Practice Questions Flashcards
The most common anal fissure location is: A. posterior midline of the anus. B. anterior anal midline. C. anterior and posterior anal midline. D. transversely across the anal mucosa.
A. posterior midline of the anus.
Rectal bleeding associated with anal fissure is usually described by the patient as:
A. drops of blood noticed when wiping.
B. dark brown to black in color and mixed in with normal-appearing stool.
C. a large amount of brisk red bleeding.
D. significant blood clots and mucus mixed with stool.
A. drops of blood noticed when wiping.
A 62-year-old woman who reports frequent constipation is diagnosed with an anal fissure. First-line therapy includes all of the following except: A. stool-bulking supplements. B. high fiber diet. C. intraanal corticosteroids. D. the periodic use of oral mineral oil.
C. intraanal corticosteroids.
A 54-year-old man with an anal fissure responds inadequately to dietary intervention and standard therapy during the past 2 weeks. Additional treatment options include all of the following except:
A. intraanal nitroglycerine ointment.
B. botulinum toxicum injection to the internal anal sphincter.
C. surgical sphincterotomy.
D. rubber band ligation of the lesion.
D. rubber band ligation of the lesion.
In a patient who presents with a history consistent with anal fissure but with notation of an atypical anal lesion, alternative diagnoses to consider include all of the following except: A. condyloma acuminata. B. Crohn’s disease. C. anal squamous cell carcinoma. D. C. difficile colitis.
D. C. difficile colitis.
Which of the following is the most likely patient report with anal fissure?
A. “I have anal pain that is relieved with having a bowel movement.”
B. “Even after having a bowel movement, I feel like I still need to ‘go’ more.”
C. “I have anal pain for up to 1–2 hours after I have a bowel movement.”
D. “I itch down there almost all the time.”
C. “I have anal pain for up to 1–2 hours after I have a bowel movement.”
Long term, recurrent high-dose oral use of mineral oil can lead to deficiency in: A. iron. B. vitamin A. C. vitamin C. D. vitamin B12.
B. vitamin A.
Rectal bleeding associated with hemorrhoids is usually described as:
A. streaks of bright red blood on the stool.
B. dark brown to black in color and mixed in with normal-appearing stool.
C. a large amount of brisk red bleeding.
D. significant blood clots and mucus mixed with stool.
A. streaks of bright red blood on the stool.
Therapy for hemorrhoids includes all of the following except: A. weight control. B. low-fat diet. C. topical corticosteroids. D. the use of a stool softener.
B. low-fat diet.
The NP is advising a 58-year-old woman about the benefits of a high-fiber diet. Which of the following foods provides the highest fiber content? A. a small banana B. 1 cup of cooked oatmeal C. a 1/2 cup serving of brown rice D. a medium-size blueberry muffin
B. 1 cup of cooked oatmeal
A 62-year-old man presents with a 2-month history of noting a “bit of dark blood mixed in with my stool most days.” Physical examination reveals external hemorrhoids, no rectal mass, and a small amount of dark brown stool on the examining digit. In-office fecal occult blood test is positive, and hemogram reveals a microcytic hypochromic anemia. The next best step in his care is to:
A. perform in-office anoscopy.
B. advise the patient use sitz baths post bowel movement.
C. refer to gastroenterology practice for colonoscopy.
D. order a double contrast barium enema.
C. refer to gastroenterology practice for colonoscopy.
Risk factors for the development of hemorrhoidal symptoms include all of the following except:
A. prolonged sitting.
B. insertive partner in anal intercourse.
C. chronic diarrhea.
D. excessive alcohol use.
B. insertive partner in anal intercourse.
Which of the following best describes Grade III internal hemorrhoids?
A. The hemorrhoids do not prolapse.
B. The hemorrhoids prolapse upon defecation but reduce spontaneously.
C. The hemorrhoids prolapse upon defecation and must be reduced manually.
D. The hemorrhoids are prolapsed and cannot be reduced manually.
C. The hemorrhoids prolapse upon defecation and must be reduced manually.
Which of the following patients should be evaluated for possible surgical intervention for hemorrhoids?
