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Paramedic Care Principles & Practice, v3, 5e (Bledsoe)
Chapter 6 Gastroenterology
1) All of the following are considered part of the lower gastrointestinal tract EXCEPT the:
A) jejunum.
B) large intestine.
C) ileum.
D) duodenum.
Answer: D
Diff: 1 Page Ref: 287
Standard: Medicine (Abdominal and Gastrointestinal Disorders)
Objective: 2
2) All of the following contribute to the pathogenesis of diverticulosis EXCEPT:

A) decreased colon motility.
B) herniation of mucosa and submucosa through the teniae coli.
C) increased colon pressure.
D) low-fiber diet.
Answer: A
Objective: 3, 4
3) Your patient, who has a history of cholecystitis, is experiencing pain in her right shoulder. She
is most likely experiencing ________ pain.
A) somatic
B) visceral
C) referred
D) peritoneal
Answer: C
Objective: 1, 5
4) Your patient is a 22-year-old female in mild distress that is complaining of left lower quadrant
abdominal pain and nausea. Which of the following questions would be least helpful when
determining the etiology of her abdominal pain?
A) "When did the pain start?"
B) "How would you describe the pain: dull, sharp, constant, intermittent?"
C) "Are you having any vomiting or diarrhea?"
D) "Have you ever had a sexually transmitted disease?"
Answer: D
Diff: 1 Page Ref: 279-280
Objective: 5, 7
1
Copyright © 2017 Pearson Education, Inc.
5) Your patient is a 44-year-old female complaining of a three-day history of localized
abdominal pain in her midepigastric region after eating. The pain tends to subside with antacids.
Today she is experiencing nausea, and the pain did not subside with antacids. The patient gives a
history of smoking and moderate alcohol consumption. The patient's skin is warm and dry, and
she has a blood pressure of 128/88, a heart rate of 84, and respirations of 20. Your course of
treatment should consist of:
A) sodium bicarbonate IV.
B) transporting the patient in a position of comfort and giving reassurance.
C) high-concentration oxygen by nonrebreathing mask.
D) IV of NS with 250 cc fluid bolus.
Answer: B
Objective: 6, 7
6) While palpating the lower abdomen of a 63-year-old male complaining of back pain, you note
a pulsating mass. You should:
A) ask the patient to take a deep breath, then palpate the mass while he exhales.
B) ask your partner to confirm the finding.
C) determine if the mass is fixed or freely mobile in the abdomen.
D) stop palpating.
Answer: D
Objective: 5, 6
7) Your patient is a 42-year-old male with a history of alcohol abuse who is in severe distress
with dysphagia and hematemesis. You note that he is becoming lethargic and is having trouble
keeping his head up. His skin is cool and clammy. HR = 138, BP = 82/56, RR = 8, SaO2 = 90%.
Proper treatment of this patient would include all of the following EXCEPT:
A) IV of NS with fluid challenge.
B) aggressive suctioning of the airway and intubation.
C) dopamine infusion.
D) placing the patient in shock position.
Answer: C
Objective: 6, 7
2
8) Your patient is a 46-year-old male truck driver who is sitting on a toilet complaining of
bleeding with defecation. He states that he had to strain significantly to produce a bowel
movement, then noted blood on his stool afterward. He claims no significant medical history, has
had no recent illness, and takes no medications. You note the presence of bright red blood on the
surface of his stool. Of the following, which is the most likely cause of his clinical condition?
A) Crohn's disease
B) Colitis
C) Upper GI bleed
D) Hemorrhoids
Answer: D
Objective: 1, 5
9) Your patient is a 12-year-old male who is conscious and alert and complaining of diffuse
abdominal pain. He states that the pain began about 3 hours after eating supper. He has had
severe diarrhea and some vomiting. Any of the following could be therapeutic EXCEPT:
A) diazepam.
B) Compazine.
C) IV of NaCl or lactated Ringer's solution.
D) Zofran.
Answer: A
Objective: 5, 7
10) Which three mechanisms can produce visceral pain?

