Gastrointestinal Disorders: Symptoms, Diagnosis, and Treatment, Exams of Nursing

Download Gastrointestinal Disorders: Symptoms, Diagnosis, and Treatment and more Exams Nursing in PDF only on Docsity!

CM3- Final Exam Questions Answers-Latest Update

patients with ____ may have salt water retention, ascites, & peripheral edema - Correct Answer cirrhosis what are some causes of Right heart failure? - Correct Answer -lung disease leading to Cor Pulmonale -Pulmonary hypertension -Pulmonary emboli S3 associated with what? - Correct Answer right heart failure (diastolic-hypertensive HFpEF) positive V/Q indicates - Correct Answer pulmonary emboli patients that have factitious disorders, malingering disorders, and personality traits show ___ behaviors to physicians - Correct Answer deliberated what are factors that do not predict adherence - Correct Answer gender age race educational level disease severity physician judgement factors that do predict patient adherence to treatment - Correct Answer characteristics of treatment regimen: -complexity/ dosing frequency -duration of regimen -side effects -costs patient characteristics: -patient beliefs -depression/anxiety patients respond better to psychologists when you call them your - Correct Answer "colleague" hypothesizes that a person adopting a new behavior progresses through specific stages of readiness to change - Correct Answer transtheoretical model of change: pre-contemplation

contemplation preparation action maintenance stage in TMC where the person has no intention to change the forseeable future and may be unaware of the problem - Correct Answer pre-contemplation stage in TMC where patients are aware problem exists and are seriously considering change but no commitment to action - Correct Answer contemplation stage in TMC where individuals are intending to take action within the next month they have unsuccessfully taken actions in the past year may report " baby steps" - Correct Answer preparation stage where individuals modify their behavior, experience, & environment -overt behavior change - Correct Answer action stage where patient prevents relapse and consolidate the gains -remaining free of the problem behavior and/ or consistently engaging in incompatible behavior for >6 mo. (6month- lifetime) - Correct Answer maintenance OARS skills of engagement stands for - Correct Answer Open-ended questions Affirmations Reflections Summaries conditions in which people are born, grow, live, work, & age - Correct Answer social determinants underserved populations have: - Correct Answer -high poverty rates -high infant mortality -high elderly population -too few primary care providers what country spends the most per capita on health care, but has lower than average outcomes - Correct Answer U.S. what modifiable CVD risk changed from 1990 to 2019 - Correct Answer -high body- mass index switch with tobacco ( tobacco now is below High body-mass index) external stressors and experiences of child maltreatment, household dysfunction, bullying, exposure to crime, discrimination, bias, and victimization - Correct Answer early life adversity (46% of children have experienced at least 1)

3 episodes of vomiting - Correct Answer recurrent vomiting severe, persistent nausea & vomiting during pregnancy, can lead to dehydration, electrolyte imbalance, & weight loss - Correct Answer hyperemesis gravidarium passive retrograde flow of esophageal contents into the mouth w/out the muscular activity associated with vomiting and w/out antecedent nausea - Correct Answer regurgitation chewing and swallowing of regurgitated food that has come back into the mouth through a voluntary increase in intraabdominal pressure w/in minutes of eating or during eating - Correct Answer rumination spasmodic respiratory movements against a closed glottis with contractions of the abdominal musculature w/out expulsion of any gastric contents; often immediately precedes vomiting; "dry heaves" - Correct Answer retching what are some triggers of nausea/ vomiting - Correct Answer staph. enterotoxin -drugs: dopamine agonists, cancer chemo, apomorphine, digoxin bilious vomiting is caused by - Correct Answer small bowel obstruction feculent (odor of feces) vomiting is caused by - Correct Answer bowel obstruction bloody or black coffee ground vomiting due to - Correct Answer large volume GI bleedings- varices, Mallory-Weiss tear, peptic ulcer partially digested food vomit is due to - Correct Answer gastroparesis, gastric outlet obstruction

