ATI LPN
Chapter 15 The Gastrointestinal System Review Questions Questions
Question 1 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. This patient's presentation is consistent with Chagas disease, caused by Trypanosoma cruzi. The patient is from Brazil, where Chagas disease is endemic. The dilated esophagus and lower esophageal sphincter tapering are classic findings of megaesophagus, a complication of Chagas disease. Serologic studies for antibodies to Trypanosoma cruzi are necessary for definitive diagnosis. Choice A: Refer for partial esophagectomy - Not appropriate as surgery is not indicated without confirming the diagnosis. Choice B: Thick and thin smears of peripheral blood looking for parasites - Not appropriate as Chagas disease is diagnosed through serologic testing, not blood smears. Choice C: Therapeutic trial of a proton pump inhibitor - Not appropriate as the patient's symptoms are likely due to Chagas disease, not gastroesophageal reflux disease.
Question 2 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, not ulcerative colitis. Rationale: A: Arthritis - Extraintestinal manifestation commonly seen in ulcerative colitis due to immune system involvement. B: Sclerosing cholangitis - Liver complication associated with ulcerative colitis. C: Autoimmune hemolytic anemia - Blood disorder linked to ulcerative colitis due to immune system dysregulation. D: Perianal fistula formation - More characteristic of Crohn's disease, not ulcerative colitis.
Question 3 of 5
Which of the following statements is true?
Correct Answer: D
Rationale: The correct answer is D because hepatitis A infection can have a relapsing course. This is due to the natural course of the infection, where patients can initially recover but then experience a recurrence of symptoms. This is different from hepatitis B or C, which typically do not have a relapsing course. A is incorrect because in alcoholic hepatitis, the AST/ALT ratio is usually greater than 2. B is incorrect because Alpha-1 Antitrypsin deficiency is associated with liver and lung diseases, not arteriovenous malformations of the brain. C is incorrect because although serum A1AT levels are used to diagnose A1AT deficiency, they are not solely diagnostic as genetic testing is also required for confirmation.
Question 4 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. Ascitic fluid sampling is crucial in ruling out bacterial peritonitis in patients with cirrhosis presenting with altered mental status. The presence of ascites, bulging flanks, and shifting dullness in the patient's examination indicates ascites, which increases the risk of spontaneous bacterial peritonitis (SBP). SBP can lead to hepatic encephalopathy, contributing to the patient's altered mental status. Sampling ascitic fluid allows for culture and analysis to identify bacterial infection. Choice A is incorrect because normal ammonia levels do not exclude hepatic encephalopathy, which can still be present due to other factors. Choice C is incorrect as aminoglycosides are not recommended for empiric antibiotic therapy in SBP. Choice D is incorrect as lactulose is indicated for hepatic encephalopathy but not for treating bacterial peritonitis.
Question 5 of 5
A patient with PUD is advised to avoid NSAIDs. What is the reason for this?
Correct Answer: C
Rationale: The correct answer is C: NSAIDs are known to irritate the gastric mucosa. NSAIDs can lead to gastric mucosal injury by inhibiting prostaglandin synthesis, which plays a protective role in maintaining the integrity of the gastric mucosa. This can result in the development or exacerbation of peptic ulcers. A: NSAIDs actually inhibit prostaglandin synthesis, leading to decreased gastric acid secretion. B: NSAIDs do not delay gastric emptying; rather, they can cause dyspepsia and increase the risk of ulcers. D: NSAIDs do not interfere with proton pump inhibitors; instead, they can reduce the efficacy of these drugs in treating ulcers.