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WorksheetsTerm Test 3 - Review
Total questions: 78
Worksheet time: 59mins
A 45-year-old taking daily NSAIDs presents with epigastric pain and vomiting shortly after meals. What is most likely medical diagnosis for this individual?
Gastric ulcer
Acute gastritis
Duodenal ulcer
Chronic fundal gastritis
You suspect chronic antral gastritis in a patient with weight loss and intermittent epigastric pain relieved by antacids. What rationale best links pathophysiology to risk?
NSAIDs increase prostaglandins, strengthening mucosal barrier
Type A autoimmune gastritis increases intrinsic factor secretion
H. pylori increases acid secretion, raising risk for duodenal ulcers
Bile reflux lowers hydrochloric acid, preventing ulcer development
Which diagnostic testing should be performed if a patient with suspected peptic ulcer disease cannot tolerate endoscopy?
Barium swallow and urea breath tests
Chest and abdominal x-rays
Serum H. pylori test
Gastric biopsy
What treatment option is best for the total eradication of an H. pylori induced duodenal ulcer?
Stop food intake to avoid acid secretion triggers
Antacids
H2 receptor antagonist plus one antibiotic
PPI plus two antibiotics
A patient with a known duodenal ulcer suddenly develops severe, spreading abdominal pain, rigid board-like abdomen, and absent bowel sounds. Which action is priority for this patient?
Administer broad-spectrum antibiotics and pain control
Provide oxygenation
Administer Lactated Ringers or colloids
Place indwelling urinary catheter to monitor urine output
A patient with hemorrhage from a gastric ulcer presents with hypotension and tachycardia. Which prioritized action plan best matches the expected source and management needs?
Expect duodenal ulcer perforation and start urinary catheter
Assume pancreatoduodenal artery bleed and give antibiotics first
Plan immediate surgical closure because all hemorrhages are perforations
Suspect gastric artery erosion and prepare for pRBC transfusion
What is the most appropriate treatment plan for a patient with a confirmed bowel obstruction?
Close observation of symptoms
Antiemetics, antibiotics
Decompression, intravenous fluids, surgical intervention
Insertion of nasogastric tube only
What is the difference in early clinical manifestations between small bowel obstruction and large bowel obstruction?
Small bowel obstruction exhibits early vomiting and colicky pain
Small bowel obstruction shows late vomiting and mild early pain
Large bowel obstruction features early borborygmi with pain relief
Large bowel obstruction presents first with projectile vomiting early
A patient with long-standing alcohol use presents with fatigue, weight loss, and later develops ascites and esophageal varices. Which explanation best supports the development of cirrhosis?
Vascular dilation lowers resistance, decreasing collateral vein formation
Inflammation improves regeneration, enhancing albumin production and preload
Fibrotic remodeling distorts lobules, raising portal resistance above 10 mmHg
Hepatocyte necrosis causes portal flow increase, reducing venous pressure
What is the rationale for the development of splenomegaly?
Posthepatic right ventricular failure reduces splanchnic inflow dramatically
Intrahepatic fibrosis and vascular remodeling cause obstruction to portal flow
Systemic hypertension directly transmits pressure to the portal system
Hypoalbuminemia increases oncotic pressure within the portal vein
A patient with cirrhosis vomits blood on a daily basis. In relation to portal hypertension, why is this happening?
Duodenal erosion secondary to hyperbilirubinemia causing mucosal injury
H. pylori infection in the stomach
Esophageal variceal rupture from collateral vein dilation under high portal pressure
Bleeding gastric ulcer unrelated to portal pressure changes
The activation of which systems further promotes the continued development of ascites?
Aldosterone secretion
ADH and RAAS
Renin deactivation
SNS
A 58-year-old with cirrhosis presents with progressive abdominal distention and ankle edema. Lab values indicates low albumin levels. What is the main cause of this patient's clinical manifestations?
Increased permeability of abdominal membrane
Increased hydrostatic pressure and decreased oncotic pressure
Decreased permeability of abdominal membrane
Decreased hydrostatic pressure and increased oncotic pressure
A patient with portal hypertension presents with an enlarged palpable spleen and thrombocytopenia (Low platelet course). Which rationale best explains the thrombocytopenia that has manifested?
