Patho Practice Test 1

Created by cmccorm090 

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1. What two segments of the small intestine intersect at the Ligament of Treitz?
a. duodenum:ileum
b. jejunum:ileum
c. duodenum:jejunum

c. duodenum:jejunum

The _______ are a conduit for small intestinal lymphatic flow. This flow passes through various channels of the lymphatic system, finally emptying into the ___________ (which is also why we don't like IJ CVC's on the left side)
a. lacteals, thoracic duct
b. crypts of Lieberkuhn, lamina propria
c. crypts of Lieberkuhn, thoracic duct
d. lacteals, lamina propria

a. lacteals, thoracic duct

Which of the following provide the liver with the majority of its blood supply?
a.Hepatic artery
b. Portal vein
c. Mesenteric vein
d. Mesenteric artery

b. Portal vein

Which of the following does NOT make up bile?
1. Cholesterol
2. Water
3. Bilirubin
4. Hydrogen ions

4. Hydrogen ions

Digestion and absorption of fat occurs in four phases. Which of the following is not a phase in which this occurs?
a. emulsification and lipolysis
b. micelle formation
c. fat absorption
d. resynthesis of triglycerides and phospholipase
e. conjugation

e. conjugation

T/F
Calcium absorption is dependent on the active form of Vitamin D, also known as 1,25-dihydroxyvitamin D.

True

All of the following are treatments for GERD except:
A. Proton pump inhibitors
B. H2 antagonists
C. Antacids
D. Sodium Bicarb

D. Sodium Bicarb

T or F
Laproscopic Fundoplication is the most common surgical intervention when medical treatment fails.

TRUE

All of the following are true about duodenal ulcers EXCEPT:
a. occur with greatest frequency of all peptic ulcers
b. manifested by chronic intermittent pain in the epigastric area when the stomach is empty
c. pain is not relieved with ingestion of food
d. may heal spontaneously but recur within months

c. pain is not relieved with ingestion of food

T/F
Signs and symptoms of chronic gastritis correlate with the severity of the disease.

False
S/S of chronic gastritis DO NOT correlate with the severity of the disease

Which of the following statements regarding gastric ulcers is false?
a. Gastric ulcers usually develop in the antral region.
b. Gastric ulcers are commonly caused by H.pylori.
c. Gastric secretion is usually significantly increased.
d. Clinical manifestations of gastric ulcers include a pattern of pain, food, and relief.

c. Gastric secretion is usually significantly increased.
Gastric secretion may be normal or less than normal and there may be a decreased mass of parietal cells.

Which of the following statements regarding stress ulcers is false?
a. Ischemic ulcers can be caused by hemorrhage.
b. Curling ulcers are stress ulcers that develop after a burn injury.
c. Cushing ulcers are associated with sepsis.
d. The primary clinical manifestation of stress ulcers is bleeding.

c. Cushing ulcers are associated with sepsis.
Cushing ulcers are associated with severe head trauma or neurosurgery.

True or False
Intrahepatic obstructive jaundice can cause conjugated and unconjugated hyperbilirubinemia.

True.
Failure of liver cells (hepatocytes) to conjugate bilirubin and of bilirubin to pass from liver to intestine.

Which of the following is the best way to determine if a patient with advanced hepatic disease developed hepatorenal syndrome?
A. Elevated serum potassium levels
B. An unexplained and progressive elevation in the plasma creatinine
C. Anorexia, weakness, and fatigue
D. Systolic blood pressure <100 mm Hg

B. An unexplained and progressive elevation in the plasma creatinine.
The serum K+ levels do not become dangerously elevated until the terminal stages of the hepatorenal syndrome. Anorexia, weakness, and fatigue are nonspecific symptoms of hepatorenal syndrome. Systolic blood pressure is usually <100, however this is not always the case. In addition to those mentioned, blood urea increases as well as urine osmolality but urine Na concentrations are below normal. Urine specific gravity is >1.015.

All of the following inhibit gastric motility and emptying EXCEPT:
A. Secretin
b. Entero-oxytocin
C. Motilin
D. Enteroglucagon

C. Motilin.
Motilin increases motility

In the mucosa of the stomach, all of the following stimulate acid secretion EXCEPT:
A. Acetylcholine
B. Gastrin
C. Histamine
D. Somatostatin

D. Somatostatin.
Somatostatin inhibits acid secretion

All of the following are true regarding GI bleeds except:
A. The accumulation of blood inside the gastrointestinal tract increases peristalsis.
B. A massive upper GI bleed may be reflected by an increase in BUN.
C. Hgb & Hct are the best indicators for acute GI bleed.
D. Frankly bloody diarrhea can be seen in both upper and lower GI bleeds.