A) Peritonitis, cholecystitis, and a ruptured abdominal aorta
B) Blunt trauma, penetrating trauma, and medical illness
C) Somatic, referred, and peritonitis
D) Distension, ischemia, and inflammation
Answer: D
Objective: 1, 3
3
11) Your patient is a 68-year-old female who is being treated for colon cancer. She is conscious
and alert, in mild distress, and complaining of progressive weakness over the past three days.
Palpation of her abdomen reveals tenderness to the lower right quadrant. Her skin is pale, cool,
and dry, and you note the smell and appearance of melena in her stool. HR = 108, BP = 100/60,
RR = 12, SaO2 = 97%. Proper treatment of this patient might include:
A) IV of normal saline with a 250 mL fluid challenge, repeated if necessary.
B) IV of 5 percent dextrose solution at 30 mL per hour.
C) two large-bore IVs of lactated Ringer's solution, wide open.
D) two large-bore IVs of normal saline, 20 mL/kg fluid bolus.
Answer: D
Objective: 6, 7
12) Your male patient complaining of abdominal pain describes his pain as a dull, crampy
sensation that is making him nauseous. The patient is most likely describing ________ pain.
A) visceral
B) referred
C) somatic
D) parietal
Answer: A
Objective: 1, 5
13) Which of the following correctly lists the organs and regions of the gastrointestinal tract in
sequence after the stomach?
A) Duodenum, jejunum, ileum, descending colon, transverse colon, ascending colon, rectum,
anus
B) Duodenum, ileum, jejunum, large intestine, anus, rectum
C) Jejunum, duodenum, ileum, large intestine, anus, rectum
D) Duodenum, jejunum, ileum, ascending colon, transverse colon, descending colon, rectum,
anus
Answer: D
Objective: 2
4
14) Your patient is a 68-year-old female complaining of diffuse abdominal pain. She has a
history of intestinal hernias and adhesions from previous abdominal surgery. Your suspicion
should be highest for:
A) appendicitis.
B) diverticulitis.
C) bowel obstruction.
D) ulcerative colitis.
Answer: C
Objective: 5
15) Your patient is a 38-year-old female with a history of Crohn's disease. She is conscious and
alert and complaining of abdominal pain. She describes a one-week history of increasingly
diffuse, crampy abdominal pain. She also states that she has had nausea and vomiting, fever, and
diarrhea the past two days. Physical examination reveals that her skin is warm and dry and that
her abdomen is tender to palpation in all quadrants with no masses or distension noted. HR =
100, BP = 118/78, RR = 14, SaO2 = 99%. Which of the following treatments is appropriate in
the prehospital management of this patient?
A) Diphenydramine
B) Ketorolac (Toradol)
C) Methylprednisolone
D) Antiemetics
Answer: D
Objective: 1, 4, 6
16) Increased hepatic resistance to blood flow, as happens in cirrhosis, results in:
A) hepatic arterial hypertension and obstruction of the common bile duct.
B) portal vein hypertension and esophageal varices.
C) portal artery hypertension and ascites.
D) hepatic vein hypertension and hepatic vein aneurysm.
Answer: B
Objective: 1, 3, 4
5
17) Bleeding in the gastrointestinal tract proximal to the ligament of Treitz is considered to be in
the:
A) small intestine.
B) lower GI tract.
C) upper GI tract.
D) colon.
Answer: C
Objective: 1, 2, 4
18) Which of the following properly accounts for the differences between visceral and somatic
pain?
A) Spilled organ contents and bacteria can result in visceral pain, while somatic pain is caused
by organ distension.
B) Visceral pain originates in the walls of hollow organs, while somatic pain originates in
skeletal muscle.
C) The nerves that carry somatic pain impulses enter the spinal column at various levels, while
the nerves that carry visceral impulses enter the spinal column via specific nerve routes.
D) The nerves that carry visceral pain impulses enter the spinal column at various levels, while
the nerves that carry somatic impulses enter the spinal column via specific nerve routes.
Answer: D
Objective: 1, 3
19) Pain that is well localized, allowing an examiner to pinpoint the area of irritation is
________ pain.
A) parietal
B) visceral
C) referred
D) somatic
Answer: D
Objective: 1, 3
6
20) Your patient is a 66-year-old female who is conscious and alert, complaining of a one-week
history of progressive "lightheadedness" with exertion. She also complains of mild nausea; dark,
sticky stools; and pain in her lower abdomen. Which of the following is the most likely cause of
this patient's condition?
A) Acute cholecystitis
B) Diverticulosis
C) Gastrointestinal bleeding
D) Ingestion of an iron or a bismuth-containing medication
Answer: C
Objective: 4, 5
21) Your patient is a 19-year-old male complaining of a two-day history of abdominal pain
described as diffuse and colicky, located around his umbilical area. He also states a loss of
appetite and a low-grade fever over the same period. Palpation of his abdomen reveals
tenderness and guarding to the periumbilical area. Of the following, which is the most likely
cause of his clinical condition?
A) Bowel obstruction
B) Appendicitis
C) Peptic ulcer disease
D) Cholecystitis
Answer: B
Objective: 5, 7
22) Murphy's sign is:

A) bruising around the umbilicus.
B) pain produced by pressing under the right costal margin in the presence of an inflamed
gallbladder.
C) pain produced by pushing 1 to 2 inches above the iliac crest on a line to the umbilicus.
D) petechial hemorrhage of the abdominal wall.
Answer: B
Objective: 1, 5
7
23) McBurney's point, a common site of pain secondary to appendicitis, is located:
A) at the midway point of a line from 1 to 2 inches above the right iliac crest to the umbilicus.
B) 2 inches above the umbilicus in the midline.
C) 1 to 2 inches above the iliac crest in the right midaxillary line.
D) at the midway point of a line from the symphysis pubis to the right anterior, superior iliac
crest.
Answer: A
Objective: 1, 2
24) Your patient is a 24-year-old male complaining of a one-week history of abdominal pain. He
describes the pain as in the upper right quadrant, dull and reproducible with movement and
palpation. He also describes a decreased appetite, weight loss, and clay-colored stool over the
same period. Of the following, which is the most likely cause of his clinical condition?
A) Colitis
B) Cholecystitis
C) Acute hepatitis
D) Pancreatitis
Answer: C
Objective: 3, 5
25) The mortality rate of ruptured esophageal varices is ________ percent.

