ATI LPN
Chapter 15 The Gastrointestinal System Review Questions Questions
Question 1 of 5
A 45-year-old woman with occasional indigestion has had episodes of chest pain and dysphagia to both solids and liquids. An upper GI series and EGD fail to disclose any structural abnormalities. What is the most appropriate initial therapy?
Correct Answer: B
Rationale: The correct answer is B: Proton-pump inhibitor. The patient's symptoms of chest pain and dysphagia are suggestive of gastroesophageal reflux disease (GERD). Proton-pump inhibitors (PPIs) are the first-line therapy for GERD as they reduce gastric acid secretion, alleviating symptoms and promoting healing of esophageal mucosa. Sucralfate is not effective for GERD symptoms. Prokinetic agents are used for motility disorders, not GERD. Benzodiazepines are not indicated for GERD and may even exacerbate symptoms. Therefore, the most appropriate initial therapy for this patient is a proton-pump inhibitor.
Question 2 of 5
A 46-year-old woman with a history of alcohol abuse is admitted for acute pancreatitis due to alcohol. She is treated with supportive care but continues to deteriorate over 72 hours. A CT scan is obtained that reveals extensive pancreatic inflammation with the suggestion of necrosis. All of the following statements are correct regarding this patient's management except
Correct Answer: A
Rationale: The correct answer is A because performing an urgent ERCP is not indicated in the management of acute pancreatitis with necrosis. ERCP is typically not recommended in the acute phase of severe pancreatitis due to the risk of exacerbating pancreatitis. - B: Antibiotic therapy with imipenem may be initiated to address potential infection in necrotizing pancreatitis. - C: A CT-guided needle aspirate of the pancreas may be performed to guide antimicrobial therapy. - D: Surgical debridement may be considered if there is evidence of infection based on gram stain and cultures from a pancreatic aspirate.
Question 3 of 5
All of the following are extraintestinal manifestations that are associated with ulcerative colitis except
Correct Answer: D
Rationale: The correct answer is D: Perianal fistula formation. Ulcerative colitis primarily affects the colon and rectum, leading to inflammation and ulceration of the intestinal lining. Perianal fistula formation is more commonly associated with Crohn's disease, which can affect any part of the gastrointestinal tract. Choices A, B, and C are extraintestinal manifestations commonly seen in ulcerative colitis due to the systemic nature of the disease and immune system involvement. Arthritis can occur due to inflammation in joints, sclerosing cholangitis affects the bile ducts, and autoimmune hemolytic anemia involves the destruction of red blood cells.
Question 4 of 5
Which of the following statements is true?
Correct Answer: D
Rationale: The correct answer is D: Hepatitis A infection may have a relapsing course. Hepatitis A infection can indeed have a relapsing course, with symptoms recurring after an initial improvement. This is due to the nature of the virus and the immune response. A: Alcoholic hepatitis typically has an AST/ALT ratio less than 2 - This statement is incorrect because in alcoholic hepatitis, the AST/ALT ratio is typically greater than 2. B: Alpha-1 Antitrypsin (A1AT) deficiency is associated with arteriovenous malformations of the brain - This statement is incorrect as A1AT deficiency is primarily associated with pulmonary manifestations such as emphysema and liver disease, not brain arteriovenous malformations. C: Serum A1AT levels are diagnostic of A1AT deficiency - This is incorrect as A1AT levels can be influenced by various factors and genetic testing is needed for a definitive diagnosis of A1AT deficiency
Question 5 of 5
A 48-year-old man with a history cirrhosis secondary to hepatitis C presents to the emergency room with confusion, altered mentation, and erratic behavior. He is afebrile. His examination is notable for grossly normal motor strength throughout, hyperreflexia, asterixis, bulging flanks, and shifting dullness. His total bilirubin is 6 mg/dL, his creatinine is 1.8 mg/dL, and his prothrombin time is elevated. His white blood cell count is 11,000/µL with $85 \%$ neutrophils. His ammonia level is 30 µg/dL (normal 15-45 µg/dL). Which of the following statements is correct?
Correct Answer: B
Rationale: The correct answer is B because the patient's presentation with cirrhosis, altered mentation, and ascites is concerning for spontaneous bacterial peritonitis (SBP). Ascitic fluid should be sampled to confirm the diagnosis and guide appropriate antibiotic therapy. Choice A is incorrect because ammonia levels can fluctuate and do not rule out hepatic encephalopathy. Choice C is incorrect as aminoglycosides are not first-line for SBP. Choice D is incorrect because lactulose is used to treat hepatic encephalopathy, not SBP. Sampling ascitic fluid is crucial in this case to diagnose and treat SBP promptly and effectively.