Drug-induced thrombocytopenia from nonselective beta-blockers is most common
Bone marrow failure from cirrhosis
Autoimmune platelet destruction triggered by hepatic autoantibodies
The trapping of platelets in the spleen, decreasing serum levels
You are triaging a cirrhotic patient with lethargy and irritability. Serum ammonia is elevated. Which additional clinical manifestations support hepatic encephalopathy rather than a primary psychiatric disorder?
Pressured speech with decreased need for sleep
Auditory hallucinations with intact orientation
Fixed delusions without neurological signs
Flapping hand tremor with disorientation to time and place
A 48-year-old with known gallstones develops sudden midabdominal pain and jaundice. What is the underlying cause?.
Renal colic referred pain to epigastrium
Bile duct obstruction causing enzyme backflow
Portal vein thrombosis reducing perfusion
Gastric outlet obstruction delaying emptying
Which scenario best differentiates acute from chronic pancreatitis when planning care?
Acute requires surgery; chronic never needs hospitalization
Acute self-resolves in days; chronic shows progressive fibrosis
Acute is always painless; chronic always excruciating
Acute causes cancer; chronic never increases risk
A male cirrhotic patient with enlargement of breast tissue is known to have serum elevations in what hormone?
Estrogen
Androgen
Testoterone
Oxytocin
Antibiotics are considered during pancreatitis treatment under which circumstance?
To prevent gallstone formation
To lower amylase levels directly
Routine prophylaxis for all patients with pancreatitis
Evidence of infection complicating pancreatitis
A 48-year-old presents with episodic right upper quadrant pain radiating to the mid-back 45 minutes after a greasy meal. Ultrasound shows gallstones in the cystic duct. Which mechanism best explains the pain pattern?
Portal venous congestion stretching vasculature
Pancreatic enzymes digest the duodenal mucosa after meals
Gallbladder contractions forcing stones against the duct wall post
A patient with known cystic duct obstruction has been admitted with fever, leukocytosis, rebound tenderness, and abdominal guarding. What is likely the cause of these clinical manifestations?
Renal colic from ureteral calculus migration
Large bowel obstruction
Uncomplicated biliary colic without inflammation
Acute cholecystitis with gallbladder inflammation
What process describes cholesterol type gallstones (cholelithiasis).
Aggregation of stones improves bile flow and relieves postprandial pain
Microstones dissolve and reduce ductal pressure over time leading to better health
Aggregation of stones cause blocks leading to cystic ducts causing inflammation
Macrostones stimulate pancreatic insulin and reduce symptoms
A patient experienced acute water loss while hiking in hot weather. Which explanation best describes how the body restores blood pressure?
Juxtaglomerular apparatus suppresses renin, preventing RAAS activation
ADH release increases nephron water reabsorption, raising plasma volume
Angiotensin II lowers aldosterone release, reducing sodium reabsorption
Hypothalamus decreases neurohypophyseal signals, limiting ADH secretion
A 68-year-old presents with fatigue and poor intake. Labs show serum BUN elevation with a high-normal serum creatinine, dry mucous membranes and high urine specific gravity. Which interpretation best explains the pattern?
High muscle breakdown increasing creatinine production
Prerenal azotemia from dehydration reducing renal perfusion
Advanced renal failure reducing tubular urea reabsorption
Hepatic failure decreasing ammonia conversion to urea
A 22-year-old has cloudy urine that is positive nitrites, and a high urine specific gravity. Which statement best supports these clinical manifestations?
Normal hydration with transient hematuria from menses
Alkaline urine from vegetarian diet without infection
Dilute urine with benign crystalluria after exercise
Concentrated urine with likely bacterial infection present
Which finding after voiding should prompt further assessment for urinary retention?
Postvoid residual <30mL
Postvoid residual of 100mL
Postvoid residual >200mL
Video urodynamics is a diagnostic test selected for complex bladder incontinence. What is a distinct characteristic of this test?