A) over 35
B) 10 to 15
C) 20 to 30
D) 15
Answer: A
Objective: 4
26) Your 43-year-old male patient is alert and oriented and complaining of abdominal pain. He
states that he is experiencing nausea and has vomited twice. Which of the following is the most
appropriate follow-up question?
A) "What were you doing when the vomiting started?"
B) "Do you drink more than three alcoholic beverages a day?"
C) "Did you become dizzy or faint while you were vomiting?"
D) "What did the material you vomited look like?"
Answer: D
Objective: 5, 7
8
27) Your patient is a 44-year-old female with a history of hiatal hernia. She is complaining of
diffuse abdominal pain. All four quadrants are tender to palpation. She also states that she has
vomited numerous times and describes the presence of bile. You note that her abdomen is
slightly distended, and auscultation of her abdomen reveals absent bowel sounds. Of the
following, which is the most likely cause of her clinical condition?
A) Pancreatitis
B) Cholecystitis
C) Diverticulitis
D) Bowel obstruction
Answer: D
Objective: 4, 5
28) A 52-year-old male is in moderate distress and complaining of nausea and vomiting. He
describes a three-day history of left upper quadrant abdominal pain described as sharp and
radiating to his back. You note a slightly distended abdomen. He called EMS today when he
developed nausea and vomiting. He denies any change of bowel habits and states he has a history
of alcoholism. Of the following, which is the most likely cause of his clinical condition?
A) Pancreatitis
B) Hepatitis
C) Peptic ulcer disease
D) Gastroenteritis
Answer: A
Objective: 4, 5
29) Which of the following questions would best help you determine if the pathology of a
patient's complaint has been progressing?
A) "On a scale of 0 to 10, with 10 being the worst pain possible, how would you have rated the
pain when it started? How would you rate the pain now?"
B) "When did your pain first start?"
C) "Have you ever felt this pain before?"
D) "On a scale of 1 to 10, with 10 being the worst pain possible, how would you rate this pain?"
Answer: A
Objective: 3, 5
9
30) Gastrointestinal emergencies account for ________ percent of emergency room visits
annually.
A) 5
B) 10
C) 2.5
D) 7.5
Answer: A
Objective: 3
31) A 46-year-old female alcoholic is hypotensive, in severe distress, complaining of dysphagia,

and vomiting bright red blood. Of the following, which is the most likely cause of this patient's
clinical condition?
A) Hemorrhagic pancreatitis
B) Acute gastroenteritis
C) Esophageal varices
D) Acute gastric ulcer perforation
Answer: C
Objective: 4, 5
32) A 56-year-old female is conscious and alert and complaining of diarrhea and nausea. The
patient describes a two-day history of her symptoms and states that the pain is "all over her
abdomen." All four quadrants are tender to palpation. She also describes hematochezia. PMH
includes CAD, and she recently began taking 325 mg of ASA once a day. Of the following,
which is the most likely cause of her clinical condition?
A) Diverticulitis
B) Peptic ulcer
C) Acute pancreatitis
D) Acute gastroenteritis
Answer: D
Objective: 4, 5
10
33) Your patient is a 25-year-old female who is complaining of pain in the midline of the lower
abdomen. Which of the following questions helps least when determining the etiology of the
patient's pain?
A) "Do you feel nauseated?"
B) "Are you having any pain with urination?"
C) "Are you experiencing pain anywhere other than your lower abdomen?"
D) "When was your last menstrual period?"
Answer: A
Objective: 3, 5
34) Which of the following statements about hepatitis is TRUE?

A) Hepatitis is caused by a wide range of potential causes.
B) All types of hepatitis are typically fatal within six months to two years.
C) The most common cause of hepatitis is alcohol abuse.
D) All types of hepatitis lead to chronic liver disease.
Answer: A
Objective: 3
35) Which of the following statements would be most typical of a patient with hepatitis?
A) "It seems like everything has a yellow tinge to it."
B) "I have sharp pain on the left side of my abdomen."
C) "I have to urinate all the time."
D) "My stools are really light in color."
Answer: D
Objective: 3
36) Which of the following is the most common chief complaint related to acute pancreatitis?
A) Headache
B) Intense abdominal pain
C) Blood in the stool
D) Diarrhea
Answer: B
Objective: 4
11
37) Which of the following assessment findings should you most expect in a patient with chronic
pancreatitis?
A) Dark-colored urine
B) Right lower quadrant pain
C) Clay-colored stool
D) Hypotension
Answer: D
Objective: 3, 4
38) Upon palpation of your patient's abdomen you note that it is very tender under the right
costal margin. This should be documented as a positive ________ sign.
A) Murphy's
B) Cullen's
C) McBurney's
D) Grey-Turner's
Answer: A
Objective: 1, 5
39) Pain at McBurney's point is associated with:

A) cholecystitis.
B) kidney stones.
C) appendicitis.
D) pancreatitis.
Answer: C
Objective: 1, 3, 4
40) Your patient is a 55-year-old male whose wife called EMS after the patient complained of
bright red bleeding during a bowel movement. The patient refuses transport, stating he has
hemorrhoids and has had similar bleeding in the past. Which of the following statements is most
appropriate?
A) "I'm sure you are right; there is nothing to worry about."
B) "Similar bleeding can be caused by more serious conditions."
C) "This does not sound like hemorrhoids."
D) "Even though this sounds like hemorrhoids, the bleeding may become life-threatening."
Answer: B
Objective: 4, 5
12
41) Which of the following best explains the underlying problem in diverticulitis?
A) Infection in an outpouching of the distal colon
B) Ulceration of the lining of the colon
C) Increased motility of the colon with increased mucus production
D) The presence of polyps in the sigmoid colon
Answer: A
Objective: 1, 3, 4
42) Which of the following would be most typical of a patient suffering from diverticulitis?
A) Dark, tarry stools
B) Diffuse abdominal pain
C) Left lower quadrant pain
D) Inability to have a bowel movement
Answer: C
Objective: 1, 3, 4
43) A Mallory-Weiss tear is a disorder of the:

A) stomach.
B) liver.
C) rectum.
D) esophagus.
Answer: D
Objective: 1, 4
44) Esophageal varices are most associated with:

A) kidney disease.
B) liver disease.
C) gastroesophageal reflux disease.
D) pancreatitis.
Answer: B
Objective: 4
13
45) What is the most common cause of chronic gastroenteritis?
A) Microbial infection
B) Floral infection
C) Elevated cortisol
D) Use of NSAIDs
Answer: A
Objective: 3, 4
46) With occlusion of the SMA or IMA vascular structures, what gastrointestinal emergency
may occur?
A) Renal infarction
B) Hepatic encephalitis
C) Pancreatitis
D) Mesenteric ischemia
Answer: D
Objective: 3, 4
47) Which of the following mechanisms is NOT characteristic for a rectal foreign body?
A) Adhesion progression
B) Accidental trauma
C) Accidental swallowing of something
D) Tumor growth
Answer: B
Objective: 4, 5
48) Abdominal pain that is dull in nature and cannot be narrowed to one specific area is known
as:
A) referred pain.
B) somatic pain.
C) visceral pain.
D) Kehr's sign.
Answer: C
Objective: 1, 3
14
49) Abdominal pain that is sharp in nature and can be localized is known as:
A) referred pain.
B) somatic pain.
C) visceral pain.
D) Kehr's sign.
Answer: B
Objective: 1, 3
50) Abdominal pain that is originating in a region other than where it is felt is known as:
A) referred pain.
B) somatic pain.
C) visceral pain.
D) Kehr's sign.
Answer: A
Objective: 1, 3
51) You are examining a patient who was recently involved in a traumatic incident. You notice
that the patient is now exhibiting periumbilical ecchymosis. This is known as:
A) Grey Turner's sign.
B) Cullen's sign.
C) Edwards' sign.
D) rigidity sign.
Answer: B
Objective: 1, 5
52) You are examining a patient who is exhibiting signs of hypovolemia. Upon inspection of the
patient's flank, you notice ecchymosis. This is known as:
A) Grey Turner's sign.
B) Cullen's sign.
C) Edwards' sign.
D) rigidity sign.
Answer: A
Objective: 1, 5
15
53) Persistent abdominal pain is considered a surgical emergency when lasting longer than:
A) 2 days.
B) 2 hours.
C) 6 days.
D) 6 hours.
Answer: D
Objective: 3, 7
54) The main purpose of the GI tract is:

A) to convert food into nutrients for the body.
B) to expel waste products.
C) to facilitate metabolism.
D) glucogenolysis.
Answer: A
Objective: 2
55) You respond to a call of an ill person. Upon arrival, you find your patient complaining of
diffuse abdominal pain and hematemesis. When asked, the patient states that the emesis was
"coffee ground" in nature. You suspect:
A) lower GI bleed.
B) upper GI bleed.
C) melena.
D) esophageal varices.
Answer: B
Objective: 4, 5
56) You respond to a patent who complains of having dark, tarry stools. Upon arrival, you notice
that the patient is pale, cool, and clammy. After initiation of two large-bore IVs, your initial fluid
bolus should be:
A) 10 mL/kg.
B) 20 mL/kg.
C) 250 mL.
D) 1000 mL.
Answer: B
Objective: 5, 6
16
57) The cause of esophageal varices can be attributed to:
A) pulmonary hypertension.
B) portal hypertension.
C) pulmonary hypotension.
D) portal hypotension.
Answer: B
Objective: 1, 3, 4
17
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7.
Who tooke to wife as yee shall vnderstand

A mayden of a noble house and olde,
Raulfe Neuil’s daughter, earle of Westmerland,
Whose sonne earle Richard, was a baron bolde,
And had the right of Salisbury in holde,
Through mariage made with good earle Thomas heyre,
Whose earned prayses neuer shall appayre.
8.
The duke my father had by this his wife

Four sonnes, of whom the eldest Edward hight,
The second Eadmund, who [in youth] did loose his life,
[1174]
At Wakefielde slayne by Clyfford cruell knight:
I George am third, of Clarence duke by right:
The fourth, borne to the mischiefe of vs all,
Was duke of Glocester,[1175] whom men did[1176]
Richard call.
9.
Whan as our sire in sute of right was slaine,

(Whose life and death himselfe declared earst)
My brother Edward plyed his cause amayne,[1177]
And got[1178] the crowne, as Warwicke hath rehearst:
The pride whereof so deepe his stomacke pearst
That hee forgot his friendes, dispisde his kin,
Of oth or office passing not a pyn.[1179]
10.
Which made the earle of Warwicke to maligne

My brother’s state,[1180] and to attempt a way
To bring from prison Henry, seely king,
To helpe him to the kingdome[1181] if hee may,
And knowing mee to bee the chiefest stay
My brother had, hee did mee vndermine
To cause mee to his treasons to encline.[1182]
11.
Whereto I was prepared long before,

My brother had beene to mee so vnkinde:
For sure no cankar fretteth flesh so sore,[1183]
As vnkinde dealing doth a louing minde:
Loue’s strongest bandes vnkindnes doth vnbinde,
It moueth loue to malice, zeale to hate,
Chiefe friendes to foes, and brethren to debate.
12.
And though the earle of Warwicke, subtile sire

