ATI LPN
Gastrointestinal System Questions and Answers Questions
Question 1 of 5
An 82-year-old woman with no past history presents to your clinic complaining of arthritic symptoms. She is on no medications at this time but needs something for her arthritis. You want to put her on nonsteroidal anti-inflammatory medicine but are concerned about her age and the risk of peptic ulcers. She has to pay for her medications out-of-pocket and requests the most inexpensive option possible. The most appropriate treatment plan would be
Correct Answer: A
Rationale: Although this woman is elderly and has a higher risk of developing NSAID toxicity, prophylaxis is currently not recommended unless there is a history of peptic ulcer disease or abdominal symptoms. Celocoxib would be an adequate alternative to minimize her risk but it is considerably more expensive than generic medications such as ibuprofen.
Question 2 of 5
A previously healthy 42-year-old woman presents to the emergency room complaining of a 10-day history of abdominal pain and fever. She also notes that for the last three days her urine has been dark. She denies alcohol intake or illicit drug use. Her last menstrual period ended five days ago. Physical examination reveals tenderness in right upper quadrant and icteric discoloration of the skin, but no palpable mass in the abdomen. Blood tests demonstrate a white blood cell count of 8.3/ L, total bilirubin of 3.4 mg/dL, alkaline phosphatase of 280 IU/L, amylase of 54 U/L, and lipase of 47 U/L. A CT scan of the abdomen demonstrates a dilated biliary duct (18 mm in diameter) with a possible stone in it. There are no stones in the gallbladder. The intrahepatic ducts are not dilated. The pancreas appears normal. The patient is admitted to the hospital. The next morning an ERCP is performed and reveals a single choledochal cyst (2 cm in diameter) of the common bile duct with a single stone inside the cyst. Endoscopic sphincterotomy is done and the stone is removed from the choledochal cyst. What further management would you offer this patient?
Correct Answer: D
Rationale: Choledochal cysts carry high malignant potential. The estimated risk of development of cholangiocarcinoma from the choledochal cyst is $3 \%$ to $20 \%$. Laparoscopic or open cholecystectomy will not decrease the risk of future development of cholangiocarcinoma.
Question 3 of 5
A 40-year-old man complains of crampy abdominal pain associated with intermittent loose stools for the last three months. He had been healthy until he developed a week of severe diarrhea while visiting India. He then took metronidazole for a week. The diarrhea was resolving by then but evolved soon afterward into his current symptoms. He finds that eating precipitates his symptoms although his weight is stable. Physical examination is unremarkable. Stool microscopy is negative and labs are unrevealing. Which of the following diagnoses is the most likely explanation for his current symptoms?
Correct Answer: A
Rationale: Postinfectious irritable bowel syndrome is an increasingly recognized form of the disease as several studies have demonstrated that a prior bout of gastroenteritis is found in approximately 10 to $20 \%$ of individuals with IBS. Giardiasis is a common cause of acute infectious diarrhea, and a single stool examination may not be sufficient for the diagnosis, but giardiasis usually resolves within several weeks without becoming a chronic illness and usually clears with metronidazole. Acquired lactose intolerance commonly occurs with intestinal infections but resolves once the infection clears. The onset of Crohn's disease does not typically occur after a bout of gastroenteritis, although intestinal bacteria are thought to fuel inflammation in Crohn's disease and antibiotics, such as ciprofloxacin and metronidazole, are used in the management of the disease.
Question 4 of 5
The presence of which of the following antibody tests (IgG) indicate probable immunity to hepatitis B?
Correct Answer: C
Rationale: Surface antibody is indicative of immunity to hepatitis B infection. Core IgG antibody and antibody to e antigen indicate past or current infection but do not confer immunity.
Question 5 of 5
Which of the following statements about pulmonary manifestations of liver disease is incorrect?
Correct Answer: A
Rationale: The hepatopulmonary syndrome is characterized by platypnea (difficulty breathing when going from lying to sitting) and orthodeoxia (decreased oxygen saturation upon sitting). It is associated with left-to-right shunting of blood. Alpha-1 antitrypsin deficiency and primary biliary cirrhosis are associated with the parenchymal lung diseases mentioned in B and D.