A. a 28-year-old woman with symptomatic external hemorrhoids who gave birth 6 days ago
B. a 48-year-old man with Grade II internal hemorrhoids and improvement with standard medical therapy
C. a 44-year-old woman who has internal and external hemorrhoids with recurrent prolapse
D. a 58-year-old man who has Grade I internal hemorrhoids and improvement with psyllium supplements
C. a 44-year-old woman who has internal and external hemorrhoids with recurrent prolapse
All of the following are typically noted in a young adult with the diagnosis of acute appendicitis except: A. epigastric pain. B. positive obturator sign. C. rebound tenderness. D. marked febrile response.
D. marked febrile response.
A 26-year-old man presents with acute abdominal pain. As part of the evaluation for acute appendicitis, you order a white blood cell (WBC) count with differential and anticipate the following results:
A. total WBCs, 4500 mm3; neutrophils, 35%; bands, 2%; lymphocytes, 45%.
B. total WBCs, 14,000 mm3; neutrophils, 55%; bands, 3%; lymphocytes, 38%.
C. total WBCs, 16,500 mm3; neutrophils, 66%; bands, 8%; lymphocytes, 22%.
D. total WBCs, 18,100 mm3; neutrophils, 55%; bands, 3%; lymphocytes, 28%.
C. total WBCs, 16,500 mm3; neutrophils, 66%; bands, 8%; lymphocytes, 22%.
You see a 72-year-old woman who reports vomiting and abdominal cramping occurring over the past 24 hours. In evaluating a patient with suspected appendicitis, the clinician considers that:
A. the presentation can differ according to the anatomical location of the appendix.
B. this is a common reason for acute abdominal pain in elderly patients.
C. vomiting before onset of abdominal pain is often seen.
D. the presentation is markedly different from the presentation of pelvic inflammatory disease.
A. the presentation can differ according to the anatomical location of the appendix.
The psoas sign can be best described as abdominal pain elicited by:
A. passive extension of the hip.
B. passive flexion and internal rotation of the hip.
C. deep palpation.
D. asking the patient to cough.
A. passive extension of the hip.
The obturator sign can be best described as abdominal pain elicited by:
A. passive extension of the hip.
B. passive flexion and internal rotation of the hip.
C. deep palpation.
D. asking the patient to cough.
B. passive flexion and internal rotation of the hip.
An 18-year-old man presents with periumbilical pain, vomiting, and abdominal cramping over the past 48 hours. Physical examination reveals rebound tenderness, and laboratory analysis shows the presence of bandemia and a total WBC of 28,000 mm3. To support the diagnosis of acute appendicitis with suspected appendiceal rupture, you consider obtaining the following abdominal imaging study: A. magnetic resonance image (MRI). B. computed tomography (CT) scan. C. ultrasound. D. flat plate.
B. computed tomography (CT) scan.
Which of the following WBC forms is an ominous finding in the presence of severe bacterial infection? A. neutrophil B. lymphocyte C. basophil D. metamyelocyte
D. metamyelocyte
Which of the following best represents the peak ages for occurrence of acute appendicitis? A. 1 to 20 years B. 20 to 40 years C. 10 to 30 years D. 30 to 50 years
C. 10 to 30 years
Clinical findings most consistent with appendiceal rupture include all of the following except:
A. abdominal discomfort less than 48 hours in duration.
B. fever greater than 102°F (>38°C).
C. palpable abdominal mass.
D. marked leukocytosis with total WBC greater than 20,000/mm3.
A. abdominal discomfort less than 48 hours in duration.
Which of the following imaging studies potentially exposes the patient being evaluated for abdominal pain to the lowest ionizing radiation burden? A. ultrasound B. barium enema C. CT scan D. abdominal flat plate
A. ultrasound
Commonly encountered diagnoses other than acute appendicitis can include which of the following in a 28-year-old with a 2-day history of lower abdominal pain and with right-sided pain slightly worse than left? (More than one can apply.) A. constipation B. pelvic inflammatory disease C. ectopic pregnancy D. splenetic infarct
A. constipation
B. pelvic inflammatory disease
C. ectopic pregnancy
Rebound tenderness is best described as abdominal pain that worsens with:
A. light palpation at the site of the discomfort.
B. release of deep palpation at the site of the discomfort.
C. palpation on the contralateral side of the abdomen.
D. deep palpation at the site of the discomfort.
B. release of deep palpation at the site of the discomfort.
Abdominal palpation that yields rebound tenderness is also known as a positive \_\_\_\_\_\_\_ sign. A. Markel’s B. Murphy’s C. Blumberg’s D. Nikolsky’s
C. Blumberg’s
Which of the following findings would you expect to encounter in a 33-year-old man with appendiceal abscess?
A. leukopenia with lymphocytosis
B. positive Cullen’s sign
C. protracted nausea and vomiting
D. dullness to percussion in the abdominal right lower quadrant
D. dullness to percussion in the abdominal right lower quadrant
A 43-year-old woman has a 12-hour history of sudden onset of right upper quadrant abdominal pain with radiation to the shoulder, fever, and chills. She has had similar, milder episodes in the past. Examination reveals marked tenderness to right upper quadrant abdominal palpation. Her most likely diagnosis is: A. hepatoma. B. acute cholecystitis. C. acute hepatitis. D. cholelithiasis.
B. acute cholecystitis.
Which of the following is usually not seen in the diagnosis of acute cholecystitis?
A. elevated serum creatinine
B. increased alkaline phosphatase level
C. leukocytosis
D. elevated aspartate aminotransferase (AST) level
A. elevated serum creatinine
Murphy’s sign can be best described as abdominal pain elicited by:
A. right upper quadrant abdominal palpation.
B. asking the patient to stand on tiptoes and then letting body weight fall quickly onto the heels.
C. asking the patient to cough.
D. percussion.
A. right upper quadrant abdominal palpation.
Which of the following is the most common serious complication of cholecystitis? A. adenocarcinoma of the gallbladder B. gallbladder empyema C. hepatic failure D. pancreatitis
D. pancreatitis
A 58-year-old man reports intermittent right upper quadrant abdominal pain. He is obese and being actively treated for hyperlipidemia. Imaging in a patient with suspected symptomatic cholelithiasis usually includes obtaining an abdominal:
A. magnetic resonance image (MRI).
B. CT scan.
C. ultrasound of the right upper quadrant.
D. flat plate.
C. ultrasound of the right upper quadrant.
Which of the following is most likely to be found in a person with acute cholecystitis? A. fever B. vomiting C. jaundice D. palpable gallbladder
B. vomiting
Risk factors for the development of cholelithiasis include all of the following except: A. rapid weight loss. B. male gender. C. obesity. D. Native American ancestry.
B. male gender.
A gallstone that is not visualized on standard x-ray is said to be: A. radiopaque. B. radiolucent. C. calcified. D. unclassified.
B. radiolucent.
Which of the following is true concerning colorectal cancer?
A. Most colorectal cancers are found during rectal examination.
B. Rectal carcinoma is more common than cancers involving the colon.
C. Early manifestations include abdominal pain and cramping.
D. Later disease presentation often includes iron-deficiency anemia.
D. Later disease presentation often includes iron-deficiency anemia.
According to the American Cancer Society recommendations, which of the following is the preferred method for annual colorectal cancer screening in a 51-year-old man? A. digital rectal examination B. fecal occult blood test C. colonoscopy D. barium enema study
B. fecal occult blood test
Which of the following is most likely to be noted in a person with colorectal cancer? A. gross rectal bleeding B. weight loss C. few symptoms D. nausea and vomiting
C. few symptoms
Which of the following does not increase a patient’s risk of developing colorectal cancer? A. family history of colorectal cancer B. familial polyposis C. personal history of neoplasm D. long-term aspirin therapy
D. long-term aspirin therapy
According to current American Cancer Society data, colorectal cancer is the number \_\_\_\_\_\_\_ cause of cancer death in men and women. A. 1 B. 3 C. 5 D. 7
B. 3
Colonic diverticulosis most commonly occurs in the walls of the: A. ascending colon. B. descending colon. C. transverse colon. D. sigmoid colon.