undigested food ( regurg) is caused by - Correct Answer achalasia, Zenker diverticulum, esophageal stenosis projectile vomit is due to - Correct Answer pyloric stenosis, increased intracranial pressure vomiting only during periods of stress - Correct Answer psychogenic vomiting vomiting >1 hr after eating - Correct Answer gastroparesis, gastric outlet obstruction symptoms of vomiting occurred within a few hours of eating/ drinking something due to staph aureus or bacillus cereus toxins - Correct Answer food poisoning What is causes vomiting from home canned or preserved food - Correct Answer botulism ( Clostridium botulinum)

what infection is caused by ingestion of raw shellfish - Correct Answer vibrio vulnificus or saxitoxin what infection is caused by ingestion of raw fish or squid? - Correct Answer anisakiasis ( caused by anisakid nematodes) abdominal pain worsened by jolting movements like riding in the car or going down the stairs ( peritoneal pain) - Correct Answer peritonitis, bowel perforation abdominal pain that is crampy, colicky - Correct Answer bowel obstruction epigastric pain radiating to back - Correct Answer pancreatitis upper abdominal pain, >30 min - Correct Answer acute cholecystitis or cholelithiasis RLQ abdominal pain, preceded vomiting - Correct Answer acute appendicitis food borne illness symptoms - Correct Answer diarrhea viral gastroenteritis symptoms - Correct Answer fever, headache, myalgia choledocholithiasis or hepatitis symptoms - Correct Answer jaundice, tan stools, dark urine if patient presents with chest pain, diaphoresis, radiation to left arm is characteristic of - Correct Answer MI altered mental status is a characteristic of - Correct Answer intracranial bleed, mass, or infection if patient presents with unintentional weight loss, what should you be concerned about - Correct Answer eating disorder, GI malignancy if patient presents with cyclic vomiting syndrome, this suggests they have - Correct Answer migraines if a patient is unable to retain oral liquids for >12 hours in adult - Correct Answer hypovolemia & electrolyte imbalance if patient has difficulty swallowing, blurred vision, dry mouth - Correct Answer botulism patient presents with paresthesias ( numbness & tingling around the mouth) , muscle weakness, this is due to - Correct Answer paralytic shellfish poisoning

what are common bacterial peritonitis organisms - Correct Answer e. coli, Klebsiella, Strep. pneumoniae what is prescribed for bacterial peritonitis - Correct Answer ceftriaxone or cipro or TMP/SMX hemorrhage originating proximal to the ligament of Treitz - Correct Answer Upper GI bleed hemorrhage distal to the ligament of Treitz - Correct Answer lower GI bleed vomiting of bright red ( fresh) blood or " coffee-ground" (old) material - Correct Answer hematemesis black, tarry, foul smelling stools - Correct Answer melena bright red blood, marron blood, or clots passed per rectum - Correct Answer hematochezia This occurs due to increased pressure in the portal circulation system from the draining of the esophageal veins into the left gastric vein - Correct Answer esophageal varices the proximal esophagus drains into the upper esophageal plexus, which drains into - Correct Answer inferior vena cava also known as caput medusae - Correct Answer portal hypertension--> visible veins viral hepatitis is most commonly associated with inflammation of the ___ - Correct Answer portal tract this causes elevated liver enzymes, jaundice, cirrhosis, & portal HTN - Correct Answer chronic hepatitis treatment of acute esophageal varices - Correct Answer IV fluids with blood transfusion, endoscopic band ligation of the bleeding vessels, octreotide ( somatostatin analog) a nonpenetrating vertical laceration of the esophageal mucosa & submucosa caused by chronic or violent vomiting, retching, or hiccuping - Correct Answer Mallory- Weiss tear Mallory-Weiss tears are common in - Correct Answer alcoholism & eating disorders involving purging what are the most common symptoms of Mallory-Weiss tear - Correct Answer hematemesis and pain

