NR507 midterm Exam Advanced Pathophysiology
Q&A Chamberlain
1. A patient with gastroesophageal reflux disease (GERD) experiences heartburn and
regurgitation. The underlying pathophysiology is most likely:
A. Increased gastric acid secretion
B. Weakened or inappropriate relaxation of the lower esophageal sphincter
C. Delayed gastric emptying only
D. Esophageal spasm
Answer: B
Rationale: GERD occurs when the LES is weakened or relaxes inappropriately, allowing
gastric acid to reflux into the esophagus, causing inflammation and symptoms.
2. Which medication class is first-line for the pharmacological management of
GERD?
A. Antacids
B. H2 receptor antagonists
C. Proton pump inhibitors
D. Prokinetic agents
Answer: C
Rationale: PPIs (e.g., omeprazole) are the most effective first-line agents for GERD
because they suppress gastric acid production more completely than H2 blockers.
3. Chronic GERD is a major risk factor for which complication?
A. Barrett esophagus and esophageal stricture
B. Gastric cancer
C. Hiatal hernia
D. Appendicitis
Answer: A
Rationale: Chronic acid exposure can lead to metaplasia (Barrett esophagus) and
fibrosis causing esophageal stricture.
4. Surgical treatment for severe hiatal hernia and GERD involves:
A. Gastric bypass
, B. Nissen fundoplication
C. Vagotomy
D. Esophagectomy
Answer: B
Rationale: Nissen fundoplication wraps the gastric fundus around the lower esophagus
to reinforce the LES.
5. A patient presents with right lower quadrant pain, fever, and rebound tenderness.
Which laboratory finding is most consistent with appendicitis?
A. Leukopenia
B. Leukocytosis with left shift
C. Elevated hematocrit
D. Decreased C-reactive protein
Answer: B
Rationale: Appendicitis causes leukocytosis (elevated WBC) with neutrophilia (left
shift) and elevated CRP.
6. The most common cause of appendicitis is:
A. Bacterial infection
B. Obstruction of the appendix lumen
C. Trauma
D. Autoimmune inflammation
Answer: B
Rationale: Appendiceal obstruction by a fecalith, lymphoid hyperplasia, or tumor leads
to increased pressure, ischemia, and bacterial overgrowth.
7. A patient with a duodenal ulcer is likely to experience pain that:
A. Worsens with food intake
B. Improves with food intake
C. Occurs immediately after eating
D. Is unrelated to meals
Answer: B
Rationale: Duodenal ulcer pain is typically relieved by food because food buffers acid.
Gastric ulcer pain often worsens with food.
Q&A Chamberlain
1. A patient with gastroesophageal reflux disease (GERD) experiences heartburn and
regurgitation. The underlying pathophysiology is most likely:
A. Increased gastric acid secretion
B. Weakened or inappropriate relaxation of the lower esophageal sphincter
C. Delayed gastric emptying only
D. Esophageal spasm
Answer: B
Rationale: GERD occurs when the LES is weakened or relaxes inappropriately, allowing
gastric acid to reflux into the esophagus, causing inflammation and symptoms.
2. Which medication class is first-line for the pharmacological management of
GERD?
A. Antacids
B. H2 receptor antagonists
C. Proton pump inhibitors
D. Prokinetic agents
Answer: C
Rationale: PPIs (e.g., omeprazole) are the most effective first-line agents for GERD
because they suppress gastric acid production more completely than H2 blockers.
3. Chronic GERD is a major risk factor for which complication?
A. Barrett esophagus and esophageal stricture
B. Gastric cancer
C. Hiatal hernia
D. Appendicitis
Answer: A
Rationale: Chronic acid exposure can lead to metaplasia (Barrett esophagus) and
fibrosis causing esophageal stricture.
4. Surgical treatment for severe hiatal hernia and GERD involves:
A. Gastric bypass
, B. Nissen fundoplication
C. Vagotomy
D. Esophagectomy
Answer: B
Rationale: Nissen fundoplication wraps the gastric fundus around the lower esophagus
to reinforce the LES.
5. A patient presents with right lower quadrant pain, fever, and rebound tenderness.
Which laboratory finding is most consistent with appendicitis?
A. Leukopenia
B. Leukocytosis with left shift
C. Elevated hematocrit
D. Decreased C-reactive protein
Answer: B
Rationale: Appendicitis causes leukocytosis (elevated WBC) with neutrophilia (left
shift) and elevated CRP.
6. The most common cause of appendicitis is:
A. Bacterial infection
B. Obstruction of the appendix lumen
C. Trauma
D. Autoimmune inflammation
Answer: B
Rationale: Appendiceal obstruction by a fecalith, lymphoid hyperplasia, or tumor leads
to increased pressure, ischemia, and bacterial overgrowth.
7. A patient with a duodenal ulcer is likely to experience pain that:
A. Worsens with food intake
B. Improves with food intake
C. Occurs immediately after eating
D. Is unrelated to meals
Answer: B
Rationale: Duodenal ulcer pain is typically relieved by food because food buffers acid.
Gastric ulcer pain often worsens with food.