C. Hgb & Hct are the best indicators for acute GI bleed.

All of the following can be seen with a massive GI bleed (loss of 1L or 20-25% of blood volume within a couple hours) except:
A. Angina
B. Pulmonary Edema
C. Abdominal Pain
D. Anxiety
E. All of the above can be seen.

E. All of the above can be seen.

The muscularis of the gastrointestinal tract is:
a. Skeletal muscle throughout the tract, particularly in the esophagus and large intestine
b. The layer that contains the blood capillaries for the entire wall of the tract
c. Composed principally of keratinized epithelium
d. Composed of circular layer, longitudinal layer and oblique layer

d. Composed of circular layer, longitudinal layer and oblique layer

True or False
Parasympathetic activity and Gastrin are inhibitory factors and make threshold potential more negative.

False.
Sympathetic activity and secretin are inhibitory factors and make threshold potential more negative.

Which of the following statements are true about the Gastrointestinal Tract?
a. The two phases of swallowing are the oropharyngeal phase (voluntary) and the esophageal phase (involuntary).
b. The two phases of swallowing are the oropharyngeal phase (involuntary) and the esophageal phase (voluntary).
c. Digestion begins in the upper part of the esophagus.
d. The tunica muscularis in the upper part of the esophagus is smooth muscle, and the lower part is striated muscle.

a. The two phases of swallowing are the oropharyngeal phase (voluntary) and the esophageal phase (involuntary).

All of the following are phases of acid secretion by the stomach except:
a. Cephalic Phase
b. Esophageal Phase.
c. Intestinal Phase
d. Gastric Phase

b. Esophageal Phase.

True or False
Diarrhea is the most common long-term alterations caused by gastric surgery.

True

All of the following will cause a decrease in the production and/or secretion of bile except.
a. Obstruction of the common bile duct
b. Nephrolithiasis
c. advanced liver disease
d. Intestinal stasis

b. Nephrolithiasis

True or false
Peptide hormones, including motilin, gastrin, secretin, and cholecystokinin, facilitate intestinal motility.

True

All statements are correct except:
a. The recommended intake of Mg for adults is 300-350mg/day
b. Phosphate is absorbed in the small intestine by passive diffusion and active transport
c. Average intake of iron is 15-30mg/day
d. Vitamin B12 is highly digested due to its binding to intrinsic factor

d. Vitamin B12 is highly digested due to its binding to intrinsic factor

The most common anatomical site of diverticula occurs at the?
a. left colon
b. ascending colon
c. small bowel
d. cecum

a. left colon

What is the most common surgical emergency of the abdomen?
a. appendicitis
b. pancreatitis
c. peritonitis
d. cholecystitis

a. appendicitis

Which of the following is not a cause of motility diarrhea?
a. Surgical bypass of an area of the intestines
b. Fistula formation between loops of intestines
c. Resection of the small intestines
d. Excessive mucosal secretion of chloride or bicarbonate-rich fluid

d. Excessive mucosal secretion of chloride or bicarbonate-rich fluid

True or False:
Prolonged diarrhea will lead to dehydration, electrolyte imbalance, metabolic alkalosis, and weight loss.

False
Metabolic Acidosis

Which of the following does not secrete the biochemicals and enzymes that are responsible for breaking down fluid and partially digested food into absorbable components of proteins, carbohydrates, and fat?
A. Liver
B. Exocrine pancreas
C. Small intestinal epithelium
D. Gallbladder

D. Gallbladder

T or F
The GI tract consists of four layers. From the inside out they are the muscularis, mucosa, submucosa, and serosa.

False
The GI tract consists of four layers. From the inside out they are the mucosa, submucosa, muscularis, and serosa.

Which of the following is true regarding resistin
a. Promotes decreased blood glucose levels

b. Promotes insulin sensitization

c. All of the above are true

d. Inhibits adipocyte differentiation

d. Inhibits adipocyte differentiation

T or F
The low levels of leptin associated with obesity are responsible for disrupting satiety signaling and therefore promoting overeating and excessive weight gain.

...

