ATI LPN
Chapter 15 The Gastrointestinal System Review Questions Questions
Question 1 of 5
A 50-year-old man with a long history of chronic obstructive pulmonary disease has noticed increasingly swollen ankles. He does not have any features of pulmonary oedema but has a raised jugular venous pressure. Which of the following is the most likely diagnosis?
Correct Answer: D
Rationale: The correct answer is D: Right heart failure. The swollen ankles and raised jugular venous pressure are consistent with right heart failure in the setting of chronic obstructive pulmonary disease. In COPD, chronic hypoxia can lead to pulmonary hypertension and subsequent right heart failure. Asthma (choice A) is a reversible airway disease, not associated with right heart failure. Congestive heart failure (choice B) typically presents with features of pulmonary edema, which are absent in this case. Constrictive pericarditis (choice C) can also cause elevated jugular venous pressure, but swollen ankles are not a common feature.
Question 2 of 5
What is the MOST common cause of pulmonary fibrosis?
Correct Answer: D
Rationale: The correct answer is D: Idiopathic. Idiopathic pulmonary fibrosis (IPF) is the most common type of pulmonary fibrosis with unknown cause. It is a chronic, progressive, and irreversible lung disease. Iatrogenic causes refer to those induced by medical treatment, which are not as common as IPF. Occupational chemical exposure and sarcoidosis are known causes of pulmonary fibrosis, but they are not as prevalent as idiopathic cases. In summary, the most common cause of pulmonary fibrosis is idiopathic, followed by occupational exposures, sarcoidosis, and iatrogenic factors.
Question 3 of 5
A 56-year-old woman with rheumatoid arthritis has severe joint pain and swelling in her hands. She has a history of peptic ulcer disease five years ago but presently has no GI symptoms. You elect to start her on an NSAID. Which of the following is correct?
Correct Answer: B
Rationale: The correct answer is B: Misoprostol is superior to an H2-blocker in prophylaxis against NSAID-related GI toxicity. Misoprostol, a prostaglandin analog, helps protect the gastric mucosa by increasing mucus production and decreasing acid secretion. This makes it more effective than H2-blockers, which only reduce acid production. Choice A is incorrect because proton-pump inhibitors are more effective than H2-blockers in preventing NSAID-related GI toxicity. Choice C is incorrect as sucralfate is not recommended for prophylaxis against NSAID-related GI toxicity. Choice D is incorrect because H. pylori infection significantly increases the risk of NSAID-induced ulcers.
Question 4 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 5 of 5
A 56-year-old Brazilian woman with a history of idiopathic cardiomyopathy presents complaining of weight loss, dysphagia, and regurgitation. A chest x-ray is done that reveals an air-fluid level at the level of the esophagus. No gastric bubble is appreciated. A barium swallow reveals a dilated esophagus that tapers at the lower esophageal sphincter. Which of the following is appropriate in this patient's evaluation/treatment?
Correct Answer: D
Rationale: The correct answer is D: Obtain serologic studies for antibodies to Trypanosoma cruzi. The patient's presentation of dysphagia, regurgitation, and dilated esophagus suggests Chagas disease, caused by Trypanosoma cruzi. Serologic studies are necessary for definitive diagnosis. Choice A is incorrect because esophagectomy is not warranted without confirming the diagnosis. Choice B is incorrect as there are no indications of parasitic infection. Choice C is incorrect as proton pump inhibitors are not appropriate for Chagas disease.