Gastrointestinal 2010

Minimum Passing Grade: 75%

There are 50 questions in this exam. You have 1 hour to finish the exam. There are
4 gastrointestinal questions in the NPTE. 1 questions for Clinical Application, 0 for
Examination, 2 for Differential Diagnosis, 1 for Intervention.

Time Allowed for Exam: 1 hrs 0 mins

1. A patient is unable to take adequate supply of nutrients by mouth due to the side
effects of radiotherapy. As a result, the patient's physician orders the implementation of
tube feeding. What type of tube is most commonly used for short term feeding?

a) Endobronchial
b) Nasogastric
c) Otopharyngeal
d) Tracheotomy

2. A physical therapist attempts to estimate the energy expenditure in calories for a

patient performing a selected activity for fifteen minutes. Assuming the therapist has a
metabolic equivalent value for the activity, what other variables are necessary in order to
obtain estimate of the patient’s energy expenditure?

a) Patient’s height and weight

b) Patient’s weight and oxygen consumption.
c) Patient’s stroke volume and heart rate.
d) Patient’s residual and volume and heart rate.

3. A female patient is referred to physical therapy. She has diabetes mellitus and
morbidly obese.The therapist notices the patient's breath has a very distinctive fruity
odor. The patient complains of feeling nauseus and weak. An entry in the medical record
indicates that the patient had diarrhea during the night. This type of scenario is most
consistent with:

a) respiratory acidosis
b) respiratory alkalosis
c) metabolic acidosis
d) metabolic alkalosis

4. A female patient is admitted with belly pain, constipation and diarrhea. The patient is
diagnosed with irritable bowel syndrome. What are the symptoms associated with
irritable bowel syndrome ?

a) Rapid weight gain

b) Headaches and blurred vision
c) Flatulence, nausea, loss of appetite
d) Increased urine output
5. Mrs Dunn who has a history of irritable bowel syndrome, is seen by the physician for
exacerbation of her condition. What is the age of onset for irritable bowel syndrome ?

a) <30
b) >30
c) <40
d) >40

6. A 46 year-old male come to your clinic with a diagnosis of pancreatitis. The patient
complaines of severe abdominal pain, nausea, vomiting and fever. The patient's diet
should consist of:

a) High carbohydrate
b) High fat content
c) No Lactose
d) High protein

7. Mary Jones presents with abdominal pain just below the rib cage. Endoscopy of the
patient reveals a gastric ulcer. What other symptoms will the patient present?

a) blood present in the vomit

b) Hypertension
c) Headaches
d) Diarrhea

8. Steven Ball presents with continuous heartburn and regurgitation. The physician
recommended Barium swallow and x-rays. Results revealed gastroesophageal reflux.
What causes this condition?

a) Hiatus hernia
b) Poor diet
c) Alcohol
d) Weight

9. Today the patient s/p 5 days post op is complaining of back and groin pain of 7/10
when lying in bed or sitting. The pain is 5/10 when standing. He is currently taking pain
medications (Opiod). What is a common side effect of this drug?

a) Dizziness
b) Diarrhea
c) Constipation
d) Drowsiness

10. Mrs. Stone presents with nausea , cramps and bloating gas. The physician orders a
lactose tolerance test. Which mineral will the patient need if she is lactose intolerant?

a) Proteins
b) Calcium
c) Carbohydrates
d) Fats
11. Your patient suffers from gastric contents reflux into the esophagus. What is your
best course of action?

a) Scheduling therapy immediately after eating

b) Scheduling therapy at least 30 minutes after eating
c) Scheduling therapy at least 60 minutes after eating
d) Scheduling therapy at least 90 minutes after eating

12. You are treating a patient with duodenal problems. You know that the duodenum is
in the lower gastrointestinal tract. What is its recognized function of this organ?

a) Absorbs water, electrolytes and nutrients

b) Neutralizes acid in food from stomach and mixes pancreatic and biliary
secretions with food.
c) Absorbs bile and intrinsic factors to be recycled.
d) Stores and eliminates food.