Which of the following is not involved in the process of retching?
a. Lower esophageal sphincter closure (the LES opens)
b. Upper esophageal sphincter closure
c. Decrease in intrathoracic pressure
d. Abdominal muscles, duodenum and antrum of the stomach contract

a. Lower esophageal sphincter closure
The LES opens

Projectile vomiting can be caused by all of the following except?
a. Increased ICP
b. Tumors in the brain
c. Brain stem aneurysm
d. Stimulation of 5-HT or dopamine D2

d. Stimulation of 5-HT or dopamine D2
While stimulation of these receptors does indeed cause nausea and vomiting, projectile vomiting is defined as vomiting not preceded by nausea or retching. So stimulation of these receptors does not cause projectile vomiting.

What acid/base disturbance is common in a patient w/ anorexia nervosa?
a. metabolic acidosis
b. resp alkalosis
c. met alkalosis
d. resp acidosis

...

Why is a patient with bulimia nervosa considered a potential difficult intubation?
a. Vomiting
b. Laxative abuse
c. Depression
d. History of over eating

a. Vomiting
Continual vomiting of chyme can cause pitted teeth, pharyngeal and esophageal inflammation, and TEF

True or False
In secondary biliary cirrhosis lab tests typically reveal a decrease in conjugated bilirubin and alkaline phosphate levels.

False
Would see an increase in conjugated bilirubin and alkaline phosphate levels.

Which of the following is true regarding cholelithiasis?
A. It is prevalent in underdeveloped countries.
B. Incidence is well-known and documented.
C. Cholesterol stones are the most common.
D. Risk factors include male gender.

C. Cholesterol stones are the most common.

All of the following are risk factors for hepatic encephalopathy in the presence of advanced liver disease EXCEPT?
a. Gastrointestinal bleeding
b. Decreased dietary protein
c. Electrolyte imbalance
d. Hypoxia

b. Decreased dietary protein

Hyperbilirubinemia and jaundice can result from all of the following EXCEPT?
a. Gallstones
b. Cirrhosis of the liver
c. Excessive production of bilirubin (excessive hemolysis)
d. Impaired renal function

d. Impaired renal function

Which of the following are incorrectly matched?
a. Chief Cells - hydrochloric acid
b. G Cells - gastrin
c. D cells - somatostatin
d. Parietal Cell - intrinsic factor
e. Enterochromaffin cells - Histamine

...

Which statement is false?
a. All are correct
b. Pepsin is inactivated by the alkiline environment of the duodenum
c. Acetylcholine, gastrin, & secretin stimulate chief cells to produce pepsinogen
d. Hydrochloric acid is needed to convert pepsin to pepsinogen
e. Acetylcholine, gastrin, & histamine stimulate parietal cells to secrete hydrochloric acid

...

The Serosa of the wall of the GI tract is made up of:
A: Circular and longitudinal muscle layers
B: Connective tissue layer and peritoneum
C: Muscularis mucosae, lamina propria, and mucous epithelium
D: Peritoneum and the submucosal plexus

B: Connective tissue layer and peritoneum

Which of the following most accurately describes primary peristalsis:
A: Occurs immediately after the oropharyngeal phase of swallowing
B: Simulated by food bolus stuck in esophageal lumen
C: Occurs independently of voluntary swallowing
D: Occurs secondary to a response from esophageal stretch receptor stimulation

A: Occurs immediately after the oropharyngeal phase of swallowing

T or F
A pyloric obstruction resulted from duodenal ulcerations require surgical intervention in order to eliminate the obstruction and restore the motility.

False
Obstructions resulting from ulceration often resolve with conservative treatment. Gastric drainage used to decompress the stomach and restore normal motility. Gastric secretions that contribute to inflammation and edema can be suppressed with omeprazole or cimetidine. Fluids and electrolytes (Na and K) are given IV to effect re- hydration and correct hypokalemia and alkalosis.

In case of the obstruction in the upper portion of small intestines an early development of which acid base abnormality is expected and what is physiological basis for the abnormality?
a. Early development of metabolic acidosis can be explained by decreased motility through the small intestines and excessive reabsorbtion of hydrogen ions.
b. Early development of metabolic alkalosis is attributed to excessive loss of hydrogen ions that normally would be reabsorbed from gastric juice.
c. Early development of metabolic acidosis can be explained by lack of bicarbonate reabsorbtion from bile and pancreatic secretions.

b. Early development of metabolic alkalosis is attributed to excessive loss of hydrogen ions that normally would be reabsorbed from gastric juice.