rupture of the esophagus by a full-thickness tear or by a tear associated with medical procedure ( endoscopy) - Correct Answer Boerhaave syndrome rupture caused by increased intraluminal pressure & decreased intrathoracic pressure - Correct Answer boerhaave syndrome boerhaave syndrome usually accompanies a history of - Correct Answer alcoholism or gastric/ duodenal ulceration can present with crepitus due to subcutaneous emphysema - Correct Answer boerhaave syndrome how to differentiate btw Boerhaave and Mallory-Weiss - Correct Answer pneumomediastinum should be observed which is more mild: boerhaave or Mallory-Weiss - Correct Answer Mallory-Wiess A clean-base ulcer suggests - Correct Answer there is no active bleeding, indicates patient no longer requires hospitalization these are a common source of upper gastrointestinal bleeding, accounting for 50% of cases - Correct Answer peptic ulcers what are common causes of peptic/ gastric ulcers - Correct Answer h.pylori or NSAIDs what is the triple treatment for h.pylori - Correct Answer proton pump inhibitor, amoxicillin, clarithromycin what type of ulcers must always be biopsied - Correct Answer gastric ulcers--> gastric carcinoma what is a frequent cause of intussusception - Correct Answer meckel's diverticulum this is a direct result of the failure of the vitelline duct to close in infants - Correct Answer intussusception (vitelline duct connects the developing midgut to the yolk sac during embryo development) what is highly accurate for Meckel's diverticulum diagnosis? - Correct Answer Technetium 99m pertechnetate scan (Meckel's scan) presents in children with painless lower Gi bleeding, massive hematochezia when acute, and melena or currant jelly or maroon stools in children when chronic - Correct Answer Meckels diverticulum

what are the 2 causes of bleeding in the ileum - Correct Answer meckel's diverticulum & intussusception refer to the dilation of blood vessels in the lower rectum - Correct Answer hemorrhoids what should you suspect in a patient with bright red blood per rectum, anal pruritis, and acute onset of perianal pain - Correct Answer symptomatic hemorrhoids where do external hemorrhoids arise from - Correct Answer inferior hemorrhoidal plexus patient describes a tearing pain with passage of bowel movements stool is sometimes accompanied by bright red bleeding - Correct Answer anal fissure presents with intermittent rectal bleeding, passage of mucus, mild diarrhea associated with fewer than 4 small loose stools per day - Correct Answer proctitis or proctosigmoiditis what is the portal drainage of the GI tract? - Correct Answer hepatic vein, portal vein, hepatic portal vein, gastric vein, splenic vein, superior mesenteric vein what drives secretion of the gall bladder? - Correct Answer CCK (Cholecytokinin) which lobe of the liver is usually bigger, right or left? - Correct Answer right this vein has echogenic walls, larger near porta hepatis? - Correct Answer portal vein this vein has hypoechoic walls, larger superiorly (as they dump into IVC) - Correct Answer hepatic vein what is a treatment for portal HTN - Correct Answer Transjugular intrahepatic portosystemic shunt (TIPS)- direct communication is formed between a hepatic vein and a branch of the portal vein, allowing the flow to bypass the liver in-phase and out-of-phase sequences can identify what in a liver - Correct Answer fatty tissues enhancement of CT of liver shows discontinuous nodular, peripheral enhancement with progressive centripetal fill-in -the most common benign vascular finding - Correct Answer liver lesions what is the most common primary malignancy of the liver and typically found in late middle age or elderly adults? - Correct Answer Hepatocellular CA (Hepatoma) what are risk factors of Hepatoma? - Correct Answer Hep B/C, alcoholism ,biliary cholangitis

