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Chapter 41 42 43 Flashcards

1
Q

In the mouth and stomach, salivary a-amylase initiates the digestion of which nutrients?

A

a. Proteins
b. Carbohydrates **
c. Fats
d. Fiber

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2
Q

Saliva contains which immunoglobulin (Ig)?

A

a. IgA***
b. IgE
c. IgG
d. IgM

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3
Q

What effect is a result of inhibiting the parasympathetic nervous system with a drug such as atropine?

A

a. Salivation becomes thinner.
* ** b. Salivation decreases. *****
c. The pH of saliva changes. d. Digestive enzymes are inhibited.

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4
Q

Food enters the stomach via which orifice or sphincter?

A

a. Cardiac ****
b. Upper esophageal
c. Gastric
d. Fundal

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5
Q

Which gastric cells secrete hydrochloric acid and intrinsic factor?

A

a. Parietal **
b. Chief
c. G
d. D

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6
Q

Which cells in the stomach secrete histamine?

A

a. Oxyntic
b. Chief
c. D
d. Enterochromaffin-like **

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7
Q

Which gastric hormone inhibits acid and pepsinogen secretion, as well as decreases the release of gastrin?

A

a. Motalin
b. Histamine
c. Somatostatin*****
d. Acetylcholine

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8
Q

Which enzyme breaks down protein-forming polypeptides in the stomach?

A

a. Acetylcholine
b. Pepsin *****
c. Gastrin
d. Secretin

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9
Q

Exposure to which substance protects the mucosal barrier of the stomach?

A

a. Prostaglandins *****
b. Acetylcholine
c. Helicobacter pylori
d. Regurgitated bile

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10
Q

The ileum and jejunum are suspended by folds of the peritoneum that contain an extensive vascular and nervous network. What are these folds called?

A

a. Ligament of Treitz
b. Mesentery **
c. Auerbach folds
d. Lamina propria

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11
Q

Where in the small intestines are lymphocytes, plasma cells, and macrophages produced?

A

a. Brush border
b. Microvilli
c. Lamina propria ****
d. Crypts of Lieberkühn

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12
Q

The student asks the professor why water and electrolytes are transported in both directions through tight junctions and intercellular spaces rather than across cell membranes. What response by the professor is best?

A

a. The intercellular hydrostatic pressure is inadequate to push the water and electrolytes across the cell membranes.
b. A balance of cations and ions among the electrolytes on each side of the cell membranes cannot be maintained.
c. The epithelial cell membranes are formed of lipids that are hydrophobic and therefore repel water. ***
d. Receptors on those cell membranes are occupied with a diffusion of amino acids and monosaccharides.

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13
Q

Which statement best describes the gastrointestinal tract?

A

a. The gastrointestinal tract is a muscular tube that transports food from the mouth to the stomach.
b. The gastrointestinal tract is a hollow tube that extends from the mouth to the anus.***
c. The gastrointestinal tract is a bag like structure that propels partially digested food (chyme).
d. The gastrointestinal tract is 5 m long and consists of three segments.

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14
Q

Glucose transport enhances the absorption of which electrolyte?

A

a. Sodium *****
b. Phosphate
c. Potassium
d. Chloride

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15
Q

What process is capable of increasing both intrathoracic and intraabdominal pressure, thereby facilitating defecation?

A

a. Relaxation of the internal anal sphincter
b. Intestinal peristalsis
c. Valsalva maneuver***
d. Ileogastric reflex

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16
Q

Which pancreatic enzyme is responsible for the breakdown of carbohydrates?

A

a. Trypsin
b. Amylase***
c. Lipase
d. Chymotrypsin

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17
Q

What is the formation of water-soluble molecules to facilitate the absorption of the byproducts of lipid hydrolysis accomplished by?

A

a. Micelles *****
b. Phospholipase
c. Chylomicrons
d. Colipase

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18
Q

What is the primary source of physiologic iron?

A

a. Transferrin from plasma
b. Pepsin form pepsinogen
c. Bile from bilirubin
d. Heme from animal protein **

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19
Q

A professor has taught a class of students about the characteristics of vitamin B12. Which statement by a student demonstrates a need for more education?

A

a. Vitamin B12 is absorbed in the terminal ileum.
b. Vitamin B12 is absorbed in its free (unbound) form in small amounts.
c. Vitamin B12 is necessary for platelet maturation. **
d. Vitamin B12 binds to intrinsic factor.

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20
Q

Which water-soluble vitamin is absorbed by passive diffusion?

