sexually involved without condom use with a man newly diagnosed with acute hepatitis B. She has not received hepatitis B immunization. You advise her to:

A. start hepatitis B immunization series.


B. limit the number of sexual partners.


C. be tested for HBsAb.


D. receive hepatitis B immune globulin and starthepatitis B immunization series.

D. receive hepatitis B immune globulin and start hepatitis B immunization series.
The HBV vaccine should not be offered to individuals who have a history of anaphylactic reaction to:

A. eggs.


B. Baker’s yeast.


C. peanuts.


D. shellfish.

B. Baker’s yeast.

Which of the following groups should be screened for hepatitis B surface antigen (HBsAg)?


A. pregnant women with no history of receiving HBV vaccine


B. pregnant women with documented prior HBV infection


C. all pregnant women regardless of HBV vaccine history


D. all newborn infants born to mothers with chronic HBV infection

C. all pregnant women regardless of HBV vaccine history

Routine testing for the presence of HBsAb after immunization with the HBV vaccine is recommended for all of the following except:

A. healthcare providers.


B. immunocompromised patients.


C. restaurant workers.


D. dialysis patients.

C. restaurant workers.

A 26-year-old male reports that he has shared a needle with a friend during injection drug use. He is certain that his friend has chronic hepatitis B infection and is uncertain about his own immunization history. You recommend:


A. starting the HBV vaccine series.


B. administering hepatitis B immune globulin.


C. starting the HBV vaccine series and administering hepatitis B immune globulin.


D. waiting until the HBsAg results before administering hepatitis B immune globulin.

C. starting the HBV vaccine series and administering hepatitis B immune globulin.

You see a 22-year-old male who is an injection drug user who has recently been diagnosed with chronic HBV infection. You recommend additional testing for all of the following except:

A. Lyme disease.


B. HIV.


C. HAV.


D. HCV

A. Lyme disease.
Antiviral treatment for chronic HBV infection includes all of the following except:

A. entecavir.


B. tenofovir.


C. lamivudine.


D. fidaxomicin.

D. fidaxomicin.
Which of the following statements is true concerning hepatitis C infection?

A. It usually manifests with jaundice, fever, and significant hepatomegaly.


B. Among health-care workers, it is most commonly found in nurses.


C. At least than 50% of persons with acute hepatitis C go on to develop chronic infection


D. Interferon therapy is consistently curative.

C. At least than 50% of persons with acute hepatitis C go on to develop chronic infection

Which of the following characteristics is predictive of severity of chronic liver disease in a patient with chronic hepatitis C?


A. female gender, age younger than 30


B. co-infection with hepatitis B, daily alcohol use


C. acquisition of virus through intravenous drug use, history of hepatitis A infection


D. frequent use of aspirin, nutritional status

B. co-infection with hepatitis B, daily alcohol use

When answering questions about hepatitis A vaccine, you consider that all of the following are true except:


A. it does not contain live virus.


B. it should be offered to individuals who frequently travel to developing countries.


C. it is a recommended immunization for healthcare workers.


D. it is given as a single dose.

D. it is given as a single dose.

To prevent an outbreak of hepatitis D infection, a NP plans to:

A. promote a campaign for clean food supplies.


B. immunize the population against hepatitis B.


C. offer antiviral prophylaxis against the agent.


D. encourage frequent hand washing.

B. immunize the population against hepatitis B.

Which of the following is true concerning hepatitis B vaccine?


A. The vaccine contains live hepatitis B virus.


B. Most individuals born since 1986 in the United States who have been fully immunized have received vaccine against HBV.


C. The vaccine is contraindicated in the presence of infection.


D. Post vaccination arthralgias are often reported.

B. Most individuals born since 1986 in the United States who have been fully immunized have received vaccine against HBV.