Perceiude I bare a grudge against my brother,
Yet toward his feate to set mee more on fire,
Hee kindled vp one firebrand with another:
For knowing fancy was the forcing rother
Which stirreth youth to any kinde of strife,
Hee offered mee his daughter to my wife.
13.
Where through, and with his crafty filed tongue,

Hee stale my heart that earst vnsteady was,
For I was witlesse, wanton, fond and yong,
Whole bent to pleasure, brittle as the glasse,
I can not lye, In vino veritas:
I did esteeme the bewty of my bryde
Aboue my selfe, and all the world beside.
14.
These fond affections ioynd with lacke of skill,

(Which trap the heart, and blind the eyes of youth,
And pricke the minde to practise any ill)
So tickled mee, that voyde of kindly truth,
(Which if it want all wretchednes[1184] ensueth)
I stinted not to persecute my brother,
Til time hee left his kingdom to another.
15.
Thus carnall loue did quench the loue of kinde,

Till lust were lost through fancy fully fed:
But whan at length I came vnto my minde,
I saw how lewdly lightnes had mee led,
To seeke with payne the perill of my heade:
For had king Henry once beene setled sure,
I was assurde my dayes could not endure.
16.
And therefore, though I bound my selfe with[1185] oth

To help king Henry all that euer[1186] I might,
Yet at the treaty of my brethren both,
Which reason graunted to require but right:
I left his part, whereby hee perisht quite:
And reconcilde mee to my brethren twayne,
And so came Edward to the crowne agayne.
17.
This made my father[1187] in law to fret and fume,

To stamp and stare, and call mee false forsworne,
And at the length with all his power, presume
To help king Henry, vtterly forlorne:
Our friendly proffers still hee tooke in scorne,
Refused peace, and came to Barnet fielde,
And there was kild, because hee would not yeelde.
18.
His brother also there with him was slayne,

Whereby decayed the keyes of chiualrye:
For neuer liu’d the matches of them twayne,
In manhood, power, and martiall pollecy,
In vertuous thewes, and friendly constancy,
That would to God, if it had bene his will,
They might haue tournde to vs and liued still.
19.
But what shalbe, shall bee: there is no choyse,

Thinges needes must driue as desteny decreeth,
For which wee[1188] ought in all our haps reioyce,
Because the eye eterne all things foreseeth
Which to no ill at any tyme agreeth,
For ills, to ill to vs, be good to it,
So far his skill’s exceede our reach of wit.
20.
The wounded man which must abyde the smart

Of stitching vp, or searing of his sore,
As thing to bad, reproues the surgeon’s art
Which not withstanding doth his health restore.
The childe likewise to science plied sore,
Counts knowledge ill, his teacher to be wood,
Yet surgery and sciences be good.
21.
But as the pacient’s griefe and scholer’s payne,

Cause them deme bad such things as sure be best,
So want of wisdome causeth vs complaine
Of euery hap, wherby we seme opprest:
The poore doe pine for pelfe, the rich for rest,
And when as losse or sicknesse vs assayle
We curse our fate, our fortune we bewayle.
22.
Yet for our good, God worketh euery thing:

For, through the death of these two noble peres,
My brother liu’d and raynde a quiet king,
Who, had they liued, perchaunce in course of years
Would haue deliuered Henry fro the breres,
Or holpe his sonne t’[1189]enioy the carefull crowne,
Wherby our line should haue bene quite put downe.
23.
A carefull crowne it may be iustly named,

Not onely for the cares thereto annext,[1190]
To see the subiect well and duly framed,
With which good care few kings are greatly vext,
But for the dred wherwith they are perplext,
Of losing lordship, liberty, or life:
Which wofull wracks in kingdoms happen ryfe.
24.
The which to shun while some to sore haue sought,

They haue not sparde all persons to suspect:
And to destroy such as they gilty thought,
Though no apparaunce proued them infect.
Take me for one of this wrong punisht sect,
Imprisonde first, accused without cause,
And done to death, no processe had by lawes.
25.
Wherin I note how vengeaunce doth acquite

Like yll for yll, how vices vertue quell:
For as my mariage loue did me excite
Agaynst the king my brother to rebell,
So loue to haue his children prosper well,
Prouoked him, agaynst both law and right,
To murder me, his brother, and his knight.
26.
For by his queene two princelyke sonnes he had,

Borne to be punisht for their parent’s synne:
Whose fortunes kalked made the father sad,
Such wofull haps were found to be therin:
Which to auouch, writ in a rotten skin,
A prophesie was found, which sayd, a G
Of Edward’s children should destruction bee.
27.
Mee to bee G, because my name was George,

My brother thought, and therefore did mee hate,
But woe be to the[1191] wicked heads that forge
Such doubtfull dreames to breede vnkinde debate:
For God, a gleue, a gibbet, grate, or gate,
A Gray, a Griffeth, or a Gregory,
As well as George, are written with a G.
28.
Such doubtfull riddles are no prophesies:

For prophesies, in writing though obscure,
Are playne in sence, the darke be very lies:
What God foresheweth is euident and pure,
Truth is no harold nor noe sophist sure:
She noteth not men’s names, their shieldes, nor
creasts,
Though she compare them vnto byrds and beasts.
29.
But whom she doth forshewe shall rayne by force,

