Patho Final Flashcards

"Through what area does the cerebrospinal fluid circulate around the brain and spinal cord?<br>a. Between the double layers of the dura mater<br>b. In the subdural space<br>c. In the subarachnoid space<br>d. Through the arachnoid villi"

"Which of the following is the usual location of language centers?<br>a. Left hemisphere<br>b. Right hemisphere<br>c. Brainstem<br>d. Hypothalamus"

"What would be the effect of damage to the auditory association area in the left hemisphere?<br>a. Loss of hearing in both ears<br>b. Inability to understand what is heard<br>c. Loss of hearing in the left ear<br>d. Inability to determine the source of the sound"

"Which of the following applies to the corticospinal tract?<br>a. It is an ascending tract<br>b. The nerve fibers conduct sensory impulses<br>c. It is an extrapyramidal tract<br>d. It is a pyramidal tract for efferent impulses"

"What is a major function of the limbic system?<br>a. Overall control of fluid balance<br>b. Required for logical thinking and reason and decision making<br>c. Determines emotional responses<br>d. Responsible for artistic and musical talents"

"Where are β1-adrenergic receptors located?<br>a. Bronchiolar walls<br>b. Arteriolar walls<br>c. Cardiac muscle<br>d. Glands of the intestinal tract"

"What does a vegetative state refer to?<br>a. Depression of the reticular activating system and inability to initiate action<br>b. Loss of awareness and intellectual function but continued brainstem function<br>c. Continuing intellectual function but inability to communicate or move<br>d. Disorientation and confusion with decreased responsiveness"

"Which of the following conditions is NOT part of the criteria for a declaration of brain death?<br>a. No activity of EEG<br>b. Absence of all reflexes<br>c. No spontaneous respirations<br>d. Presence of any head injury"

"What is the best definition of aphasia?<br>a. The inability to comprehend or express language appropriately<br>b. Difficulty swallowing<br>c. Loss of the visual field contralateral to the area of damage<br>d. The inability to articulate words clearly"

"What is an early indicator of increased intracranial pressure?<br>a. Papilledema<br>b. Bilateral fixed dilated pupils<br>c. Decreasing responsiveness<br>d. Rapid heart rate"

"What is the rationale for vomiting in a patient who has increased intracranial pressure?<br>a. Chemoreceptors responding to changes in the blood<br>b. Pressure extending to spinal nerves<br>c. Pressure on the emetic center in the medulla<br>d. Stimuli to the hypothalamic center for hunger and thirst"

"What is the typical change in blood pressure in a patient who has increased intracranial pressure?<br>a. Erratic diastolic pressure<br>b. Decreasing systolic pressure<br>c. Systolic and diastolic pressure decreasing proportionately<br>d. Increasing pulse pressure"

"The largest category of primary malignant brain tumors that arise from cells in the central nervous system are called:<br>a. Gliomas<br>b. Sarcomas<br>c. Lymphomas<br>d. Myelomas"

"Which of the following causes papilledema?<br>a. Increased pressure of cerebrospinal fluid at the optic disc<br>b. Increased intraocular pressure<br>c. Pressure on the oculomotor nerve<br>d. Pressure on the optic chiasm"

"What is the effect of an enlarged brain abscess on cardiovascular activity?<br>a. Increased heart rate and systemic vasodilation<br>b. Low blood pressure and irregular heart and respiratory rates<br>c. Systemic vasoconstriction and slower heart rate<br>d. Immediate depression of the cardiac control centers"

"As intracranial pressure rises the pupil of the eye ipsilateral to the lesion becomes dilated and unresponsive to light because of pressure on the:<br>a. Optic nerve<br>b. Peripheral nervous system fibers in cranial nerve III<br>c. Sympathetic nervous system nerve to the eye<br>d. Occipital lobe"

"Which of the following characteristics indicates that the CSF is normal?<br>a. Cloudy and pale yellow color<br>b. Presence of erythrocytes<br>c. Presence of numerous leukocytes<br>d. Clear and colorless fluid"

"Which of the following statements is TRUE about malignant brain tumors?<br>a. Most brain tumors arise from malignant neurons<br>b. Primary brain tumors rarely metastasize outside the CNS<br>c. The blood-brain barrier prevents secondary brain tumors<br>d. Brainstem tumors do not manifest signs until they are quite large"

"Secondary brain tumors usually arise from:<br>a. Severe head trauma<br>b. Metastasized breast or lung tumors<br>c. Exposure to carcinogenic agents<br>d. Exposure to radiation"

"Why are focal or generalized seizures sometimes an early indication of a brain tumor?<br>a. Surrounding inflammation stimulates neurons to discharge spontaneously<br>b. Malignant tumors cause alkalosis exciting the CNS<br>c. Systemic effects of the brain tumor may cause seizures<br>d. Metabolic effects of cancer change blood chemistry to trigger seizures"

"Which of the following statements is TRUE about transient ischemic attacks?<br>a. They usually cause necrosis and permanent brain damage<br>b. They may be caused by rupture of an aneurysm or a damaged artery<br>c. They usually indicate systemic hypertension<br>d. They can warn of potential cerebrovascular accidents"

"What is the probable source of an embolus causing a cerebrovascular accident?<br>a. Right ventricle of the heart<br>b. Femoral vein<br>c. Common carotid artery<br>d. Pulmonary artery"

"Collateral circulation is most likely to be present when a CVA results from:<br>a. Rupture of cerebral artery<br>b. An embolus<br>c. Atherosclerosis<br>d. Vasospasm in the cerebral circulation"

"All of the following apply to CVA EXCEPT:<br>a. The common cause is an atheroma with thrombus<br>b. Maximum necrosis and infarction develop within several hours of onset<br>c. Warning signs may appear with partial obstruction of the artery<br>d. Increasing neurological deficits usually develop during the first few days"

"Signs and symptoms of a stroke depend upon:<br>a. Location of obstruction size of artery and area affected<br>b. Duration of the blockage distance from the heart and type of obstruction<br>c. Health of the victim area affected and collateral circulation<br>d. Size of the obstruction condition of the heart and duration of blockage"

"In the weeks following CVA why might some neurological function return?<br>a. Presence of collateral circulation<br>b. Immediate therapy to dissolve thrombi and maintain perfusion<br>c. Reduced inflammation in the area<br>d. Development of alternative neuronal pathways"

"Which of the following statements about berry aneurysms in the brain is NOT true?<br>a. They usually develop at points of bifurcation in the circle of Willis<br>b. They are usually asymptomatic for many years<br>c. CSF remains free of blood<br>d. Following rupture blood appears in the subarachnoid space"

"In a case of bacterial meningitis where does swelling and purulent exudate form?<br>a. In the pia mater arachnoid and surface of the entire brain<br>b. In the dura mater and epidural space<br>c. At the site of injury or entry point of microbes<br>d. Primarily around the spinal cord"

"What are significant signs of acute bacterial meningitis?<br>a. Severe headache nuchal rigidity and photophobia<br>b. Fatigue fever and anorexia<br>c. Focal signs such as paralysis in a limb<br>d. Ascending paralysis beginning in the legs"

"In many types of encephalitis such as St. Louis encephalitis how are the viruses transmitted?<br>a. Carriers<br>b. Mosquito and tick bites<br>c. Respiratory droplets<br>d. Septic emboli"

