Chapter 16: Blood Vessels

Multiple Choice

1. The characteristics of arterial pulses are directly affected by all of the following except: a. the volume of blood ejected. b. peripheral arterial resistance. c. venous valvular competence. d. blood viscosity. e. distensibility of aorta.

ANS: C

Arterial pulses are affected by stroke volume (volume of blood ejected), distensibility of the aorta and large arteries, viscosity of the blood, and peripheral arteriolar resistance. Venous valvular competence contributes to the venous blood flow back to the heart.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

2. The level at which the jugular venous pulse is visible gives an indication of: a. mitral valve efficiency. b. aortic valve efficiency. c. stroke volume. d. left ventricular pressure. e. right atrial pressure.

ANS: E

The level at which the jugular venous pulse is visible indicates right atrial pressure. The jugular veins empty into the superior vena cava, which empties into the right atria. The jugular venous system reflects the competency of the right side of the heart. The other four possible answers reflect the competency of the left side of the heart.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

3. Vascular changes expected in older adults include: a. loss of vessel elasticity. b. decreased peripheral resistance. c. decreased pulse pressure. d. constriction of the aorta and major bronchi. e. increased vasomotor tone.

ANS: A

With age, the walls of the arteries become calcified, and they lose their elasticity and vasomotor tone; therefore, they lose their ability to respond appropriately to changing body needs. Increased peripheral vascular resistance occurs, causing an increas e in blood pressure.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular a. The thumb should never be used to assess pulses. b. Palpate at least one pulse in each extremity, usually the most proximal one. c. The pulses are most readily felt over arteries that lie over bones. d. Extremity pulses do not normally generate waveforms. e. The pads of the fourth and fifth digits of the e a i e ha d a e he sensitive.

4. Which of the following statements is true regarding the examination of peripheral arteries?

ANS: C

The pulses are best palpated over arteries that are close to the surface of the body and lie over bones. The arterial pulses with the digital pads of the second and third fingers. The thumb may also be used if vessels have a tendency to move or roll when palpated by the fingers. Palpate at least one pulse, the most distal pulse, in each extremity to determine the sufficiency of the arterial circulation. Arterial pulses have contour (waveform).

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular a. Femoral b. Radial c. Temporal d. Brachial e. Carotid

5. Which arterial pulse is most useful in evaluating heart activity?

ANS: E

Carotid arteries provide the most easily accessible arterial pulse and are closest to the heart and therefore are most useful in evaluating heart activity.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

6. The term claudication refers to: a. pain from muscle ischemia. b. lack of palpable pulsations. c. visible extremity changes of arterial occlusion. d. numbness and tingling in toes and fingers. e. constriction or narrowing of a vessel.

ANS: A

Claudication is known as pain that results from muscle ischemia. This pain is described as a dull ache with muscle fatigue and can often be accompanied by cramping. It is brought on by sustained exercise and relieved by rest. Individuals with peripheral artery disease experience claudication because of a decrease in the amount of blood passing through the artery as a result of atherosclerosis, which cause the arteries to become narrow. Risk factors for claudication are hypertension, smoking, hyperlipidemia, diabetes, and old age.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

7. Conduction system impairment should be suspected if an irregular heartbeat is: a. galloping. b. paradoxical. c. patternless. d. weak. e. bounding.

ANS: C

A patternless, unpredictable, irregular rate may indicate heart disease or conduction system impairment. A gallop is an abnormal regular heart rhythm with three sounds in each cycle resembling the gallop of a horse. Amplitude of the paradoxical pulse decreases on inspi ration.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular a. Thick, calloused skin b. Ruddy, thin skin c. Warmer temperature of extremity in contrast to other body parts d. Thin atrophied skin e. Full superficial veins with rapid filling

8. You are examining Mr. S, a 79-year-old man with diabetes who is complaining of claudication. Which of the following physical findings is consistent with the diagnosis of arterial insufficiency?

