ATI LPN
NCLEX Questions Gastrointestinal System Questions
Question 1 of 5
All of the following statements about Helicobacter pylori (H. pylori) are true except
Correct Answer: C
Rationale: H. pylori resides in the mucus layer of the stomach, where it exerts its urease activity. It does not invade the epithelium. The production of ammonia, the stimulation of acid secretion, and the disruption to the protective mucus layer are three mechanisms by which H. pylori promotes injury. H. pylori also stimulates interleukin-8, a cytokine associated with inflammation. H. pylori is causally associated with gastric adenocarcinoma and MALT lymphoma of the stomach. Eradication of H. pylori has been shown to cause regression of MALT lymphoma, but it has not been shown to prevent adenocarcinoma of the stomach. Three- or four-drug regimens are superior to two-drug regimens.
Question 2 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 patient has developed obstructive jaundice. Obstructive jaundice and severe progressive weight loss in this young male with a long history of diabetes mellitus and heavy smoking could indicate a malignant neoplasm. Dilatation of both intra- and extrahepatic ducts, along with the fullness in the head of the pancreas, are suspicious for obstructing tumor in the head of the pancreas or in the major duodenal papilla (ampullary mass). The patient clinically does not have evidence of gastric outlet or duodenal obstruction (i.e., no nausea or vomiting), so an upper GI series is not indicated. Abdominal ultrasound and HIDA scan are unlikely to provide more information in this case. ERCP will allow visualization of the major duodenal papilla and reveal information about the biliary and pancreatic ducts (e.g., diameter, location, and grade of obstruction). ERCP can also relieve the obstruction with internal biliary stenting. If cannulation of the biliary ducts during the ERCP is not successful, then more invasive transcutaneous transhepatic cholangiography is indicated. This patient may also need endoscopic ultrasound with fine-needle aspiration biopsy to rule out an early, small mass in the head of the pancreas not detected by abdominal CT scan.
Question 3 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: This young man with weight loss, malodorous, bulky stools, increased appetite, and iron deficiency anemia has celiac disease as the most likely diagnosis. Patients occasionally may feel constipated; however, the stools are unusually bulky and consistently malodorous. The disease is diagnosed by biopsy of the small bowel by upper endoscopy (Answer A). Elevated anti-endomysial antibodies are highly suggestive. Fat malabsorption can be rigorously established by fecal fat collection. The differential diagnosis includes chronic pancreatitis, which is best evaluated by CT scan. A colonoscopy is helpful to evaluate iron deficiency anemia to rule out colonic tumors or other causes of occult blood loss or to assess for inflammatory bowel disease. However, in this patient with malabsorption, increased appetite, and young age, sprue is more likely to explain the constipation and iron deficiency anemia. He does not have abdominal pain, blood in the stools, or diarrhea, the most common symptoms of inflammatory bowel disease. Colonoscopy will be less useful.
Question 4 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: This man presents with the hallmarks of Whipple's disease (i.e., abdominal pain, diarrhea, weight loss, and arthralgias). His workup has made the diagnoses of thyroid disease, HIV, inflammatory bowel disease, and collagen vascular diseases unlikely. His small bowel biopsy is consistent with changes seen in Whipple's disease. Electron microscopy of the specimen should be able to identify the Whipple bacillus. In contrast, the pathologic findings in celiac disease include decreased villous height to crypt depth, decreased epithelial surface cell height, and increased lymphocytic infiltration of the mucosa. PAS-positive material in the lamina propria is not seen. The treatment for Whipple's disease is one year of trimethoprim/sulfamethoxazole. A gluten-free diet would be used for celiac disease. A lactose-free diet is indicated for patients with lactose intolerance. Cholestyramine is used for patients with bile acid diarrhea, usually in the setting of ileal disease. Prednisone can be used in some cases of inflammatory bowel disease and refractory celiac sprue but is not appropriate for Whipple's.
Question 5 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: Hepatomegaly, portal vein thrombosis, or new ascites in someone with chronic hepatitis B is hepatocellular carcinoma until proven otherwise. Replication flares do not typically present with pain or hepatomegaly.