A

a. Vitamin B6 *****
b. Vitamin B1
c. Vitamin K
d. Folic acid

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21
Q

Which vitamin facilitates the absorption of iron by the epithelial cells of the duodenum and jejunum?

A

a. B6
b. C **
c. E
d. B12

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22
Q

What is the role of the normal intestinal bacterial flora?

A

a. Metabolizing bile salts, estrogens, and lipids ****
b. Breaking down proteins into amino acids
c. Facilitating the motility of the colon
d. Metabolizing aldosterone and insulin

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23
Q

How are Kupffer cells best described?

A

a. Natural killer cells that produce interferon-gamma (IFN-)
b. Contractile and therefore capable of regulating the sinusoid blood flow
c. Bactericidal and therefore central to innate immunity ************
d. Able to metabolize estrogen, progesterone, and androgens

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24
Q

Bilirubin is a byproduct of the destruction of which aged cells?

A

a. Platelets
b. Protein
c. Leukocytes
d. Erythrocytes****

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25
Q

The process of conjugation of bilirubin in the liver is best described as which transformation?

A

a. Unconjugated (fat-soluble) bilirubin into urobilinogen b. Unconjugated (fat-soluble) bilirubin into conjugated (water-soluble) bilirubin *******
c. Conjugated (water-soluble) bilirubin into unconjugated (fat-soluble) bilirubin
d. Conjugated (water-soluble) bilirubin into urobilinogen

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26
Q

A professor has been teaching a class on gastrointestinal function. Which statement by a student indicates the need for more education?

A

a. Within 30 min of eating, the gallbladder forces bile into the stomach. **
b. Cholinergic branches of the vagus nerve mediate gallbladder contraction.
c. Cholecystokinin provides hormonal regulation of gallbladder contraction.
d. The sphincter of Oddi controls the flow of bile from the gallbladder.

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27
Q

Which structure synthesizes clotting factors and the vitamin K necessary for hemostasis?

A

a. Colon
b. Spleen
c. Gallbladder
d. Liver **

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28
Q

How many days does it take for the entire epithelial population of the small intestines to be replaced?

A

a. 30 to 45
b. 15 to 25
c. 7 to 15
d. 4 to 7 ****

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29
Q

Which statement, made by a student, is correct regarding the state of the intestinal tract at birth?

A

a. The intestinal tract is colonized by Escherichia coli.
b. The intestinal tract is sterile. *****
c. Clostridium welchii is present in but in very small numbers.
d. Streptococcus colonization in the intestinal tract has begun.

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30
Q

Where in the brain is the vomiting center located?

A

a. Hypothalamus
b. Medulla oblongata ***
c. Pons
d. Midbrain

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31
Q

Antiemetic agents, such as domperidone and metoclopramide, are antagonists for which receptors?

A

a. 5-Hydroxytryptamine (5-HT) serotonin
b. Histamine-2
c. Acetylcholine
d. Dopamine ***

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32
Q

A patient in the clinic reports projectile vomiting without nausea or other gastrointestinal symptoms. What action by the healthcare professional is most appropriate?

A

a. Provide antiemetic medications.
b. Arrange a brain scan. ***
c. Administer intravenous hydration.
d. Schedule a GI consultation.

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33
Q

A patient reports feeling constipated. When assessing this patient, how often should the patient report bowel movements to be considered within the normal range?

A

a. Once a day
b. Once every 2 days
c. ONCE A WEEK *******
d. Once every 2 weeks

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34
Q

How many stools per day are considered the upper limits of normal?

A

a. Two
b. THREE **
c. Five
d. Seven

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35
Q

The adult intestine processes approximately how many liters of luminal content per day?

A

a. 3
b. 6
c. 9 **
d. 12

36
Q

A person who has cholera (Vibrio cholerae) would be expected to have which type of diarrhea?

A

a. Osmotic
b. SECRETORY****
c. Small volume
d. Motility

37
Q

What type of diarrhea is a result of lactase deficiency?

A

a. Motility
b. OSMOTIC ****
c. Secretory
d. Small-volume

38
Q

A professor has taught the students about the pathogenesis of abdominal pain. Which statement by a student indicates the professor needs to review the material?

A

a. Chemical mediators, such as histamine, bradykinin, and serotonin, produce abdominal pain.
b. Edema and vascular congestion produce abdominal pain by stretching.
c. Ischemia, caused by distention of bowel obstruction or mesenteric vessel thrombosis, produces abdominal pain.
D. Low concentrations of anaerobes, such as Streptococci, Lactobacilli, Staphylococci, Enterobacteria, and Bacteroides, produce abdominal pain. *******

39
Q

How can abdominal pain that is visceral in nature best be described?