ANS: D

An individual with peripheral artery disease or claudication will have thin skin with localized pallor and cyanosis, a loss of body warmth in the affected area. There may be collapsed superficial veins with delayed filling.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

9. A sound similar to a murmur that is heard over arteries is a: a. thrill. b. hum. c. friction rub. d. bruit. e. heave.

ANS: D

A bruit is the sound of turbulent blood flow auscultated over arteries and heard best with the bell of the stethoscope. Thrills, as well as a heave, are palpated findings. A friction rub is a distinct sound heard when two surfaces are rubbed together as occurs with pericardial or pleural inflammation. Hums are low-pitched sounds associated with the venous system.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

10. In differentiating between an occluded artery or vein, a differentiating sign (present in venous but not arterial occlusion) is: a. color change. b. edema. c. pain with walking. d. pain with palpation. e. paralysis.

ANS: B

Deep vein thrombosis is suspected if swelling, pain, and tenderness occur over a vein. An occluded artery does not cause any swelling (edema). A positive Homan sign indicates venous thrombosis. Paralysis is a rare complication of arterial occlusion.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular a. Supine b. Semi-Fowler c. Upright d. Left lateral recumbent e. Leaning forward

11. T a e a a ie j g la ei , he he h ld fi be laced i hich i i ?

ANS: A

To assess jugular veins, place the patient in supine position. This causes engorgement of the jugular veins. Then gradually raise the head of the bed until the jugular vein pulsating becomes visible between the angle of the jaw and the clavicle. Jugular veins cannot be palpated.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

12. Observation of hand veins can facilitate the assessment of: a. mitral valve competency. b. stoke volume. c. right heart pressure. d. pulse pressure. e. left heart pressure.

ANS: C

Hand veins can be used as an auxiliary manometer of right heart pressure. Assess the hand ei hile he ha d i a he a ie ide. The ai e he ha d il he ei c lla e, a d then use a ruler to measure the vertical distance between the midaxillary line (level of the heart) and the level of the collapsed hand veins.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

13. If pitting edema is unilateral, you would suspect occlusion of a: a. lymphatic duct. b. major vein. c. surface capillary. d. superficial artery. e. deep artery.

ANS: B

If edema is unilateral, you should suspect the occlusion of a major vein. If edema is bilateral, consider congestive heart failure. If edema occurs without pitting, suspect arterial disease and occlusion or lymphedema.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular a. It is an accurate indicator of heart failure. b. It is exaggerated in patients with right heart failure. c. It is normal when patients are sitting up straight. d. It should be absent in older patients with heart failure. e. It never elevates the jugular venous pressure (JVP) in patients without heart

14. Which of the following statements is most accurate in describing hepatic jugular reflux?

ANS: B

Hepatojugular reflux is used to evaluate right heart failure and is exaggerated when right heart failure is present. All patients will have elevation of the JVP with this maneuver, depending on the elevation of their head and their underlying venous pressure. Use your hand and apply firm pressure to the abdomen in the mid-epigastric region while the patient breathes regularly. Observe the neck for increased JVP followed by an abrupt fall in JVP when the hand pressure is released. The JVP quickly returns to its true level between the abdominal hand pressure and the release of the abdominal hand pressure.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

15. A bounding pulse in an infant may be associated with: a. patent ductus arteriosus. b. coarctation of the aorta. c. decreased cardiac output. d. peripheral vaso-occlusion. e. painful, swollen extremities.

ANS: A

A bounding pulse is associated with a large left-to-right shunt produced by a patent ductus arteriosus. A weaker or thinner pulse represents diminished cardiac output or peripheral vasoconstriction. A difference in pulse amplitude between upper extremities or between femoral and radial pulses and absence of the femoral pulse suggests a coarctation of the aorta. Painful, swollen extremities are usually a sign of venous occlusion.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

16. A venous hum heard over the internal jugular vein of a child: a. usually signifies untreatable illness. b. usually has no pathologic significance. c. usually requires surgical intervention. d. must be monitored until the child is grown. e. usually indicates dehydration.

ANS: B

A venous hum is caused by the turbulence of blood flow in the internal jugular veins. A venous hum is common in children and usually has no pathologic significance. To detect a venous hum, auscultate over the right supraclavicular space at the medial end of the clavicle and along the anterior border of the sternocleidomastoid muscle. It is louder during diastole.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

17. In pregnancy, blood pressure is lowest: a. at conception. b. during the first trimester. c. during the second trimester. d. during the third trimester. e. at the time of delivery.

