ATI LPN
NCLEX Questions Gastrointestinal System Questions
Question 1 of 5
A 42-year-old accountant is referred to your office for evaluation of progressive weight loss. He has lost 20 pounds over the last 6 months. He has a long history (16 years) of insulin-dependent diabetes mellitus. He denies alcohol abuse but admits to heavy smoking (2 packs of cigarettes per day for 20 years). Three days ago he noticed that his urine became dark and that his skin started to itch. He had a CT scan of the abdomen last week that revealed fullness in the head of the pancreas with dilatation of intra- and extrahepatic biliary ducts. The CT scan did not demonstrate a discrete mass in the pancreas or liver, gallstones, or pancreatitis. His physical examination is normal except for obvious jaundice. His blood work reveals WBC count 6.4, total bilirubin 5.7 mg/dL, alkaline phosphatase 340 U/L, amylase 64 U/L, and lipase 47 U/L. Which of the following tests would you order next?
Correct Answer: C
Rationale: The correct answer is C: Endoscopic retrograde cholangiopancreatography (ERCP). ERCP is the next appropriate step for this patient due to the presence of jaundice, dark urine, and dilatation of the biliary ducts on CT scan, which indicate a likely biliary obstruction. ERCP allows direct visualization of the biliary tree and pancreatic duct, as well as therapeutic interventions such as stent placement or stone removal. This procedure can help identify the cause of the jaundice and guide further management. Choice A (Hepatobiliary scintigraphy) is used to evaluate gallbladder function but is not the most appropriate test in this scenario where biliary obstruction is suspected. Choice B (Abdominal ultrasound) can help identify biliary dilatation but does not provide direct visualization or therapeutic options like ERCP. Choice D (Transcutaneous transhepatic cholangiography) is an invasive test that is typically reserved
Question 2 of 5
A 62-year-old man presents complaining of abdominal pain and diarrhea. He notes that the symptoms have been going on for three months now and he has lost about 20 pounds over that span. He also complains of migratory arthralgias for the past year. He denies any past medical history. He never smoked cigarettes and drinks about two beers per week. He denies use of illicit drugs. A review of records from an evaluation done by another physician reveals a normal thyroid-stimulating hormone level, negative ANA, a normal sedimentation rate, and a negative HIV test. He had a flexible sigmoidoscopy done, which failed to reveal any abnormalities. You refer him for upper endoscopy and a duodenal biopsy is done, which reveals extensive PAS-positive material in the lamina propria and villous atrophy. What is the most appropriate therapy for this patient?
Correct Answer: D
Rationale: The correct answer is D: Trimethoprim/sulfamethoxazole. This patient has symptoms consistent with Whipple's disease, a rare systemic infection caused by Tropheryma whipplei. The PAS-positive material in the duodenal biopsy is characteristic of Whipple's disease. Trimethoprim/sulfamethoxazole is the recommended treatment for this condition. It works by targeting the bacteria responsible for the infection. A gluten-free diet (choice A) is used for celiac disease, which presents with similar symptoms but would not show PAS-positive material on biopsy. A lactose-free diet (choice B) is used for lactose intolerance and does not address the underlying cause of the symptoms. Cholestyramine (choice C) is used to lower cholesterol levels and would not treat an infectious cause like Whipple's disease.
Question 3 of 5
A 52-year-old Chinese man with chronic hepatitis B presents with abdominal pain and new ascites. Ultrasound of the liver reveals enlarged liver, and portal vein thrombosis. The most likely diagnosis is
Correct Answer: B
Rationale: The correct answer is B: Hepatocellular carcinoma. In this case, the patient with chronic hepatitis B has developed new-onset ascites, enlarged liver, and portal vein thrombosis, which are classic findings of hepatocellular carcinoma. The presence of ascites and portal vein thrombosis suggests advanced liver disease, increasing the likelihood of hepatocellular carcinoma. Acute flare of hepatitis (choice A) typically presents with elevated liver enzymes without the specific findings mentioned. Outflow obstruction and congestion (choice C) would not explain the portal vein thrombosis. Superinfection with hepatitis D (choice D) is unlikely as it typically occurs in patients with concurrent hepatitis B infection. Therefore, hepatocellular carcinoma is the most likely diagnosis in this patient based on the clinical presentation and imaging findings.
Question 4 of 5
Which of the following is the most common cause of Peptic Ulcer Disease (PUD)?
Correct Answer: A
Rationale: The correct answer is A: Bacterial infection by Helicobacter pylori. H. pylori is the most common cause of Peptic Ulcer Disease (PUD) as it infects the stomach lining, leading to inflammation and ulcer formation. Studies have shown a strong association between H. pylori infection and PUD. Other choices like high-fat diet and smoking can exacerbate PUD symptoms but are not the primary cause. Viral infections are not known to be a common cause of PUD. Therefore, A is the correct choice based on scientific evidence and research.
Question 5 of 5
In PUD management, what is the role of sucralfate?
Correct Answer: B
Rationale: The correct answer is B. Sucralfate forms a protective barrier over ulcers by binding to the ulcer site and creating a physical barrier against acid and pepsin. This protects the ulcer from further damage and allows it to heal. The other choices are incorrect because: A: Sucralfate does not neutralize stomach acid, it works by forming a barrier. C: Sucralfate does not eradicate H. pylori, which is typically treated with antibiotics. D: Sucralfate does not inhibit acid production, it works by creating a protective barrier.