"All of the following apply to tetanus infection EXCEPT:<br>a. It is caused by an anaerobic spore-forming bacillus<br>b. The exotoxin causes strong skeletal muscle spasms<br>c. Death usually results from respiratory failure<br>d. Signs of fever vomiting stiff neck and paralysis"

"In cases of Guillain-Barre syndrome what does the pathophysiology include?<br>a. Damage to motor neurons of spinal cord and medulla<br>b. Encephalopathy with headache and coma<br>c. Infection of motor cortex<br>d. Inflammation and demyelination of peripheral nerves leading to ascending paralysis"

"How does a depressed skull fracture cause brain damage?<br>a. Bone fragment penetrates and tears brain tissue<br>b. Section of skull missing leaves brain unprotected<br>c. Section of skull displaced below level causing pressure on brain<br>d. Many fracture lines cause instability"

"Following a head injury what is the most likely cause of secondary damage to the brain?<br>a. Hematoma or infection<br>b. Laceration by foreign objects<br>c. Hypoxia or acidosis<br>d. Tearing of blood vessels as brain rotates"

"An epidural hematoma is located between the:<br>a. Dura mater and arachnoid mater<br>b. Dura mater and skull<br>c. Arachnoid mater and pia mater<br>d. Pia mater and brain"

"What does the term otorrhea mean?<br>a. Bleeding from the nose<br>b. CSF leaking from the ear<br>c. Torn meninges but no skull fracture<br>d. Hemorrhage from the ear"

"Following a spinal injury at C5 what is the expected effect during spinal shock?<br>a. Spastic paralysis below injury<br>b. Urinary incontinence<br>c. Possible periods of apnea<br>d. Normal blood pressure"

"Following an injury at L2 to L3 what would indicate recovery from spinal shock?<br>a. Spastic paraplegia<br>b. Urinary retention<br>c. Labile body temperatures<br>d. Increased sensation in legs"

"What are the signs of autonomic dysreflexia in a person with cervical spinal injury?<br>a. Unexpected drop in blood pressure and apnea<br>b. Sudden marked increase in blood pressure with bradycardia<br>c. Hyperreflexia in arms and legs<br>d. Urinary and bowel incontinence"

"Expressive aphasia is most likely to result from damage to:<br>a. Left frontal lobe<br>b. Left temporal lobe<br>c. Right motor cortex<br>d. Wernicke’s area"

"Which of the following is the usual result of damage to the right occipital lobe?<br>a. Left eye is blind<br>b. Loss of left visual field<br>c. Right eye is blind<br>d. Visual loss in the medial half of each eye"

"How does the heart rate change as intracranial pressure increases?<br>a. Rate decreases<br>b. Rate increases<br>c. No change in rate<br>d. Irregular heart rate"

"Which statement best describes herniation resulting from increased intracranial pressure?<br>a. Movement of brain tissue into ventricles<br>b. Movement of brain stem upward<br>c. Pushing of excess CSF and blood down around spinal cord<br>d. Displacement of brain tissue downward toward spinal cord"

"Which type of cerebrovascular accident has the poorest prognosis?<br>a. CVA caused by thrombus<br>b. Hemorrhagic CVA<br>c. Embolic CVA<br>d. No difference among types"

"Which of the following factors predispose an individual to a CVA?<br>a. Hypertension<br>b. Smoking cigarettes<br>c. History of coronary artery disease<br>d. Diabetes mellitus"

"What are the significant early signs of a ruptured cerebral aneurysm?<br>a. Impaired speech and muscle weakness<br>b. Severe headache nuchal rigidity and photophobia<br>c. Abnormal sensations and tremors<br>d. Vomiting and visual abnormalities"

"The stroke scale used to rapidly diagnose a stroke include:<br>a. Capacity for speech level of consciousness motor skills eye movements<br>b. Motor skills spatial awareness time awareness facial recognition<br>c. Short-term memory cognitive skills speech name recognition<br>d. Hand-eye coordination problem solving ability to stand or walk consciousness"

"With regard to meningitis choose the correct combination of microbe and age group commonly affected:<br>a. E. coli; elderly<br>b. H. influenzae; neonate<br>c. N. meningitides; children and youth<br>d. S. pneumoniae; young children"

"Which of the following statements applies to lumbar puncture?<br>a. It is usually performed at L3-L4<br>b. Fluid is withdrawn from epidural space<br>c. It can be used to confirm any diagnosis<br>d. Tissue seals immediately after puncture"

"Which signs are indicative of post-polio syndrome?<br>a. Progressive spastic paralysis<br>b. Ascending flaccid paralysis<br>c. Progressive fatigue and weakness<br>d. Increasing numbness and paresthesias"

"Which of the following does NOT apply to Reye’s syndrome?<br>a. There is no permanent damage in the body<br>b. It is precipitated by viral infection plus ASA<br>c. Cerebral edema develops<br>d. Liver damage is common"

"Which type of fracture typically occurs at the base of the skull?<br>a. Depressed<br>b. Countercoup<br>c. Comminuted<br>d. Basilar"

"The primary reason for seizures frequently occurring with head injuries is:<br>a. Presence of blood irritates neurons<br>b. Otorrhea or rhinorrhea changes ICP<br>c. Inflammatory response causes general hypoxia<br>d. CNS is depressed"

"Brain injury where the brain is injured when it bounces off the skull due to sudden acceleration or deceleration is referred to as a/an:<br>a. Linear fracture<br>b. Contusion<br>c. Basilar injury<br>d. Countercoup injury"

"The rabies virus is usually transmitted by:<br>a. Respiratory droplets<br>b. Insects such as mosquitoes<br>c. Bites from infected animals<br>d. Fecal-oral route"

"Common manifestations of rabies infection include:<br>a. Headache foaming at the mouth and difficulty swallowing<br>b. Difficulty walking and coordinating movements<br>c. Decreased sensitivity to sound and touch<br>d. Vomiting liver and kidney damage"

"Which statement is TRUE about tetanus infection?<br>a. It is caused by a virus<br>b. Infection usually develops in deep puncture wounds<br>c. It causes flaccid skeletal muscles<br>d. It affects peripheral nerves initially in legs and feet"

"Which of the following impairments results from infection by the polio virus?<br>a. Pain and paresthesia in a cranial nerve or dermatome<br>b. Loss of motor and sensory function in peripheral nerves<br>c. Inflammation and increased intracranial pressure<br>d. Loss of function of motor neurons of spinal cord and medulla"

"Herpes zoster can be identified by a typical:<br>a. Unilateral rash and pain along a cranial nerve or dermatome<br>b. Weakness and muscle atrophy in legs<br>c. Ascending paralysis commencing in legs<br>d. Skeletal muscle spasms in face and neck"

"Which of the following conditions is marked by focal signs?<br>a. Meningitis<br>b. Brain abscess<br>c. Encephalitis<br>d. Intracerebral hemorrhage"

"Typical signs of TIA include:<br>a. Rapidly increasing intracranial pressure<br>b. Loss of consciousness<br>c. Transient muscle weakness in a hand or leg<br>d. Headache photophobia and nuchal rigidity"

"In cases of noncommunicating hydrocephalus why does excess cerebrospinal fluid accumulate?<br>a. Absorption of CSF through arachnoid villi is impaired<br>b. Excessive amounts of CSF produced in ventricles<br>c. An obstruction is present in the aqueduct of Sylvius or other channel<br>d. Flow around spinal cord is blocked"