Alpha-fetoprotein (AFP) is a marker for - Correct Answer Hepatocellular carcinoma liver decreases in echotexture so echogenic fat portal triads stand out more in - Correct Answer liver edema in this liver pathology, the echotexture increases so normal fat around portal triads no longer seen - Correct Answer enlarged fatty liver pathology for segmental liver pathology - Correct Answer fatty liver subacute hepatitis infiltrating HCC presents on CT with <10+ HU less than spleen - Correct Answer fatty liver presents on CT nodular and with cirrhosis-Regen noduled - Correct Answer alcoholic liver ( most common) on CT, presents with irregular nodular outer surface, widened fissures, enlarged left lobe - Correct Answer cirrhosis presents with an enlarged spleen and varices in the abdomen - Correct Answer portal HTN what are the 4 portocaval anastomoses - Correct Answer paraumbilical esophageal lumbar segmental rectal hemorrhoidal what drains into the splenic vein? what drains into the portal vein? - Correct Answer inferior mesenteric; superior mesenteric what forms due to reversal of portal venous flow - Correct Answer varices massive structural changes associated with fibrosis & increased vascular tone in the hepatic microcirculation around the central vein - Correct Answer portal HTN in cirrhosis What does NOT have a significant distortion ferromagnetic effect on MRI in Wilson's disease? - Correct Answer copper patient presents with a nodular liver CT and Keyser Fleischer rings (reddish-brown ring around iris), what is the diagnosis? - Correct Answer Wilson's disease what is the diagnosis for a perivascular CT of liver? - Correct Answer congested liver parasitic infection

patient with elevated aminotransferase & no other etiology most likely has - Correct Answer celiac disease what is the most common non-invasive tests and first-level screening test for celiac disease - Correct Answer Tissue transglutaminase (tTG) IgA antibodies (however the gold standard is a small bowel biopsy) what is the gold standard test for celiac disease? - Correct Answer small bowel disease what is the most important screening test for colorectal cancer - Correct Answer colonoscopy (recommend repeat testing every 10 years after normal study) what is a noninvasive test and low-cost test for colorectal cancer - Correct Answer Fecal immunochemical test (FIT)- sensitivity is low -detects hemoglobin in stool -home-based test if patient cannot do a colonoscopy or FIT test, what is the second choice for colorectal cancer testing? - Correct Answer CT colonography every 5 years FIT- fecal DNA test every 3 years enzymes indicative of hepatocyte disease are - Correct Answer ALT & AST AST is elevated more than ALT in what disorder - Correct Answer chronic alcoholism what are the enzymes indicative of liver plasma membrane integrity - Correct Answer ALT, AST, LD (lactate dehydrogenase) what can you test for excretory functions of the hepatobiliary system? - Correct Answer bilirubin an increase in the prothrombin time (PT), or the international normalized ratio (INR) is a sign of - Correct Answer liver dysfunction what tests are used to diagnose viral hepatitis? - Correct Answer hepatitis serologic tests an a-antitrypsin deficiency indicates - Correct Answer non-viral liver disease what test can be used for cirrhosis? - Correct Answer liver biopsy** ( definitive) blood tests laboratory panel: FibroSure test

many patients with PBC (cirrhosis) are positive for what antibodies? - Correct Answer AMA ( anti-mitochondrial) if hyperbilirubinemia is present and unconjugated bilirubin is present, what is the cause - Correct Answer hemolysis if there is conjugated bilirubin then what would you expect to see on labs - Correct Answer ALT/ AST increase levels an amylase or lipase elevation grater than 3x normal level signifies - Correct Answer acute pancreatitis what is the most common used test for chronic pancreatitis - Correct Answer CBC what is a tumor marker for pancreatic cancer? - Correct Answer CA 19- what test can be done for pancreatic cancer - Correct Answer pancreatic cyst fluid analysis insulinoma tumor occurs in what organ - Correct Answer pancreas Gastrinoma (Zollinger-Ellison syndrome) most commonly occurs in what organ - Correct Answer duodenum what is the most common/easiest test for diabetes - Correct Answer random plasma glucose (>200 mg/dl is diagnostic) what fasting plasma glucose (FPG) is diagnostic for diabetes - Correct Answer > mg/dL What oral glucose tolerance test is diagnostic of DM? - Correct Answer a 2hr postbolus PG (plasma glucose) level of 200 mg/DL HbA1c level that is diagnostic of diabetes - Correct Answer >6.5% if patient has a fasting glucose from 100-126mg/dL and an impaire glucose tolerance of 140-200mg/dL, what is their diagnosis? - Correct Answer prediabetes how can prediabetes be fixed - Correct Answer loose body weight, exercise, medications if a 12 year old presents with RLQ pain and is found to have acute appendicitis, but you are unable to reach her parents. Would you perform the procedure or wait for parental consent? - Correct Answer perform appendectomy bc this is considered an emergency how long is acute diarrhea? - Correct Answer <2 wks

