ATI LPN
Gastrointestinal System Quiz Questions Questions
Question 1 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 2 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 3 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 4 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).
Question 5 of 5
When educating a patient with PUD about lifestyle changes, which habit is most important to avoid?
Correct Answer: B
Rationale: Smoking impairs mucosal healing, increases acid production, and delays recovery, making it the most critical habit to avoid in PUD.