Abdominal Problems Flashcards by Trish Odom

Lipids are broken down where in the GI tract?

A. Esophagus
B. Stomach
C. Small intestine
D. Large intestine

B. Stomach

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Marvin, a known alcoholic with cirrhosis, is frequently admitted for coagulopathies and occasionally receives blood transfusions. His wife asks why he has a bleeding problem. You respond:
A. Occasionally he accumulates blood in the gut.
B. There is an interruption of normal clotting mechanisms.
C. Long term alcohol abuse has made his vessels very friable.
D. His bone marrow has been affected

B. There is an interruption of normal clotting mechanisms.

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Jonas, age 34, had a Billroth II (hemigastrectomy and gastrojejunostomy) performed 1 week ago and just started eating a bland diet. What do you suspect when he complains of epigastric fullness, distention, discomfort, abdominal cramping, nausea, and flatus after eating?

A. Obstruction
B. Dumping syndrome
C. Metabolic acidosis
D. Infectious colitis

B. Dumping syndrome

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A common complication of viral gastroenteritis in children is:

A. Dehydration
B. GI bleeding
C. Peritonitis
D Bacterial sepsis

A. Dehydration

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The most important diagnostic test for celiac disease is:

A. Confirming malabsorption by lab tests
B. Barium enema
C. A peroral biopsy of the duodenum
D. A gluten free diet trial with an accompanying improvement in mucosal histological response

D. A gluten free diet trial with an accompanying improvement in mucosal histological response

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What is the most common cause of melena?

A. Colon cancer
B. Upper GI bleeding
C. Drug abuse
D. Smoking

B. Upper GI bleeding

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Which maneuver for diagnosing appendicitis is done by deep palpation over the LLQ with resultant pain in the RLQ?

A. Rovsing’s sign
B. Psoas sign
C. Obturator sign
D. McBurney’s sign

A. Rovsing’s sign

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Sam has UC and is on a low residue diet. Which foods do you recommend Sam avoid?

A. Potato skins, potato chips, and brown rice
B. Vegetable juices and cooked and canned vegetables
C. Ground beef, veal, pork, and lamb
D. White rice and pasta

A. Potato skins, potato chips, and brown rice

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Which of the following treatments for UC is contraindicated?

A. A high calorie, nonspicy, caffeine free diet that is low in high residue foods and milk products
B. Corticosteroids in the acute phase
C. Antidiarrheal agents
D. Colectomy with permanent ileostomy in severe cases

C. Antidiarrheal agents

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Olive has an acute exacerbation of Crohn’s disease. Which lab test values would you expect to be decreased?

A. ESR
B. LFT
C. Vitamin A, B complex, and C levels
D. Bilirubin

C. Vitamin A, B complex, and C levels

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You suspect Harry has a peptic ulcer and tell him that it has been found to be strongly associated with:

A. anxiety and panic attacks
B. long term NSAID use
C. infection with H. pylori
D. a family history of peptic ulcer

C. infection with H. pylori

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You are doing routine teaching with a patient who has a family history of colorectal cancer. You know she misunderstands the teaching when she tells you:

A. decrease her fat intake
B. increase her fiber intake
C. continue her daily ASA use
D. increase her fluid intake

D. increase her fluid intake

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The proper order of assessment of the abdomen is:

A. palpation, percussion, auscultation, inspection
B. inspection, palpation, auscultation, percussion
C. inspection, auscultation, percussion, palpation
D. percussion, auscultation, inspection, palpation

C. inspection, auscultation, percussion, palpation

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Which of the following antibiotics causes more episodes of nausea and/or vomiting than the others?

A. Azithromycin
B. Erythromycin
C. Penicillin
D. Tetracycline

B. Erythromycin

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Melva presents with an exacerbation of acute pancreatitis and you are going to admit her to the hospital. Which is the most important factor in determining a negative long term outcome for her?