13. Annie Sims is diagnosed with anorexia nervosa. What is the main cause of this
condition ?

a) Low esteem
b) Bullying
c) Changes in brain structure
d) Depression

14. Your patient complains of epigastric pain and heartburn. He was diagnosed with
peptic ulcer disease. What can cause this disease?

a) Particular medicines
b) Poor diet
c) Constipation
d) Obesity

15. Steven presents with pain and tenderness located on the left side of the lower
abdomen. In a complicated diverticulitis, what other structures can be affected?

a) Abdominal ascites
b) Peritonitis
c) Urine retention
d) Nausea

16. Diverticulitits is a condition of inflamed or infected diverticula. What is the percentage

of population for this disease to occur in people over 40 years of age ?

a) 5%
b) 10%
c) 15%
d) 20%
17. Mr. Brown presents with steady pain in the right upper abdomen that increases
rapidly and lasts from 30 minutes to several hours. Which population are at an increased
risk for this condition?

a) American Indians
b) Afro Caribbean
c) Chinese
d) Italians

18. A patient presents with left upper quadrant and abdominal pain. Based on your
patient's complaints, which among the conditions below will be your clinical diagnosis?

a) Duodenal ulcer.
b) Perforated colon.
c) Appendicitis.
d) Intestinal obstruction.

19. A female presents to her physician with right upper quadrant pain, nausea. vomiting,
low grade fever and pain under the scapula. What condition do you suspect this patient
has?

a) Cholecystitis.
b) Kidney stone.
c) Urethral stone.
d) Intestinal obstruction.

20. Your patient was diagnosed with gall stones. How would you describe gall stones?

a) Small pebble like substances that develop in the gall bladder.

b) cholesterol crystalline material.
c) One stone, that obstructs the common bile duct.
d) Small dark stone made of bilirubin.

21. Which condition can lead to toxemia and shock, circulatory failure and respiratory
distress?

a) Appendicitis
b) Diverticular disease
c) Crohn’s disease
d) Peritonitis

22. A 45 year old female developed a bronchopneumonia with Streptococcus

pneumoniae and died after a week in the hospital, despite antibiotic therapy. According
to the autopsy, there is cirrhosis of the liver. What caused this patient's condition?

a) Hepatitis B
b) Chronic alcoholism
c) Oral contraceptive
d) Colon Cancer
23. What are the key points of examination for gastrointestinal dysfunction?

a) Blood work : bilirubin

b) Hemoglobin
c) Hematocrit
d) Serum sodium

24. Mary Jones presents with constipation. The physician examines the patient and
found that the stomach was impacted with feces. What would be the appropriate course
of action ?

a) laxatives
b) Anti-inflammatory
c) Antifungal
d) Antidepressant

25. Mrs Jules has been diagnosed with anemia. She complains of fatigue and weight
loss. The physician wants to confirm if this patient has malabsorption syndrome. Which
test will confirm this diagnosis?

a) Fasting Blood Sugar

b) Serum cholesterol
c) Blood gases
d) Hematocrit

26. Simon was diagnosed with rectal cancer. What is the most appropriate treatment for
his condition?

a) Surgical resection of the tumor

b) Laparotomy
c) Palliative treatment
d) Medication

27. Your patient presents with pain in the stomach and blood in his stools. The physician
diagnosed Colorectal cancer. What causes this condition ?

a) History of polyps
b) Stomach ulcers
c) Gastric reflux
d) Gastritis

28. A 36 year old woman has an elevated serum lipase. The pancreas is edematous,
with areas of hemorrhagic necrosis.What is the most probable etiology for this process:

a) Diabetes Mellitus
b) Gallstones
c) Cytomegalovirus infection
d) Cystic Fibrosis
29. John presents to the physician with flu like symptoms. After tests are complete, the
patient has hepatitis A confirmed. What is the mode of transmission?

a) Ingestion of fecal matter, even in microscopic amounts, from close person-to-

person contact or ingestion of contaminated food or drinks.
b) Contact with infectious blood, semen, and other body fluids from having sex with
an infected person, sharing contaminated needles to inject drugs, or from an
infected mother to her newborn.
c) Contact with the blood of an infected person, primarily through sharing
contaminated needles to inject drugs.
d) Contact with infectious blood, similar to how HBV is spread.

