GI

Question 1

relief w/ eating food

Answer 1

duodenal ulcer

Question 2

no relief w/ eating food

Answer 2

gastric ulcer

Question 3

board like/rigid abdomen, quiet bowel sounds

Answer 3

perforation(5-10% of PUD cases….less common)

Question 4

Melena, hematemesis

% of PUD?

Answer 4

gi bleed (20% of PUD cases…more common)

Question 5

H2 Blockers

Answer 5

Ranitidine (Zantac), Famotidine (Pepcid)

Question 6

Lansoprazole (Prevacid) 15mg/day

Omeprazole (PRilosec) 20mg/day

Answer 6

PPI

Question 7

PUD Management

1. order of tx
2. assistive meds

Answer 7

1. H2B (1st line med) q HS ==> BID ==> + PPI ==> refer
2. Mucal protective agents (give 2 hrs apart from other meds)
   ex: bismuth subsalicylate (pepto-bismol)
   misoprostol (cytoect) QID w/ food
   maalox

Question 8

H. Pylori tx

1. generally
2. most popular regimen

Answer 8

1. two antibiotics + proton pump inhibitor or bismuth
2. A) Flagyl 500mg BID, + Clarithormycin (Biaxin) 500mg BID both w/ meals, + omeprazole (Prilosec) 20mg bid b/f meals all for 7 days.
   B) Same as above except Amoxicillin instead of flagyl

Question 9

GERD
A) S/S
B) diagnostics

Answer 9

A) retrosternal burning
bitter taste in mouth
belching, hiccoughs, dysphagia
B) EGD to r/o barrett’s (throat cancer)

Question 10

Symptom of Dysphasia in older vs younger pt

Answer 10

older ==> symptom of GERD

younger ==> symptom of possible cancer

Question 11

GERD mgt

1) lifestyle
2) meds

Answer 11

1) elevate head of bed, no spicy etoh caffeine, no smoking, wt reduction
2) antacids prn ==> H2 blockers (tidines) @HS ==> PPI “zoles” ==> referr

Question 12

syndrome of acute nausea, vomiting, diarrhea, and cramping from inflammation/irritation of gastric mucosa, nonspecific.

Answer 12

Gastroenteritis

Question 13

Gastroenteritis mgt

Answer 13

not indicated unless persist > 72hrs or if note blood in stool…then==>
Stool culture, O&P, WBC, fecal occult

Question 14

Gastroenteritis causes

Answer 14

virus (most common in winter)
bacterial
parasitic
emotional stress

Question 15

Route

1) Hep A
2) Hep B
3) Hep C

Answer 15

1. oral-fecal
2. all body fluids (bld, saliva, semen, vaginal secretions)
3. Blood (from transfusion, 50% IV drug use)

Question 16

Hepatitis C S/S

1. early
2. later
3. labs

Answer 16

1. Pre-icteric: fatigue/malaise, anorexia, n/v, HA, aversion to to smoking/etoh
2. Icteric: wt loss, jaundice, pruritus, RUQ pain, dark urine, hepatosplenomegaly
3. Elevated AST & ALT (500 -2000)

Question 17

Hepatitis Labs:

Answer 17

Elevate AST/ALT,

Question 18

PCR (polymerase chain reaction)

Answer 18

IDS prior exposure from current viremia in hep C

Question 19

1. IgM, Anti-HAV
2. IgG, Anti HAV
3. IgG, IgM, HBsAg
4. IgM, HBsAg

Answer 19

1. Hep A Immediate - acute
2. Hep A gone - gone?
3. Hep B chronic
4. Hep B aqute
   5.

Question 20

Diverticulitis

1. higher incidence in?
2. s/s of problem?
3. diagnostics
4. need to r/o?

Answer 20

1. higher incidence in those with low dietary fiber
2. LLQ pain problem
3. sigmoidoscopy show inflammation, CT to r/o abbess
4. abd films to r/o free air

Question 21

Irritable Bowel Snydrome

1. incidence/causes
2. diagnositcs
3. mgt

Answer 21

1. F>M, stress theory (control issue?)
2. normal findings on sigmoidocopy, barium studies, rectal exam
3. emotional support, high fiber diet, SSRI for depression

Question 22

deep pain on inspiration while fingers are placed under the right rib cage.

Answer 22

+ murphy sign ==> cholecystitis

Question 23

Gold Standard for Cholecystitis diagnosis

Answer 23

ultrasound (plan film may show gallstones)

Question 24

Cholecystitis s/s

Answer 24

Murphy’s sigh, RUQ tenderness, muscle garding, rebond pian, fever, palpable gallbladder in 15% of cases

Question 25

Bowel Obstruction s/s

Answer 25

- high pitched, tinkling bowel sounds (think water over rocks) - unable to pass gas/stool - plain films: dilated loops of bowel and air fluid levels (horizonital shape if SBO & frame patten if LBO) - vomiting within minutes of pain (proximal BO) and within hours of pain (distal BO)

Question 26

Ulcerative colitis 1. s/s 2. diagnosis 3. mgt

Answer 26

1. hallmark symptom: bloody diarrhea "the squirts" 2. sigmoidoscopy shows inflammation/ulcers of colon, stool studies negative 3. Hydrocortisone suppositories & enemas, Mesalamine (Canasa) suppositories or enemas (anti-inflammatory drug)

Question 27

#1 reason for filling toilet up with blood

Answer 27

ulcerative colitis

Question 28

Ulcerative Colitis vs Crohn's

Answer 28

1. Ulcerative colitis==> diffuse mucosal inflammation of colon, also may involve rectum 2. Crohn's ==> upper bowel malabsorption syndrome w/ ulcers

Question 29

2 cancer killer in US

Answer 29

colorectal cancer

Question 30

ulcerative colitis mgt

Answer 30

1. mesalamine (canasa) suppository (anti-inflammatory drug) | 2. hydrocortisone suppositories and enemas

Question 31

risk factor for bowel obstruction

Answer 31

- adhesions from prior abdominal surgeries | - colon cancer

Question 32

common presentation in Men 18 - 30 yrs

Answer 32

appendicitis

Question 33

Psoa's sign 1. what is positive? 2. what does positive mean?

Answer 33

1. pain with right thigh extension | 2. appendicitis

Question 34

Obturator sign 1. What is positive 2. What does positive mean?

Answer 34

1. Pain with internal rotation of flexed right thigh | 2. appendicitis

Question 35

Rovsing's sign 1. What is positive 2. What does positive mean?

Answer 35

1. RLQ abd pain when presure applied to the LLQ. | 2. appendicitis

Question 36

appendicitis diagnostics

Answer 36

1. WBC: high - mildly elevated | 2. CT or US is diagnostic

Question 37

Gerontology Considerations

Answer 37

Decreased: 1. jaw muscles for chewing 2. thirst/taste perception 3. liver size & liver blood flow ==> altered drug absorption * Constipation NOT a normal finding in gero: common cause hx of laxative abuse