ATI LPN
Gastrointestinal System Questions and Answers Questions
Question 1 of 5
In a patient with an office blood pressure (BP) measured as above 140/90 mmHg, which of the following should be used to confirm a diagnosis of hypertension?
Correct Answer: C
Rationale: Ambulatory BP>=135/85 mmHg confirms hypertension per guidelines, making C the correct answer.
Question 2 of 5
A 72-year-old patient with lifelong asthma and dilated cardiomyopathy from a viral infection complains of worsening symptoms of shortness of breath. He is on optimal treatment for asthma. His echocardiogram confirms heart failure with an ejection fraction of 30%, which is thought to account for his breathlessness. He has minimal wheeze, bi-basal crackles and oxygen saturations of 95% on air. He is on Furosemide 80 mg twice daily and, ramipril 5 mg once daily with normal renal function. What would be an ideal initial step for this patient?
Correct Answer: D
Rationale: A beta-blocker (e.g., bisoprolol) trial improves mortality in HFrEF (EF 30%), making E the best initial step with normal renal function.
Question 3 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 4 of 5
A 56-year-old man chokes on a piece of steak while dining in a restaurant. The steak transiently becomes impacted in his esophagus. The next day, a barium swallow reveals a short, ringlike structure in his distal esophagus.
Correct Answer: C
Rationale: The patient has a congenital Schatzki's ring that produces the described symptoms, which are often referred to as the 'steakhouse syndrome.' The ring is generally disrupted with a single endoscopic dilatation. The Schatzki's ring does not increase the risk for developing esophageal cancer.
Question 5 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.