30. Brian, a 38 year old male patient, comes in for treatment of Hepatitis B
immunoglobulin ( HBIG ). What are the known causes of this condition ?

a) Intercourse with an infected person.

b) Contaminated food or drink
c) Contaminated water
d) Close contact with someone who has the infection.

31. Surgery is performed on a middle aged woman, with removal of the gall bladder.
Which of the following factors is LEAST likely to increase the risk for gall stone
formation?

a) Pregnancy
b) Cytomegalovirus infection
c) Native American ancestry
d) Increasing age

32. Bill, an alcoholic. was diagnosed with cirrhosis of the liver. What is the etiology of this
condition ?

a) Anorexia nervosa
b) Hepatitis C
c) Gastritis
d) Gall stones

33. Harry presents with weight loss and jaundice. The physician diagnosed him to have
pancreatic cancer. What is the percentage of fatality for this condition?

a) 25%
b) 50%
c) 75%
d) 100%
34. Joan presents with pain in the right upper quadrant pain. She is otherwise
asymptomatic. The physician diagnosed her to have cholecystitis. What is the best
recommended treatment for this condition ?

a) Surgery
b) Low fat diet
c) High in protein
d) Medication

35. A 42 year old male has had episodes of substernal burning pain following meals. He
has no nausea or vomiting. A stool guaiac is negative. An upper endoscopy is
performed, and there are regions of the lower esophagus that appear erythematous. The
most likely etiology for this finding is:

a) Gastroesophageal reflux disease

b) CREST syndrome
c) Chronic alcoholism
d) Corticosteroid therapy

36. A 41 year old male has had epigastric pain for several weeks. He tries over-the-
counter antacid medications, but the pain persists. Which of the following factors
contributed most to the development of his duodenal ulcer?

a) A high fat, low fiber diet

b) Infection with Helicobacter pylori
c) Calcium carbonate containing agents
d) Chronic alcoholism

37. A 54 year old male complains of abdominal pain, fever, and diarrhea. His hospital
stay was marked by persistent pneumonia requiring broad spectrum antibiotic therapy.
What condition did this patient develop?

a) Acute infarction
b) Colitis
c) Candidiasis
d) Crohn's disease

38. Mary Stone, a 70 year-old patient, is diagnosed with a gastric ulcer. She was
prescribed with an antibiotic. What is the most recognized antibiotic for this condition?

a) Penicillin
b) Metronidazole
c) Ampicillin
d) Oxytetracycline
39. A 24 year old man has experienced lower abdominal pain for about a day. When
examined in the emergency room, palpation of the abdomen reveals no masses, and
bowel sounds are still present. He has pain most localized to the right lower quadrant,
along with rebound tenderness. What condition does this patient have?

a) Crohn's disease
b) Acute appendicitis
c) Cirrhosis of the liver
d) Hepatitis A

40. A 41-year-old man has a history of drinking 1 to 2 liters of whisky per day for the past
20 years. He has had numerous episodes of nausea and vomiting in the past 5 years.
He now experiences a bout of prolonged vomiting, followed by massive hematemesis.
On physical examination his vital signs are T 36.9 C, P 110/min, RR 22/min, and BP
80/40 mm Hg lying down. His heart has a regular rate and rhythm with no murmurs and
his lungs are clear to auscultation. There is no abdominal tenderness or distension and
bowel sounds are present. His stool is negative for occult blood. Which of the following is
the most likely diagnosis?

a) Esophageal laceration
b) Hiatal hernia
c) Cirrhosis of the liver
d) Hepatitis C