ANS: C

The lowest levels occur in the second trimester and then rise but still remain below prepregnancy levels.

TOP: Discipline: Physiology MSC: Organ System: Cardiovascular

18. A major risk factor for arterial embolic disease is: a. venous thrombosis. b. atrial fibrillation. c. hypotension. d. diuretic therapy. e. constrictive pericarditis.

ANS: B

Atrial fibrillation results in a disturbance of blood flow through the atrium. Blood is not pumped out completely, so it may pool and clot. An embolus can travel throughout the arterial system, causing an occlusion of small arteries and leading to necrosis of the tissue.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

19. In children, coarctation of the aorta should be suspected if you detect: a. a delay between the radial and femoral pulses. b. a simultaneous radial and femoral pulse. c. an absent femoral pulse on the left. d. bilateral absence of femoral pulses. e. equal blood pressures in the arms and legs.

ANS: A

Coarctation of the aorta is a congenital stenosis or narrowing seen most commonly in the descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum. Ordinarily, the radial and femoral pulses are palpated simultaneously. When there is a delay or a palpable diminution of amplitude of the femoral pulse, coarctation must be suspected. Differences in blood pressure taken in the arms and legs should confirm the suspicion.

TOP: Discipline: Pathophysiology MSC: Organ System: Cardiovascular

Chapter 17: Breasts and Axillae Ball: Seidel

Multiple Choice

1. The largest amount of glandular breast tissue lies in the: a. upper inner quadrant. b. lower inner. c. tail of Spence. d. upper outer quadrant. e. lower outer.

ANS: D

The greatest amount of glandular tissue in the breast lies in the upper outer quadrant.

TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive

2. Montgomery tubercles are most prominent in the breasts of: a. men. b. patients with lung disease. c. adolescent girls. d. prepubertal girls. e. pregnant women.

ANS: E

Montgomery tubercles undergo hypertrophy and become more prominent in the breast of pregnant and lactating women.

TOP: Discipline: Physiology MSC: Organ System: Reproductive a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Stage 5

3. Around 75% of women are menstruating by which Tanner stage of breast development?

ANS: D

About one-fourth of women begin menstruation at stage 4. Around 75% are menstruating at stage 4, the stage at which the areola forms a second mound. Some 10% of young women do not begin to menstruate until stage 5.

TOP: Discipline: Physiology MSC: Organ System: Reproductive a. Thickening of the inframammary ridge b. Hypertrophy of glandular tissue c. Increase in number of lactiferous ducts d. Reduction of fat deposits e. Shortening of Cooper s ligaments

4. Which breast change is typical after menopause?

ANS: A

After menopause, the breast tissue atrophies and is replaced by fat deposit, the inframammary ridge at the lower edge of the breast thickens, and the breast hangs more loosel as Cooper s ligaments relax.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

5. In a woman complaining of a breast lump, it is most important to ask about: a. its relationship to menses. b. weight gain. c. sleep patterns. d. immunization status. e. alcohol consumption.

ANS: A

Hormonal changes of menstruation can result in breast tenderness, swelling, and enlarged nodes that can be felt on palpation.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive a. Drinking three glasses of wine per week b. Early menopause c. Nulliparity d. Late menarche e. Young age at birth of first child

6. A 50-year-old woman presents as a new patient. Which finding in her personal and social history would increase her risk profile for developing breast cancer?

ANS: C

Nulliparity or late age at birth of first child (after 30 years old) is a risk factor for breast cancer. Other risk factors include late menopause, early menarche, and drinking more than one alcoholic drink daily.

TOP: Discipline: Biostatistics MSC: Organ System: Reproductive a. Lateral b. Sitting c. Standing d. Supine e. Prone

7. Inspection of the breasts usually begins with the patient in which position?

ANS: B

Inspection begins with the patient in a sitting position with arms hanging loosely at the sides.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

8. In patients with breast cancer, peau d orange skin is often first evident: a. in the axilla. b. in the upper inner quadrant. c. on or around the nipple. d. at the inframammary ridge. e. in the tail of Spence.

