,NU 545 Unit 6 | Physio-Pathological Basis of Advanced Nursing |
University of South Alabama
1. Which mechanism best explains the development of gastroesophageal reflux
disease (GERD)?
A) Increased lower esophageal sphincter tone
B) Transient relaxation of the lower esophageal sphincter
C) Delayed gastric emptying with normal sphincter function
D) Excessive salivary bicarbonate secretion
Correct Answer: Transient relaxation of the lower esophageal sphincter
Rationale: GERD is primarily caused by transient relaxation or incompetence of
the lower esophageal sphincter, allowing acidic gastric contents to reflux into the
esophagus. Increased sphincter tone would prevent reflux, delayed gastric
emptying is a contributing factor but not the primary mechanism, and salivary
bicarbonate is protective rather than causative.
2. What is the primary pathophysiologic mechanism underlying duodenal ulcer
formation?
A) Decreased gastric acid secretion
B) Increased acid delivery to the duodenum overwhelming mucosal defenses
C) Autoimmune destruction of gastric parietal cells
D) Complete loss of duodenal bicarbonate secretion
Correct Answer: Increased acid delivery to the duodenum overwhelming
mucosal defenses
,Rationale: Duodenal ulcers result from excessive acid and pepsin delivery to the
duodenum, which overwhelms the mucosal defense mechanisms, including
bicarbonate secretion. Decreased acid secretion would protect against ulcers,
autoimmune parietal cell destruction causes achlorhydria, and complete loss of
bicarbonate secretion is less common than relative insufficiency.
3. A patient with long-standing GERD develops difficulty swallowing and weight
loss. Which complication should be suspected?
A) Mallory-Weiss tear
B) Barrett esophagus with dysplasia
C) Achalasia
D) Esophageal varices
Correct Answer: Barrett esophagus with dysplasia
Rationale: Chronic GERD can lead to Barrett esophagus, characterized by
intestinal metaplasia of the distal esophageal mucosa, which predisposes to
dysplasia and adenocarcinoma. Mallory-Weiss tears cause acute bleeding,
achalasia involves motility dysfunction, and esophageal varices are related to
portal hypertension.
4. Which gastrointestinal hormone is primarily responsible for stimulating gastric
acid secretion?
A) Secretin
B) Cholecystokinin
C) Gastrin
D) Somatostatin
, Correct Answer: Gastrin
Rationale: Gastrin, secreted by G cells in the gastric antrum, stimulates parietal
cells to secrete hydrochloric acid. Secretin and cholecystokinin primarily affect
pancreatic and biliary function, while somatostatin inhibits gastric acid secretion.
5. What is the primary mechanism of constipation in a patient with a low-fiber
diet?
A) Increased colonic motility
B) Prolonged colonic transit with excessive water absorption
C) Hypersecretion of intestinal fluid
D) Impaired bile acid synthesis
Correct Answer: Prolonged colonic transit with excessive water absorption
Rationale: Low dietary fiber reduces stool bulk and slows transit, allowing more
water to be absorbed from the stool, resulting in hard, dry stools. Increased
motility causes diarrhea, hypersecretion causes secretory diarrhea, and impaired
bile acid synthesis causes steatorrhea.
6. Which type of diarrhea is characterized by large volumes of watery stool
without blood or pus?
A) Osmotic diarrhea
B) Secretory diarrhea
C) Exudative diarrhea
D) Motility-related diarrhea
University of South Alabama
1. Which mechanism best explains the development of gastroesophageal reflux
disease (GERD)?
A) Increased lower esophageal sphincter tone
B) Transient relaxation of the lower esophageal sphincter
C) Delayed gastric emptying with normal sphincter function
D) Excessive salivary bicarbonate secretion
Correct Answer: Transient relaxation of the lower esophageal sphincter
Rationale: GERD is primarily caused by transient relaxation or incompetence of
the lower esophageal sphincter, allowing acidic gastric contents to reflux into the
esophagus. Increased sphincter tone would prevent reflux, delayed gastric
emptying is a contributing factor but not the primary mechanism, and salivary
bicarbonate is protective rather than causative.
2. What is the primary pathophysiologic mechanism underlying duodenal ulcer
formation?
A) Decreased gastric acid secretion
B) Increased acid delivery to the duodenum overwhelming mucosal defenses
C) Autoimmune destruction of gastric parietal cells
D) Complete loss of duodenal bicarbonate secretion
Correct Answer: Increased acid delivery to the duodenum overwhelming
mucosal defenses
,Rationale: Duodenal ulcers result from excessive acid and pepsin delivery to the
duodenum, which overwhelms the mucosal defense mechanisms, including
bicarbonate secretion. Decreased acid secretion would protect against ulcers,
autoimmune parietal cell destruction causes achlorhydria, and complete loss of
bicarbonate secretion is less common than relative insufficiency.
3. A patient with long-standing GERD develops difficulty swallowing and weight
loss. Which complication should be suspected?
A) Mallory-Weiss tear
B) Barrett esophagus with dysplasia
C) Achalasia
D) Esophageal varices
Correct Answer: Barrett esophagus with dysplasia
Rationale: Chronic GERD can lead to Barrett esophagus, characterized by
intestinal metaplasia of the distal esophageal mucosa, which predisposes to
dysplasia and adenocarcinoma. Mallory-Weiss tears cause acute bleeding,
achalasia involves motility dysfunction, and esophageal varices are related to
portal hypertension.
4. Which gastrointestinal hormone is primarily responsible for stimulating gastric
acid secretion?
A) Secretin
B) Cholecystokinin
C) Gastrin
D) Somatostatin
, Correct Answer: Gastrin
Rationale: Gastrin, secreted by G cells in the gastric antrum, stimulates parietal
cells to secrete hydrochloric acid. Secretin and cholecystokinin primarily affect
pancreatic and biliary function, while somatostatin inhibits gastric acid secretion.
5. What is the primary mechanism of constipation in a patient with a low-fiber
diet?
A) Increased colonic motility
B) Prolonged colonic transit with excessive water absorption
C) Hypersecretion of intestinal fluid
D) Impaired bile acid synthesis
Correct Answer: Prolonged colonic transit with excessive water absorption
Rationale: Low dietary fiber reduces stool bulk and slows transit, allowing more
water to be absorbed from the stool, resulting in hard, dry stools. Increased
motility causes diarrhea, hypersecretion causes secretory diarrhea, and impaired
bile acid synthesis causes steatorrhea.
6. Which type of diarrhea is characterized by large volumes of watery stool
without blood or pus?
A) Osmotic diarrhea
B) Secretory diarrhea
C) Exudative diarrhea
D) Motility-related diarrhea