D. sigmoid colon.
Approximately what percent of the population will develop diverticulosis by the time they reach 50 years of age? A. 10% B. 20% C. 33% D. 50%
C. 33%
Which of the following is most consistent with the presentation of a patient with colonic diverticulosis?
A. diarrhea and leukocytosis
B. constipation and fever
C. few or no symptoms
D. frank blood in the stool with reduced stool caliber
C. few or no symptoms
Which of the following is most consistent with the presentation of a patient with acute colonic diverticulitis?
A. cramping, diarrhea, and leukocytosis
B. constipation and fever
C. right-sided abdominal pain
D. frank blood in the stool with reduced stool caliber
A. cramping, diarrhea, and leukocytosis
Major risk factors for diverticulosis include all of the following except:
A. low-fiber diet.
B. family history of the condition.
C. older age.
D. select connective tissue disorders (e.g., Marfan
syndrome).
A. low-fiber diet.
To avoid the development of acute diverticulitis, treatment of diverticulosis can include: A. avoiding foods with seeds. B. the use of fiber supplements. C. ceasing cigarette smoking. D. limiting alcohol intake.
B. the use of fiber supplements.
The location of discomfort with acute diverticulitis is usually in which of the following areas of the abdomen? A. epigastrium B. left lower quadrant C. right lower quadrant D. suprapubic
B. left lower quadrant
Which of the following best describes colonic diverticulosis?
A. bulging pockets in the intestinal wall
B. poorly contracting intestinal walls
C. strictures of the intestinal lumen
D. flaccidity of the small intestine
A. bulging pockets in the intestinal wall
You are seeing Mr. Lopez, a 68-year-old man with suspected acute colonic diverticulitis. In choosing an appropriate imaging study to support this diagnosis, which of the following abdominal imaging studies is most appropriate? A. flat plate B. ultrasound C. CT scan with contrast D. barium enema
C. CT scan with contrast
In the evaluation of acute diverticulitis, the most appropriate diagnostic approach to rule out free air in the abdomen includes: A. barium enema. B. plain abdominal film. C. abdominal ultrasound. D. lower endoscopy.
B. plain abdominal film.
A 56-year-old woman is diagnosed with mild diverticulitis. In addition to counseling her about increased fluid intake and adequate rest, you recommend antimicrobial treatment with: A. amoxicillin with clarithromycin. B. linezolid with daptomycin. C. ciprofloxacin with metronidazole. D. nitrofurantoin with doxycycline.
C. ciprofloxacin with metronidazole.
Lower gastrointestinal (GI) hemorrhage associated with diverticular disease usually manifests as:
A. a painless event.
B. a condition noted to be found with a marked febrile response.
C. a condition accompanied by severe cramp-like abdominal pain.
D. a common chronic condition.
A. a painless event.
Measures to prevent colonic diverticulosis and diverticulitis include all of the following except:
A. increased whole grain intake.
B. regular aerobic exercise.
C. adequate hydration.
D. refraining from excessive alcohol intake.
D. refraining from excessive alcohol intake.
The gastric parietal cells produce: A. hydrochloric acid. B. a protective mucosal layer. C. prostaglandins. D. prokinetic hormones.
A. hydrochloric acid.
Antiprostaglandin drugs cause stomach mucosal injury primarily by:
A. a direct irritative effect.
B. altering the thickness of the protective mucosal layer.
C. decreasing peristalsis.
D. modifying stomach pH level.
B. altering the thickness of the protective mucosal layer.
A 24-year-old man presents with a 3-month history of upper abdominal pain. He describes it as an intermittent, centrally located “burning” feeling in his upper abdomen, most often occurring 2 to 3 hours after meals. His presentation is most consistent with the clinical presentation of: A. acute gastritis. B. gastric ulcer. C. duodenal ulcer. D. cholecystitis.