A

a. Diffuse, vague, poorly localized, and dull ****
b. It travels from a specific organ to the spinal cord.
c. The pain lateralizes from only one side of the nervous system
d. Associated with the peristalsis of the gastrointestinal tract

40
Q

A patient asks the healthcare professional to describe the cause of gastroesophageal reflux disease (GERD). What response by the professional is best?

A

a. Excessive production of hydrochloric acid
b. Zone of low pressure of the lower esophageal sphincter *******
c. Presence of Helicobacter pylori in the esophagus
d. Reverse muscular peristalsis of the esophagus

41
Q

A patient has frank bleeding of the rectum. How does the healthcare professional document this finding?

A

a. Melena
b. Hematochezia ***
c. Occult bleeding
d. Hematemesis

42
Q

What is the cause of functional dysphagia?

A

a. Intrinsic mechanical obstruction
b. Extrinsic mechanical obstruction
c. Tumor
d. Neural or muscular disorders **

43
Q

A patient has been diagnosed with reflux esophagitis (GERD). What instruction by the healthcare professional is most appropriate?

A

a. Exercise soon after eating to increase gastric emptying.
b. Try these proton-pump inhibitors for 2 weeks.***
c. You need to schedule an upper GI endoscopy soon. d. Over-the-counter antiemetics work well for this condition.

44
Q

By what mechanism does intussusception cause an intestinal obstruction?

A

a. Telescoping of part of the intestine into another section of intestine ****
b. Twisting the intestine on its mesenteric pedicle
c. Loss of peristaltic motor activity in the intestine
d. Fibrin and scar tissue that attaches to the intestinal omentum

45
Q

A patient has been admitted for a possible small intestinal obstruction. What is the first sign the healthcare professional assesses for that would indicate the presence of this condition?

A

a. Vomiting
b. Dehydration
c. Electrolyte imbalances
d. Distention **

46
Q

An intestinal obstruction at the pylorus or high in the small intestine causes metabolic alkalosis by causing which outcome?

A

a. Gain of bicarbonate from pancreatic secretions that cannot be absorbed
b. Excessive loss of hydrogen ions normally absorbed from gastric juices **
c. Excessive loss of potassium, promoting atony of the intestinal wall
d. Loss of bile acid secretions that cannot be absorbed

47
Q

A patient has been admitted to the hospital with a possible bowel obstruction. Which assessment finding would alert the healthcare professional that the obstruction is in the small vs. large intestine?

A

a. Profuse vomiting of clear gastric fluids
b. Vague dull hypogastric pain without vomiting
c. Colicky pain caused by distention, followed by vomiting **
d. Excruciating pain, vomiting, and fever

48
Q

A patient has chronic gastritis. What treatment does the healthcare professional educate the patient on?

A

a. Antibiotic therapy ***
b. Corticosteroids
c. Vitamin B12 injections
d. Pancreatic enzyme replacemenT

49
Q

A peptic ulcer may occur in all of these areas except which?

A

a. Stomach
b. Duodenum
c. Jejunum ****
d. EsophaguS

50
Q

A class of students has learned about contributing factors to duodenal ulcers. What statement indicates to the professor that the students need a review?

A

a. Bleeding from duodenal ulcers causes hematemesis or melena.
b. Gastric emptying is slowed, causing greater exposure of the mucosa to acid. ***
c. The characteristic pain begins 30 min to 2 hours after eating d. Duodenal ulcers occur with greater frequency than other types of peptic ulcers.

51
Q

After a partial gastrectomy or pyloroplasty, clinical manifestations that include increased pulse, hypotension, weakness, pallor, sweating, and dizziness are the results of which mechanism?

A

a. Excessive relaxation of gastric and vascular smooth muscles
b. Postoperative hemorrhage
c. Concentrated food bolus, causing hyperglycemia
d. Rapid gastric emptying **

52
Q

A patient reports dumping syndrome after a partial gastrectomy. What does the healthcare professional teach this patient?

A

a. Eat small, frequent high-protein meals. **
b. This will need surgical correction.
c. Take antacids 30 min before meals.
d. Drink plenty of water with your meals.

53
Q

The most common clinical manifestation of portal hypertension is what type of bleeding?

A

a. Rectal
b. Duodenal
c. Esophageal ***
d. Intestinal

54
Q

A patient has portal hypertension-induced splenomegaly. Which lab value would the healthcare professional associate with this condition?

A

a. Low white blood cell count
b. Low platelet count *****
c. High red cell count
d. High hemoglobin and hematocrit

55
Q

A professor has taught the students about the sources of increased ammonia in patients with hepatic encephalopathy. What statement by a student indicates the professor should review this material?