"All of the following are typical signs of hydrocephalus in the neonate EXCEPT:<br>a. Enlarged head with bulging fontanels<br>b. Vomiting headache and paralysis<br>c. Irritability and feeding difficulties<br>d. Eyes turned downward with sclerae showing above pupils"

"The best description of myelomeningocele is:<br>a. Asymptomatic failure of posterior spinous processes to fuse<br>b. Herniation of meninges through vertebral defect<br>c. Herniation of meninges CSF and spinal cord or nerves through vertebral defect<br>d. Herniation of brain tissue through cranial defect"

"How is the presence of spina bifida diagnosed?<br>a. Prenatally by ultrasound or detection of AFP in maternal blood or amniotic fluid<br>b. Only after birth by direct observation of sac<br>c. After birth when sac herniates as CSF builds up<br>d. Only with spinal X-ray"

"What characteristic is common to all individuals with cerebral palsy?<br>a. Some loss of cognitive function<br>b. One or more types of seizure<br>c. Serious communication difficulties<br>d. Some degree of motor disability"

"Which of the following applies to cerebral palsy?<br>a. Nonprogressive brain damage to fetus or neonate<br>b. Genetic defect affecting metabolism causing neuron degeneration<br>c. Developmental error of peripheral nervous system<br>d. Chromosomal defect with many abnormalities"

"Which of the following is characteristic of generalized seizures?<br>a. Localization of seizure activity<br>b. Uncontrolled discharge of neurons in both hemispheres<br>c. Developmental error during PNS growth<br>d. Chromosomal defect"

"From the following choose the two events that immediately follow the aura during a tonic-clonic event:<br>a. Prodromal signs then clonic stage<br>b. Clonic stage then tonic stage<br>c. Loss of consciousness then tonic stage<br>d. Loss of consciousness and cessation of respiration"

"What does the clonic stage of a seizure consist of?<br>a. Sudden strong skeletal muscle contraction and rigidity<br>b. Cry and contraction of abdominal and thoracic muscles<br>c. Alternating contractions and relaxation of skeletal muscles<br>d. Cessation of all skeletal muscle activity"

"How would a seizure consisting of bizarre or inappropriate activity be classified?<br>a. Absence seizure<br>b. Psychomotor seizure<br>c. Focal seizure<br>d. Jacksonian seizure"

"Which of the following is characteristic of multiple sclerosis?<br>a. Remissions and exacerbations<br>b. Predictable progression in all patients<br>c. Onset only after age 60<br>d. Full recovery during remissions"

"Which statement does NOT apply to the pathophysiology of multiple sclerosis?<br>a. Demyelination of axons<br>b. It affects brain spinal cord and cranial nerves<br>c. It affects motor sensory and autonomic fibers<br>d. Progressive random degeneration of peripheral nerves"

"Which of the following are common early signs of multiple sclerosis?<br>a. Paralysis lower body and impaired cognition<br>b. Areas of numbness weakness in legs visual problems<br>c. Sensory deficit with memory loss and incontinence<br>d. Tremors speech impairment hearing loss"

"Which of the following applies to Parkinson’s disease?<br>a. Usually develops in men and women over 60 years of age<br>b. There is no apparent genetic component<br>c. Majority caused by antipsychotic medications<br>d. It rarely develops in women"

"What is the pathophysiological change in Parkinson’s disease?<br>a. Degeneration of pyramidal tracts<br>b. Excess stimulatory neurotransmitters<br>c. Degeneration of basal nuclei with dopamine deficit<br>d. Deficit of acetylcholine and frontal motor cortex degeneration"

"Which of the following are common early manifestations of Parkinson’s disease?<br>a. Tremors at rest in hands and repetitive motion<br>b. Extreme weakness in legs and spastic arms<br>c. Visual deficits and speech impairment<br>d. Loss of facial expressions and altered posture and gait"

"In which type of neuron is progressive degeneration occurring with ALS?<br>a. Upper motor neurons<br>b. Upper and lower motor neurons<br>c. Motor and sensory neurons<br>d. Motor sensory and autonomic neurons"

"Which of the following statements does NOT apply to myasthenia gravis?<br>a. Cholinergic receptors at NMJ are damaged<br>b. It is an autoimmune disorder<br>c. Muscle weakness and fatigue occur in face and neck<br>d. Dementia develops in later stage"

"Which statement applies to Huntington’s disease?<br>a. Autosomal recessive trait<br>b. Manifested by age 20 years<br>c. Choreiform movements in upper body and decreased ability to concentrate<br>d. Causes decreased levels of all neurotransmitters"

"What are the characteristic changes in the brain of a patient with Alzheimer’s disease?<br>a. Cortical atrophy with plaques and neurofibrillary tangles impairing conduction<br>b. Increased ACh and decreased GABA and serotonin<br>c. Obstruction of many small arteries and arterioles throughout cortex<br>d. Vacuoles forming in neurons rapidly destroying them"

"Which disease is associated with excessive dopamine secretion decreased gray matter in the temporal lobes and abnormal hippocampal cells in the brain?<br>a. Creutzfeldt-Jakob disease<br>b. Schizophrenia<br>c. Panic disorder<br>d. Depression"

"In which disorders do biochemical abnormalities involving neurotransmitters in the brain occur?<br>a. Bipolar disorder<br>b. Schizophrenia<br>c. Huntington’s disease<br>d. AIDS dementia"

"Which of the following are typical characteristics associated with schizophrenia?<br>a. Disorganized thought processes short attention span delusions<br>b. Lack of energy and motivation poor concentration insomnia<br>c. Hyperventilation tachycardia intense anxiety<br>d. Memory loss mood swings hostile behavior"

"What is the typical initial effect of a herniated intervertebral disc at the L4 to L5 level?<br>a. Back pain and weakness at waist level<br>b. Muscle weakness in both legs<br>c. Lower back pain radiating down the leg<br>d. Urinary incontinence"

"What causes a herniated intervertebral disc?<br>a. Tear in nucleus pulposus<br>b. Protrusion of nucleus pulposus through annulus fibrosus<br>c. Displacement of annulus fibrosis between laminae<br>d. Failure of spinous processes to restrict movement"

"Which dietary supplement has reduced the incidence of spina bifida in recent years?<br>a. Vitamin B6<br>b. Folic acid<br>c. Vitamins A and D<br>d. Zinc and magnesium"

"Which is the most common cause of brain damage in children with cerebral palsy?<br>a. Hyperbilirubinemia<br>b. Hypoglycemia<br>c. Hypoxia<br>d. Trauma"

"The ataxic form of cerebral palsy results from damage to the:<br>a. Cerebellum<br>b. Motor cortex<br>c. Basal nuclei<br>d. Pyramidal tracts"

"Which of the following is used to confirm the diagnosis of and classify seizures?<br>a. Characteristics of aura<br>b. Presence of precipitating factors<br>c. Electroencephalogram<br>d. Changes in cerebrospinal fluid"

"Which statement does NOT apply to status epilepticus?<br>a. Seizures are recurrent or continuous without full recovery<br>b. Severe hypoxia and acidosis develop<br>c. Person does not lose consciousness during seizure<br>d. If persistent additional brain damage may occur"

"Which type of seizure commonly occurs in children?<br>a. Absence<br>b. Tonic-clonic<br>c. Focal<br>d. Complex partial"