She tearms a wolfe, a dragon, or a beare:
A wilfull prince, a raynlesse ranging[1192] horse:
A bold, a lion: a cowarde much in feare,
A hare or harte: a crafty, pricked eare:
A leacherous, a bull, a goate, a foale:
An vndermyner, a moldwarpe, or a mole.
30.
By knowen beastes thus truth doth playne declare

What men they be of whom shee speakes before:
And who so can men’s properties compare
And marke what beast they doe resemble more:
Shall soone discerne who is the griesly bore:
For God by beastes expresseth men’s condicions,
And not theyr badges, haroldes supersticions.
31.
And learned Merlyne, whom God gaue[1193] the sprite

To know and vtter princes actes to come,
Like to the Iewish prophets, did recite
In shade of beastes, theyr doings all and some,
Expressing plaine by maners of the dome,
That kinges and lordes such propertyes should haue
As haue the beastes whose name he to them gaue.
32.
Which while the foolish did not well consider,

And seeing princes gaue, for difference
And knowledge of theyr issues mixt together,
All maner beastes for badges of pretence,
There tooke those badges to expresse the sence
Of Merlyne’s minde, and those that gaue the same,
To bee the princes noted by theyr name.
33.
And hereof sprang the false namde prophesies,
That goe by letters, siphers, armes, or sines:
Which all bee foolish, false, and crafty lyes,
Deuisde by gesse, or guiles vntrue deuines:
For whan they saw that many[1194] of many lynes
Gaue[1195] armes alyke, they wist not which was hee
Whom Merlyne ment the noted beast to bee.
34.
For all the broode of Warwicke’s gaue the beare,

The Buckinghams doe likewise gieue the swan:
But which beare bearer should the lyon teare
They were as wise as Goose the fery man:
Yet in theyr skill they ceased not to scan,
And to bee deemed of the people wise,
Set forth theyr gloses vpon[1196] prophesies.
35.
And whome they douted openly to name

They darkely tearmed or by some letter ment,
For so they thought, how euer the world did frame,
Preserue themselues from shame, or being shent:
For, howsoeuer contrary it went,
They might expound their meaning otherwise,
As haps in things should newely still arise.
36.
And thus there grewe of a mistaken truth,

An art so false as made the true suspect:
Whereof hath come much mischiefe, more the ruth
That errours should our mindes so much infect,
True prophets[1197] haue fowly beene reiect:
The false, which breede both murder, warre, and strife,
Beleeued to the losse[1198] of many a good man’s life.
37.
And therefore, Baldwine, teach men to discerne,

Which prophecies be false and which bee true:
And for a ground this lesson let them learne,
That all bee false which are deuised newe:
The age of thinges are iudged by the hue:
All riddels made by letters, names or armes,
Are yong and false, far worse then witche’s charmes.
38.
I knowe thou musest at this lore of mine,

How I, no studient, should haue learned it:
And dost impute it to the fume of wine
That stirs the tongue, and sharpneth vp the wit:
But harke, a friend did teach mee euery whit,
A man of mine, in all good knowledge rife,
For which hee guiltlesse lost his learned life.
39.
This man abode my seruaunt many a day,

And still in study set his whole delight:
Which taught mee more then I could beare away
Of euery arte: and by his searching sight
Of thinges to come hee would foreshew as right,
As I rehearse the pageants that were past:
Such perfectnes God gaue him at the last.
40.
He knew my brother Richard was the bore,

Whose tuskes should teare my brother’s boyes and me,
And gaue me warning therof long before:
But wyt nor warning can in no degree
Let thinges to hap, which are ordainde to bee:
Witnesse the painted lionesse, which slue
A prince imprisoned, lyons to eschewe.
41.
He told me eke[1199] my yoke fellow should dy,

(Wherin would God he had bene no deuyne)
And after her death I[1200] should woo earnestly
A spouse, wherat my brother would repine,
And finde the meanes she should be none of[1201] mine:
For which such malice should among vs ryse,
As saue my death no treaty should decise.
42.
And as he sayd, so all things came to passe:

For whan king Henry and his sonne were slaine,
And euery broyle so throughly quenched was
That the king my[1202] brother quietly did raygne,
I, reconciled to his loue agayne,
In prosperous health did leade a quiet lyfe,
For fiue yeares space with honours laden rife.
43.
And to augment the fulnesse of my blisse,

Two louely children by my wife I had:
But froward hap, whose maner euer is
In chiefest ioy to make the happy sad,
Bemixt my sweete with bitternes too bad:
For while I swam in ioyes on euery side,
My louing wife, my cheifest iewell dyed.
44.
Whose lacke whan sole I had bewaylde a yeare,

The duke of Burgoine’s wife, dame Margarete,
My louing sister willing me to chere,
To mary[1203] agayne did kindely me intreate:
And wisht me matched with a mayden nete,
A step daughter of her’s, duke Charles’ hayre,[1204]
A noble damsell, yong, discrete and fayre.
45.
To whose desire because I did enclyne,

The king my brother douting my degree
Through prophesies, against vs did repyne,
And at no hand would to our wills agree:
For which such rancoure pearst both him and mee,
That face to face we fell at flat defiaunce,
But were appeased by frends of our aliaunce.
46.
Howbeit my mariage vtterly was dasht:

Wherin because my seruant sayd his minde,
A meane was sought wherby he mought[1205] be lasht:
And, for they could no crime agaynst him fynd,
They forgde a fault the people’s eyes to blinde,
And told he should by sorceries pretend
To bring the king vnto a spedy ende.
47.
Of all which poynts he was as innocent

