practice questions-AGACNP questions well answered rated A+ 2023/2024

practice questions-AGACNPThe most common cause of intestinal obstruction is: A. Adhesion B. Tumor C. Ischemic bowel D. Umbilical hernia - correct answer A- adhesion A firm liver on physical exam is usually associated with: A. Ascites B. Passive congestion C. Cirrhosis D. Hepatic carcinoma - correct answer B- Passive congestion Differential diagnosis of lower GI Bleed - correct answer -Diverticulum hemmorhage -Occult neoplastic -Colitis (infectious, ischemic, radiation, ulcerative colitis >Crohn's disease) -Angiodysplasia -Anorectal (fissure, hemorrhoid, rectal ulcer) -Vasculitis Goals of GI Bleed Resuscitation - correct 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? - correct answer Factor II, VII, IX, X and proteins C and S How is the adequacy of vit. K dependent clotting factors estimated? - correct answer PT and INR. Prolongated from impaired coagulation factor synthesis or Vitamin K deficiency. (If PT/INR normalize after Vit K administration, this indicates Vit K deficiency). AST and ALT enzymes - correct answer Elevations-->hepatocellular injury, necrosis. Marked elevations (>1000) typically occur with acute hepatocellular injury (viral, drugs, ischemia). AST>2x ALT = alcohol. AST<1 ALT = viral hepatitis Alkaline phosphatase (ALP) enzyme - correct answer Elevations-->cholestatic (biliary obtruction, space-occupying/infiltrative lesions of liver). ALP present in multiple tissues. An elevated GGT (enzyme) establishes hepatic origin of ALP Normal value: 50 - 136 alpha-Fetoprotein (AFP) - correct answer Normal adult level: <10 Insensitive marker for hepatocellular carcinoma. Mild-moderate elevations in acute & chronic liver inflammation. Hypoalbuminemia - correct answer Frequently decreased in chronic liver disease. Also: chronic inflammation; expanded plasma volume; GI or renal losses. May be normal in acute liver disease because albumin 1/2 life is 20 days. Normal value: 3.4 - 5 Bilirubin - correct answer Degradation product of hemoglobin. Total bili = conjugated + unconjugated fractions. Normally bilirubin is processed by the liver and conjugated to a pigment secreted in the bile. The more rapid destruction of RBCs-->higher bilirubin level. Mainly excreted in feces. Causes of unconjugated hyperbilirubinemia: - correct answer Excessive bilirubin production: hemolysis and hemolytic anemias, ineffective erythropoesis, resorption of hematomas Causes of elevated total bilirubin: - correct answer Obstructive or hepatocellular origin of jaundice Normal value: 0.2 - 1 All of the following are s/s of acute appendicitis, except: A. abdominal rigidity B. a positive Murphy's sign C. abdominal guarding D. a positive psoas sign - correct answer B) A positive Murphy's sign is not associated with acute appendicitis; rather it is associated w/acute cholecystitis 70 yr old male w/6 wk hx of indigestion after meals relieved with Maalox. Denies wt loss, change in appetite. Current med includes ASA 325 mg, enalapril 10 mg, and multivitamin. Exam reveals HR 80, BP 130/70 with normal cardiac, abdominal, & lung exam. Rectal exam reveals brown stool, + for blood. What is the next step in the evaluation of this patient? A. Tell patient to report back if further blood in stool B. Instruct patient to stop taking aspirin C. Have patient return in 1 week for repeat rectal D. Refer to gastroenterologist for further evaluation - correct answer D) The next step would be to refer the patient to GI for further evaluation. It would also be appropriate for the pt to stop aspirin but the cause of the blood in the stool needs to be determined. Crohn's disease is characterized by all of the following except: A. diarrhea B. LLQ abdominal pain C. weight loss D. rectal bleeding - correct answer B) Crohn's disease is not characterized by LLQ abdominal pain. It is associated with diarrhea, RLQ abdominal pain, wt loss, and rectal bleeding A hepatic bruit suggests: A. ascites B. carcinoma of the liver C. peritonitis D. mesenteric ischemia - correct answer B) hepatic bruit suggests liver carcinoma