"All of the following may precipitate a seizure EXCEPT:<br>a. Hypoglycemia<br>b. Hypoventilation<br>c. Brain abscess<br>d. High fever in young child"

"Which of the following is NOT a typical effect of advanced Parkinson’s disease?<br>a. Difficulty chewing and swallowing<br>b. Urinary retention<br>c. Loss of vision<br>d. Orthostatic hypotension"

"Which of the following is a typical early sign of ALS?<br>a. Impaired ventilation<br>b. Cognitive impairment<br>c. Poor control of eye movement<br>d. Weakness and muscle atrophy in upper limbs"

"Which class of drugs may provide temporary improvement in myasthenia gravis?<br>a. Skeletal muscle relaxants<br>b. Dopamine replacement drugs<br>c. Anticholinesterase agents<br>d. GABA replacement drugs"

"Which of the following are typical early signs of Alzheimer’s disease?<br>a. Behavioral changes<br>b. Reduced ability to reason and problem solve<br>c. Decreased verbal response<br>d. Urinary incontinence"

"Which of the following is NOT considered a common contributing factor to AIDS dementia?<br>a. Invasion of CNS by HIV<br>b. Development of arteriosclerosis<br>c. Secondary toxoplasmosis infection<br>d. Development of cerebral lymphoma"

"Communicating hydrocephalus causes increased intracranial pressure because of:<br>a. Atresia at foramen magnum<br>b. Failure of subarachnoid space to absorb CSF<br>c. Obstruction in lumbar area of spinal cord<br>d. Scar tissue from encephalitis blocking flow of CSF"

"Failure of the spinous processes to fuse but without herniation of meninges is called:<br>a. Spina bifida occulta<br>b. Meningocele<br>c. Myelomeningocele<br>d. Encephalocele"

"Which statement is TRUE about amyotrophic lateral sclerosis (ALS)?<br>a. Cognitive function remains normal<br>b. ALS affects primarily young women<br>c. Sensory neurons are damaged initially<br>d. Cause of death is usually a cardiac arrhythmia"

"Creutzfeldt-Jakob disease is caused by:<br>a. Inheritance of an autosomal dominant trait<br>b. Infection in the brain by HIV<br>c. An autoimmune reaction that damages nerve receptors<br>d. Infection in the brain by a prion"

"Huntington’s disease is diagnosed by:<br>a. Urinalysis<br>b. Motor skills tests<br>c. DNA analysis<br>d. Antibody agglutination test"

"Which statement is TRUE about depression?<br>a. It is classified as a mood disorder<br>b. Episodes of intense fear are recurrent<br>c. It is caused by excess dopamine<br>d. It only occurs after trauma"

"What kind of control is indicated when increased blood glucose levels stimulate secretion of insulin?<br>a. Control by releasing hormones<br>b. Control by tropic hormones<br>c. Negative feedback control<br>d. Hypothalamus/hypophysis coordination"

"What is the most common cause of endocrine disorders?<br>a. Malignant neoplasm<br>b. Infection<br>c. Congenital defect<br>d. Benign tumor"

"Choose the statement that applies to type I diabetes mellitus:<br>a. Onset often occurs during childhood<br>b. Relative insufficiency of insulin resistance develops<br>c. It can be treated by diet and oral hypoglycemics only<br>d. Complications rarely occur"

"Why does polyuria develop with diabetes mellitus?<br>a. Increased thirst and hypoglycemia<br>b. Ketoacidosis<br>c. Osmotic pressure due to glucose<br>d. Diabetic nephropathy"

"What is the cause of diabetic ketoacidosis?<br>a. Excess insulin in the body<br>b. Loss of glucose in urine<br>c. Failure of kidney to excrete acids<br>d. Increased catabolism of fats and proteins"

"What is a precipitating factor for diabetic ketoacidosis?<br>a. Skipping a meal<br>b. Anorexia<br>c. Serious infection<br>d. Insulin overdose"

"Which of the following may cause insulin shock to develop?<br>a. Strenuous exercise<br>b. Missing an insulin dose<br>c. Eating excessively large meals<br>d. Sedentary lifestyle"

"Which of the following indicates hypoglycemia in a diabetic?<br>a. Deep rapid respirations<br>b. Flushed dry skin and mucosa<br>c. Thirst and oliguria<br>d. Staggering gait disorientation and confusion"

"Which of the following are signs of diabetic ketoacidosis?<br>a. Toxic effects of excessive insulin<br>b. Excessive glucose in blood<br>c. Metabolic acidosis<br>d. Lack of glucose in brain cells"

"Immediate treatment for insulin shock may include:<br>a. Administration of bicarbonates<br>b. Consumption of fruit juice or candy<br>c. Induced vomiting<br>d. Consumption of large amounts of water"

"What causes loss of consciousness in a person with diabetic ketoacidosis?<br>a. Toxic effects of excessive insulin<br>b. Excessive glucose in blood<br>c. Metabolic acidosis<br>d. Lack of glucose in brain cells"

"Which of the following does NOT usually develop as a complication of diabetes?<br>a. Osteoporosis<br>b. Nephropathy<br>c. Impotence<br>d. Peripheral neuropathy"

"How do many oral hypoglycemic drugs act?<br>a. Replace insulin in type I diabetes<br>b. Transport glucose into body cells<br>c. Prevent gluconeogenesis<br>d. Stimulate pancreas to produce more insulin"

"Diabetes may cause visual impairment through damage to the lens; this is referred to as:<br>a. Cataracts<br>b. Macular degeneration<br>c. Myopia<br>d. Strabismus"

"Why is amputation frequently a necessity in diabetics?<br>a. Necrosis and gangrene in feet and legs<br>b. Lack of glucose to cells in feet and legs<br>c. Severe dehydration in tissues<br>d. Elevated glucose increasing blood viscosity"

"A type of diabetes that may develop during pregnancy and disappear after delivery is called:<br>a. Temporary maternal diabetes<br>b. Fetal diabetes<br>c. Acute developmental diabetes<br>d. Gestational diabetes"

"Which one of the following develops hypoglycemia more frequently?<br>a. Type I diabetic patients<br>b. Type II diabetic patients<br>c. Patients with a poor stress response<br>d. Patients with a regular exercise and meal plan"

"Which hormonal imbalance causes Addison’s disease?<br>a. Increased glucocorticoids<br>b. Decreased glucocorticoids<br>c. Deficit of ADH<br>d. Deficit of T3 and T4"

"Which hormonal imbalance causes myxedema?<br>a. Increased glucocorticoids<br>b. Decreased glucocorticoids<br>c. Deficit of ADH<br>d. Deficit of T3 and T4"

"Which hormonal imbalance causes diabetes insipidus?<br>a. Increased insulin<br>b. Decreased glucocorticoids<br>c. Deficit of ADH<br>d. Deficit of T3 and T4"

"What is caused by hyperparathyroidism?<br>a. Hypocalcemia<br>b. Tetany<br>c. Bone demineralization<br>d. Deficit of vitamin D"

"What is caused by hypocalcemia due to hypoparathyroidism?<br>a. Skeletal muscle twitching or spasm<br>b. Weak cardiac contraction<br>c. Increased secretion of PTH<br>d. Decreased serum phosphate level"

"Which of the following applies to acromegaly?<br>a. It occurs in infants and children<br>b. It causes excessive longitudinal bone growth<br>c. It results from excessive secretion of growth hormone<br>d. It does not change soft tissue growth"

