ATI LPN
Gastrointestinal System Quiz Questions Questions
Question 1 of 5
A 56-year-old woman presents to discuss the results of her recent upper endoscopy. She was having some mild abdominal pain, so she underwent the procedure, which revealed an ulcer in the antrum of the stomach. Biopsy of the lesion revealed the presence of H. pylori. All of the following statements regarding her condition are correct except
Correct Answer: B
Rationale: H. pylori is thought to be responsible for a majority of cases of peptic ulcer disease. It has been associated with MALT as well as adenocarcinoma. Triple drug therapy has been shown to be more effective than dual therapy. With adequate treatment, reinfection is rare. Although urea breath testing is probably a better tool for diagnosis of active infection and adequacy of treatment, quantitative serology can be used to monitor treatment efficacy. A $30 \%$ fall in IgG titer should be seen after therapy.
Question 2 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 3 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 4 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.
Question 5 of 5
A 50-year-old man with a history of alcoholic cirrhosis presents with new-onset ascites, fever, chills, and abdominal pain. His ascitic fluid is sampled and reveals a white blood cell count of 750/mL with $50 \%$ neutrophils. Gram stain of the fluid shows white blood cells but no organisms. Which of the following statements is correct regarding this patient's care?
Correct Answer: C
Rationale: This patient has more than 250 neutrophils in his ascitic fluid and presents with symptoms typical of bacterial peritonitis. He should be treated with antibiotics regardless of the Gram stain and culture results because they can often be negative. Empiric therapy usually consists of a broad-spectrum agent such as cefotaxime. Recurrent episodes are common, with $70 \%$ of patients experiencing a second episode within one year. Prophylactic therapy is indicated for patients with recurrent infections but not after the first infection. Clindamycin or ampicillin would be poor antibiotic choices; better coverage against enteric gram-negatives would be warranted (e.g., norfloxacin).