Direct visualization of bladder mucosa
Correlation of filling and voiding with imaging anatomy
Measurement of urethral sphincter nerve potentials
Faster estimation of postvoid residual volume
A patient with persistent hematuria requires direct visualization of the bladder interior via the urethra. Which procedure is indicated?
Cystoscopy inspecting inside of the bladder
Cystometry assessing filling pressures only
Ureteroscopy evaluating upper urinary tract
Uroflowmetry timing complete bladder emptying
You see unilateral hydronephrosis with increased serum potassium and metabolic acidosis. Which mechanism links the obstruction to these laboratory findings?
Overproduction of bicarbonate by compensatory hyperfunction
Impaired excretion of H+ and K+ from reduced concentrating ability
Loss of nephron number from compensatory hypertrophy
Enhanced excretion of H+ and K+ due to higher flow
A patient has just been treated for bilateral urinary tract obstruction and develops post-obstructive diuresis. What is the most appropriate action?
Delay labs because electrolyte changes stabilize within two days
Start diuretics to prevent edema
Restrict fluids to reduce ongoing polyuria and sodium loss
Aggressively replace isotonic fluids and monitor electrolytes closely
A 59-year-old warehouse worker in a hot climate has low fluid intake and presents with sudden flank pain. Later, they are diagnosed with kidney stones. What are the associated risk factors?
Age
Diet
Seasonal weather
Occupation
A patient with recurrent calcium oxalate kidney stones seeks preventative strategies. What information is most appropriate to provide?
Increase fluids, adjust urine pH, reduce dietary oxalate
Restrict fluids, increase protein intake
Delay pain control, increase sodium intake
Use routine antibiotics, keep urine acidic, limit fruit and vegetables intake
A patient develops glomerular injury after a streptococcus infection. What mechanism most likely explains the injury?
Direct toxin-mediated podocyte apoptosis
Deposition of circulating antigen–antibody complexes
Hemodynamic shear stress causing endothelial rupture
Type IV hypersensitivity against basement membrane
Which finding most specifically suggests glomerulonephritis on urinalysis?
High specific gravity without cells
Crystals without cellular elements
Red blood cell casts in the sediment
Ketones with hyaline casts present
Which type of dietary restrictions is important for patients with CKD?
High potassium, low salt, high protein
Low fat, low salt, high protein
Low protein, low sodium, low potassium, low phosphate
At what stage is renal function less than 10% of normal?
Renal insufficiency
Kidney failure
End-stage kidney disease
Acute tubular necrosis
A patient with severe hypotension develops reduced renal perfusion. What intrarenal pathology most likely follows if renal ischemia persists?
Acute tubular necrosis from prolonged hypoperfusion
Ureteral destruction from obstructing ureteral stones
Neurogenic bladder causing urinary retention
Glomerulopathies with immune complex deposition
A patient has a GFR of 22 mL/min with hyperphosphatemia and metabolic acidosis. Which CKD stage best fits these findings?
Stage II: mild damage with subtle hypertension
Stage III: moderate damage with mild symptoms
Stage V: end-stage disease with severe symptoms
Stage IV: severe damage with moderate complications
A patient presents with dizziness and lethargy. Which alteration in kidney function causes the clinical manifestations of dizziness and lethargy?
Increased protein excretion
Renal oxygen consumption
Erythropoietin production
Which mechanism best explains spontaneous bone fractures in a patient with chronic kidney disease?
Progressive accumulation of uremic neurotoxins causing encephalopathy
Extracellular volume expansion increasing cardiac workload
Osteitis fibrosa with bone resorption from hyperparathyroidism
Suppression of cell‑mediated immunity increasing infection risk
Which laboratory pattern most strongly supports chronic kidney disease in a patient with risk factors and clinical manifestations?
High creatinine with elevated BUN, abnormal urinalysis
Normal creatinine with low BUN, dilute urinalysis
Low creatinine with normal BUN, clear urinalysis
Fluctuating creatinine with low BUN, sterile urinalysis
Why is supplemental vitamin D important in the overall plans of care for patients with CKD?