"Which of the following may cause goiter?<br>a. Hyperthyroidism<br>b. Hypothyroidism<br>c. Lack of iodine in the diet<br>d. Pheochromocytoma"

"Which signs are typical of Graves’ disease?<br>a. Facial puffiness bradycardia lethargy<br>b. Exophthalmos and tachycardia<br>c. Delayed physical and intellectual development<br>d. Goiter and decreased basal metabolic rate"

"Characteristics of Cushing’s syndrome include all of the following EXCEPT:<br>a. Heavy body and round face<br>b. Atrophied skeletal muscle in limbs<br>c. Staring eyes with infrequent blinking<br>d. Atrophy of lymph nodes"

"Which of the following is an effect of long-term glucocorticoid therapy?<br>a. Decreased secretion from adrenal cortex gland<br>b. Increased inflammatory response<br>c. Hypotension and poor circulation<br>d. Increased hypersensitivity reactions"

"Which of the following is an effect of Addison’s disease?<br>a. Elevated blood glucose levels<br>b. High blood pressure<br>c. Low serum potassium levels<br>d. Poor stress response"

"What is the most common cause of type I diabetes mellitus?<br>a. Increased glucose production in liver<br>b. Destruction of pancreatic cells by autoimmune reaction<br>c. Increased resistance of body cells to insulin<br>d. Chronic obesity"

"Why does glucosuria occur in diabetics?<br>a. Excess ketoacids displace glucose into filtrate<br>b. Excess water draws more glucose into urine<br>c. Amount of glucose in filtrate exceeds renal tubule transport limit<br>d. Insulin needed for glucose reabsorption"

"Which of the following are common early signs of pituitary adenoma?<br>a. Persistent headaches<br>b. Hemianopia<br>c. Hypertension<br>d. Papilledema"

"Which of the following does NOT apply to inappropriate ADH syndrome?<br>a. Cause is excess ADH secretion<br>b. Severe hyponatremia results<br>c. Excessive sodium is retained<br>d. Fluid retention increases"

"What is/are the effect(s) of thyrotoxic crisis?<br>a. Hyperthermia and heart failure<br>b. Hypotension and hypoglycemia<br>c. Toxic goiter and hypometabolism<br>d. Decreased stress response"

"Which condition may precipitate or exacerbate hyperglycemia?<br>a. Hypothyroidism<br>b. Cushing’s disease<br>c. Addison’s disease<br>d. Growth hormone deficit"

"Which condition may cause immunosuppression?<br>a. Graves’ disease<br>b. Acromegaly<br>c. Cushing’s disease<br>d. Diabetes insipidus"

"Hyperosmolar hyperglycemic nonketotic coma more frequently develops in patients with:<br>a. Type I diabetes<br>b. Type II diabetes<br>c. Graves’ disease<br>d. Hyperparathyroidism"

"Which of the following is recommended for immediate treatment of hypoglycemic shock?<br>a. If conscious immediately give sweet fruit juice honey candy or sugar<br>b. If unconscious give nothing by mouth (IV glucose)<br>c. Treat immediately with insulin<br>d. Give large quantity of clear fluids for shock"

"All these tissues use glucose without the aid of insulin EXCEPT:<br>a. Liver<br>b. Digestive system<br>c. Exercising skeletal muscle<br>d. Brain"

"Differences between type I and type II diabetes include which of the following?<br>a. Type I weight gain common type II weight loss common<br>b. Type I leads to fewer complications<br>c. Type I controlled by diet/exercise type II requires insulin<br>d. Type I more frequent in children/adolescents type II more often in adults"

"Complications of diabetes mellitus include:<br>a. Peripheral neuropathy<br>b. Frequent infections<br>c. Cataracts<br>d. A B and C"

"Which of the following often causes hyperparathyroidism?<br>a. Malignant tumor in parathyroid glands<br>b. End-stage renal failure<br>c. Osteoporosis<br>d. Radiation involving thyroid/neck"

"Dwarfism is caused by:<br>a. Excessive levels of somatotropin<br>b. Deficit of somatotropin<br>c. Excessive insulin<br>d. Excessive parathyroid hormone"

"Which of the following results from a deficit of ADH?<br>a. Inappropriate ADH syndrome<br>b. Gigantism<br>c. Diabetes insipidus<br>d. Myxedema"

"Goiters occur more frequently in persons living in the:<br>a. Great Lakes or mountainous regions<br>b. Southwest United States<br>c. Temperate regions<br>d. Areas bordering oceans"

"Which of the following is caused by Graves’ disease?<br>a. Hypermetabolism<br>b. Decreased size of thyroid gland<br>c. Bradycardia and hypothermia<br>d. Decreased blood levels of T3 T4 and TSH"

"Goiters may be caused by:<br>a. Hypothyroid conditions only<br>b. Either hypothyroid or hyperthyroid conditions<br>c. Hyperthyroid conditions only<br>d. Fungal infections such as candidiasis"

"Severe impairment of all aspects of growth and development including difficulty feeding mental retardation and stunted skeletal growth are associated with:<br>a. Myxedema<br>b. Cushing’s syndrome<br>c. Diabetes insipidus<br>d. Cretinism"

"A benign tumor of the adrenal medulla that secretes epinephrine and norepinephrine is called:<br>a. Pheochromocytoma<br>b. Cushing’s syndrome<br>c. Graves’ disease<br>d. Addison’s disease"

"The anterior pituitary gland secretes all of the following hormones EXCEPT:<br>a. Prolactin<br>b. Glucagon<br>c. Adrenocorticotropic hormone<br>d. Growth hormone"

"Which of the following applies to oxytocin?<br>a. Stimulates contraction of uterus after delivery<br>b. Stimulates ejection of breast milk during lactation<br>c. Stimulates mammary gland production of milk<br>d. Released from adenohypophysis"

"Which of the following is a major function of the hormone norepinephrine?<br>a. Inhibition of excessive stress response<br>b. Visceral and cutaneous vasoconstriction<br>c. Increased force of heart contraction<br>d. Vasodilation in skeletal muscle"

"Early signs of hyperglycemia include polyphagia which means:<br>a. Thirst<br>b. Increased urine output<br>c. Hunger<br>d. Glucose in urine"

"Which hormone is involved in both the stress response and anti-inflammatory response?<br>a. Aldosterone<br>b. Norepinephrine<br>c. Thyroxine<br>d. Cortisol"

"Polydipsia occurs with diabetes mellitus when:<br>a. Lack of insulin causes hunger<br>b. Ketone levels rise in blood<br>c. Polyuria causes dehydration<br>d. Glucosuria causes ketoacidosis"

"Metabolic syndrome is marked by:<br>a. Abnormal lipid and glucose metabolism<br>b. Periodic hypotension<br>c. Deficit of glucagon<br>d. Early onset of type I diabetes mellitus"

"Compensation mechanisms occurring in the early stage of diabetic ketoacidosis include:<br>a. Kussmaul respirations<br>b. Polydipsia<br>c. Ketonuria<br>d. Seizures"

"Which of the following may occur with a pituitary adenoma?<br>a. Low blood pressure and bradycardia<br>b. Headache and seizures<br>c. Vomiting and diarrhea<br>d. Loss of vision in one eye"