A

a. End products of intestinal protein digestion are sources of increased ammonia.
b. Digested blood leaking from ruptured varices is a source of increased ammonia.
c. Accumulation of short-chain fatty acids are a source of increased ammonia. *******
d. Ammonia-forming bacteria in the colon are sources of increased ammonia.

56
Q

Hepatic fat accumulation is observed in which form of cirrhosis?

A

a. Biliary
b. Metabolic
c. Postnecrotic
d. Alcoholic *****

57
Q

A student asks the healthcare professional to explain the pathophysiologic process of alcoholic cirrhosis. What statement by the professional would not be consistent with complete knowledge about this process?

A

a. Inflammation and damage leading to cirrhosis begin in the bile canaliculi.***
b. Alcohol is transformed to acetaldehyde, which promotes liver fibrosis.
c. Mitochondrial function is impaired, decreasing oxidation of fatty acids.
d. Acetaldehyde inhibits export of proteins from the liver.

58
Q

A student learns what information about acute pancreatitis?

A

a. Autoimmune process with IgG attacking pancreatic acinar cells
b. It is usually a severe disease with a high mortality rate.
c. Pancreatic enzymes autodigest pancreatic cells and tissues.*******
d. Oversecretion of pancreatic enzymes and malnutrition

59
Q

The mutation of which gene is an early event associated with the pathogenetic origin of esophageal cancer?

A

a. KRAS
b. TP53 *****
c. myc
d. HER2

60
Q

Incomplete fusion of the nasomedial and intermaxillary process during the fourth week of embryonic development causes which condition in an infant?

A

a. Cleft palate
b. Sinus dysfunction
c. Cleft lip ***
d. Esophageal malformation

61
Q

Increased gastrin secretion by the mother in the last trimester of pregnancy may cause which condition in the infant?

A

a. Pyloric stenosis ***
b. Meconium ileus
c. Esophageal atresia
d. Galactosemia

62
Q

Parents report their 3-week-old infant who eats well and has gained weight began to vomit forcefully for no apparent reason. What treatment option does the healthcare professional prepare to educate the parents on?

A

a. A gastric feeding tube
b. Wheat-free diet
c. Corrective surgery ****
d. Lactose-free diet

63
Q

Which term is used to identify a condition in which the developing colon remains in the upper right quadrant instead of moving to its normal location?

A

a. Intestinal malrotation **
b. Ileocecal displacement
c. Duodenal obstruction
d. Pyloric stenosis

64
Q

Which term is used to identify an intestinal obstruction caused by meconium formed in utero that is abnormally sticky and adheres firmly to the mucosa of the small intestine?

A

a. Meconium cecum
b. Meconium ileus ****
c. Meconium obstruction
d. Meconium vivax

65
Q

A newborn has meconium ileus. What diagnostic test does the healthcare professional advise the parents about?

A

a. Colonoscopy
b. Pulmonary function studies
c. A sweat test **
d. Nerve conduction studies

66
Q

Congenital aganglionic megacolon (Hirschsprung’s disease) involves inadequate motility of the colon caused by neural malformation of which nervous system?

A

a. Central
b. Parasympathetic *****
c. Sympathetic
d. Somatic

67
Q

An infant has been diagnosed with intussusception and the student asks the healthcare professional to explain the condition. What explanation by the professional is most accurate?

A

a. Poor colonic motility due to a problem in the parasympathetic nervous system
b. The colon stays in the upper right quadrant instead of moving to its normal location.
c. One part of the intestine telescopes into another section of the intestine. ****
d. Fibrosis increases the resistance to blood flow within the portal system.

68
Q

An infant suddenly develops abdominal pain, becomes irritable, and draws up the knees. Vomiting occurs soon afterward. The mother reports that the infant passed a normal stool, followed by one that looked like currant jelly. What treatment does the healthcare professional prepare the infant for?

A

a. Corrective surgery
b. Reduction enema *****
c. Gastric decompression
d. Anal dilation

69
Q

Cystic fibrosis is characterized by which symptom?

A

a. Excessive mucus production ****
b. Elevated blood glucose levels
c. Low sodium content in perspiration
d. Abnormally thin exocrine secretions

70
Q

A child has cystic fibrosis (CF). Which medication does the healthcare professional teach the parents about?

A

a. Salt tablets
b. Pancreatic enzymes **
c. Antihypertensives
d. Antibiotics

71
Q

What causes a person with cystic fibrosis to experience an exocrine pancreatic insufficiency?

