ATI LPN
NCLEX Questions Gastrointestinal System Questions
Question 1 of 5
A 65-year-old white female with a history of arthritis, congestive heart failure, and osteoporosis complains of odynophagia for two weeks. A barium swallow shows a moderate-sized crater just above the gastroesophageal junction. What is the least likely contributor to this condition?
Correct Answer: D
Rationale: The correct answer is D: Calcium channel-blocker. The crater above the gastroesophageal junction is likely due to a peptic ulcer, which can be caused by NSAIDs and alendronate due to their potential to irritate the gastric mucosa. Iron sulfate can also contribute to gastrointestinal irritation but is less common compared to NSAIDs and alendronate in causing ulcers. Calcium channel-blockers, on the other hand, do not have a direct irritant effect on the gastrointestinal mucosa and are not associated with peptic ulcers. Therefore, calcium channel-blockers are the least likely contributor to the formation of the crater in this scenario.
Question 2 of 5
A 25-year-old dental technician has noticed a 10-pound weight loss despite increased appetite, generalized weakness, and constipation with infrequent but unusually voluminous and malodorous stools. On physical examination, he is thin, pale, and appears tired. His abdomen is protuberant but soft. Labs reveal a microcytic anemia. Which of the following is least likely to be helpful?
Correct Answer: D
Rationale: The correct answer is D: Colonoscopy. In this scenario, the patient's symptoms point towards malabsorption, which is typically associated with issues in the small intestine, not the colon. Therefore, a colonoscopy, which examines the large intestine, would be least likely to be helpful in diagnosing the underlying cause of his symptoms. Choices A, B, and C would be more beneficial as they can help identify potential causes of malabsorption such as celiac disease, pancreatic insufficiency, or small bowel abnormalities.
Question 3 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 4 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 5 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.