ANS: C

The areola is the most common initial site to visuali e peau d orange skin.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

9. A peppering of nontender, nonsuppurative Montgomery tubercles is considered to be a: a. normal finding. b. sign of carcinoma. c. skin disease. d. symptom of malnutrition. e. sign of late menarche.

ANS: A

Montgomery tubercles are the tiny bumps scattered around the areola and are regarded as an expected finding when they are nontender and have no purulent drainage.

TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive

10. Recent unilateral inversion of a previously everted nipple suggests: a. obesity. b. cancer. c. benign breast disease. d. pregnancy. e. mastitis.

ANS: B

Recent unilateral inversion or retraction of a previously everted nipple suggests malignancy rather than a benign condition.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive a. Light areolae b. Nipple inversion c. Retracted areolae d. Supernumerary nipples e. Nipple and areolar colors do not match

11. Which condition is more common in African American women than in white women?

ANS: D

The incidence of supernumerary nipples is higher in African American women than in white women.

TOP: Discipline: Biostatistics MSC: Organ System: Reproductive a. fingertips b. finger pads c. palms of the hands d. ulnar surface of the hands e. thumbs

12. When palpating breast tissue, the examiner should use the _____ at each site.

ANS: B

The finger pads are used for breast palpation because they are more sensitive than the fingertips.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

13. Documentation of a breast mass location is: a. according to illustration, without a narrative. b. according to clock positions from the nipple. c. measured with calipers from the nipple. d. measured in centimeters from the sternal notch. e. measured in centimeters from the axilla.

ANS: B

Documenting a breast mass is described according to clock positions and distance from the nipple, or according to quadrants of the breast. An illustration should appear in the medical record as well.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

14. If a firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40-year-old patient s breast, ou should: a. ask the patient if she has a history of breast cancer. b. refer the patient for biopsy. c. ask the patient to have a mammogram as soon as possible. d. record the finding in the patient s record. e. tell the patient to stop drinking alcohol.

ANS: D

The inframammary ridge thickens and can be felt more easily with age. It is an expected, normal finding without indications for further action.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

15. A 12-year-old boy is being seen because of right-sided breast tenderness. Your examination technique includes inspection and palpation with a finding of swelling and a palpable firm, mobile, pealike mass under the areola. Recommendations to the child and parent are to: a. apply an Ace wrap compression bandage for 6 hours a day. b. return for evaluation in 6 months if the problem persists. c. obtain a surgical referral for needle biopsy. d. discontinue all contact sports. e. administer urine screen for illicit drugs.

ANS: B

Many boys at puberty have unilateral or bilateral subareolar masses, resulting from hormonal changes. Most of these disappear in 6 to 12 months without further intervention. Reassurance to the young man that this is a common occurrence is essential.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

16. To spread the breast tissue evenly over the chest wall, you should ask the woman to lie supine with: a. her arms straight alongside her body. b. both arms overhead with her palms upward. c. her hands clasped just above her umbilicus. d. one arm overhead and a pillow under her shoulder. e. both hands pressed against her hips.

ANS: D

Breast tissue is spread more evenly across the chest wall when the patient raises one arm overhead with a small pillow or rolled towel under that shoulder.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

17. When e amining a illar l mph nodes, the patient s arm is: a. raised full above the head. b. extended at the side. c. pressed against the hip. d. crossed over the chest. e. flexed at the elbow.

ANS: E

To e amine the a illa, support the patient s lower arm with the elbow fle ed with one of our hands and use your other hand to palpate the axilla.

TOP: Discipline: Physiology MSC: Organ System: Reproductive

18. Lymphatic flow of the breast primarily drains: a. inferiorly toward the abdomen. b. laterally toward the corresponding arm. c. radially. d. medially toward the sternum. e. inferomedially toward the xiphoid.

ANS: C

Each breast contains a lymphatic network that drains the breast radially and deeply to underlying lymphatics.