A. age
B. infection
C. pain
D. length of time between exacerbations

B. infection

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One of the alarm signs and symptoms of IBS that requires prompt investigation is:

A. blood or pus in the stool
B. weight gain
C. hyperkalemia
D. first onset in the teen years

A. blood or pus in the stool

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In a 2 month old infant with vomiting an diarrhea, the most effective way to determine a fluid deficit is to check for:

A. decreased peripheral perfusion
B. hyperventilation
C. irritability
D. hyperthermia

A. decreased peripheral perfusion

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The most common anal fissure location is:

posterior midline of anus

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Rectal bleeding associated with anal fissure is usually described by the patient as:

drops of blood noticed when wiping

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A 62 yo woman who reports frequent constipation is diagnosed with an anal fissure. First line therapy includes all of the following except:
 A. stool bulking supplements
 B. high fiber diet
 C. intraanal corticosteroids
 D. periodic use of mineral oil

C. intraanal corticosteroids

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A 54 yo man with an anal fissure responds inadequately to dietary intervention and standard therapy during the past 2 weeks. Additional treatment options include all of the following except:

A. intraanal nitro ointment
B. botox to internal anal sphincter
C. surgical sphincterotomy
D. rubber band ligation of the lesion

D. rubber band ligation of the lesion

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In a patient who presents with a history consistent with anal fissure but with notation of an atypical anal lesion, alternative diagnoses to consider include all of the following except:

A. condylomata acuminate
B. Crohn’s disease
C. anal squamous cell carcinoma
D. C. difficile colitis

D. C. difficile colitis

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Which of the following is the most likely patient report with anal fissure?

A. I have anal pain that is relieved with having a BM
B. Even after a BM, I feel like I still need to go more
C. I have anal pain for up to 1-2 hours after a BM
D. I itch down there almost all the time

C. I have anal pain for up to 1-2 hours after a BM

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Long term, recurrent high dose oral use of mineral oil can lead to deficiency in:

vitamin A

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Rectal bleeding associated with hemorrhoids is usually described as:

streaks of bright red blood on stool

Therapy for hemorrhoids includes all of the following except: A. weight control B. low fat diet C. topical corticosteroids D. stool softener

B. low fat diet

The NP is advising a 58 yo woman about the benefits of a high fiber diet. Which of the following foods provides the highest fiber content? A. 1 small banana B. 1 cup of cooked oatmeal C. 1/2 cup of brown rice D. medium sized blueberry muffin

D. medium sized blueberry muffin

A 62 yo man presents with a 2 month history of noting a bit of dark blood mixed in with my stool most days", PE reveals external hemorrhoids, no rectal mass, and a small amount of dark brown sool on the examining digit. In office occult test is positive, and a hemogram reveals a microcytic hypochromic anemia. The next best step is:

Refer to GI for colonoscopy

Risk factors for the development of hemorrhoidal symptoms include all of the following except: A. prolonged sitting B. insertive partner in anal intercourse C. chronic diarrhea D. excessive alcohol use

B. insertive partner in anal intercourse

Which of the following patients should be evaluated for possible surgical intervention for hemorrhoids? A. a 28-year-old woman with symptomatic external hemorrhoids who gave birth 6 days ago B. a 48-year-old man with Grade II internal hemorrhoids and improvement with standard medical therapy C. a 44-year-old woman who has internal and external hemorrhoids with recurrent prolapse D. a 58-year-old man who has Grade I internal hemorrhoids and improvement with psyllium supplements

C. a 44-year-old woman who has internal and external hemorrhoids with recurrent prolapse

All of the following are typically noted in a young adult with the diagnosis of acute appendicitis except: A. epigastric pain. B. positive obturator sign. C. rebound tenderness. D. marked febrile response.

D. marked febrile response.

A 26 yo man presents with acute abdominal pain. You order a CBC and anticipate:

Left shift with bandemia

You see a 72 yo woman with vomiting and abdominal cramping occurring over the past 24 hours. You consider that:

the presentation can differ according to the anatomical location of the appendix

The psoas sign can be best described as abdominal pain elicited by:

passive extension of the hip

The obturator sign can best be described as abdominal pain elicited by:

passive flexion and internal rotation of the hip

An 18 yo man presents with periumbilical pain, vomiting, and abdominal cramping over the past 48 hours. PE reveals rebound tenderness, and labs show bandemia and leukocytosis. To support appendicitis with rupture diagnosis you consider which abdominal imaging study:

CT scan

Which WBC form is an ominous finding in the presence of severe bacterial infection?

metamyelocyte

Which best represents the peak ages for acute appendicitis?

10 to 30 yo

Clinical findings most consistent with appendiceal rupture include all of the following except: A. abdominal discomfort less than 48 hours in duration. B. fever greater than 102°F (>38°C). C. palpable abdominal mass. D. marked leukocytosis with total WBC greater than 20,000/mm3

A. abdominal discomfort less than 48 hours in duration.

Which imaging study potentially exposes the patient being evaluated for abdominal pain to the lowest radiation?

