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NR 576 FINAL EXAM REVIEW 2025|QUESTIONS AND
ANSWERS| A+ GRADED
Assessing for prior antibiotic use is a critical part of the history in patients with presenting with _______________ due to_________________ Diarrhea/CDiff Irritable bowel syndrome disorder of the bowel function not from anatomic abnormality--constipation, diarrhea, bloating, urgency w/diarrhea +s/s--result from disordered sensations or abnormal function of the small and large bowel NOT associated with serious medical conditions, IBD, CA Inflammatory bowel disorder chronic immunologic disease that manifests in intestinal inflammation Ulcerative colitis crohn's disease Two common inflammatory bowel diseases
Ulcerative colitis-mucosal surface of the colon is inflamed and ultimately results in frability, erosions, and bleeding--most common in recto-sigmoid colon. Can involve entire colon, pain in RLQ Crohns disease-inflammation extends deeper into the intestional wall and can involve all or any layer of the bowel wall and any portion of the GI tract from the mouth to the anus--skipped lesions, pain in LLQ Diverticulitis Symptoms: LLQ pain/tenderness, fever, N/V/D Need imagining especially if perforation or peritonitis is suspected--free air=perforation; patient may have ileus, small or large bowel obstruction Can use plain x-ray CT or Barium enema are preferred CT with contrast is more sensitive and accurate Identify the significance of Barrett's esophagus After repeated exposure to gastric contents, inflammation of the esophageal mucosa becomes chronic Blood flow increases, erosion occurs As erosion heals, normal squamous epithelium replaced with metaplastic columnar epithelium containing goblet and columnar cells. More resistant to acid and supports esophageal healing Premalignant tissue 40 - fold frisk for developing esophageal adenocarcinma
Medications for GERD antacids or OTC H2 (Tagamet, zantac, axid) Rx-strength H2 (ranitidine 150mg BID, famotidine 20mg BID) or PPI (pantoprazole 40mg daily, omeprazole 20mg daily) PPI (Omeprazole 40mg daily) Surgery (fundoplication) Differential diagnosis of acute abd pain Acute appendicitis Acute pancreatitis Acute cholecystitis Acute appendicitis Inflammation of the vermiform appendix; due to obstruction or infection Most common surgical emergency of the abdomen Hollow tube - most common cause is obstruction of appendix Fecaltih - hard lump of fecal matter Undigested seeds Pinworm infections Lymphoid follicle growth/lymphoid hyperplasia Symptoms
- Symptoms Nausea/vomiting
RLQ pain Guarding Acute pancreatitis Sudden inflammation and hemorrhaging of the pancreas due to destruction by its own digestive enzymes
- Autodigestion Most of the time mild, but can be severe Pancreas Long skinny gland, length of dollar bill Located in upper abdomen Behind the stomach Endocrine Alpha/beta cells produce insulin & glucagon that are secreted into the blood stream Exocrine Leading causes: ETOH abuse Gallstones Other Causes of acute pancreatitis
- I Get Smashed I - idoipathic G- gallstones E- ETOH abuse
Stone can get more stuck w/ more squeezing Bile starts to irritate mucosa Mucosa starts to produce mucous and inflamm enzymes Leads to inflammation, distention, pressure build up Bacterial growth (E. coli, enterococci, bacteroides fragilis, colstriduim) As GB "balloons", pain shifts to RUQ, R scapula/shoulder Bacteria invades in & through GB wall, into peritoneum, causing peritonitis Rebound tenderness Murphy's Sign = Put pressure on right side under ribs. This will hold GB in place. Have patient take a deep breath. The diaphragm will push on the GB & a painful response = Cholecystitis Immune response Neutrophilic leukocytosis Fever Acute appendicitis diagnostics Diagnosis is made clinically and based on history and physical Elevated WBC Mild Fever, 99- 100 RLQ pain/McBurneys point CT abd may help rule out other diagnostic possibilities ABD ultrasound helps to visualize the inflamed appendix
Acute pancreatitis diagnostics Pain in epigastrium which radiates to back Labs Increase in amylase; gold standard in diagnoses (up to 3x the normal level) Increase in lipase CT scan US to look for gallstones Acute cholecystitis diagnostics US confirmed Detects stones Sonographic murphy sign Tenderness when sonogram is over gallbladder GB wall thickening Sludge Distention of GB or common bile duct Cholescintigraphy (HIDA scan) Radiolabeled marker used to visualize the biliary system Acute cholecys - ducts are blocked, GB can't be seen Endoscopic Retrograde Cholangiopancreatography (ERCP) Endoscope down to pancreas Dye injected & viewed via fluoro Magnetic Resonance Cholangiopancreatography (MRCP)
- Visualizes bili system with MRI
ATB
o Surgical Removal
- Cholecystectomy
- Laparoscopic What is sensorineural hearing loss Results from deterioration of cochlea
- Loss of hair cells form the organ of Corti
- Gradual and progressive
- Not correctable but preventable What is conductive hearing loss Obstruction between middle and outer ear
- Most types are reversible Triad symptoms associated with Meniere's disease Sensory disorder of labyrinth (semi-circular canal system) and cochlea
- S/S: - Vertigo
- Hearing loss
- Tinnitus
Symptoms associated with peritonsillar abscess Increasing unilateral ear and throat pain ipsilateral to the affected tonsil