Helps regulate calcium and phosphorus levels
Pulls calcium from bone cells into circulation
Decreases the activity of the parathyroid
Which advantage of hemodialysis addresses the most beneficial electrolyte control?
Removes desired amounts of potassium
Provides steady glucose infusion
Lowers sodium intake requirement
Which peritoneal dialysis advantage relates to the cardiovascular system?
Elevates afterload during fluid exchanges
Better BP management
Produces frequent hypotensive episodes
A 12-year-old with recent sudden weight loss, polydipsia, polyuria, and fatigue is found to have hyperglycemia. Which pathophysiologic process best explains the onset of clinical manifestations?
Glucagon deficiency leading to hypoglycemia and dehydration
Autoimmune beta-cell destruction causing severe insulin deficiency
Insulin resistance in muscle with compensatory hyperinsulinemia
Rapid beta-cell apoptosis with transient hyperinsulinemia
What percentages of beta-cell loss contributes to the clinical manifestations of type 1 diabetes?
20 to 30 percent
A50 to 60 percent
80 to 90 percent
Complete 100 percent
You must prioritize two confirmatory diagnostic tests of diabetes for a 17-year-old who is hyperventilating and has sweet, fruity smelling breath. Which pair best balances immediate confirmation with long-term control assessment?
Random glucose and OGTT together same day
Two Hemoglobin A1C tests on separate days
Urine ketones and OGTT after recovery
Fasting glucose and Hemoglobin A1C together
A 52-year-old presents with obesity, hypertension, dyslipidemia and fatigue. Which mechanism best explains the progression of Type 2 diabetes?
Pancreatic exocrine enzyme deficiency impairing carbohydrate digestion
Persistent insulin resistance with compensatory hyperinsulinemia
Autoimmune beta-cell destruction causing absolute insulin deficiency
Episodic hypoglycemia leading to reduced hepatic gluconeogenesis
A patient with newly diagnosed Type 2 diabetes has initiated dietary changes and metformin. After three months, A1C remains above target. What adjustment should be made to manage serum glucose?
Delay changes and recheck A1C in twelve months
Stop metformin and intensify lifestyle alone
Switch metformin to a short-acting sulfonylurea
Add exogenous insulin to existing metformin therapy
A 28-year-old with type 1 diabetes using exogenous insulin becomes pale, diaphoretic with tremors while at home. They later report dizziness and visual disturbances. Serum blood glucose is low at 2.9mmol/L. Which immediate action best balances rapid reversal and safety?
Have the patient eat a high-fat meal with protein
Start IV dextrose infusion at maintenance rate
Advise rest and hydration without carbohydrate intake
Give oral fast-acting glucose and reassess in minutes
Which reasoning best explains why osmotic diuresis occurs during DKA and leads to electrolyte losses?
Liver gluconeogenesis consumes electrolytes, reducing renal filtration and urine output
Excess glucose raises plasma osmolality, pulling water into urine with Na, K, Cl, Mg, PO4
Insulin deficiency directly excretes electrolytes without affecting urine volume
Ketone bodies increase urine acidity, trapping electrolytes but conserving water
A 22-year-old with type 1 diabetes presents with polyuria, dehydration signs, abdominal pain, and deep rapid breathing. Labs show glucose 18 mmol/L and metabolic acidosis. Which immediate intervention best addresses the primary physiologic derangement?
Begin insulin bolus to normalize glucose quickly
Administer bicarbonate to correct acidosis immediately
Give 0.9% NaCl to restore intravascular volume
Start oxygen to correct tissue hypoxia rapidly
An insulin infusion is required for a patient in DKA. Which potassium status warrants delaying insulin until corrected to avoid worsening arrhythmia risk?
Serum K+ 4.0 mmol/L with normal ECG
Serum K+ 3.2 mmol/L with muscle weakness
Serum K+ 5.0 mmol/L with peaked T waves
Serum K+ 3.6 mmol/L with mild cramps
A patient presents with fatigue, weight gain, and cold intolerance. Lab results reveal low thyroid hormone levels. Which medical diagnosis is anticipated?
