APEA MODULE 8 FITZGERALD BOARD
REVIEW BOOK 2026\2027 UPDATED AND
GRADED A+
Rectal bleeding associated with hemorrhoids is usually described as:
a) streaks of bright red blood on the stool
b) dark brown to black in color and mixed in with normal-appearing stool
c) a large amount of brisk red bleeding
d) Significant blood clots and mucus mixed with stool - CORRECT
ANSWER a
Therapy for hemorrhoids includes all of the following except:
a) weight control
b) low-fat diet
c) topical corticosteroids
d) the use of a stool softener - CORRECT ANSWER b
The NP is advising a 58 year old woman about the benefits of a high fiber
diet. Which one of the following foods provides the highest fiber content?
a) a small banana
b) 1 cup cooked oatmeal
c) a 1/2 cup serving of brown rice
d) a medium size blueberry muffin - CORRECT ANSWER b
,A 62 year old man presents with a 2 month history of noting a "bit of dark
blood mixed in with my stool most days." Physical examination reveals
external hemorrhoids, no rectal mass, and a small amount of dark brown
stool on the examining digit. In-office fecal occult blood test is positive, and
hemogram reveals a microcytic hypochromic anemia. The next best step in
his care is to:
a) perform in-office anoscopy
b) advise patient to use sitz baths post bowel movement
c) refer to gastroenterology practice for colonoscopy
d) order a double contrast barium enema - CORRECT ANSWER c
Risk factors for the development of hemorrhoidal symptoms include all of
the following except:
a) prolonged sitting
b) insertive partner anal intercourse
c) chronic diarrhea
d) excessive alcohol use - CORRECT ANSWER b
Which of the following best describes Grade III internal hemorrhoids?
a) The hemorrhoids do not prolapse
b) The hemorrhoids prolapse upon defecation but reduce spontaneously
c) The hemorrhoids prolapse upon defecation and must be reduced
manually
d) The hemorrhoids are prolapsed and cannot be reduced manually -
CORRECT ANSWER c
Which of the following patients should be evaluated for possible surgical
intervention for hemorrhoids?
,a) a 28 year old woman with symptomatic external hemorrhoids who gave
birth 6 days ago
b) A 48 year old man with Grade II internal hemorrhoids and improvement
with standard medical therapy
c) a 44 year old woman who has internal and external hemorrhoids with
recurrent prolapse
d) a 58 year old man who has Grade I internal hemorrhoids and
improvement with psyllium supplements - CORRECT ANSWER c
A 43 year old woman has a 12-hour history of sudden onset of right upper
quadrant abd. pain with radiation to the shoulder, fever and chills. She has
had similar, milder episodes in the past. Exam reveals marked tenderness
to RUQ upon palpation. Her most likely diagnosis is:
a) hepatoma
b) acute cholecystitis
c) acute hepatitis
d) cholelithiasis - CORRECT ANSWER b
Which of the following is usually not seen in the diagnosis of acute
cholecystitis?
a) elevated serum creatinine
b) increased alkaline phosphatase level
c) leukocytosis
d) elevated AST level - CORRECT ANSWER a
Murphy's sign can be best described as abd. pain elicited by:
a) RUQ abd palpation
, b) asking pt. to stand on tiptoes and then letting body weight fall quickly
onto heels
c) asking pt. to cough
d) percussion - CORRECT ANSWER a
Which of the following is the most common serious complication of
cholecystitis?