Commonly encountered diagnoses other than appendicitis can include which of the following in a 28 yo with a 2 day history of lower abdominal pain with right sided pain slightly worse than the left?

PID ectopic pregnancy constipation

Rebound tenderness is best described as abdominal pain that worsens with:

release of deep palpation at the site of the discomfort

Abdominal palpation that yields rebound tenderness is also known as:

Blumberg's sign

Which findings would you expect to encounter in a 33 yo man with appendiceal abscess?

dullness to percussion in RLQ

A 43 yo woman has a 12 hour history of sudden onset RUQ pain with radiation to the shoulder, fever, and chills. She has similar, milder episodes in the past. Exam reveals marked tenderness to palpation. Her most likely diagnosis is

acute cholecystitis

Which of the following is usually not seen in the diagnosis of acute cholecystitis? A. elevated serum creatinine B. increased alkaline phosphatase level C. leukocytosis D. elevated aspartate aminotransferase (AST) level

A. elevated serum creatinine

Murphy's sign can be best described as abdominal pain elicited by:

RUQ palpation

Which is the most common serious complication of cholecystitis?

pancreatitis

A 58 yo man reports intermittent RUQ pain. He is obese and being actively treated for hyperlipidemia. Imaging in a patient with symptomatic cholelithiasis usually includes an abdominal:

RUQ US

What is most likely to be found in a person with acute cholecystitis?

vomiting

Risk factors for the development of cholethiasis include all of the following except: A. rapid weight loss. B. male gender. C. obesity. D. Native American ancestry.

B. male gender

A gallstone that is not visualized on XR is said to be:

radiolucent

Later colorectal cancer presentation often includes what condition?

IDA

According to ACS recommendations, what is the preferred method for annual colorectal cancer screening in a 51 yo man?

Fecal occult blood test

Which is most likely to be noted in a person with colorectal cancer?

few symptoms

Which does not increase a patient's risk of developing colorectal cancer? A. family history of colorectal cancer B. familial polyposis C. personal history of neoplasm D. long-term aspirin therapy

D. long-term aspirin therapy

According to ACS, colorectal cancer is the number____cause of cancer death in men and women.

Approximately what percent of the population will develop diverticulosis by the time they reach 50 yo?

33%

Which is most consistent with acute colonic diverticulitis? A. cramping, diarrhea, and leukocytosis B. constipation and fever C. right-sided abdominal pain D. frank blood in the stool with reduced stool caliber

A. cramping, diarrhea, and leukocytosis

Major risk factors for diverticulosis include all of these except: A. low-fiber diet. B. family history of the condition. C. older age. D. select connective tissue disorders (e. g. , Marfan syndrome).

A. low-fiber diet.

To avoid diverticulitis treatment of diverticulosis includes: A. avoiding foods with seeds. B. the use of fiber supplements. C. ceasing cigarette smoking. D. limiting alcohol intake.

B. the use of fiber supplements.

The location of discomfort with acute diverticulitis is usually in which of the following areas of the abdomen?

LLQ

You are seeing Mr. Lopez, a 68 yo man with suspected diverticulitis. In choosing an appropriate imaging study to support this diagnosis, which study is most appropriate?

CT scan with contrast

In evaluation of acute diverticulitis, the most appropriate diagnostic approach to rule out free air in the abdomen is

plain abdominal film

Measures to prevent diverticulosis and diverticulitis include all of the following except: A. whole grain intake. B. regular aerobic exercise. C. adequate hydration. D. refraining from excessive alcohol intake.

D. refraining from excessive alcohol intake.

The gastric parietal cells produce:

hydrochloric acid

Antiprostaglandin drugs cause stomach mucosal injury primarily by:

altering the thickness of the protective mucosal layer

A 24 yo man presents with a 3 month history of upper abdominal pain. He describes it as an intermittent, centrally located burning feeling in his upper abdomen, most often occurring 2-3 hours after meals. His presentation is most consistent with:

duodenal ulcer

When choosing pharmacological interventions to prevent recurrence of duodenal ulcer in a middle aged man, you prescribe:

H2 blocker

The H2 blocker most likely to cause drug interactions with phenytoin and theophylline is:

cimetidine

Which is least likely to be found in a patient with gastric ulcer? A. history of long-term naproxen use B. age younger than 50 years C. previous use of H2RA or antacids D. cigarette smoking

B. age younger than 50 years

You see a 48 yo woman who has been taking a COX-2 for the past 3 years. In counseling her, you mention that long term use of COX-2 inhibitors is associated with all of the following except: A. hepatic dysfunction. B. gastropathy. C. cardiovascular events. D. cerebrovascular events.