Pituitary adenoma
Thyroid hormone resistance
Autoimmune thyroiditis
Iodine excess
You evaluate a patient with low serum thyroid hormone. TSH is high and TRH is high. Which malfunction of the thyroid feedback loop best fits the clinical manifestations?
Pituitary malfunction decreasing TSH secretion
Hypothalamic malfunction reducing TRH release
Peripheral resistance to thyroid hormone action
Primary thyroid malfunction impairing hormone synthesis
A 62-year-old with gradual weight gain, cold intolerance, lethargy, and low basal body temperature presents for evaluation. Which diagnostic pattern best supports primary hypothyroidism in this patient, and why?
Elevated TSH with low free T4 indicating thyroid failure
Low TSH with high free T4 indicating pituitary overactivity
Normal TSH with low free T4 indicating euthyroid illness
Elevated TSH with high free T4 indicating overreplacement
A patient with severe palpitations, tremors, and high heart rate from hyperthyroidism needs symptomatic relief STAT while awaiting definitive therapy. Which option addresses symptoms without altering thyroid hormone synthesis?
Inderal
PTU
Radioactive iodine
A 28-year-old with untreated Graves disease develops severe tachycardia, hyperthermia, agitation, abdominal pain, vomiting, and delirium after a pneumonia diagnosis. Which immediate action is appropriate?
Start high-calorie feeding to correct catabolism
Administer insulin bolus to treat stress hyperglycemia
Initiate IV fluids and reduce circulating thyroid hormone
Begin broad diuretics to lower cardiac preload
In planning nutrition for a 24-hour fast, which hormone pattern most reliably sustains plasma glucose from endogenous sources overnight?
Falling epinephrine with rising insulin release
Rising glucagon with supportive cortisol release
Stable thyroid hormone with peak prolactin release
Rising insulin with suppressed glucagon release
Which scenario best demonstrates how counter-regulatory hormones provide and regulate glucose release for energy during stress?
Hyponatremia activates ADH to conserve free water
Hypercalcemia triggers calcitonin to protect bone mass
Hypothyroidism raises TSH to maintain thermogenesis
Sepsis elevates cortisol to sustain gluconeogenesis
A 22-year-old with a temporal skull fracture briefly regains consciousness, then develops worsening headache, vomiting, and ipsilateral pupil dilation. Which hematoma type best fits the clinical manifestations?
Epidural with arterial bleeding
Subdural hematoma with capillary bleeding
Subdural hematoma with arterial bleeding
Intracerebral hematoma with venous bleeding
A patient presents with the following: GCS of 14, no loss of consciousness, confusion for five minutes and a normal physical examination. Which type of TBI has the patient experienced?
Severe TBI
Moderate TBI
Mild
A 68-year-old on anticoagulant medication presents two weeks after a minor fall with agitation, confusion, and disconjugate gaze. Brain CT scan shows blood collection. What is the most appropriate action?
Observe only because reabsorption will occur quickly
Delay surgery because it is always self-limited
Craniotomy or drainage to relieve pressure
Administer thrombolytics to dissolve the clot
You are triaging a patient after a crash. They have a GCS of 10, loss of consciousness for 2 hours, amnesia lasting 36 hours and an abnormal CT. Which classification of TBI reflects all findings?
Moderate TBI
Mild TBI
Severe TBI
A patient presents 12 hours after a head injury with a GCS of 6, more than 6 hours of unconsciousness, and abnormal pupillary reaction with decerebrate posturing. Which additional finding most strongly aligns with the same severity category?
Normal brain imaging with intact brain stem
Amnesia resolving within 24 hours without deficits
Brief confusion with difficulty sleeping a few days
Increased intracranial pressure appearing 4–6 days post injury
A 58-year-old with hypertension and new onset atrial fibrillation asks which single change would most reduce stroke risk in the next year. Which response is best?