41. A 50-year-old man has had persistent nausea for 5 years with occasional vomiting.
On physical examination there are no abnormal findings. He undergoes an upper GI
endoscopy, and a small area of gastric fundal mucosa has loss of rugal folds. Biopsies
are taken and microscopically reveal well-differentiated adenocarcinoma confined to the
mucosa. An upper GI endoscopy performed 5 years previously showed a pattern of
gastritis and microscopically there was chronic inflammation with the presence of
Helicobacter pylori. Which of the following interpretations is most applicable to his
neoplasm?

a) A 5-year survival following resection of >90%

b) Metastases limited to regional lymph nodes
c) A high prevalence in the United States
d) Survival rate of 10% after 2 years

42. A patient is admitted to the hospital with oesophageal variceal bleeding. How is this
condition monitored?

a) 30minutes - hour monitoring of heart rate and blood pressure

b) 1-2 hourly monitoring of heart rate and blood pressure
c) 1-4 hourly monitoring of heart rate and blood pressure
d) 4 2- 4 hourly monitoring of heart rate and blood pressure
43. A 58-year-old man has had increasing difficulty swallowing for the past 6 months and
has lost 5 kg. No abnormal physical examination findings are noted. Which of the
following is the most likely risk factor for development of his disease?

a) Chronic alcoholism
b) Iron deficiency
c) High sugar diet
d) High fruit diet

44. Your patient has a history of acute ulcerative colitis and Crohn's disease . What are
the life threatening features of this disease ?

a) Severe sepsis / septic shock

b) Peritonitis
c) Abdominal ascites
d) Heart failure

45. A female patient presents with diarrhea and vomiting. Which test should should be
performed to assess the patency of her GI tract?

a) Endoscopy
b) Laryngoscopy
c) laparoscopy
d) cystoscopy

46. A 15-year-old boy from Ghana has the acute onset of right upper quadrant
abdominal pain. Abdominal ultrasound reveals a dilated gallbladder with thickened wall
and filled with calculi. A laparoscopic cholecystectomy is performed. The pathologist
assistant opens the gallbladder to reveal ten multifaceted 0.5 to 1 cm diameter dark,
greenish-black gallstones. Which of the following underlying conditions does this boy
most likely have?

a) Crohn disease
b) Sickle cell anemia
c) Hypercholesterolemia
d) Diabetes Mellitus

47. A 34-year-old healthy woman develops sudden severe abdominal pain. On physical
examination she is afebrile. The pain is centered in the mid-epigastric region, though
there is marked diffuse tenderness in all quadrants. Bowel sounds are absent. No
masses are palpable. Which of the following laboratory test findings is most likely to be
present in this woman?

a) increased cholesterol
b) hypercalcemia
c) increased bilirubin
d) hypernatremia
48. A 45-year-old man has had vague abdominal pain and nausea for the past 3 years.
This pain is unrelieved by antacid medications. He has no difficulty swallowing and no
heartburn following meals. On physical examination there are no abnormal findings.
Which of the following conditions is most likely present with this man?

a) Helicobacter pylori infection

b) Crohn's disease
c) Rabies virus
d) HIV virus

49. A 31-year-old woman has a 10 year history of intermittent, bloody diarrhea. She has
no other major medical problems. On physical examination there are no lesions palpable
on digital rectal examination, but a stool sample is positive for occult blood. Colonoscopy
reveals a friable, erythematous mucosa with focal ulceration that extends from the
rectum to the mid-transverse colon. This patient is at greatest risk for development of
which of the following conditions?

e) appendicitis
f) colitis
g) Diverticulitis
h) pancreatitis

50. A 60-year-old man has had anorexia, vomiting, and vague abdominal pain
accompanied by weight loss of 6 kg over the past 2 months. Physical examination
reveals supraclavicular non-tender lymphadenopathy. He becomes progressively
cachectic and dies. Which of the following conditions most likely preceded development
of his terminal illness?

a) Constipation
b) Pernicious anemia
c) Gastroenteritis
d) Food poisoning