During abdominal surgery, immobilization of the patient's intestines is often desirable. Which of the following types of medications would be most effective at immobilizing the intestines?

Correct Answer: C

Rationale: The correct answer is C: an anticholinergic medication. Anticholinergic medications inhibit the action of acetylcholine, a neurotransmitter responsible for stimulating intestinal motility. By blocking acetylcholine, anticholinergics can effectively immobilize the intestines during surgery. Choice A (a cholinergic medication) would have the opposite effect by stimulating intestinal motility. Choice B (an antiadrenergic medication) is not directly related to immobilizing the intestines. Choice D is incorrect as only option C is the most effective at achieving intestinal immobilization.

Correct Answer: B

Rationale: The most likely diagnosis for the given presentation is Gastro-oesophageal reflux disease (GERD). The chest pain exacerbated by lying flat and relieved by leaning forward is typical of GERD due to acid reflux when lying down. Angina and myocardial infarction typically present with exertional chest pain, while pulmonary embolism presents with sudden onset pleuritic chest pain often associated with shortness of breath. Therefore, the correct answer is B.

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.

Correct Answer: A

Rationale: The correct answer is A: Right-sided heart failure secondary to lung disease. In cor pulmonale, chronic lung disease such as COPD leads to pulmonary hypertension, which in turn causes the right side of the heart to work harder and eventually fail. This is because the right side of the heart pumps blood to the lungs to pick up oxygen, and when the lungs are diseased, the heart has to pump harder to maintain adequate blood flow. Choices B, C, and D are incorrect because they do not accurately describe cor pulmonale. Left-sided heart failure (choice B) is not directly related to lung disease, whereas lung disease secondary to left-sided heart failure (choice C) and lung disease secondary to right-sided heart failure (choice D) are not accurate descriptions of cor pulmonale.

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.