Weekend jogging without medical evaluation
Daily blood pressure monitoring
Daily multivitamin without prescription drugs
EMS brings a patient to triage that 2hrs ago experienced facial droop, arm drift, and slurred speech. Which plan is most appropriate?
Obtain CT or MRI to exclude hemorrhage, give IV tPA if eligible
Delay imaging for ECG first, then start antiplatelet therapy
Start anticoagulation immediately, image after neurological improvement
Wait for intra-arterial stent placement decision, then order CT
A 62-year-old with hypertension collapses during exertion. Diagnostic imaging shows intraparenchymal bleeding with rapid edema peaking at 72 hours. Which plan of action prioritizes survival in the first week?
Aggressive blood pressure reduction with ICP control and rebleed prevention
Immediate high-dose anticoagulation with permissive hypertension strategy
Observation only because edema settles by two weeks without intervention
Early thrombolysis with fluids to optimize cerebral perfusion pressure
Which statement suggests rupture of an intracranial aneurysm leading to hemorrhage?
Explosive headache rapidly followed by unconsciousness within minutes
Gradual dull headache with intermittent confusion over weeks
Focal sensory aura preceding mild headache for several days
Positional headache relieved by rest and hydration
Which statement best explains neurological decline in hemorrhagic stroke?
Accumulated blood compresses tissue causing edema, ischemia, and necrosis
Arterial occlusion increases perfusion causing cortical hyperactivity
CSF overproduction reduces ICP leading to neuronal apoptosis
Venous dilation improves oxygenation preventing edema formation
A patient develops an intraparenchymal hematoma increasing brain tissue volume. What compensatory response maintains normal intracranial pressure before decompensation takes place?
Brain tissue expands uniformly without shifting
Venous outflow accelerates from cranial vault
Arterial vasodilation increases cerebral inflow
CSF shifts to spinal subarachnoid space
You are planning care for a patient progressing from ineffective compensation to brain tissue hypoxia with widened pulse pressure, bradycardia, and small sluggish pupils. Which action is most appropriate for care of this patient?
Lower PaCO2 to reduce cerebral blood volume
Induce systemic hypertension to force blood into brain
Increase venous compression to lower arterial inflow
Expand CSF production to buffer pressure spikes
An intubated patient’s PaO2 drops from 90 to 50 mmHg despite normal PaCO2. Which statement best explains cerebral changes and guides the priority actions?
Vasoconstriction, resistance rises, increase ventilation rate
Vasodilation, resistance falls, correct hypoxia to prevent acidosis
No change in tone, start mannitol for edema
Vasodilation, resistance rises, decrease FiO2 to avoid toxicity
A trauma patient develops progressive brain swelling localized near a contusion that has begun to spread. Which edema type is this?
Osmotic edema from hyponatremia and water influx
Interstitial edema from CSF transudation with hydrocephalus
Cytotoxic edema from cellular transport failure and hypoxia
Vasogenic edema from capillary permeability and protein leak
An unconscious patient shows closed hands, arms adducted and flexed against the chest, legs internally rotated, and feet turned inward, as in the image. Which posturing pattern is most consistent with the clinical manifestations?
Decerebrate posturing
Decorticate posturing
A patient with suspected increased intracranial pressure develops a fixed, unresponsive, unilaterally dilated pupil and decerebrate posturing? Which statements supports what is happening with the patient?
Impending brain herniation requiring emergent escalation
Isolated ulnar nerve palsy needing splinting only
Peripheral vestibular disorder requiring antiemetics
Benign vasovagal episode resolving with fluids
A patient with traumatic brain injury develops signs of increased intracranial pressure and impending herniation. Which diagnostics and actions are best for this patient?
Begin ventilation first, avoid mannitol, rely on serial neuro exams
Order CT then MRI, start IV mannitol, begin ICP monitoring
Skip imaging, give corticosteroids, start tube feeds immediately
Order MRI only, delay monitoring, consider oral diuretics later
A hockey player strikes the front of their head on the boards, then becomes drowsy minutes later. Which focal injury most likely has occurred?
Primary open skull fracture
Primary subdural hematoma
Primary coup at impact site,