"Which of the following may cause hypertension?<br>a. Hypoparathyroidism<br>b. Hypoglycemia<br>c. Pheochromocytoma<br>d. Addison’s disease"

"Catabolic effects of Cushing’s syndrome include:<br>a. Osteoporosis<br>b. Hypertension<br>c. Increased erythrocyte production<br>d. Moon face and buffalo hump"

"Blood glucose levels are increased by:<br>a. Glucocorticoids<br>b. Glucagon<br>c. Epinephrine<br>d. Norepinephrine"

"Which of the following are likely present in a patient immobilized for a long period of time?<br>a. Hypocalcemia and low serum PTH levels<br>b. Hypocalcemia and high serum PTH levels<br>c. Hypercalcemia and low serum PTH levels<br>d. Hypercalcemia and high serum PTH levels"

"Which of the following may cause high serum levels of PTH?<br>a. Hypoparathyroidism<br>b. Chronic renal failure<br>c. Hypercalcemia<br>d. Adenoma in thyroid gland"

"Diabetic retinopathy results from:<br>a. Degeneration of large blood vessels supplying the eye<br>b. Abnormal metabolism in the lens of the eye<br>c. Neuropathy affecting the optic nerve<br>d. Obstruction or rupture of retinal blood vessels"

"Which of the following cells in the gastric mucosa produce intrinsic factor and hydrochloric acid?<br>a. Parietal cells<br>b. Chief cells<br>c. Mucous cells<br>d. Gastrin cells"

"Which of the following is the primary site for absorption of nutrients?<br>a. Stomach<br>b. Duodenum<br>c. Ileum<br>d. Ascending colon"

"When highly acidic chyme enters the duodenum which hormone stimulates release of pancreatic secretions with high bicarbonate ion content?<br>a. Gastrin<br>b. Secretin<br>c. Cholecystokinin<br>d. Histamine"

"Which of the following breaks protein down into peptides?<br>a. Amylase<br>b. Peptidase<br>c. Lactase<br>d. Trypsin"

"In which structure is oxygenated blood mixed with unoxygenated blood to support its functions?<br>a. Pancreas<br>b. Liver<br>c. Small intestine<br>d. Spleen"

"Which of the following stimulates increased peristalsis and secretions in the digestive tract?<br>a. Sympathetic nervous system<br>b. Vagus nerve<br>c. Increased saliva<br>d. Absence of food in system"

"Which of the following is contained in pancreatic exocrine secretions?<br>a. Bicarbonate ion<br>b. Hydrochloric acid<br>c. Activated digestive enzymes<br>d. Insulin"

"The presence of food in the intestine stimulates intestinal activity but inhibits gastric activity through the:<br>a. Defecation reflex<br>b. Enterogastric reflex<br>c. Vomiting reflex<br>d. Autodigestive reflex"

"Which of the following processes is likely to occur immediately after a meal?<br>a. Lipolysis<br>b. Ketogenesis<br>c. Gluconeogenesis<br>d. Glycogenesis"

"What does the term gluconeogenesis refer to?<br>a. Breakdown of glycogen to produce glucose<br>b. Conversion of excess glucose into glycogen for storage<br>c. Formation of glucose from protein and fat<br>d. Breakdown of glucose into carbon dioxide and water"

"Normally proteins or amino acids are required to produce all of the following EXCEPT:<br>a. Peptide hormones<br>b. Clotting factors and antibodies<br>c. Cellular energy<br>d. Hemoglobin"

"Which of the following statements applies to bile salts?<br>a. They give feces the brown color<br>b. They are enzymes that break down fats<br>c. They emulsify lipids and lipid-soluble vitamins<br>d. They are excreted in feces"

"The visceral peritoneum:<br>a. Lines the abdominal wall<br>b. Hangs from stomach over small intestine<br>c. Contains many pain receptors<br>d. Forms the outer covering of the stomach"

"The early stage of vomiting causes:<br>a. Metabolic alkalosis<br>b. Metabolic acidosis<br>c. Increased respirations<br>d. Increased excretion of hydrogen ions"

"Yellow or greenish stained vomitus usually indicates the presence of:<br>a. Bile<br>b. Blood<br>c. Protein<br>d. Bacteria"

"Small hidden amounts of blood in stool are referred to as:<br>a. Melena<br>b. Occult blood<br>c. Frank blood<br>d. Hematemesis"

"Severe vomiting can lead to metabolic acidosis because of increased:<br>a. Ketones produced<br>b. CO2 retained in lungs and kidneys<br>c. Hypovolemia and lactic acid production<br>d. Metabolic rate"

"Which of the following applies to the act of swallowing?<br>a. It requires coordination of cranial nerves V IX X and XII<br>b. It is entirely voluntary<br>c. It is controlled by a center in hypothalamus<br>d. It does not affect respiration"

"What does the defecation reflex require?<br>a. Stimulation by sympathetic nervous system<br>b. Contraction of internal sphincter<br>c. Coordination through sacral spinal cord<br>d. Voluntary relaxation of pelvic muscles"

"What is the definition of dysphagia?<br>a. Herniation of gastric mucosa through weakened muscle<br>b. Recurrent reflux of chyme into esophagus<br>c. Absence of connection of esophagus to stomach<br>d. Difficulty in swallowing"

"What does congenital esophageal atresia cause?<br>a. Direct passage of saliva and food into trachea<br>b. Repeated reflux of gastric secretions into esophagus<br>c. No fluid or food entering the stomach<br>d. Gastric distention and cramps"

"Which of the following applies to cleft palate?<br>a. Direct passage of saliva and food from mouth into trachea<br>b. Repeated reflux of gastric secretions into esophagus<br>c. No fluid or food entering the stomach<br>d. Gastric distention and cramps"

"Oral candidiasis is considered to:<br>a. Be a common bacterial infection in infants<br>b. Cause painful ulcerations in mucosa and tongue<br>c. Cause white patches that cannot be scraped off<br>d. Be an opportunistic fungal infection of the mouth"

"Why does herpes simplex infection tend to recur?<br>a. Active infection is usually asymptomatic<br>b. Virus builds resistance<br>c. Virus persists in latent form in sensory nerve ganglia<br>d. Virus mutates so no immunity develops"

"What does the term periodontitis refer to?<br>a. Erosion of enamel tooth surface<br>b. Bacterial damage to teeth and surrounding alveolar bone<br>c. Inflammation and infection of gingivae<br>d. Formation of calcified plaque"

"What are common locations for oral cancer?<br>a. Floor of mouth or tongue borders<br>b. Mucosa lining cheeks<br>c. Hard and soft palate<br>d. Gingivae near teeth"

"What is a common cause of hiatal hernia?<br>a. Abnormally long esophagus<br>b. Increased intra-abdominal pressure<br>c. Stenosis of hiatus in diaphragm<br>d. Small fundus in stomach"

"What is a common sign of acute gastritis?<br>a. Colicky upper right quadrant pain<br>b. Vomiting and anorexia<br>c. Projectile vomiting after eating<br>d. Diarrhea with abdominal distention"

"What does the pathophysiology of chronic gastritis include?<br>a. Atrophy of gastric mucosa with decreased secretions<br>b. Hyperchlorhydria and chronic peptic ulcers<br>c. Frequent vomiting and diarrhea<br>d. Episodes of acute inflammation and edema"