a) adenocarcinoma of the gallbladder
b) gallbladder empyema
c) hepatic failure
d) pancreatitis - CORRECT ANSWER d
A 58 year old man reports intermittent RUQ abd pain. He is obese and
being actively treated for hyperlipidemia. Imaging in a patient with
suspected symptomatic cholelithiasis usually includes obtaining an
abdominal:
a) MRI
b) CT
c) US of RUQ
d) flat plate - CORRECT ANSWER c
Risk factors for the development of cholelithiasis include all of the following
except:
a) rapid weight loss
b) male gender
c) obesity
REVIEW BOOK 2026\2027 UPDATED AND
GRADED A+
Rectal bleeding associated with hemorrhoids is usually described as:
a) streaks of bright red blood on the stool
b) dark brown to black in color and mixed in with normal-appearing stool
c) a large amount of brisk red bleeding
d) Significant blood clots and mucus mixed with stool - CORRECT
ANSWER a
Therapy for hemorrhoids includes all of the following except:
a) weight control
b) low-fat diet
c) topical corticosteroids
d) the use of a stool softener - CORRECT ANSWER b
The NP is advising a 58 year old woman about the benefits of a high fiber
diet. Which one of the following foods provides the highest fiber content?
a) a small banana
b) 1 cup cooked oatmeal
c) a 1/2 cup serving of brown rice
d) a medium size blueberry muffin - CORRECT ANSWER b
,A 62 year old man presents with a 2 month history of noting a "bit of dark
blood mixed in with my stool most days." Physical examination reveals
external hemorrhoids, no rectal mass, and a small amount of dark brown
stool on the examining digit. In-office fecal occult blood test is positive, and
hemogram reveals a microcytic hypochromic anemia. The next best step in
his care is to:
a) perform in-office anoscopy
b) advise patient to use sitz baths post bowel movement
c) refer to gastroenterology practice for colonoscopy
d) order a double contrast barium enema - CORRECT ANSWER c
Risk factors for the development of hemorrhoidal symptoms include all of
the following except:
a) prolonged sitting
b) insertive partner anal intercourse
c) chronic diarrhea
d) excessive alcohol use - CORRECT ANSWER b
Which of the following best describes Grade III internal hemorrhoids?
a) The hemorrhoids do not prolapse
b) The hemorrhoids prolapse upon defecation but reduce spontaneously
c) The hemorrhoids prolapse upon defecation and must be reduced
manually
d) The hemorrhoids are prolapsed and cannot be reduced manually -
CORRECT ANSWER c
Which of the following patients should be evaluated for possible surgical
intervention for hemorrhoids?
,a) a 28 year old woman with symptomatic external hemorrhoids who gave
birth 6 days ago
b) A 48 year old man with Grade II internal hemorrhoids and improvement
with standard medical therapy
c) a 44 year old woman who has internal and external hemorrhoids with
recurrent prolapse
d) a 58 year old man who has Grade I internal hemorrhoids and
improvement with psyllium supplements - CORRECT ANSWER c
A 43 year old woman has a 12-hour history of sudden onset of right upper
quadrant abd. pain with radiation to the shoulder, fever and chills. She has
had similar, milder episodes in the past. Exam reveals marked tenderness
to RUQ upon palpation. Her most likely diagnosis is:
a) hepatoma
b) acute cholecystitis
c) acute hepatitis
d) cholelithiasis - CORRECT ANSWER b
Which of the following is usually not seen in the diagnosis of acute
cholecystitis?
a) elevated serum creatinine
b) increased alkaline phosphatase level
c) leukocytosis
d) elevated AST level - CORRECT ANSWER a
Murphy's sign can be best described as abd. pain elicited by:
a) RUQ abd palpation
, b) asking pt. to stand on tiptoes and then letting body weight fall quickly
onto heels
c) asking pt. to cough
d) percussion - CORRECT ANSWER a
Which of the following is the most common serious complication of
cholecystitis?
a) adenocarcinoma of the gallbladder
b) gallbladder empyema
c) hepatic failure
d) pancreatitis - CORRECT ANSWER d
A 58 year old man reports intermittent RUQ abd pain. He is obese and
being actively treated for hyperlipidemia. Imaging in a patient with
suspected symptomatic cholelithiasis usually includes obtaining an
abdominal:
a) MRI
b) CT
c) US of RUQ
d) flat plate - CORRECT ANSWER c
Risk factors for the development of cholelithiasis include all of the following
except:
a) rapid weight loss
b) male gender
c) obesity