C. duodenal ulcer.
When choosing pharmacological intervention to prevent recurrence of duodenal ulcer in a middle-aged man, you prescribe:
A. a proton pump inhibitor (PPI).
B. timed antacid use.
C. antimicrobial therapy.
D. a histamine2-receptor antagonist (H2RA).
C. antimicrobial therapy.
The H2RA most likely to cause drug interactions with phenytoin and theophylline is: A. cimetidine. B. famotidine. C. nizatidine. D. ranitidine.
cimetidine
Which of the following is least likely to be found in a patient with gastric ulcer? A. history of long-term naproxen use B. age younger than 50 years C. previous use of H2RA or antacids D. cigarette smoking
B. age younger than 50 years
Nonsteroidal antiinflammatory drug (NSAID)-induced peptic ulcer can be best limited by the use of: A. timed antacid doses. B. an H2RA. C. an appropriate antimicrobial. D. misoprostol.
D. misoprostol.
Cyclooxygenase-1 (COX-1) contributes to: A. the inflammatory response. B. pain transmission. C. maintenance of gastric protective mucosal layer. D. renal arteriole constriction.
C. maintenance of gastric protective mucosal layer.
Cyclooxygenase-2 (COX-2) contributes to: A. the inflammatory response. B. pain transmission inhibition. C. maintenance of gastric protective mucosal layer. D. renal arteriole dilation.
A. the inflammatory response.
You see a 48-year-old woman who has been taking a cyclooxygenase-2 (COX-2) inhibitor for the past 3 years. In counseling her, you mention that long-term use of COX-2 inhibitors is associated with all of the following except: A. hepatic dysfunction. B. gastropathy. C. cardiovascular events. D. cerebrovascular events.
A. hepatic dysfunction.
A 64-year-old woman presents with a 3-month history of upper abdominal pain. She describes the discomfort as an intermittent, centrally located “burning” feeling in the upper abdomen, most often with meals and often accompanied by mild nausea. Use of an over-the-counter H2RA affords partial symptom relief. She also uses diclofenac on a regular basis for the control of osteoarthritis pain. Her clinical presentation is most consistent with: A. acute gastroenteritis. B. gastric ulcer. C. duodenal ulcer. D. chronic cholecystitis.
B. gastric ulcer.
Which of the following statements about Helicobacter pylori is false?
A. H. pylori is a gram-negative, spiral-shaped bacterium.
B. Infection with H. pylori is the most potent risk factor for duodenal ulcer.
C. The organism is often resistant due to the production of beta-lactamase.
D. H. pylori is transmitted via the oral-fecal or oral-oral route.
C. The organism is often resistant due to the production of beta-lactamase.
The most sensitive and specific test for H. pylori infection from the following list is:
A. stool Gram stain, looking for the offending organism.
B. serological testing for antigen related to the infection.
C. organism-specific stool antigen testing.
D. fecal DNA testing.
C. organism-specific stool antigen testing.
Which of the following medications is a PPI? A. loperamide B. metoclopramide C. nizatidine D. lansoprazole
D. lansoprazole
Peptic ulcer disease can occur in any of the following locations except: A. duodenum. B. stomach. C. esophagus. D. large intestine.
D. large intestine.
An ulcer that is noted to be located in the region below the lower esophageal sphincter and before the pylorus is usually referred to as a(n) \_\_\_\_\_\_\_\_ ulcer. A. duodenal B. esophageal C. gastric D. stomach
C. gastric
A 56-year-old man with a 60 pack-year cigarette smoking history, recent 5-lb unintended weight loss, and a 3-month history of new-onset symptoms of peptic disease presents for care. He is taking no medications on a regular basis and reports drinking approximately six 12-oz beers per week with no more than 3 beers per day. Physical examination is unremarkable except for mild pharyngeal erythema and moderate epigastric tenderness without rebound. The most helpful diagnostic test at this point in his evaluation is a: A. upper endoscopy. B. barium swallow. C. evaluation of H. pylori status. D. esophageal pH monitoring.
A. upper endoscopy.