"What is a common cause of gastroenteritis due to Salmonella?<br>a. Unrefrigerated custards or salad dressings<br>b. Poorly canned foods<br>c. Raw or undercooked poultry or eggs<br>d. Contaminated water"

"Which individual is likely to develop acute gastritis?<br>a. Long-term heavy cigarette smoker<br>b. Patient with arthritis taking enteric-coated aspirin daily<br>c. Person with autoimmune reaction in gastric mucosa<br>d. Individual with shellfish allergy"

"What does congenital pyloric stenosis involve?<br>a. Absence of peristalsis in lower stomach<br>b. Failure of opening to develop between stomach and duodenum<br>c. Hypertrophy of smooth muscle in pylorus<br>d. Thickening of gastric wall due to chronic inflammation"

"A patient with acquired pyloric stenosis would likely:<br>a. Have an increase in appetite<br>b. Have chronic diarrhea<br>c. Develop severe colicky pains<br>d. Vomit undigested food from previous meals"

"Prolonged or severe stress predisposes to peptic ulcer disease because:<br>a. Reduced blood flow to gastric wall and mucous glands<br>b. Reduced bicarbonate content in bile and pancreatic secretions<br>c. Stress increases number of acid- and pepsinogen-secreting cells<br>d. Increased epinephrine increases motility"

"The pathophysiology of peptic ulcer disease may involve any of the following EXCEPT:<br>a. Decreased resistance of mucosal barrier<br>b. Increased stimulation of pepsin and acid secretions<br>c. Infection by H. pylori<br>d. Increased stimulation of mucus-producing glands"

"Which of the following would a perforated gastric ulcer likely cause?<br>a. Severe anemia<br>b. Chemical peritonitis<br>c. Severe gastric hemorrhage<br>d. Pyloric obstruction"

"What is frequently the first manifestation of stress ulcers?<br>a. Abdominal discomfort between meals and at night<br>b. Nausea and diarrhea<br>c. Hematemesis<br>d. Sharp colicky pain with food intake"

"What would be the result of chronic bleeding from gastric carcinoma?<br>a. Occult blood in stool and anemia<br>b. Hematemesis and shock<br>c. Abdominal pain and distention<br>d. Red blood on surface of stool"

"Following gastric resection the onset of nausea cramps and dizziness immediately after meals indicates:<br>a. A large volume of chyme has entered intestines causing distention<br>b. Severe hypoglycemia has developed<br>c. Pylorus is restricting flow of chyme<br>d. Bile and pancreatic secretions are irritating small intestine"

"Bilirubin is a product of:<br>a. Hemolysis of red blood cells and breakdown of hemoglobin<br>b. Production of excess chyme and bile<br>c. Mixing of undigested food and gastric secretions<br>d. Accumulation of white blood cells due to infection"

"Why does mild hyperbilirubinemia occur in newborns?<br>a. Blood incompatibility between mother and child<br>b. Damage to erythrocytes during birth<br>c. Poor circulation and albumin transport<br>d. Immature liver cannot process bilirubin quickly enough"

"Predisposing factors to cholelithiasis include excessive:<br>a. Bilirubin or cholesterol concentration in bile<br>b. Water content in bile<br>c. Bile salts in bile<br>d. Bicarbonate ions in bile"

"What is the major effect when a gallstone obstructs the cystic duct?<br>a. Intrahepatic jaundice<br>b. Acute pancreatitis<br>c. Severe colicky pain in upper right quadrant<br>d. Inflammation and infection in gallbladder"

"Obstruction of the biliary tract by gallstones is referred to as:<br>a. Cholelithiasis<br>b. Cholecystitis<br>c. Cholangitis<br>d. Choledocholithiasis"

"Which of the following applies to hepatitis A infection?<br>a. Also called serum hepatitis<br>b. Transmitted by fecal-oral route<br>c. Contains double strand DNA<br>d. Frequently leads to chronic hepatitis"

"What can be concluded if hepatitis B antigen level remains high in serum?<br>a. Acute infection is present<br>b. Chronic infection has developed<br>c. Liver failure is in progress<br>d. Prolonged recovery from any viral infection"

"What is the most common type of hepatitis transmitted by blood transfusion?<br>a. HAV<br>b. HBV<br>c. HCV<br>d. HEV"

"During the course of hepatitis B infection the onset of jaundice occurs in the:<br>a. Incubation period<br>b. Preicteric stage<br>c. Icteric stage<br>d. Posticteric stage"

"What is the likely effect of long-term exposure to a hepatotoxin?<br>a. Full recovery after toxin removed<br>b. Acute vomiting steatorrhea jaundice<br>c. Continued mild inflammation without permanent damage<br>d. Gradual irreversible damage to liver and cirrhosis"

"What indicates the presence of third-stage alcoholic hepatitis?<br>a. Below normal AST and ALT<br>b. Upper left quadrant tenderness and dull pain<br>c. Small firm nodular liver and portal hypertension<br>d. Decreased production of clotting factors"

"A factor that may precipitate encephalopathy with cirrhosis is elevated:<br>a. Serum urea<br>b. Conjugated bilirubin<br>c. Serum ammonia<br>d. Serum pH"

"In patients with cirrhosis serum ammonia may increase when:<br>a. Ingesting excessive lipids<br>b. Bleeding occurs in digestive tract<br>c. Increase in unconjugated bilirubin occurs<br>d. Less bile is produced"

"What is the primary cause of esophageal varices?<br>a. Increased hydrostatic pressure in veins<br>b. Alcohol irritating mucosa<br>c. Failure to inactivate estrogen<br>d. Poor nutritional status"

"What is the primary cause of increased bleeding tendencies associated with cirrhosis?<br>a. Anemia and leukopenia<br>b. Jaundice and pruritus<br>c. Recurrent infections<br>d. Deficit of vitamin K and prothrombin"

"Which factors contribute to ascites in patients with cirrhosis?<br>a. Increased aldosterone and deficit of albumin<br>b. Severe anemia and increased bilirubin<br>c. Hypokalemia and increased ammonia<br>d. Hyperproteinemia and persistent hypotension"

"Which of the following is a major cause of primary hepatocellular cancer?<br>a. Metastatic tumors<br>b. Acute hepatitis<br>c. Long-term exposure to certain chemicals<br>d. Chronic cholelithiasis"

"What causes massive inflammation and necrosis in acute pancreatitis?<br>a. Formation of multiple thrombi and ischemia<br>b. Infection by intestinal microbes<br>c. Immune complex reaction<br>d. Autodigestion of tissue by pancreatic enzymes"

"How do chemical peritonitis and shock frequently result from acute pancreatitis?<br>a. Inflammation and increased vascular permeability of peritoneum affect fluid balance<br>b. Erosion in intestinal wall releases bacteria<br>c. Fat necrosis and hypocalcemia develop<br>d. Secretions become more acidic"

"Malnutrition may develop in children with celiac disease because of:<br>a. Damage to intestinal villi<br>b. Obstruction in pancreatic ducts<br>c. Acidosis preventing enzyme activation<br>d. Insufficient bile for absorption"

"Which of the following best describes steatorrhea?<br>a. Light gray-colored stool<br>b. Tarry black stool<br>c. Bulky fatty foul-smelling stools<br>d. Watery stools with mucus and blood"

"What is the dietary requirement for a child with celiac disease?<br>a. Low sodium high fat<br>b. High carbohydrate low protein<br>c. High calorie with vitamin supplements<br>d. Gluten-free"