Hyperbilirubinemia can cause all of the following except:

A. potential displacement of highly protein-bounddrugs.


B. scleral icterus.


C. cola-colored urine.


D. reduction in urobilinogen.

D. reduction in urobilinogen.
Monitoring for hepatoma in a patient with chronic hepatitis B or C often includes periodic evaluation of:

A. erythrocyte sedimentation rate.


B. HBsAb.


C. alpha-fetoprotein.


D. bilirubin.

C. alpha-fetoprotein.
Which of the following is an expected laboratory result in a patient with acute hepatitis A infection (normal values: AST, 0 to 31 U/L; ALT, 0 to 40 U/L)?

A. AST, 55 U/L; ALT, 50 U/L


B. AST, 320 U/L; ALT, 190 U/L


C. AST, 320 U/L; ALT, 300 U/L


D. AST, 640 U/L; ALT, 870 U/L

D. AST, 640 U/L; ALT, 870 U/L
Which of the following is most likely to be reported in a patient on long-term use of a 3-hydroxy-3-methylglutaryl–coenzyme A (HMG-CoA) reductase inhibitor (statin)?

A. AST, 22 U/L; ALT, 28 U/L


B. AST, 320 U/L; ALT, 190 U/L


C. AST, 32 U/L; ALT, 120 U/L


D. AST, 440 U/L; ALT, 670 U/L

A. AST, 22 U/L; ALT, 28 U/L

When discussing the use of immunoglobulin (IG) with a 60-year-old woman who was recently exposed to the hepatitis A virus, you consider that:


A. IG is derived from pooled donated blood.


B. the product must be used within 1 week of exposure to provide protection.


C. its use in this situation constitutes an example of active immunization.


D. a short, intense flu-like illness often occurs after its use.

A. IG is derived from pooled donated blood.

You see a 48-year-old woman with nonalcoholicfatty liver disease. Evaluation of infectious hepatitis includes the following:


Anti-HAV IgG—negative


Anti-HBs—negative


Anti-HCV—negative


When considering her overall health status, you advise receiving which of the following vaccines?


A. immunization against hepatitis A and B as based on her lifestyle risk factors


B. immunization against hepatitis B and C


C. immunization against hepatitis A and B


D. immunization against hepatitis A, B, and C

C. immunization against hepatitis A and B

Which of the following hepatitis forms is most effectively transmitted from the man to the woman via heterosexual vaginal intercourse?

A. hepatitis A


B. hepatitis B


C. hepatitis C


D. hepatitis D

B. hepatitis B

In a 28-year-old man who presents with a 6-month history of involuntary weight loss, recurrent abdominal cramping, loose stools, and anterior and posterioranal fissure, which of the following diagnoses should be considered?


A. ulcerative colitis


B. Crohn’s disease


C. C. difficile colitis


D. condyloma acuminata

B. Crohn’s disease

Which of the following patient complaints should be evaluated further in making a differential of irritable bowel syndrome (IBS)?


A. a 52-year-old female with a first degree family history of colorectal cancer, recent constipation, and abdominal pain


B. a middle-aged adult with low albumin and leukocytosis


C. both patients outlined in responses A and B


D. a 16-year-old female with chronic, alternating constipation and diarrhea when she is studying for high school exams and worrying about her parents’ impending divorce

C. both patients outlined in responses A and B

The pathophysiology of IBS can be best described as:


A. shares the same pathophysiology as inflammatory bowel disease.


B. a patchy inflammatory process in the small bowel that most adolescents will outgrow with vigorous exercise and a low residue diet.


C. a condition that is the result of abnormal gut motor/sensory activity


C. an overstimulation of pancreatic beta cell production.

C. a condition that is the result of abnormal gut motor/sensory activity

Diagnostic criteria for irritable bowel syndrome include abdominal pain that is associated with allof the following except:


A. improvement with defecation.


B. a change in frequency of stool.


C. a change of stool form.


D. unexplained weight loss.

D. unexplained weight loss.

When considering an IBS diagnosis, the NP should be aware that:


A. diagnosis is largely based on clinical presentation and application of the Rome III Criteria.


B. a colonoscopy should be done routinely when the diagnosis is suspected.


C. CBC, ESR, CRP and serum albumin should be the initial labs for an IBS workup.


D. once an IBS diagnosis has been confirmed, you can assure the patient that treatment is generally curative.

A. diagnosis is largely based on clinical presentation and application of the Rome III Criteria.

Altering the gut pain threshold in IBS is a possible therapeutic outcome with the use of:


A. loperamide (Imodium®).


B. dicyclomine (Bentyl®).


C. bismuth subsalicylate (Pepto-Bismol®).


D. amitriptyline (Elavil®).

D. amitriptyline (Elavil®).

Tenesmus is defined as which of the following?


A. rectal burning with defecation


B. a sensation of incomplete bowel emptying that isdistressing and sometimes painful


C. weight loss that accompanies many bowel diseases


D. appearance of frank blood in the stool

B. a sensation of incomplete bowel emptying that is distressing and sometimes painful

Concerning IBS, which of the following statements is most accurate?


A. Patients most often report chronic diarrhea as the most distressing part of the problems.


B. Weight gain is often reported.


C. Patients can present with bowel issues ranging from diarrhea to constipation.


D. The condition is associated with a strongly increased risk of colorectal cancer.

C. Patients can present with bowel issues ranging from diarrhea to constipation.

An example of a medication with prokineticactivity is:

A. dicyclomine (Bentyl).


B. metoclopramide (Reglan®).


C. loperamide (Imodium).


D. psyllium (Metamucil®).

B. metoclopramide (Reglan®).

Diagnostic testing in IBS often reveals:


A. evidence of underlying inflammation.


B. anemia of chronic disease.


C. normal results on most testing.


D. mucosal thickening on abdominal radiological imaging.

D. mucosal thickening on abdominal radiological imaging.

Which of the following is an appropriate treatment for IBS?


A. high fat, low residue diet.


B. high fiber, low fat diet and stress modification.


C. antispasmotics and loperamide for diarrhea predominance.


D. tricyclic antidepressants for constipation predominance.

C. antispasmotics and loperamide for diarrhea predominance.

The clinical indication for the use of lubiprostone (Amitiza®) is for:


A. the treatment of constipation that is not amenableto standard therapies.


B. intervention in intractable diarrhea.


C. control of intestinal inflammation.


D. the relief of intestinal spasms.

A. the treatment of constipation that is not amenable to standard therapies.

Irritable bowel syndrome is characterized by all of the following except:


A. weight loss and malnutrition.


B. abdominal pain or discomfort (hypersensitivity) at least three times per month for a 6-month period.


C. Altered bowel pattern in the absence of detected structural abnormalities.


D. occurs two to three times more often in women than men.

A. weight loss and malnutrition.

Diagnostic testing in inflammatory bowel disease (IBD) often reveals:


A. evidence of underlying inflammation.


B. notation of intestinal parasites.


C. normal results on most testing.


D. a characteristic intra abdominal mass on radiological imaging.

A. evidence of underlying inflammation.

Laboratory evaluation during an IBD flare will reveal elevated levels of all of the following except:


A. CRP.


B. SeCr.


C. ESR.


D. WBC.

B. SeCr.

IBD is associated with all of the following types of anemia except:


A. anemia of chronic disease.


B. iron-deficiency anemia.


C. megaloblastic anemia.


D. anemia associated with acute blood loss.

C. megaloblastic anemia.

Which of the following best describes the hemogram results in a person with anemia of chronic disease that often accompanies IBD?