what should you this is diarrhea persist if patient stops eating - Correct Answer chronic watery diarrhea of secretory disorder diarrhea 6 hrs after eating mayonnaise, potato/egg salad, custard, poultry - Correct Answer Staph aureus diarrhea 6hrs after eating fried rice - Correct Answer bacillus cereus diarrhea or fever - Correct Answer salmonella, shigella, campylobacter diarrhea 8-14 hrs after eating poorly reheated meats or poultry - Correct Answer C.perfringens diarrhea 8-72 hrs after eating seafood - Correct Answer vibrio periumbilical abdominal pain is associated with - Correct Answer small bowel process lower abdominal pain is associated with - Correct Answer large bowel, infection, Ulcerative colitis generalized abdominal pain is associated with - Correct Answer ischemic bowel, celiac sprue, IBS abdominal pain that is relieved after bowel movement is associated with - Correct Answer IBS Straining at stool or a sense of urgency is characteristic of - Correct Answer ulcerative colitis, IBS, proctitis constipation is associated with what disorders - Correct Answer paradoxical diarrhea / IBS patient presents with fatigue, tachycardia, dermatisis or dry skin , anxiety - Correct Answer endocrine disorder patient presents with Hypotension, right-sides heart failure, bronchospasm, flushing - Correct Answer carcinoid tumor Reiter Syndrome Triad - Correct Answer Uveitis, urethritis, arthritis "Can't see can't pee can't climb a tree" -usually after infection with Salmonella or Shigella, Campylobacter, Yersinia travel to U.S. mountain area and drank form spring and now has diarrhea, what bacteria should you be concerned with - Correct Answer giardia

what bacteria is carried by pet iguanas or turtles - Correct Answer salmonella alarm symptoms of diarrhea - Correct Answer thirst, fatigue, dizziness nausea,vomiting fever bloody stools weight loss awakens from sleep Rome diagnostic criteria is used to rule out - Correct Answer IBS 1st test that should be performed on chronic diarrhea - Correct Answer CBC basic metabolic panel anti-tissue transglutaminase and total IgA CRP management plan for diarrhea - Correct Answer 1- rehydration 2- early refeeding (no fats/ fried, no dairy, no sugar-free anything, no alcohol) 3- antidiarrheal meds probiotics and zinc supplementation for diarrhea is effective in children or adults? - Correct Answer children Finding asterixis and ascites, along with decreased serum albumin (<2.8 g/dL) and a prolonged prothrombin time—clearly indicate what? - Correct Answer cirrhosis what is the most common differential for a person <30 yrs with jaundice - Correct Answer viral hepatitis what is the most common differential for a patient 40-60 yrs old and jaundice? - Correct Answer alcoholic liver disease what is the most likely diagnosis for a patient older than 6o yrs with jaundice? - Correct Answer gallstones what is the gold standard for renal imaging according to the AAST? - Correct Answer contrast-enhanced CT what should be done to check for complications of a managed non-operatively patient with grade IV or V injury - Correct Answer repeat contrast enhanced CT 48-72 hrs after intitial what effect on capillary hydrostatic pressure and plasma oncotic pressure cause edema

• Correct Answer increased capillary hydrostatic pressure decreased plasma oncotic pressure