A

a. Pancreatic ducts are obstructed with mucus. ****
b. Impaired blood supply to the pancreas causes ischemia.
c. A genetically impaired pancreas is unable to produce digestive enzymes.
d. The pancreas has a volvulus at the ampulla of Vater.

72
Q

A student asks the professor to explain the characteristic appearance of stools in people with cystic fibrosis. What explanation by the professor is best?

A

a. Bile ducts obstructed with mucus, leading to clay colored stools
b. Mechanical obstruction causes narrow, ribbon-like stool
c. Deficiency of pancreatic enzymes leads to steatorrhea.*******
d. Ischemia due to sodium blockages causes bloody stools

73
Q

Which disorder is characterized by damage to the mucosa of the duodenum and jejunum and impaired secretion of secretin, cholecystokinin, and pancreatic enzymes?

A

a. Wilson disease
b. Cystic fibrosis
c. Gluten-sensitive enteropathy ***
d. Galactosemia

74
Q

An infant has gluten-sensitive enteropathy and the parents ask the healthcare professional to explain why the baby bruises so easily. The professional explains that the baby has which deficit?

A

a. Vitamin K deficiency from fat malabsorption ***
b. Bone marrow function depression
c. Iron, folate, and B12 deficiency anemias
d. Prescribed daily warfarin

75
Q

What does the student learn distinguishes kwashiorkor from marasmus?

A

a. All nutrients, proteins, fats, and carbohydrates are reduced in kwashiorkor.
b. Physical growth of children is stunted in kwashiorkor but not in marasmus.
c. Muscle wasting, diarrhea, low hemoglobin, and infection characterize kwashiorkor.
d. Subcutaneous fat, hepatomegaly, and fatty liver are present in kwashiorkor *****

76
Q

Why is prolonged diarrhea more severe in children than it is in adults?

A

a. Less water is absorbed from the colon in children.
b. Fluid reserves are smaller in children.***
c. Children have a higher fluid volume intake.
d. Children have diarrhea more often than adults.

77
Q

A newborn baby displays jaundice 20 hours after birth. What action by the healthcare professional is most appropriate?

A

a. Draw blood to measure total bilirubin.**
b. Teach the patient about phototherapy.
c. Obtain consent for blood transfusions.
d. Prepare to administer vitamin K.

78
Q

What is physiologic jaundice in a newborn caused by?

A

a. Reabsorption of bilirubin in the small intestine
b. Impaired hepatic uptake and excretion of bilirubin
c. Increased bilirubin production
d. Mild conjugated (indirect-reacting) hyperbilirubinemia ***

79
Q

A woman who is positive for hepatitis B is in labor. What action by the healthcare professional is most appropriate?

A

a. Draw blood for a drug screen.
b. Encourage the mother to bottle feed.
c. Immunize the newborn within 12 hours. ***
d. Discuss poor infant survival.

80
Q

Why is prolonged diarrhea more severe in children than it is in adults?

A

a. Less water is absorbed from the colon in children.
b. Fluid reserves are smaller in children.***
c. Children have a higher fluid volume intake.
d. Children have diarrhea more often than adults.

81
Q

A newborn baby displays jaundice 20 hours after birth. What action by the healthcare professional is most appropriate?

A

a. Draw blood to measure total bilirubin.**
b. Teach the patient about phototherapy.
c. Obtain consent for blood transfusions.
d. Prepare to administer vitamin K.

82
Q

What is physiologic jaundice in a newborn caused by?

A

a. Reabsorption of bilirubin in the small intestine
b. Impaired hepatic uptake and excretion of bilirubin
c. Increased bilirubin production
d. Mild conjugated (indirect-reacting) hyperbilirubinemia ***

83
Q

A woman who is positive for hepatitis B is in labor. What action by the healthcare professional is most appropriate?

A

a. Draw blood for a drug screen.
b. Encourage the mother to bottle feed.
c. Immunize the newborn within 12 hours. ***
d. Discuss poor infant survival.

84
Q

Cirrhosis causes intrahepatic portal hypertension in children as a result of which mechanism?

A

a. Fibrosis that increases the resistance to blood flow within the portal system ***
b. Increased pressure from the twisting of the common bile ducts
c. Development of collateral circulation within the portal system
d. Shunting of fluid to the spleen or abdomen

85
Q

A child has chronic hepatitis and the healthcare professional wants to assess the child for portal hypertension. What action by the professional is most appropriate?

A

a. Listen to the child’s lung sounds
b. Assess for pedal edema
c. Palpate the child’s abdomen **
d. Inspect the skin for jaundice

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