- Dysphagia
- Drooling
- Trismus
- Erythema
- Edema of the soft palate with fluctuance on palpation Most common cause of viral pharyngitis Adenovirus: MOST common - RSV
- Influenza A&B - Epstein-Barr
- coxsackie - enteroviruses
- herpes simplex Most common cause of acute N/V Gastroenteritis The importance of obtaining an abdominal xray to rule out perforation or obstruction even though the diagnosis of diverticulitis can be made clinically Abdominal xray films should be obtained on all patients with suspected diverticulitis to look for free air (indicating perforation), ileus, or obstruction
- Tender anterior cervical adenopathy Identify the clinical findings associated with mononucleosis
- Fever
- Malaise
- Severe sore throat
- Exudative tonsillitis (50% of cases)
- Palatal petchiae
- Rash - Anterior/posterior cervical lymphadenopathy
- Splenic enlargement - POC Monospot test: (+) Identify common characteristics in a rash caused be Group A Strep Sandpaper rash Fine, red, sparing hands & soles Discuss that the diagnosis of streptococcal pharyngitis can be made clinically based on the Centor criteria
- Absence of cough
- Tonsillar exudates
- History of fever
- Tender anterior cervical adenopathy
Describe an intervention for a patient with gastroenteritis
- Supportive care: fluid and nutrients
- Low residue diet (BRAT) - no evidence that this helps, but may be more tolerable for pt
- Viral cause = NO antibiotics
- Education surrounding not prescribing antibiotics/not spreading germs/eating safe foods Imodium/Zofran/Phenergan Discuss an appropriate treatment for prophylaxis or treatment of traveler's diarrhea
- empirical antimicrobial therapy: Trimethoprim-sulfamethoxazole (Bactrim) 1 PO BID ×3d
- ciprofloxacin (Cipro) 500 mg
- norfloxacin (Noroxin) 400 mg
- ofloxacin (Floxin) 300 mg Identify at least one effective treatment for Irritable Bowel Syndrome (IBS)
- For IBS - C o Psyllium (fiber) o docusate (softner) o bisacodyl/senna (stimulant/irritant) o loperamide (antidiarrheal)
Surgery Discuss that the majority of dyspnea complaints are due to cardiac or pulmonary decompensation
- 2/3 of symptomatic patients the etiology is due to cardiopulmonary disease
- 1/3 of all cases the cause of dyspnea is multifactorial
- Common cardiopulmonary conditions: We have an expert-written solution to this problem! Explain the differences between intra-thorax and extra-thorax flow disorders Flow Disorders
- Intrathorax
- Obstruction of distal/smaller airway
- Extrathorax
- Obstruction of proximal/larger airway Identify at least three examples of flow disorders (intra and/or extra thorax) Intrathorax flow disorders: originate from obstruction of distal/smaller airways
- asthma
- bronchiolitis
- vascular ring
- solid foreign body aspiration
- lymph node enlargement pressure
- These types of disorders cause expiratory effort in infants and also in children less than 5 years of age (bronchiolitis)
- Extrathorax flow disorders: originate from obstruction of the larger airways
- rhinitis with nasal obstruction, nasal polyp
- cranio-facial malformation
- obstructive sleep apnea
- tonsil-adenoid hypertrophy
- laryngo-tracheo-malacia
- larynx papilloma
- Diphtheria
- croup, epiglottitis
- thymus hypertrophy
- Infants or children ages 5 and younger are affected, and they have clinical findings of inspiratory stridor Identify at least three examples of volume disorders (intra and/or extra thorax)
- Intrathorax volume disorders include lung parenchyma disorders
- pneumonia (infection, aspiration)
- atelectasis
- pulmonary edema
- near drowning
- Extrathorax volume disorders that are due to respiratory center disorders
- anemia
- metabolic acidosis
- CNS infections: meningitis, encephalitis
- encephalopathy (typhoid, DHF, metabolic)
- psychologic (anxiety, usually adolescent)
- poisoning (salycylate, alcohol)
- trauma capitis
- CNS disease sequelae
- These disorders cause deep rapid breathing Discuss diagnosis for asthma Essential elements to consider- HX- cough (especially nocturnal), recurrent wheeze, recurrent episodic dyspnea, recurrent chest tightness Symptoms worsen in relation to specific factors- changes in weather, exercise, environmental allergens, GERD, Beta blockers, sensitivity to ASA, strong emotional expression To establish the diagnosis of asthma, episodic symptoms of airflow obstruction must be present, airflow obstruction must be at least partially reversible, and must rule out other diagnoses.
Spirometry measurements are helpful in diagnosis & in evaluation of management The diagnosis is made by demonstrating the reversibility of the airway obstruction from the pre- and post- PFTs. Reversibility is defined as a 15% or greater increase in the FEV1 after 2 puffs of a beta-adrenergic agonist have been inhaled. When spirometry is non-diagnostic, bronchial provocation testing maybe useful with histamine, methacholine, or exercise. Discuss risk factors and for asthma Risk Factors Family or personal history- allergic rhinitis, eczema/atopic diseases Residing in urban area Exposure to smoke or air pollution Cockroaches and dust Viral respiratory infections Cold air intolerance obesity Discuss diagnosis treatments for asthma *Short acting bronchodilator (albuterol) is a mainstay of treatment for ALL asthma patients