TOP: Discipline: Gross Anatomy MSC: Organ System: Reproductive

19. You are performing a clinical breast examination for a 55-year-old woman. While palpating the supraclavicular area, you suspect that you felt a node. To improve your hooked technique, you should: a. apply lotion to your hands. b. use both hands simultaneously. c. ask the patient to press both palms together. d. ask the patient to lower her shoulder on that side. e. ask the patient to turn her head toward that side.

ANS: E

Having the patient turn her head toward the examination side, as well as raising the shoulder on that same side, gives your fingers more room to palpate deeper into the fossa.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

20. Male gynecomastia associated with recreational or prescription drug use can be expected to: a. lessen when the body becomes accustomed to the drug. b. resolve after the drug is discontinued. c. leave permanent breast enlargement when the drug is discontinued. d. cause purulent drainage if left untreated. e. lead to an increased risk of breast cancer.

ANS: B

Gynecomastia associated with illicit or prescription drug use (antihypertensive, estrogens, or steroids) usually resolves after the offending drug is discontinued and does not require further intervention.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

21. A nursing mother complains that her breasts are tender. You assess hard, shiny, and erythremic breasts bilaterally. You should advise the patient to: a. massage gently and continue nursing. b. apply warm compresses and stop nursing. c. monitor her temperature and restrict fluids. d. sleep with a bra and wash her breasts with antibacterial soap. e. stop nursing and restrict fluids.

ANS: A

This patient has engorged breasts. The aim of treatment is to promote breast drainage. Stopping nursing will increase the risk that a breast infection will turn into a breast abscess. The other choices do not encourage breast milk flow. Only mild soaps are advised; harsh soaps can dry and crack the nipple and compound infection.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

22. You are conducting a clinical breast examination for a 30-year-old patient. Her breasts are symmetrical with bilateral, multiple tender masses that are freely movable with well -defined borders. You recognize that these symptoms and assessment findings are consistent with: a. fibroadenoma. b. Paget disease. c. cancer. d. mammary duct ectasia. e. fibrocystic changes.

ANS: E

Fibrocystic changes are tender masses, usually bilateral, with multiple round, mobile, well-delineated borders. Fibroadenoma and cancer are usually nontender; Paget disease is an eczema-like condition of the nipple that signals an underlying cancer. Mammary duct ectasia most commonly occurs in menopausal women.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

23. Your patient is a nursing mother who asks you to look at a mole she has under her left breast at the inframammary fold. The mole is nontender and soft and has grown in size since she started nursing. There are no other changes to the mole. This mole probably represents an undiagnosed: a. retention cyst. b. case of Paget disease. c. supernumerary nipple. d. fat necrosis. e. Montgomery tubercle.

ANS: C

Supernumerary nipples appear as one or more extra nipples located along the embryonic mammar ridge (the milk line ). These nipples and areolae ma be pink or brown, are usually small, and are commonly mistaken for moles. Infrequently, some glandular tissue may accompany these nipples.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

24. All of the following are true statements about the risks of Breast Cancer Screening except: a. risk of false-positive results. b. possible pain from testing. c. possibility of adverse psychologic responses. d. there is little evidence that breast cancer screening reduces mortality. e. overdiagnosis of lesions that would not become clinically significant.

ANS: D

While breast cancer screening is beneficial in r educing mortality, it also carries potential harms. Potential harms include false-positive and false-negative results, additional testing and biopsies, overdiagnosis (diagnosis of lesions that would not become clinically significant) and subsequent treatment, pain from testing, and adverse psychologic responses.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive a. 24 to 50 b. 35 to 49 c. 50 to 74 d. 65 to 84 e. Over age 75

25. Most of the benefit of mammography screening occurs in which age group?

ANS: C

Breast cancer mortality is reduced with mammography screening, although estimates are of borderline statistical significance, the magnitudes of effect are small for younger ages, and results vary depending on how cases were accrued in trials. Most of the benefits of mammography results from screening during ages 50 to 74 years. There are insufficient data to assess the benefits and harms of screening women age 75 years or older.

TOP: Discipline: Pathophysiology MSC: Organ System: Reproductive

Multiple Choice

1. Peristalsis of intestinal contents is under the control of: a. cognitive processes. b. gravity. c. the autonomic nervous system. d. the fluid content of the stomach. e. cerebellum.

