ATI LPN
Gastrointestinal System Quiz Questions Questions
Question 1 of 5
A 50-year-old patient is admitted with acute exacerbation of COPD. He is started on salbutamol, ipratropium nebulisers and oral steroids. The following day the nurses call the junior doctor as the patient is complaining of severe pain in the left eye. The doctor examines finds that his eye is red and a diagnosis of acute glaucoma is made. Which of the following statements is true?
Correct Answer: A
Rationale: Ipratropium, an anticholinergic, can cause pupillary dilatation via aerosol escape to the eye, precipitating angle-closure glaucoma, making A the correct answer.
Question 2 of 5
A 65-year-old man reports that he frequently regurgitates food several hours after eating, and experiences chest pain and dysphagia to both liquids and solids. This has been associated with weight loss. He has no other medical problems. A CXR shows an air/fluid level in a dilated esophagus and an absent gastric air bubble. No mass in the distal esophagus or proximal stomach is identified at the time of endoscopy. The best therapy for this patient is
Correct Answer: B
Rationale: The patient has primary achalasia, with typical CXR findings. The upper endoscopy has ruled out secondary achalasia, in that no mass was detected at the GE junction or cardia. The best treatment for this patient is endoscopic balloon dilatation, to stretch the LES, and disrupt muscle fibers. This therapy remains the mainstay for most patients with achalasia, although surgical myotomy and injection of botulinum toxin are also used.
Question 3 of 5
Which of the following statements regarding pancreatic cancer is correct?
Correct Answer: C
Rationale: Although serum CA 19-9 is not a useful screening tool in asymptomatic patients, it is quite sensitive and specific in patients with symptoms of the disease. Tumors arising from the tail or body of the pancreas are usually associated with a poorer prognosis and these patients are rarely resectable. A palpable gallbladder (Courvoisier's sign) has been described as being suggestive of a tumor at the head of the pancreas but not the tail. This sign lacks specificity, however.
Question 4 of 5
A 32-year-old woman with a one-year history of ulcerative colitis involving her whole colon presents with a one-week history of severe abdominal pain and bloody diarrhea about 10 times per day. Her heart rate is $95 / \mathrm{min}$, blood pressure 100/60, temperature $37.4^{\circ} \mathrm{C}$. Abdominal exam reveals mild abdominal distention with bowel sounds. Stool culture is negative for infection. The patient is admitted and treated with intravenous corticosteroids and oral mesalamine. Her abdominal x-ray reveals a cecal diameter of $10 \mathrm{~cm}$. Seventy-two hours after admission her symptoms have minimally improved; she is having about eight episodes of bloody diarrhea, but still has constant abdominal pain, and her examination and abdominal x-ray findings are unchanged. Which of the following options would be inappropriate?
Correct Answer: B
Rationale: Narcotics are contraindicated in the setting of toxic megacolon, as are anticholinergics and other agents that may adversely affect colonic tone such as may occur with hypokalemia or hypomagnesemia. Narcotics decrease colonic transit and can result in increased colonic dilatation and the risk of colonic perforation. Emergent colectomy is indicated in the setting of toxic megacolon if warning features occur such as increasing colon diameter, abdominal distention or decreasing bowel sounds. Even prior to such warning symptoms developing, patients often undergo colectomy in the setting of toxic megacolon if corticosteroids fail to induce remission as ultimately, approximately half of affected patients ultimately require colectomy even when other medical therapies such as cyclosporine induces remission. One week of intravenous cyclosporine induces remission in one half to two thirds of patients with severe ulcerative colitis. Infliximab is better known for its effectiveness in inducing remission in patients with Crohn's disease, but recent studies demonstrate similar effectiveness in treating acute severe ulcerative colitis.
Question 5 of 5
A 28-year-old woman at 34 weeks of gestation presents with elevated liver enzymes and pruritus. Labs reveal total bilirubin to be 4.2 mg/dL, AST 480 U/L, ALT 640 U/L, and alkaline phosphatase 232 U/L. Viral hepatitis serologies and ANA are negative. On physical examination, she is jaundiced, but has a normal blood pressure, no edema, and a soft abdomen. The fetus is in no distress. Which of the following is true?
Correct Answer: B
Rationale: The likely diagnosis is intrahepatic cholestasis of pregnancy, which resolves after delivery. Prompt delivery is indicated only for fetal distress. Intrahepatic cholestasis tends to recur with subsequent pregnancies and can be treated with cholestyramine and ursodeoxycholic acid. LCHAD deficiency is associated with acute fatty liver of pregnancy and HELLP syndrome.