A. hepatic dysfunction.

A 64 yo woman presents with a 3 month history of upper abdominal pain. She describes the discomfort as an intermittent, centrally located "burning" feeling in the upper abdomen, most often with meals and often accompanied by mild nausea. Use of OTC H2 blockers affords partial symptom relief. She also uses diclofenac on a regular basis for the control of OA. Her presentation is most consistent with:

gastric ulcer

Which of the following is false about H. Pylori? A. H. pylori is a Gram-negative, spiral-shaped bacterium. B. Infection with H. pylori is the most potent risk factor for duodenal ulcer. C. The organism is often resistant due to the production of beta-lactamase. D. H. pylori is transmitted via the oral-fecal or oral-oral route.

C. The organism is often resistant due to the production of beta-lactamase.

The most sensitive and specific test for H. Pylori is from the following list is: A. stool Gram stain, looking for the offending organism. B. serological testing for antigen related to the infection. C. organism-specific stool antigen testing. D. fecal DNA testing.

C. organism-specific stool antigen testing

Which of the following medications is a PPI? A. loperamide B. metoclopramide C. nizatidine D. lansoprazole

D. lansoprazole

Peptic ulcer disease can occur in any of the following locations except: A. duodenum. B. stomach. C. esophagus. D. large intestine.

D. large intestine.

An ulcer that is noted to be located in the region below the lower esophageal sphincter and before the pylorus is usually referred to as:

gastric ulcer

A 56 yo man with a 60 pack year cigarette smoking history, recent 5 lb unintended weight loss, and a 3 month history of new onset symptoms of peptic ulcer disease presents for care. He is taking no medications on a regular basis and drinks 6 12 oz beers per week with no more than 3 per day. PE is unremarkable except for mild pharyngeal erythema and moderate epigastric tenderness without rebound. The most helpful diagnostic test at this point is a:

upper endoscopy

Long term PPI use is associated with all of the following except: A. increased risk of pneumonia in hospitalized patients. B. increased risk of C. difficile colitis in hospitalized patients. C. reduced absorption of calcium and magnesium. D. reduced absorption of dietary carbohydrates.

D. reduced absorption of dietary carbohydrates

To avoid rebound gastric hyperacidity following discontinuation of long term PPI use, all of the following methods can be used except: A. gradually tapering the PPI dose with supplemental antacid. B. switch to every-other-day dosing of PPI with supplemental antacid. C. switch to a low-dose H2RA therapy with supplemental antacid. D. empiric H. pylori therapy.

D. empiric H. pylori therapy.

A 35 yo woman complains of a 6 month history of periodic "heartburn" primarily after eating tomato based sauces. Her weight is unchanged and exam reveals a single altered finding of epigastric tenderness without rebound. As first line therapy you advise:

avoiding trigger foods

You see a 62 yo man diagnosed with esophageal columnar epithelial metaplasia. You realize he is at increased risk for:

esophageal adenocarcinoma

In caring for a patient with symptomatic GERD, you prescribe a PPI to:

increase the pH of the stomach

Which of the following is not an "alarm" finding in the person with GERD symptoms? A. Weight gain B. Dysphagia C. Odynophagia D. Iron deficiency anemia

A. weight gain

Risk factors for Barrett esophagus include all of the following except: A. history of cigarette smoking. B. older than 50 years of age. C. male gender. D. African American ethnicity

D. African American ethnicity

Which is at greatest risk of esophageal cancer? A. 34-year-old male who eats a high-fat diet B. 76-year-old male who stopped smoking 15 years ago C. 45-year-old woman with a history of 6 full-term pregnancies D. 58-year-old female vegetarian