ANS: C

The movement of food and digestive products is regulated by the autonomic nervous system.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

2. The superior most part of the stomach is the: a. body. b. fundus. c. pylorus. d. cardiac orifice. e. pyloric orifice.

ANS: B

The most superior aspect of the stomach is the fundus, followed by the body, and then the most distal part, the pylorus.

TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal

3. The appendix is an extension of the: a. ileum. b. cecum. c. ascending colon. d. transverse colon. e. descending colon.

ANS: B

The appendix is a blind-ended tube connected to the cecum, the site of the beginning of the large intestine, located in the right lower quadrant of the abdomen. It develops embryologically from the cecum.

TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal

4. One major function of the liver is to: a. secrete pepsin. b. emulsify fats. c. store glycogen. d. absorb bile. e. produce insulin.

ANS: C

The liver plays a metabolic role; it converts glucose to glycogen, stores it, and then converts glycogen back to glucose as needed by the body.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

5. The majority of nutrient absorption takes place in the: a. stomach. b. small intestine. c. cecum. d. transverse colon. e. descending colon.

ANS: B

Very little absorption takes place in the stomach; most absorption takes place in the small intestine. The cecum and transverse colon are part of the large intestine, and its major function is water reabsorption.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

6. The major function of the large intestine is: a. water absorption. b. food digestion. c. carbohydrate absorption. d. mucous absorption. e. glycogen breakdown.

ANS: A

The major function of the large intestine is the absorption of water and excretion of solid waste material in the form of stool. Mucous glands secrete large quantities of alkaline mucus.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

7. Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the: a. spleen. b. kidney. c. liver. d. pancreas. e. gallbladder.

ANS: C

The liver is responsible for converting fat-soluble waste to water-soluble materials so the kidneys can excrete them as well as convert ammonia to urea.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal a. Kidney and liver b. Liver and gallbladder c. Stomach and spleen d. Gallbladder and pancreas e. Pancreas and kidney

8. Which abdominal organs also produce hormones and function as endocrine glands?

ANS: E

The pancreas produces pancreatic juices as well as insulin and glucagon; the kidneys produce urine as well as the hormones rennin and erythropoietin.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

9. Mrs. G is 7 months pregnant and states that she has developed a problem with constipation. She eats a well-balanced diet and is usually regular. You should explain that constipation is common during pregnancy because of changes in the colorectal areas, such as: a. decreased movement through the colon and increased water absorption from stool. b. increased movement through the colon and increased salt taken from foods. c. looser anal sphincter and less nutrients taken from foods. d. tighter anal sphincter and less iron eliminated in the stool. e. increased absorption of nutrients and water in the colon.

ANS: A

Constipation and flatus are more common during pregnancy because the colon is displaced, peristalsis is decreased, and water absorption is increased. The colon does not absorb nutrients, and a tighter sphincter tone is not related to pregnancy.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

10. The most pronounced functional change of the gastrointestinal (GI) tract in older adults is: a. decreased hydrochloric acid production. b. increased motility. c. decreased bile absorption. d. decreased motility. e. increased saliva secretion.

ANS: D

A decrease in motility of the gastrointestinal (GI) tract is the most pronounced GI change in older adults.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

11. The family history of a patient with diarrhea and abdominal pain should include inquiry about cystic fibrosis because it: a. only affects the GI tract. b. is one cause of malabsorption syndrome. c. is a curable condition with medical intervention. d. is the most frequent cause of diarrhea in general practice. e. is a common genetic disorder.

ANS: B

Cystic fibrosis is an uncommon, chronic genetic disorder affecting multiple systems. In the gastrointestinal tract, it causes malabsorption syndrome because of pancreatic lipase deficiency. Steatorrhea and abdominal pain from increased gas production are f requent concerns.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

12. Infants born weighing less than 1500 g are at higher risk for: a. hepatitis A. b. necrotizing enterocolitis. c. urinary urgency. d. cystic fibrosis. e. pancreatitis.