"What are the typical changes occurring with Crohn’s disease?<br>a. Flattening of villi in small intestine<br>b. Multiple herniations of mucosa<br>c. Continuous mucosal inflammation in rectum and colon<br>d. Inflamed wall of ileum alternating with thick fibrotic or normal areas"

"Stools that are more liquid and contain mucus and frank blood are typical of:<br>a. Diverticulitis<br>b. Ulcerative colitis<br>c. Crohn’s disease<br>d. Celiac disease"

"How may a fistula form with Crohn’s disease?<br>a. Lack of peristalsis causing dilation<br>b. Fibrosis causing obstruction<br>c. Erosion causing bleeding<br>d. Recurrent inflammation necrosis and fibrosis forming connection between loops"

"How does iron deficiency anemia frequently develop with ulcerative colitis?<br>a. Loss of surface area in ileum<br>b. Bone marrow depression<br>c. Chronic blood loss in stools<br>d. Insufficient hydrochloric acid"

"What is the cause of inflammatory bowel disease?<br>a. Physical and emotional stress<br>b. Autoimmune reaction<br>c. Combination of recessive genes<br>d. Idiopathic"

"What pain is typical of diverticulitis?<br>a. Lower left quadrant<br>b. Lower right quadrant<br>c. Sharp colicky periumbilical<br>d. Lower abdominal pain radiating to groin"

"What usually indicates acute appendicitis?<br>a. Infection in appendix<br>b. Severe diarrhea episode<br>c. Obstruction of lumen of appendix<br>d. Eating low-fiber diet"

"With acute appendicitis localized pain and tenderness in the lower right quadrant results from:<br>a. Increased peristalsis in adjacent colon<br>b. Inflammation and stretching of appendiceal wall<br>c. Increased gas and fluid inside appendix<br>d. Local inflammation of parietal peritoneum"

"How does localized peritonitis develop from acute appendicitis before rupture?<br>a. Omentum walls off inflamed area<br>b. Bacteria escape through necrotic wall<br>c. Obstructing object causes edema<br>d. Bacteria escape into blood"

"What is a typical early sign of cancer in the ascending colon?<br>a. Change in shape of stool<br>b. Incomplete emptying<br>c. Mild persistent LLQ pain<br>d. Occult blood in stool"

"To which site does colon cancer usually first metastasize?<br>a. Lungs<br>b. Stomach<br>c. Liver<br>d. Spleen"

"How does a volvulus cause localized gangrene in the intestine?<br>a. Hypotension causes ischemia<br>b. Mesenteric arteries are compressed in twisted section<br>c. Section herniates through abdominal wall<br>d. Distention increases permeability"

"Which of the following is a typical indicator of intestinal obstruction caused by paralytic ileus?<br>a. Excessive audible bowel sounds<br>b. Intermittent colicky pain<br>c. Severe steady abdominal pain<br>d. Visible peristalsis"

"A congenital condition in which parasympathetic innervation is missing from a section of colon impairing motility is referred to as:<br>a. Diverticulitis<br>b. Crohn’s disease<br>c. Irritable bowel syndrome<br>d. Hirschsprung’s disease"

"What causes hypovolemic shock to develop with intestinal obstruction?<br>a. Continued vomiting and fluid shift into intestine<br>b. Hemorrhage into intestine<br>c. Rupture of intestinal wall<br>d. Repeated severe diarrhea"

"What causes the characteristic rigid abdomen found in the patient with peritonitis?<br>a. Increased fluid and gas distention<br>b. Inflammation causing firm mass<br>c. Inflamed peritoneum causing reflex abdominal muscle spasm<br>d. Voluntary contraction for protection"

"What would be the likely outcome from chemical peritonitis related to a perforated gallbladder?<br>a. Leakage of intestinal bacteria into blood and cavity<br>b. Massive hemorrhage and shock<br>c. Breakdown of gallstones<br>d. Increasing peristalsis with spasms"

"How does pelvic inflammatory disease frequently lead to bacterial peritonitis?<br>a. Chemical irritation by secretions<br>b. Ulceration and perforation of uterus<br>c. Infection spreads through fallopian tubes into peritoneal cavity<br>d. Gangrene spreads into pelvic cavity"

"Choose the significant change in arterial blood gases expected with prolonged severe vomiting:<br>a. Increased bicarbonate increased PCO2 pH 7.4<br>b. Decreased bicarbonate decreased PCO2 pH 7.35<br>c. Increased bicarbonate decreased PCO2 pH 7.35<br>d. Decreased bicarbonate increased PCO2 pH 7.45"

"When dehydration reduces compensation possible for acidosis from prolonged diarrhea what change indicates this?<br>a. pH rises above 7.45<br>b. Bicarbonate increases pH normal<br>c. Bicarbonate decreases pH drops below 7.35<br>d. PCO2 rises pH around 7.4"

"Bile pigment gallstones are more common in individuals dealing with:<br>a. Obesity<br>b. High cholesterol levels<br>c. Alcoholic cirrhosis<br>d. Use of oral contraceptives"

"Dehydration limits compensation available for acid-base imbalance from prolonged vomiting and diarrhea because:<br>a. Hypovolemia limits renal function<br>b. Increased respirations cannot remove more H+<br>c. Increased ADH blocks secretion of H+<br>d. More sodium and potassium retained"

"Which of the following is the most frequent location of peptic ulcers?<br>a. Lower esophagus<br>b. Antrum of stomach<br>c. Proximal duodenum<br>d. Distal duodenum"

"In peptic ulcer disease which of the following does NOT decrease resistance of mucosal barrier?<br>a. Prolonged vasoconstriction<br>b. Excessive glucocorticoid intake<br>c. Proteases and cytotoxins from H. pylori<br>d. Decreased vagal stimulation"

"An individual with peptic ulcer disease exhibits hematemesis. What does this probably indicate?<br>a. Perforation<br>b. Obstruction<br>c. Erosion of a large blood vessel<br>d. Development of malignancy"

"What does the term melena mean?<br>a. Blood in a dark-colored stool<br>b. Occult blood in stool<br>c. Blood in sputum<br>d. Blood in vomitus"

"Which of the following is NOT a common predisposing factor to gastric carcinoma?<br>a. Ingestion of smoked foods<br>b. Genetic factors<br>c. Ingestion of foods preserved with nitrates<br>d. Anti-inflammatory medications such as ASA"

"Which of the following frequently occurs 2 to 3 hours after meals in post-gastrectomy patients?<br>a. Hypoglycemia<br>b. Hypovolemia<br>c. Abdominal cramps and distention<br>d. Increased peristalsis and diarrhea"

"Which term refers to an inflammation usually related to infection of the bile ducts?<br>a. Cholelithiasis<br>b. Cholecystitis<br>c. Cholangitis<br>d. Choledocholithiasis"

"Which of the following is NOT usually present during the icteric stage of viral hepatitis?<br>a. Hepatomegaly<br>b. Elevated serum liver enzymes<br>c. Esophageal varices<br>d. Lighter-colored stools"

"Which type(s) of hepatitis increase(s) the risk of hepatocellular carcinoma?<br>a. HBV<br>b. HCV<br>c. HBV and HCV<br>d. Neither"

"Which type of hepatitis virus requires the presence of hepatitis B virus so as to replicate?<br>a. HAV<br>b. HCV<br>c. HDV<br>d. HEV"