Which of the following is not a risk factor for primary liver cancer
A) Exposure to mycotoxins
B) The presence of liver flukes
C) Heavy smoking and drinking of alcohol
D) History of pancreatitis

D) History of pancreatitis

True or False
Cancer of the liver is the fifth most common case of cancer and the third leading cause of cancer death worldwide.

True

Where does the majority of water absorption take place?
a. colon
b. small intestine
c. stomach
d. bladder

b. small intestine

Where does digestion of carbohydrates occur first?
a. mouth
b. stomach
c. small intestine
d. colon

a. mouth

Chronic alcoholic hepatitis is a precursor of cirrhosis and is characterized by all of the following EXCEPT:
a. inflammation
b. necrosis of hepatocytes
c. decreased serum IgG
d. lipid peroxidation

c. decreased serum IgG

(True/False)
The cessation of alcohol in patients with alcoholic cirrhosis will allow liver damage to be reversed.

False
Cessation of alcohol consumption slows the progression of liver damage, improves clinical symptoms, and prolongs life. Although the liver damage is irreversible, measures that halt the inflammation and destruction of liver cells prolong life.

All of the following are true regarding cancer of the lower intestinal tract except
Choose one answer.
a. Cancer is more prevalent in the colon than in the rectum
b. Colon cancer is more prevalent in African Americans
c. The prevalence of colorectal cancer is lowest in populations with high socioeconomic standards
d. Cancer of the colon tends to occur in individuals older than 50 yrs

c. The prevalence of colorectal cancer is lowest in populations with high socioeconomic standards

Which of the following is not true regarding polyps?
Choose one answer.
a. A polyp is a finger-like projection arising from the mucosal epithelium
b. Most colon cancers arise from hypoplastic polyps
c. Most polyps are benign
d. The larger the polyp is, the greater the risk of colorectal cancer

...

The clinical course of hepatitis usually consists of 4 phases: incubation, prodromal, icteric and recovery phase. Which of these statements about hepatitis is INCORRECT?
a. the incubation phase varies between the different types of hepatitis
b. the prodromal phase begins about 2 weeks after exposure and ends with the appearance of jaundice
c. the icteric phase begins 1-2 weeks after the prodromal phase and is the actual phase of illness
d. the recovery phase begins with the resolution of jaundice, about 6-8 weeks after exposure
e. all of these statements are correct

E. all of these statements are correct

Which statement about cirrhosis is FALSE?
a. cirrhosis is a leading cause of death in the United States
b. cirrhosis is reversible
c. cirrhosis is an inflammatory disease that disrupts liver structure and function
d. obstruction caused by cirrhosis can cause portal hypertension

b. cirrhosis is reversible

What is the incubation period of HAC (hepatitis A virus)?
a.1-2 weeks
b.2-4 weeks
d.6-8 weeks
c.4-6 weeks

c.4-6 weeks

True or False
Hepatitis D depends on Hepatitis B for replication?

FALSE
Hepatitis A is usually transmitted by the fecal-oral route.

During the cephalic and gastric phases of digestion, gallbladder contraction is mediated by _____?
a. sympathetic nerve stimulation
b. cholinergic branches of the vagus nerve
c. pancreatic polypeptide
d. the release of cholecystokinin

b. cholinergic branches of the vagus nerve

The endocrine pancreas secretes all EXCEPT
a. insulin
b. somatostatin
c. pancreatic polypeptide
d. cholecystokinin

d. cholecystokinin

With pancreatic inflammation you would expect to see
a. Normal serum amylase of 55
b. An elevated level of serum amylase of 220
c. An elevated lipase of 0.8 somogyi units/ml
d. A decrease amylase level of 75

b. An elevated level of serum amylase of 220

True or False
With biliary obstruction you would expect the alkaline phosphatase to be 45units/L

True

As bicarbonate secretion increases, which ion secretion must decrease to maintain electroneutrality?
a. Potassium
b. Chloride
c. Magnesium
d. Sodium

b. Chloride

T or F Fiberoptic endoscopy allows direct visualization of the gastrointestinal tract.

T

T or F Probiotics are living microorganisms in food or dietary supplements that survive in the stomach acid and bile and are safe for human ingestion.

T

T or F Cancer of the gallbladder and biliary tract is more common in women than in men.