ANS: B

Necrotizing enterocolitis is a gastrointestinal disease that mostly affects premature infants; it involves infection and inflammation that causes destruction of the bowel, and it becomes more apparent after feedings. Low birth weight does not relate to the development of hepatitis

A, urinary urgency, cystic fibrosis, or pancreatitis.

TOP: Discipline: Biostatistics MSC: Organ System: Gastrointestinal a. Bladder b. Cecum c. Gallbladder d. Stomach e. Liver

13. Which structure is located in the hypogastric region of the abdomen?

ANS: A

The hypogastric (pubic) area contains the ileum, the bladder, and the pregnant uterus.

TOP: Discipline: Gross Anatomy MSC: Organ System: Gastrointestinal

14. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient: a. hold his or her breath. b. sit upright. c. flex his or her knees. d. raise his or her head off the pillow. e. fully extend the legs.

ANS: C

To help relax the abdominal musculature, it is helpful to place a small pillow under the patient s head and under slightl fle ed knees. The other choices increase muscle fle ion.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

15. You ask the patient to raise the head and shoulders while lying in a supine position. A midline abdominal ridge rises. You chart this observation as a(n): a. small inguinal hernia. b. large epigastric hernia. c. abdominal lipoma. d. diastasis recti. e. incisional hernia.

ANS: D

A diastasis recti occurs when abdominal contents bulge between two abdominal muscles to form a midline ridge as the head is lifted. It has little clinical significance and most often occurs in repeated pregnancies and obesity.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal a. Cushing disease b. Diastasis recti c. Liver cirrhosis d. Recent pregnancy e. Intraabdominal bleeding

16. What condition is associated with striae that remain purplish?

ANS: A

Striae from pregnancy or obesity begin as a pink or purple color then turn silvery white; striae associated with Cushing disease stay purplish.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

17. Visible intestinal peristalsis may indicate: a. normal digestion. b. intestinal obstruction. c. increased pulse pressure of aorta. d. aortic aneurysm. e. paralytic ileus.

ANS: B

Peristalsis is not usually visible and when detected may indicate an intestinal obstruction.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

18. After thorough inspection of the abdomen, the next assessment step is to: a. percuss. b. palpate nonpainful areas. c. auscultate. d. perform a rectal examination. e. palpate painful areas.

ANS: C

Assessment of the abdomen begins with inspection followed by auscultation. This break from the usual system examination sequence is because palpation and percussion can alter the frequency as well as the intensity of bowel sounds. Therefore, auscultation i s done first.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

19. Peritonitis often produces bowel sounds that are: a. decreased. b. increased. c. high pitched. d. absent. e. accentuated.

ANS: A

Decreased bowel sounds occur with peritonitis and paralytic ileus.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

20. An examiner can recognize a friction rub in the liver by a sound that is: a. clicking, gurgling, and irregular. b. high pitched and associated with respirations. c. loud, prolonged, and gurgling. d. soft, low-pitched, and continuous. e. low pitched, tinkling, and unrelated to respirations.

ANS: B

An abdominal friction rub is rare and can be identified when high-pitched sounds are auscultated in association with respirations.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

21. To correctly document absent bowel sounds, one must listen continuously for: a. 30 seconds. b. 1 minute. c. 3 minutes. d. 5 minutes. e. 10 minutes.

ANS: D

Absent bowel sounds are confirmed after listening to each quadrant for 5 minutes.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal a. Arterial bruit b. Gastric rumbling c. Renal hyperresonance d. Borborygmi e. Venous hum

22. When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous systems?

ANS: E

Venous hum is associated with blood flow in venous collaterals found in portal hypertension. Aortic bruit occurs during systole, and a venous hum is a continuous sound and softer than a bruit. The other choices are not vascular sounds.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

23. Percussion of the abdomen begins with establishing: a. liver dullness. b. spleen dullness. c. gastric bubble tympany. d. overall dullness and tympany in all quadrants. e. bladder fullness.

ANS: D

Percussion begins with a general establishment over all quadrants for areas of dullness and tympany and then proceeds to specific target organs.

TOP: Discipline: Physiology MSC: Organ System: Gastrointestinal

24. An umbilical assessment in the newborn that is of concern is: a. a thick cord. b. an umbilical hernia. c. one umbilical artery and two veins. d. pulsations superior to the umbilicus. e. visible nondistended superficial veins.