A. microcytic, hypochromic


B. macrocytic, normochromic


C. normocytic, normochromic


D. hyperproliferative

C. normocytic, normochromic
IBD is a term usually used to describe:

A. ulcerative colitis and irritable bowel syndrome.


B. C. difficile colitis and Crohn’s disease.


C. Crohn’s disease and ulcerative colitis.


D. inflammatory colitis and ileitis.

C. Crohn’s disease and ulcerative colitis.

“Skip lesions” are usually reported during colonoscopy in:


A. irritable bowel syndrome.


B. ulcerative colitis.


C. Crohn’s disease.


D. C. difficile colitis.

C. Crohn’s disease.

First-line therapy for Crohn’s disease or ulcerative colitis is:


A. oral aminosalicylates.


B. parenteral corticosteroids.


C. antibiotics.


D. immune modulators.

A. oral aminosalicylates.

Immune modulators are often used for intervention in:


A. ulcerative colitis.


B. irritable bowel syndrome.


C. Crohn’s disease.


D. ulcerative colitis and Crohn’s disease.

D. ulcerative colitis and Crohn’s disease.
After a decade of disease, a person with ulcerative colitis is at increased risk of malignancy involving the:

A. small bowel.


B. large intestine.


C. duodenum.


D. stomach.

B. large intestine.
Crohn’s disease is associated with increased risk of malignancy involving the:

A. small bowel.


B. large intestine.


C. duodenum.


D. stomach.

A. small bowel.

Onset of symptoms is before age 30 to 40 years in most cases.



Both

The patient population is predominately female.

IBS

The condition is often referred to as spastic colon by the general population.

IBS

Extraintestinal manifestations occasionally include nondestructive arthritis and renal calculi.

IBD

This is a potentially life-threatening condition.

IBD

The etiology likely involves an autoimmune response to the GI tract

IBD

Patients should be advised to avoid trigger foods.

Both

Involvement can be limited to intestinal mucosa only, or the full thickness of the intestinal wall can be involved.

IBD

The etiology is considered to be an alteration in small and large bowel motility.

IBS

Potential complications include fistula formation and perineal disease.

IBD

Potential complications include increased risk for colonic malignancy.

IBD

Celiac disease is also called all of the following except:

A. gluten-induced enteropathy


B. celiac sprue


C. sprue


D. small bowel malabsorption syndrome

D. small bowel malabsorption syndrome

All of the following characterize celiac disease except:


A. temporary immunological gluten disorder.


B. affects more often people of Northern European ancestry.


C. causes diffuse damage to the proximal small intestinal mucosa with malabsorption of nutrients.


D. often misdiagnosed as irritable bowel disease.

A. temporary immunological gluten disorder.

Celiac disease’s classic presentation can include all of the following except:


A. weight loss, chronic diarrhea, and musclewasting.


B. flatulence and abdominal distension.


C. as growth restriction when diagnosed in children less than 2 years old.


D. reported egg intolerance.

D. reported egg intolerance.

The most accurate serological markers to diagnose celiac sprue are:

A. ESR and CRP.


B. IgA endomysial and IgA tTG antibodies.


C. mucosal biopsies of the terminal ileum.


D. H. pylori IgG antibodies.

B. IgA endomysial and IgA tTG antibodies.

Patients with celiac disease present with similar signs and symptoms of all of the following conditions except:


A. acute appendicitis.


B. bacterial overgrowth.


C. cow’s milk intolerance.


D. tropical sprue.

A. acute appendicitis.

Which of the following would be an acceptable food choice for a person with celiac disease?

A. beer and popcorn


B. vegetarian pizza


C. steak with mashed potatoes


D. chicken nuggets

C. steak with mashed potatoes

An 8-year-old girl is diagnosed with celiac disease. When counseling her parents, you advise that the child should:


A. consume whole grains, especially wheat, oats and barley.


B. carefully plan exercise to minimize symptoms.


C. avoid intake of semolina, spelt, and rye.


D. avoid birthday parties or other gatherings that may expose the child to offending foods.

C. avoid intake of semolina, spelt, and rye.

Risk factors for acute pancreatitis include all of the following except:

A. hypothyroidism.


B. dyslipidemia.


C. abdominal trauma.


D. thiazide diuretic use.

A. hypothyroidism.

Ms. Lane, a 38-year-old woman with a long-standing history of alcohol abuse, presents with a 4-day history of a mid abdominal ache that radiates through to the back, remains relatively constant, and has been accompanied by nausea and three episodes of vomiting. She has tried taking antacids without relief. Her skin is cool and moist with a blood pressure of 90/72 mm Hg, pulse rate of 120 bpm, and respiratory rate of 24/min. Findings that would support a diagnosis of acute pancreatitis include all of the following except:


A. elevated serum amylase level.


B. elevated lipase level.


C. jaundice.


D. upper abdominal tenderness without localizationor rebound.

C. jaundice.

Your next best action in caring for Ms. Lane in the previous question is to:


A. refer to the acute care hospital for admission.


B. attempt office hydration after administration of an analgesic agent.


C. initiate therapy with ranitidine (Zantac) and an antacid.


D. obtain serum electrolyte levels.

A. refer to the acute care hospital for admission.

Other than the pancreas, other sources of amylase include all of the following except:

A. salivary glands.


B. lung cancer.


C. ovarian cyst.


D. adipose tissue.

D. adipose tissue.
Elevated lipase levels can be a result of all of the following conditions except

A. hepatic failure


B. renal failure


C. perforated duodenal ulcer


D. bowel obstruction or infarction.

A. hepatic failure.

Which of the following statements is true when evaluating a patient with acute pancreatitis?


A. Diagnosis can be made by clinical assessment alone.


B. The pancreas can be clearly visualized by abdominal ultrasound.


C. Measuring serum lipase level along with amylase level increases diagnostic specificity in acute pancreatitis.


D. Hypocalcemia is a nearly universal finding.

C. Measuring serum lipase level along with amylase level increases diagnostic specificity in acute pancreatitis.

When using the Ranson criteria to evaluate the severity of acute pancreatitis, a severe clinical course is predicted with a score of:


A. less than 2.


B. 3 or greater.


C. 6 or greater.


D. 8 or greater.

B. 3 or greater.

Common signs and symptoms of a pancreatic pseudo cyst include all of the following except:


A. abdominal pain that radiates to the back.


B. nausea and vomiting.


C. jaundice.


D. a mass that can be felt in the upper abdomen.

C. jaundice

Which of the following diagnostic tests is most effective in determining if a pseudocyst is benign?

A. CT scan


B. MRI scan


C. analysis of cyst fluid


D. serum amylase and lipase levels

C. analysis of cyst fluid

A 56-year-old man with a history of colon cancer under goes a follow-up abdominal MRI scan. A small mass is identified on the pancreas that is later diagnosed as a benign pseudocyst. The pseudocystis not causing any symptoms and measures 8 mm in diameter. You consider:


A. repeating the scan in 1 year to check for anychanges.


B. draining the pseudocyst.


C. surgical removal of the pseudocyst.


D. initiating a regimen of antiinflammatory medica-tion to decrease the size of the pseudocyst.

A. repeating the scan in 1 year to check for any changes

Risk factors for pancreatic cancer include all of the following except:

A. hypertension.


B. history of chronic pancreatitis.


C. tobacco use.


D. diabetes mellitus.

A. hypertension.
In assessing a person with suspected pancreatic cancer, the nurse practitioner anticipates which of the following findings?

A. palpable midline abdominal mass


B. midepigastric pain that radiates to the midback orlower back region


C. presence of Cullen sign


D. positive obturator and psoas signs

B. midepigastric pain that radiates to the midback or lower back region
All of the following laboratory findings are expected in a patient with pancreatic cancer except:

A. elevated total bilirubin.


B. diminished platelet count.


C. elevated alkaline phosphatase.


D. elevated direct bilirubin.

B. diminished platelet count.
The clinical presentation of pancreatic cancer involving the head of the pancreas usually includes:

A. painless jaundice.


B. polycythemia.


C. hematuria.


D. hyperkalemia.

A. painless jaundice


Which of the following is least likely to be found in a person with pancreatic cancer?

A. history of chronic pancreatitis


B. lesion identified on abdominal CT


C. normocytic, normochromic anemia


D. elevation of amylase level

D. elevation of amylase level