As is the babe that lacketh kindely breth:
And yet condemned by the king’s assent,
Most cruelly put to a shamefull death:
This fierd my hart, as foulder doth the heath:
So that I could not but exclame and cry,
Agaynst so great and open iniury.
48.
For this I was commaunded to the tower,

The king my brother was so cruel harted,
And when my brother Richard saw the hower
Was come, for which his hart so sore had smarted,
He thought it best take time before it parted:
For he endeuoured to attayne the crowne,
From which my life must nedes haue held him downe.
49.
For though the king within a while had died,

As nedes he must, he surfayted so oft,
I must haue had his children in my guyde,
So Richard should besyde the crowne haue coft:
This made him ply the while the wax was soft,
To finde a meane to bring me to an ende,
For realm-rape spareth neyther kin nor frend.
50.
And whan hee sawe how reason can asswage

Through length of time my brother Edward’s ire,
With forged tales hee set him newe in rage,
Till at the last they did my death conspire:
And though my truth sore troubled their desire,
For all the world did knowe mine innocence,
Yet they agreede to charge mee with offence.
51.
And, couertly, within the tower they calde

A quest, to geue such verdite as they should:
Who what with feare and what with fauour thralde,
Durst not pronounce but as my brethren would:
And though my false accusers neuer could
Proue ought they sayd, I guiltlesse was condemned:
Such verdites passe where iustice is contemned.
52.
This feate atchiued, yet could they not for shame
Cause mee bee kild by any[1206] common way,
But like a wolfe the tyrant Richard came,
(My brother, nay my butcher I may say)[1207]
Unto the tower when all men were away,[1208]
Saue such as were prouided for the feate:
Who in this wise did straungely mee entreate.
53.
His purpose was with a prepared string

To strangle mee: but I bestird mee so,
That by no force they could mee therto bring,
Which caused him that purpose to forgo:
Howbeit they bound mee, whether I would or no,
And in a but of malmesey standing by,
Newe christned mee, because I should not cry.[1209]
54.
Thus drownde I was, yet for no due desert,

Except the zeale of justice bee a crime:
False prophecies bewitcht king Edward’s hart,
My brother Richard to the crowne would clime:
Note these three causes in thy rufull rime,
And boldly say they did procure my fall,
And death of deaths most straunge and hard of all.
55.
And warne all[1210] princes prophecyes to eschue,

That are to darke and doubtfull to be knowen:
What God hath sayd, that cannot but ensue,
Though all the worlde would haue it ouerthrowne:
When men suppose by fetches of theyr owne
To fly[1211] theyr fate, they furder on the same,
Like quenching blastes which[1212] oft reuiue the flame.
56.
Will princes therefore, not to thinke by murder

They may auoyde what prophecyes behight,
But by theyr meanes, theyr mischiefes they may furder,
And cause God’s vengeaunce heauier to alight:
Woe worth the wretch that striues with God’s foresight:
They are not wise, but wickedly do arre,
Which thinke yll deedes due destenies may barre.
57.
For if wee thinke that prophecyes be true,

We must beleue it cannot but betyde,
Which God in them foresheweth shall ensue,
For his decrees vnchaunged doe abide:
Which to be true my brethren both haue tryed,
Whose wicked warkes warne princes to detest,
That other’s harmes may keepe them better blest.[1213]
[By that this tragedy was ended, night was so nere come that
wee could not conueniently tary together any longer: and therefore
sayd maister Ferrers: “It is best my maisters to stay here. For wee be
come now[1214] to the end of Edward the fourth’s raigne.[1215] For
the last whom wee finde vnfortunate therein, was the duke of
Clarence: in whose behalfe I commend much that which hath bene
noted. Let vs therefore for this time leaue with him, and this day
seauen nights hence, if your busines will so suffer, let vs all meete
here together[1216] agayne. And you shall see that in the meane
season I will not only deuise vpon this my selfe, but cause diuers
other of my acquayntance, which can doe very well, to helpe vs
forwarde with the rest.” To this euery man gladly agreed. “Howbeit,”
sayd[1217] another, “seing we shall end at Edward the fourth’s end,
let himselfe make an ende of our daye’s labour, with the same
oration which maister Skelton made in his name, the tenour whereof,
so far as I remember, is as foloweth.”][1218]
Howe King Edward the fourth[1219]
through his surfeting and
vntemperate life, sodaynly dyed in the
middest of his prosperity, the nynth of
Aprill, Anno 1483.
1.
Miseremini mei yee that bee my frendes,

This world hath formed mee downe to fall:
How may I endure whan that euery thing ends?
What creature is borne to be eternall?
Now there is no more but pray for mee all,
Thus say I, Edward, that late was your king,
And twenty-two[1220] yeares ruled this imperiall,[1221]
Some vnto pleasure and some to no lyking:
Mercy I aske of my misdoyng,
What avayleth it frendes to bee my foe?
Sith I cannot resist, nor amend your complayning,
Quia ecce[1222] nunc in puluere dormio.
2.
I sleepe now in mould as it is naturall,

As earth vnto earth hath his reuerture:
What ordayned God to bee terrestriall,[1223]
Without recourse to the earth by nature?
Who to liue euer may himselfe assure?
What is it to trust to mutability?
Sith that in this worlde nothing may endure:
(For now am I gone that was late in prosperity)
To presume thereuppon it is but[1224] vanity:
Not certayne, but as a chery fayre full of wo:
Raigned not I of late in great prosperity?[1225]
Et ecce in nunc puluere dormio.
3.
Where was in my life such an one as I,

