MN551 ADVANCED PATHOPHYSIOLOGY FINAL EXAM

MN551 ADVANCED PATHOPHYSIOLOGY FINAL EXAM
1. A 35yearold female patient is seen in the clinic complaining of abdominal pain. Which of the
following should be included in the history and physical exam?
Digital rectal exam
Pelvic exam
Sexual history
All of the above
Hiatal hernia – protrusion of the stomach or regurgitation of the stomach contents into the
esophagus
2. A patient is seen in the office and is complaining of constipation. The patient lists all of the
following medications. Which drug could be responsible for the constipation?
Multivitamin
Magnesium hydroxide
PeptoBismol
Ibuprofen
3. A patient with complaints of diarrhea is seen. Which of the following should be included
on the differential diagnosis list for a patient with diarrhea?
Gastroenteritis
Inflammatory bowel disease
Lactase deficiency All
of the above
4. Mr. J. K., 38 years old, is 5 feet 8 inches tall and weighs 189 pounds. He reports that he
has had intermittent heartburn for several months for which he takes Tums with temporary
relief. He has been waking during the night with a burning sensation in his chest. Which
additional information would lead you to believe that gastroesophageal reflux disease (GERD) is
the cause of his pain?
The pain seems better when he smokes to relieve his nerves.
Coffee and fried foods do not bother him.
He awakens at night coughing with a bad taste in his mouth. All of
the above
5. A 29yearold Englishman is seen in the office with complaints of pain in his chest and belly for
2 weeks. He gets temporary relief from Alka Seltzer. The burning pain wakes him at night and
radiates up into his chest. Which factor favors a diagnosis of gastric ulcer? Pg 1181
His gender
His age
His use of Alka Seltzer
6. Which of the following is most effective in diagnosing appendicitis? Pg 1193
History and physical
Sedimentation rate Kidneys, ureter, bladder (KUB) radiograph
Complete blood cell (CBC) count with differential (note: there is not always and elevated WBC
count)
7. Which of the following is associated with celiac disease (AKA celiac sprue or glutensensitivity
enteropathy)? Pg 1199
Malabsorption
Constipation
Rectal bleeding
Esophageal ulceration
8. A 45yearold patient presents with a chief complaint of generalized abdominal pain. Her
physical exam is remarkable for left lower quadrant (LLQ) tenderness. Which of the following
should be considered in the differential diagnosis at this time? Pg 1192
Endometriosis
Colon cancer
Diverticulitis
All of the above
9. A 46yearold female is seen in the clinic with abdominal pain. Which of the following tests is
essential for this patient?
Complete blood cell (CBC) count with differential
Urine hCG
Barium enema
Computed tomography (CT) of the abdomen
10. A 25yearold accountant is seen in the clinic complaining of crampy abdominal pain after
meals. She is often constipated and takes laxatives. Following this, she has diarrhea for a couple
of days. She temporarily feels better after a bowel movement. She states she is embarrassed by
flatulence and has abdominal distension. She has had no weight loss or blood in her stool. This
problem has gone on for about 6 months. What should the next step be?
Obtain a complete history.
Order a barium enema.
Schedule a Bernstein’s test. (tests esophageal function)
Prescribe a trial of antispasmodics. 
11. A 28yearold patient is seen in the clinic with colicky abdominal pain, particularly with
meals. She has frequent constipation, flatulence, and abdominal distension. Which of the data
make a diagnosis of diverticulitis unlikely? Pg 1192-1193
Her age (typically seen by age 60)
Frequent constipation (common with diverticulitis)
Flatulence (common with diverticulitis)
Colicky abdominal pain
12. A 28yearold patient is seen with complaints of diarrhea. Which of the following
questions would help the clinician establish the diagnosis of irritable bowel syndrome? Pg 1184
Feels relief after a bowel movement
Sometimes is constipated
Does not defecate in the middle of the night
All of the above
13. A patient is diagnosed with gastroesophageal reflux disease (GERD), and his endoscopic
report reveals the presence of Barrett’s epithelium. Which of the following information should
the clinician include in the explanation of the pathology report? Pg 1175
This is a premalignant tissue.
This tissue is resistant to gastric acid.
This tissue supports healing of the esophagus.
All of the above
14. Which of the following dietary information should be given to a patient with
gastroesophageal reflux disease (GERD)?
Eliminate coffee.
Drink peppermint tea to relieve stomach distress.
Recline and rest after meals.
Limit the amount of antacids.
Notes: Proton pump inhibitors, avoiding large meals, and remaining upright after meals helps
with GERD.
15. The patient with gastroesophageal reflux disease (GERD) should be instructed to
eliminate which of these activities?
Swimming
Weight lifting
Golfing
Walking
16. A patient is diagnosed with Giardia (protozoan infection) after a backpacking trip in the
mountains. Which of the following would be the appropriate treatment?
Vancomycin
Penicillin
Metronidazole Bactrim
17. A 22yearold is seen complaining of vague belly pain. This type of pain is seen at what point
in appendicitis? Pg 1193
Very early
3 to 4 hours after perforation
Late in inflammation
Appendicitis never presents with vague pain. 

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