Unit 2 Part 2 Flashcards
An adult patient reports intermittent, crampy abdominal pain with vomiting. The provider notes marked abdominal distention and hyperactive bowel sounds. What will the provider do initially?
a. Admit the patient to the hospital for consultation with a surgeon
b. Obtain upright and supine radiologic views of the abdomen
c. Prescribe an antiemetic and recommend a clear liquid diet for 24 hours
d. Schedule the patient for a barium swallow and enema
B
If available, the primary care provider can order radiographic studies of the abdomen and chest. Once small bowel obstruction is confirmed or suspected, immediate hospitalization with surgeon referral is necessary. Because small bowel obstruction can have potentially serious or life-threatening consequences, waiting 24 hours is not recommended.
A patient is in clinic for evaluation of sudden onset of abdominal pain. The provider palpates a pulsatile, painful mass between the xiphoid process and the umbilicus. What is the initial action?
a. Order a CBC, type and crossmatch, electrolytes, and renal function tests.
b. Perform an ultrasound examination to evaluate the cause.
c. Schedule the patient for an aortic angiogram.
d. Transfer the patient to the emergency department for a surgical consult.
D
This patient has symptoms and physical findings consistent with a ruptured aortic aneurysm and should have an immediate surgical consult. Ordering other tests is not necessary by the primary provider.
A patient reports anal pruritis and occasional bleeding with defecation. An examination of the perianal area reveals external hemorrhoids around the anal orifice as the patient is bearing down. The provider orders a colonoscopy to further evaluate this patient. What is the treatment for this patient’s symptoms?
a. A high-fiber diet and increased fluid intake
b. Daily laxatives to prevent straining with stools
c. Infiltration of a local anesthetic into the hemorrhoid
d. Referral for possible surgical intervention
A
Most hemorrhoids, unless incarcerated or painful, are treated conservatively. A high-fiber diet and increased fluid intake are recommended first. Daily laxatives are not recommended because the variation in stool consistency makes hemorrhoid management more difficult.
Infiltration of a local anesthetic is performed for thrombosed external hemorrhoid prior to removing the clot. Hemorrhoidectomy is performed for severe or very painful hemorrhoids.
A patient has sudden onset of right upper quadrant (URQ) and epigastric abdominal pain with fever, nausea, and vomiting. The emergency department provider notes yellowing of the sclerae. What is the probable cause of these findings?
a. Acute acalculous cholecystitis
b. Chronic cholelithiasis
c. Common bile duct obstruction
d. Infectious cholecystitis
C
This patient has symptoms of cholecystitis with bile duct obstruction, which causes jaundice. The common triad of RUQ pain, fever, and jaundice occurs when a stone is lodged in the common bile duct. Acute acalculous cholecystitis is inflammation without stones. Chronic cholelithiasis does not cause acute symptoms; jaundice occurs with obstruction. Infectious cholecystitis may occur without obstruction.
A patient presents with fever, nausea, vomiting, anorexia, and right upper quadrant abdominal pain. An ultrasound is negative for gallstones. Which action is necessary to treat this patient’s symptoms?
a. Empirical treatment with antibiotics
b. Hospitalization for emergent treatment
c. Prescribing ursodeoxycholic acid
d. Supportive care with close follow-up
B
This patient has symptoms of acute acalculous cholecystitis and is critically ill. Hospitalization is required. Empirical treatment with antibiotics and supportive care with follow-up do not address critical care needs. Ursodeoxycholic acid is a medication that helps with gallstone dissolution; this patient does not have gallstones.
Which diagnostic test will the provider safely order for a 30-year-old woman reporting right upper quadrant abdominal pain, nausea, and vomiting?
a. Abdominal computed tomography (CT) with contrast
b. Abdominal ultrasound
c. Magnetic resonance imaging (MRI) of the abdomen
d. Plain abdominal radiographs
B
Women of childbearing age may safely have ultrasound. Until pregnancy is ruled out, the other studies may be harmful to a developing fetus and should be avoided.
A patient with a previous history of liver disease is diagnosed with a bile duct obstruction. Which procedure will be prescribed for this patient?
a. Chemical dissolution of the gallstone
b. Lithotripsy
c. Open cholecystectomy
d. Laparoscopic cholecystectomy
C
Patients with possible liver disease should have open cholecystectomy. The other procedures are contraindicated. Chemical dissolution is not reliable and may take some time.
A patient diagnosed with chronic constipation uses polyethylene glycol and reports increased abdominal discomfort with nausea and vomiting. What is the initial action by the provider?
a. Increase the dose of polyethylene glycol
b. Obtain radiographic abdominal studies
c. Perform a stool culture and occult blood
d. Refer to a specialist for colonoscopy
B
Patients with abdominal pain, nausea, and vomiting should have radiologic studies to exclude obstruction, ileus, megacolon, or volvulus. If those are ruled out, increasing the laxative may be warranted. Stool culture is indicated if the parasite ascariasis is suspected. Referral for colonoscopy is needed if alarm symptoms for neoplasm are present.