While lady fortune had with me[1226] continuaunce:
Graunted not shee mee to haue victory,
In England to raigne and to contribute Fraunce?
Shee tooke mee by the hand and led me a daunce,
And with her sugred lips on mee shee smyled,
But what for dissembled countenaunce,
I could not beware till I was beguyled:
Now from this world shee hath mee exiled,
Whan I was lothest hence for to goe,
And am in age as[1227] (who sayth) but a childe,
Et ecce nunc in puluere dormio.
4.
I had enough, I held mee not content,

Without remembraunce that I should dye:
And moreouer to encroch redy was I bent,
I knew not how long I should it occupye,
I made the towre strong, I wist not why:
I knew not to whom I purchased Tartersall:
I mended Douer on the mountayne hye:
And London I prouoked to fortify the wall:
I made Notingham a place full royall:
Windsore, Eltam, and many other mo,
Yet at the last I went from them all,
5.
Where is now my conquest and victory?
Where is my riches and royall array?
Where be my coursers and my horses hye,
Where is my myrth, my solace, and my play?
As vanity to nought all[1228] is wythered away:
O lady Bes long for mee may you call,
For I am departed vntill dome’s day:
But loue you that lord that is soueraine of all:
Where bee my castles and buildings royall?
But Windsore alone now haue I no moe,
And of Eton the prayers perpetuall,
6.
Why should a man bee prowde or presume hye?

Saint Bernard thereof nobly doth treate,
Saying a man is but a sacke of stercory,
And shall retourne vnto wormes meate:
Why, what became of Alexander the great?
Or else of strong Sampson, who can tell?
Were not wormes ordaynde theyr flesh to freate?
And of Salomon that was of wit the well,
Absolon preferred his hayre for to sell,
Yet for his bewty wormes eate him also,
And I but late in honoures did excell,
7.
I haue played my pageant, now am I past,

Yee wot well all I was of no great elde:
Thus all thing concluded shalbe at the last,
When death approcheth then lost is the fielde:
Then seing this world me no longer vpheld,
(For nought would conserue mee here in this place)
In manus tuas Domine my spirit vp I yeelde,
Humbly beseeching thee, O God, of thy grace,
O you courteous commons your heartes embrace,
Beningly now to pray for mee also,
For right well you[1229] know your king I was:
Et ecce nunc in puluere dormio.[1230]
[Whan this was sayd, euery man for that[1231] time tooke his
leaue of other, and departed (for then it waxed darke) appointing a
new day of meeting, which being come, we met all together againe.
And whan we had saluted one another, then one tooke the booke,
and began to read the story of king Edward the fifte: (for there wee
left) and when hee came to the apprehending of the lord Riuers:
“Stay there I pray you,” sayd I, “for here is his complaint. For the
better vnderstanding whereof, you must imagine that he was
accompanied with the lord Richard Gray, Hawt, and Clappam,
whose infortunes hee bewaileth after this maner.”]

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2) All of the following contribute to the pathogenesis of diverticulosis EXCEPT:

10) Which three mechanisms can produce visceral pain?

22) Murphy's sign is:

25) The mortality rate of ruptured esophageal varices is ________ percent.

31) A 46-year-old female alcoholic is hypotensive, in severe distress, complaining of dysphagia,

34) Which of the following statements about hepatitis is TRUE?

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44) Esophageal varices are most associated with:

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Who tooke to wife as yee shall vnderstand

The duke my father had by this his wife

Whan as our sire in sute of right was slaine,

Which made the earle of Warwicke to maligne

Whereto I was prepared long before,

And though the earle of Warwicke, subtile sire

Where through, and with his crafty filed tongue,

These fond affections ioynd with lacke of skill,

Thus carnall loue did quench the loue of kinde,

And therefore, though I bound my selfe with[1185] oth

This made my father[1187] in law to fret and fume,

His brother also there with him was slayne,

But what shalbe, shall bee: there is no choyse,

The wounded man which must abyde the smart

But as the pacient’s griefe and scholer’s payne,

Yet for our good, God worketh euery thing:

A carefull crowne it may be iustly named,

The which to shun while some to sore haue sought,

Wherin I note how vengeaunce doth acquite

For by his queene two princelyke sonnes he had,

Mee to bee G, because my name was George,

Such doubtfull riddles are no prophesies:

But whom she doth forshewe shall rayne by force,

By knowen beastes thus truth doth playne declare

And learned Merlyne, whom God gaue[1193] the sprite

Which while the foolish did not well consider,

For all the broode of Warwicke’s gaue the beare,

And whome they douted openly to name

And thus there grewe of a mistaken truth,

And therefore, Baldwine, teach men to discerne,

I knowe thou musest at this lore of mine,

This man abode my seruaunt many a day,

He knew my brother Richard was the bore,

He told me eke[1199] my yoke fellow should dy,

And as he sayd, so all things came to passe:

And to augment the fulnesse of my blisse,

Whose lacke whan sole I had bewaylde a yeare,

To whose desire because I did enclyne,

Howbeit my mariage vtterly was dasht:

Of all which poynts he was as innocent

For this I was commaunded to the tower,

For though the king within a while had died,

And whan hee sawe how reason can asswage

And, couertly, within the tower they calde