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. Anticholinergics inhibit the action of acetylcholine, which is responsible for stimulating intestinal motility. By blocking this stimulation, anticholinergic medications can effectively immobilize the intestines during surgery. Choice A, cholinergic medication, would have the opposite effect by increasing intestinal activity. Choice B, antiadrenergic medication, does not directly affect intestinal motility. Choice D is incorrect as both cholinergic and anticholinergic medications cannot be effective at immobilizing the intestines simultaneously.

Correct Answer: B

Rationale: The correct answer is B: Gastro-oesophageal reflux disease. This is known as the classic presentation of pericarditis. The pain worsens when lying flat due to increased pressure on the inflamed pericardium, and improves when leaning forward, reducing pressure. Angina (A) typically presents with exertional chest pain, not worsened by lying flat. Myocardial infarction (C) presents with crushing chest pain, not positional like pericarditis. Pulmonary embolism (D) presents with sudden onset dyspnea and chest pain, not exacerbated by lying flat.

Correct Answer: D

Rationale: The most likely diagnosis for the 50-year-old man with swollen ankles, raised jugular venous pressure, and a history of chronic obstructive pulmonary disease is right heart failure (Choice D). In this case, the patient's symptoms suggest signs of right-sided heart failure, such as peripheral edema and jugular venous distention. Chronic obstructive pulmonary disease can lead to pulmonary hypertension, causing right heart failure. Asthma (Choice A) is primarily a respiratory condition, not typically associated with jugular venous distention or peripheral edema. Congestive heart failure (Choice B) usually presents with features of pulmonary edema and bilateral lower extremity edema, rather than isolated right-sided heart failure. Constrictive pericarditis (Choice C) may present with jugular venous distention, but it is less common compared to right heart failure in a patient with a history of chronic obstructive pulmonary disease.

Correct Answer: A

Rationale: The correct answer is A because cor pulmonale refers to right-sided heart failure caused by lung disease. In chronic obstructive pulmonary disease (COPD), the lungs are diseased, leading to pulmonary hypertension and subsequent strain on the right side of the heart. This results in right ventricular hypertrophy and eventually right-sided heart failure. Choice B is incorrect because left-sided heart failure is not the primary cause of cor pulmonale in COPD. Choice C is incorrect as it suggests that lung disease is secondary to left-sided heart failure, which is not the case in cor pulmonale. Choice D is also incorrect as it implies that lung disease leads to right-sided heart failure, which is the opposite of the actual relationship in cor pulmonale.

Correct Answer: D

Rationale: The correct answer is D: Idiopathic. Idiopathic pulmonary fibrosis is the most common cause of pulmonary fibrosis, accounting for about 20-30% of cases. It is a chronic and progressive lung disease of unknown cause. Other choices are less common causes: A) Iatrogenic refers to fibrosis caused by medical interventions, B) Occupational chemical exposure can lead to fibrosis but is not the most common cause, and C) Sarcoidosis causes granulomatous inflammation, not fibrosis.