ATI LPN
Questions for Review of Systems Gastrointestinal Questions
Question 1 of 5
A 45-year-old woman with a history of arthritis has had severe heartburn and indigestion for six months, which has been refractory to antacid use. Her history is remarkable for arthritic pain in her hands and Raynaud's phenomenon. Her physical examination shows multiple telangectasias on her face and arms. You obtain an esophageal manometry study. What findings are consistent with this diagnosis?
Correct Answer: C
Rationale: The patient has scleroderma esophagus, which results in atrophy of the esophageal smooth muscle. As a result, such patients lose peristalsis and LES tone, leading to severe GERD symptoms and esophagitis.
Question 2 of 5
A 40-year-old woman presents complaining of a one-day history of intense epigastric abdominal, nausea, and vomiting. She reports that she has never had symptoms like this before. She has no significant past medical history. She denies cigarette use. She drinks about two drinks per week socially. She denies drug use. She takes no medications. Her physical examination is remarkable for a temperature of $100.2^{\circ} \mathrm{F}$, pulse of $100 / \mathrm{min}$, respiratory rate $20 / \mathrm{min}$, blood pressure 115/75. There is epigastric tenderness that extends to the right upper quadrant. There is no rebound tenderness although there is some voluntary guarding. Bowel sounds are present. Her laboratory values reveal the following: WBC 8.6/mm3, HCT 36%, Platelets 140/mm3, AST 33 U/L, ALT 22 U/L, Alkaline phosphatase 86 U/L, Amylase 300 U/L, Lipase 250 U/L, Creatinine 1.1 mg/dL, EKG Normal sinus rhythm, no evidence of ischemia, Upright chest x-ray No infiltrates, effusions, or evidence of free air under the diaphragms. What is the most appropriate next test to order?
Correct Answer: C
Rationale: This woman presents with signs and symptoms consistent with acute pancreatitis. After initial management, the goal should be to determine the underlying etiology of the attack. Gallstones and alcohol are the leading causes in the United States. Since this woman does not have a significant alcohol intake history, gallstones should be suspected. An ultrasound is the best test to detect gallstones. An abdominal x-ray is unnecessary since it would add little information and most gallstones would not be seen on plain x-ray. A CT scan is a good test for imaging the pancreas but ultrasound is better for detecting gallstones. In the absence of evidence of infection or severe pancreatitis, routine CT scanning is unnecessary. ERCP and HIDA scans do not visualize the gallbladder well.
Question 3 of 5
A 75-year-old man presents two days after having sudden onset of abdominal pain in his left lower quadrant, which lasted for one day and was associated with the passage of several episodes of bloody stool. His pain has now resolved. He had a similar episode one month previously. His past medical history is notable for hypertension, diabetes mellitus, atrial fibrillation, and previous coronary artery bypass surgery. His medications include a $\beta$-blocker, metformin, and digoxin. His last screening colonoscopy four years ago was unremarkable. His abdominal exam is notable for mild tenderness in his left lower quadrant but is otherwise unremarkable. His cardiovascular exam is notable for an irregular heart rhythm with a normal ventricular rate. His labs reveal mild anemia, mildly elevated glucose levels, a normal white count and lactate levels and his abdominal x-ray is unremarkable. Which of the following statements are incorrect?
Correct Answer: B
Rationale: Colonic ischemia is the most likely diagnosis. Although diverticulitis and inflammatory bowel disease are possible, the short history is against IBD and to a lesser extent diverticulitis because the symptoms resolved without antibiotics. Colonic ischemia can present with mild transient symptoms that resolve without evidence on colonoscopy or persist with segmental hemorrhagic colitis, bleeding into the submucosa, gangrene, and eventually structuring. In addition to the causes listed in Answer C, other well-recognized causes of colonic ischemia include emboli, hypotension, vasculitis, hypercoagulable states, vascular surgery, and other drugs such as cocaine.
Question 4 of 5
The diagnosis of hemochromatosis involves all of the following except
Correct Answer: D
Rationale: Slit lamp examination is performed when there is clinical suspicion of Wilson's disease. All the other markers are used in the diagnosis. Transferrin saturation is the ideal screening test, since serum ferritin is an acute phase reactant and therefore may be elevated nonspecifically. However, the gold standard for diagnosis is liver biopsy with iron quantitation. Genetic mutations (i.e., C282Y and H63D) may be seen in approximately $85 \%$ of patients with hemochromatosis and therefore is not a good test to screen for hemochromatosis.
Question 5 of 5
The following statements about liver transplantation are true except
Correct Answer: D
Rationale: The allocation of cadaveric liver organs is based on severity of liver disease (model for end stage liver disease [MELD] score), rather than solely relying on waiting times. Primary care physicians are often involved in the long-term management of liver transplant patients, especially preventative care.