True

T or F Blood flows from the GI tract to the liver via Hepatic Veins and then from the liver to the IVC via Portal Veins.

F

The large intestine and rectum receive blood supply PRIMARILY from what source?
a. iliac artery
b. femoral artery
c. mesenteric artery
d. abdominal aorta

c. mesenteric artery

Which factor does NOT contribute to the development of ascites?
a. Portal Hypertension
b. Splanchnic Vasodilation
c. Hepatocyte failure
d. Sodium Excretion

d. Sodium Excretion

All of the following are true statements about bile secretion and bilirubin except:
a. free bilirubin is water soluble and also known as conjugated bilirubin
b. bilirubin may act as an antioxidant, provide cytoprotection, protect against cancer and cardiovascular disease
c. choleresis is another name for bile secretion
d. choleretic agents stimulate the liver to secrete bile and includes secretin, cholecystokinin, and vagal stimulation

a. free bilirubin is water soluble and also known as conjugated bilirubin

Which of the following is an important risk factor for stomach cancer
a. type O blood
b. H. pylori
c. Tobacco
d. Diabetes

b. H. pylori

T or F An acute occlusion of the mesenteric artery can be caused by artherosclerosis.

F

The accessory organs of digestion include the liver, pancreas, and spleen?

F

Which of the following is NOT true about duodenal ulcers?
a. Duodenal ulcers are the most common peptic ulcer.
b. Duodenal ulcers are associated with increased numbers of parietal cells in the stomach.
c. Pain occurs with food ingestion and is relieved when the stomach is empty.
d. Duodenal ulcers are associated with elevated gastrin levels and rapid gastric emptying.

c. Pain occurs with food ingestion and is relieved when the stomach is empty.

Which digestive system cancer accounts for the largest percentage of cancer related deaths?
a. Cancer of the esophagus
b. Colorectal cancer
c. Cancer of the pancreas
d. Cancer of the stomach

b. Colorectal cancer

In treating acute pancreatitis which narcotic is best to use in relieving pain?
a. Fentanyl
b. Remifentanyl
c. Meperidine
d. Morphine

c. Meperidine

What is a true statement about unconjugated bilirubin?
a. It is found next to a hepatocyte
b. Combines with albumin to dissolve in blood.

b. Combines with albumin to dissolve in blood.

Vascular and hematologic functions of the liver involve all of the following except:
a. the liver releases blood to maintain systemic circulatory volume in the event of hemorrhage
b. the liver receives all of the venous blood from the gut and pancreas
c. vitamin K absorption is independent of bile production in the liver
d. the amount of stored blood in the liver depends on pressure relationships in the arteries and veins

c. vitamin K absorption is independent of bile production in the liver

Irritable bowel syndrome is characterized by all except:
a. Pain
b. Diarrhea
c. Constipation
d. Bloody Stool

d. Bloody Stool

What are apudomas?
a. Cancer of islets of Langerhans
b. Cancer of exocrine pancreas
c. Cancer of biliary tract
d. Cancer of gallbladder

a. Cancer of islets of Langerhans

T or F Portal hypertension is an elevation of portal venous pressure to at least 10 mmHg.

T

T or F A patient experiencing Dumping Syndrome is expected to have increased plasma volume, resulting in decreased heart rate, hypertension,weakness, sweating and dizziness.

F

Crohn Disease can effect which part of the gastrointestinal tract?
a. Rectum
b. All answers are correct
c. Duodenum
d. Distal small intestine
e. Proximal large colon

b. All answers are correct

All of the following are possible complications associated with an intestinal obstruction EXCEPT:
a. Hyperkalemia
b. Loss of Water
c. Bacterial Translocation
d. Atelectasis

a. Hyperkalemia

You are going to pre-assess a patient known to have a small bowel obstruction. Upon entering the room the patient states that they just vomited bile-stained fluid. During your assessment the patient is noted to have mild distention of the abdomen. Where might the small bowel obstruction be located?
a. Cecum
b. Proximal Small Bowel
c. Distal (lower) Small Bowel
d. Pylorus

b. Proximal Small Bowel

T or F Pancreatic enzymes used to hydrolyze proteins, carbohydrates, and fats are present in an active form inside the pancreas.

F

Arterial blood is supplied to the pancreas from branches off which artery?
a. Celiac Artery
b. None of the above
c. Superior Mesenteric Artery
d. All of the above

d. All of the above

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