A patient has recurrent constipation which improves with laxative use but returns when laxatives are discontinued. Which pharmacologic treatment will the provider recommend for long-term management?
a. Bisacodyl
b. Docusate sodium
c. Methylcellulose
d. Mineral oil
C
Methylcellulose is a bulk-forming product and is used initially. The other medications are used for more severe constipation and not recommended for long-term use. Mineral oil, an emollient, will soften stool, but it has been associated with aspiration and lipoid pneumonia, prevents absorption of fat-soluble vitamins, and can cause fecal incontinence; it is not generally recommended.
A patient reports a decrease in the frequency of stools and asks about treatment for constipation. Which findings are part of the Rome IV criteria for diagnosing constipation? (Select all that apply.)
a. Feeling of incomplete evacuation
b. Fewer than 5 stools per week
c. Hard or lumpy stools
d. Presence of irritable bowel syndrome
e. Symptoms present for 3 months
A, C, E
According to the Rome III criteria, symptoms must have begun 6 months prior and persisted for at least 3 months and include a feeling of incomplete evacuation, lumpy or hard stools, fewer than 3 stools per week, and not meeting criteria for irritable bowel syndrome.
A patient, who first developed acute diarrhea 2 weeks ago, presents to clinic reporting profuse watery, bloody diarrheal stools 6 to 8 times daily. The provider notes a toxic appearance with moderate dehydration. Which test is indicated to diagnose this problem?
a. Qualitative and quantitative fecal fat
b. Stool collection for 24-hour stool pH
c. Stool sample for C. difficile toxin
d. Wright stain of stool for white blood cells
C
Patients with acute onset diarrhea lasting more than 2 weeks with profuse, watery, bloody stools of more than 6 times in a 24-hour period warrants testing for C. difficile toxin.
Qualitative and quantitative fecal fat, 24-hour pH studies, and Wright stain for WBCs are performed when chronic diarrhea are present.
A patient who developed chronic diarrhea after gastric surgery asks what can be done to mitigate symptoms. What will the provider recommend initially?
a. A diet high in carbohydrates
b. Avoiding liquids with meals
c. Empirical antibiotic therapy
d. Probiotic supplements
B
Initial suggestions for treating postoperative diarrhea will include avoiding fluids during meals and lying down after meals. Concentrated carbohydrates may trigger symptoms. Empirical antibiotic therapy is indicated for small intestinal bacterial overgrowth syndrome with specific symptoms and an association with an elevated folate level. Probiotic supplements may be used as adjunctive therapy.
Which types of chronic noninfectious diarrhea will cause fatty stools? (Select all that apply.)
a. Celiac disease
b. Cystic fibrosis
c. Diabetes mellitus
d. Lactose intolerance
e. Pancreatic insufficiency
A, B, E
Celiac disease, cystic fibrosis, and pancreatic insufficiency all produce malabsorption of fats and will result in fatty stools. Diabetes results in glucose malabsorption, while lactose intolerance causes lactose malabsorption.
Yellowing of the whites of a person’s eyes (jaundice) can be caused by:
a) Excessive sun exposure
b) Accumulation of bilirubin
c) Increased red blood cell count
d) Dehydration
B
Jaundice results from the accumulation of bilirubin, a yellow pigment formed during the breakdown of red blood cells.
Which antispasmodic is commonly used to relieve an acute attack of gallbladder-related symptoms?
a) Acetaminophen
b) Hyoscine butylbromide (Buscopan)
c) Ibuprofen
d) Ondansetron
B
Buscopan is an antispasmodic that helps relax smooth muscles, relieving symptoms associated with gallbladder attacks.
How do gallstones cause pancreatitis?
a) By direct pressure on the pancreas
b) By increasing insulin production
c) By releasing digestive enzymes
d) By affecting bile absorption
B
Gallstones can cause pancreatitis by obstructing the common bile duct, leading to the backup of bile and digestive enzymes into the pancreas.
What distinguishes cholelithiasis from cholecystitis?
a) Location of gallstones
b) Presence of gallstones with inflammation
c) Size of the gallbladder
d) Severity of pain
B
Cholelithiasis refers to the presence of gallstones, while cholecystitis involves inflammation of the gallbladder, often due to gallstones blocking the cystic duct.
A patient has persistent epigastric pain occurring 2 to 3 hours after a meal. Which test is definitive for diagnosis peptic ulcer disease (PUD) in this patient?
a. Barium swallow with radiography
b. Breath test or stool antigen testing for H. pylori
c. Endoscopy with biopsy of gastric mucosa
d. Physical exam with percussion of the upper abdomen
C
Endoscopy provides the most accurate diagnosis of PUD and allows biopsy of multiple areas to exclude malignancy. Barium swallow may still be performed in patients unwilling to undergo endoscopy. Breath tests and stool antigen testing for H. pylori can confirm a bacterial cause. Physical exam generally yields negative findings.