B. 76-year-old male who stopped smoking 15 years ago

A 36 yo man complains of nausea, fever, malaise, and abdominal pain. He shows signs of jaundice and reports darkly colored urine. Diagnostic results show elevated serum aminotransferase less than 10 times upper limits of normal. His most likely diagnosis is:

viral hepatitis

You are caring for a 45 yo woman from a developing country. She reports that she had "yellow jaundice" as a young child. Her PE is unremarkable. Her labs are: AST 22 (0-31), ALT 25(0-40), HAV IgG +. This reveals:

resolved Hep A infection

The most common source of Hep A infection is:

contaminated water supply

In addition to the lab work described, results reveal the following for the above mentioned patient. HbsAg: +. This finding is most consistent with:

chronic hepatitis B

All are effective methods to kill the Hep A virus EXCEPT: A. heating food to more than 185ºF (85ºC) for 1 minute. B. adequately chlorinating water. C. cleaning surfaces with a 1:100 bleach solution. D. freezing food for at least 1 hour.

D. freezing food for at least 1 hour.

A 54 yo man has been recently diagnosed with HAV infection. You recommend all of the following except: A. eating smaller, more frequent meals to help combat nausea. B. avoiding consumption of any alcohol. C. reviewing current medication use for consideration of discontinuation. D. taking daily acetaminophen to alleviate joint pains.

D. taking daily acetaminophen to alleviate joint pains

Clinical findings in a patient with acute hepatitis B likely include all of the following except: A. abdominal rebound tenderness. B. scleral icterus. C. a smooth, tender, palpable hepatic border. D. report of myalgia.

A. abdominal rebound tenderness

Risk factors for HBV infection include all of the following except: A. having multiple sexual partners. B. having an occupation that exposes you to human blood. C. injection drug user. D. eating food prepared by a person with an HBV infection.

D. eating food prepared by a person with an HBV infection.

Routine testing for HBsAg after immunization with HBV vaccine is recommended for all of the following except: A. healthcare providers. B. immunocompromised patients. C. restaurant workers. D. dialysis patients.

C. restaurant workers

You see a 22 yo male who is an injection drug user, recently diagnosed with chronic HBV. You recommend additional testing for all of the following except: A. Lyme disease. B. HIV. C. HAV. D. HCV.

A. Lyme disease

Antiviral treatment for chronic HBV includes all of the following except: A. entecavir. B. tenofovir. C. lamivudine. D. fidaxomicin.

D. fidaxomicin

Which statement is true concerning HCV? A. It usually manifests with jaundice, fever, and significant hepatomegaly. B. Among health-care workers, it is most commonly found in nurses. C. At least than 50% of persons with acute hepatitis C go on to develop chronic infection. D. Interferon therapy is consistently curative.

C. At least than 50% of persons with acute hepatitis C go on to develop chronic infection.

Which characteristic is predictive of severity of chronic liver disease in a patient with chronic Hep C? A. female gender, age younger than 30 B. co-infection with hepatitis B, daily alcohol use C. acquisition of virus through intravenous drug use, history of hepatitis A infection D. frequent use of aspirin, nutritional status

B. co-infection with hepatitis B, daily alcohol use

When answering questions about HAV. You consider all of the following are true except: A. it does not contain live virus. B. it should be offered to individuals who frequently travel to developing countries. C. it is a recommended immunization for health-care workers. D. it is given as a single dose.

D. it is given as a single dose.

Which is true concerning Hep B vaccine? A. The vaccine contains live hepatitis B virus. B. Most individuals born since 1986 in the USA who have been fully immunized have received vaccine against HBV. C. The vaccine is contraindicated in the presence of HIV infection. D. Postvaccination arthralgias are often reported.

Most individuals fully immunized since 1986 have received the vaccine

Hyperbilirubinemia can cause all of the following except: A. potential displacement of highly protein-bound drugs. B. scleral icterus. C. cola-colored urine. D. reduction in urobilinogen

D. reduction in urobilinogen

Which patient complaints should be evaluated further in making a differential of IBS? A. a 52-year-old female with a first degree family history of colorectal cancer, recent constipation, and abdominal pain B. A middle-aged adult with low albumin and leukocytosis C. Both patients outline in responses A and B D. a 16-year-old female with chronic, alternating constipation and diarrhea when she is studying for high school exams and worrying about her parents' impending divorce

C. Both patients outline in responses A and B

Diagnostic criteria for IBS include abdominal pain that is associated with all of the following except: A. improvement with defecation. B. a change in frequency of stool. C. a change of stool form. D. unexplained weight loss.

D. unexplained weight loss.

Abdominal Problems Flashcards

(105 cards)