AGACNP PRACTICE TEST QUESTIONS AND
VERIFIED ANSWERS
The most common cause of intestinal obstruction is:
A. Adhesion
B. Tumor
C. Ischemic bowel
D. Umbilical hernia - ANSWER A- adhesion
A firm liver on exam is most likely to be encountered with:
A. Ascites
B. Passive congestion
C. Cirrhosis
D. Hepatic carcinoma - ANSWER B- Passive congestion
Lower GI Bleed differential diagnosis - ANSWER -Diverticulum hemmorhage
-Occult neoplastic
-Colitis (infectious, ischemic, radiation, ulcerative colitis >Crohn's disease)
-Angiodysplasia
-Anorectal (fissure, hemorrhoid, rectal ulcer)
-Vasculitis
Objectives of GI Bleed Resuscitation - ANSWER -Volume resuscitation (IV
fluids, PRBCs)
, -Reverse coagulopathy: (FFP, vit K), platlet goal >50,000
-ICU if vital signs unstable or poor end-organ perfusion
-Labs: H&H, platlet, PT/PTT, LFT, BUN/Creatinine
What are the vitamin K dependent clotting factors synthesized by the liver? -
ANSWER Factor II, VII, IX, X and proteins C and S
How is adequacy of vit. K dependent clotting factors estimated? - ANSWER
PT and INR.
Delayed from impaired synthesis of coagulation factors or Vitamin K
deficiency. (If PT/INR normalizes after administration of Vit K, it indicates Vit
K deficiency).
AST and ALT enzymes - ANSWER Elevations-->hepatocellular damage,
necrosis. Persisting elevations (>1000) are typically encountered in acute
hepatocellular damage (viral, drugs, ischemia). AST>2x ALT = alcohol. AST<1
ALT = viral hepatitis
Alkaline phosphatase (ALP) enzyme - ANSWER Elevations-->cholestatic
(obstruction of bile, space-occupying/infiltrative lesions of liver). ALP is
present in some tissues. Increased GGT (enzyme) is indicative of hepatic origin
of ALP
Normal value: 50 - 136
alpha-Fetoprotein (AFP) - ANSWER Normal adult level: <10
Not very sensitive marker for hepatocellular carcinoma. Weak-moderate
elevations in acute & chronic liver inflammation.
VERIFIED ANSWERS
The most common cause of intestinal obstruction is:
A. Adhesion
B. Tumor
C. Ischemic bowel
D. Umbilical hernia - ANSWER A- adhesion
A firm liver on exam is most likely to be encountered with:
A. Ascites
B. Passive congestion
C. Cirrhosis
D. Hepatic carcinoma - ANSWER B- Passive congestion
Lower GI Bleed differential diagnosis - ANSWER -Diverticulum hemmorhage
-Occult neoplastic
-Colitis (infectious, ischemic, radiation, ulcerative colitis >Crohn's disease)
-Angiodysplasia
-Anorectal (fissure, hemorrhoid, rectal ulcer)
-Vasculitis
Objectives of GI Bleed Resuscitation - ANSWER -Volume resuscitation (IV
fluids, PRBCs)
, -Reverse coagulopathy: (FFP, vit K), platlet goal >50,000
-ICU if vital signs unstable or poor end-organ perfusion
-Labs: H&H, platlet, PT/PTT, LFT, BUN/Creatinine
What are the vitamin K dependent clotting factors synthesized by the liver? -
ANSWER Factor II, VII, IX, X and proteins C and S
How is adequacy of vit. K dependent clotting factors estimated? - ANSWER
PT and INR.
Delayed from impaired synthesis of coagulation factors or Vitamin K
deficiency. (If PT/INR normalizes after administration of Vit K, it indicates Vit
K deficiency).
AST and ALT enzymes - ANSWER Elevations-->hepatocellular damage,
necrosis. Persisting elevations (>1000) are typically encountered in acute
hepatocellular damage (viral, drugs, ischemia). AST>2x ALT = alcohol. AST<1
ALT = viral hepatitis
Alkaline phosphatase (ALP) enzyme - ANSWER Elevations-->cholestatic
(obstruction of bile, space-occupying/infiltrative lesions of liver). ALP is
present in some tissues. Increased GGT (enzyme) is indicative of hepatic origin
of ALP
Normal value: 50 - 136
alpha-Fetoprotein (AFP) - ANSWER Normal adult level: <10
Not very sensitive marker for hepatocellular carcinoma. Weak-moderate
elevations in acute & chronic liver inflammation.