ANS: C

What is expected is two arteries and one vein. A single umbilical artery indicates the possibility of congenital anomalies. A thick cord suggests a well-nourished fetus, an umbilical hernia will generally spontaneously close by 2 years, and pulsations to the abdomen in the epigastric area are common. Nondistended superficial veins are usually visible in thin infants.

TOP: Discipline: Embryology MSC: Organ System: Gastrointestinal

25. Failure to pass a meconium stool in the first 24 hours after birth along with abdominal distention is often the first sign of: a. Meckel diverticulum. b. cystic fibrosis. c. biliary atresia. d. hydramnios. e. Wilms tumor.

ANS: B

Meconium ileus is often the first manifestation of cystic fibrosis or Hirschsprung disease.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal a. Positive psoas sign b. Positive McBurney sign c. History of periumbilical pain d. Rebound tenderness e. Obturator muscle test

26. A patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course?

ANS: E

Psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the right lower quadrant are signs of appendicitis. Conditions that cause irritation of the obturator muscle are late findings usually associated with a ruptured appendix or pelvic abscess.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

27. Flatulence, diarrhea, dysuria, and tenderness with abdominal palpation are findings most associated with: a. peptic ulcer disease. b. pancreatitis. c. ruptured ovarian cyst. d. splenic rupture. e. diverticulitis.

ANS: E

No choice other than diverticulitis has all of these presenting symptoms.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

28. A 45-year-old man relates a several-week history of severe intermittent abdominal burning sensations. He relates that the pain is relieved with small amounts of food. Before starting the physical examination, you review his laboratory work, anticipating a(n): a. elevated white blood cell count. b. decreased potassium level. c. positive Helicobacter pylori result. d. increased urine specific gravity. e. folate deficiency.

ANS: C

The patient s presenting s mptoms suggest peptic ulcer disease. The supporting laborator finding is the presence of H. pylori.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

29. Costovertebral angle tenderness should be assessed whenever you suspect the patient may have: a. cholecystitis. b. pancreatitis. c. pyelonephritis. d. ulcerative colitis. e. intussusception.

ANS: C

Pyelonephritis is characterized by flank pain and costovertebral angle tenderness.

TOP: Discipline: Pathophysiology MSC: Organ System: Renal/Urinary

30. The most common congenital anomaly of the gastrointestinal tract is: a. biliary atresia. b. meconium ileus. c. intussusception. d. Meckel diverticulum. e. pyloric stenosis.

ANS: D

Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract.

TOP: Discipline: Embryology MSC: Organ System: Gastrointestinal a. Intussusception b. Kidney stones c. Meconium ileus d. Pyloric stenosis e. Necrotizing enterocolitis

31. Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A sausage-shaped mass is palpable in his right upper quadrant. Joe s lower quadrant feels empt , and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Bab Joe s s mptoms?

ANS: A

Intussusception refers to the prolapse of one segment of the intestine into another causing intestinal obstruction. Whereas a sausage-shaped mass may be palpated in the right or left upper quadrant, the lower quadrant feels empty (positive Dance sign); it commonly occurs between 3 and 12 months of age.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

32. In older adults, overflow fecal incontinence is commonly caused by: a. malabsorption. b. parasitic diarrhea. c. Meckel diverticulum. d. fistula formation. e. fecal impaction.

ANS: E

Constipation with overflow occurs when the rectum contains hard stool and soft feces above leak around the mass of stool.

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal

33. Given the high certainty that screening results in reduced mortality, current recommendations include screening for colorectal cancer beginning at age 50 and continuing until age: a. 65. b. 70. c. 75. d. 80. e. 85.

ANS: C

In 2016 the U.S. Preventive Services Task Force (USPSTF) updated its previous recommendations based on a review of the evidence assessing both benefits and harms of screening. Given the high certainty that screening results in reduced mortality, the USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. Screening for colorectal cancer in adults ages 76 to 85 years should be an individual one, taking into account the patient s overall health and prior screening histor .

TOP: Discipline: Pathophysiology MSC: Organ System: Gastrointestinal