ATI LPN
Questions About Gastrointestinal System Questions
Question 1 of 5
When should patients take proton pump inhibitors?
Correct Answer: A
Rationale: PPIs are most effective taken 30-60 minutes before a meal to inhibit acid secretion before food stimulates it, making A the correct answer.
Question 2 of 5
A 32-year-old woman presents with a 10-month history of an intermittent burning sensation in the epigastrium that is sometimes related to eating. She has heard about bacteria that can cause gastrointestinal (GI) symptoms. She has had no change in her weight and denies dysphagia. Her laboratory tests are normal. Which of the following would you recommend?
Correct Answer: A
Rationale: The patient presents with dyspepsia. In individuals who are under the age of 45 years and present with no other warning signs (e.g., anemia, weight loss, or dysphagia), a serum qualitative test for H. pylori can be obtained to document H. pylori infection, provided that the patient has no prior history of being treated. A serum IgG can remain positive even after antibiotic eradication. In H. pylori-positive individuals who do not respond to therapy, an upper endoscopy would be the next test. An upper GI series cannot detect H. pylori and is less sensitive than endoscopy in detecting lesions of the esophagus, stomach, and proximal small bowel. Empiric therapy for H. pylori is never recommended.
Question 3 of 5
A 68-year-old man with a history of diabetes, hypertension, and coronary artery disease (s/p coronary artery bypass graft two years ago) presents to the emergency room with fevers and left-sided abdominal pain. His physical examination reveals a temperature of $101.5^{\circ} \mathrm{F}$, pulse 96, and blood pressure of 135/80. His abdomen is soft with moderate left lower quadrant tenderness. There is no rebound or guarding. Bowel sounds are present. A CT scan is done which reveals inflammation around an area of the left colon. The next step in his workup/management should be
Correct Answer: A
Rationale: The patient has evidence of diverticulitis. He has no evidence of perforation or abscess formation on the CT scan. Barium enema and colonoscopy should be avoided during acute infections since they will increase the risk of perforation. Surgery may be necessary if the patient fails to improve or if the attacks are recurrent but urgent surgery is not indicated. Antibiotic therapy geared toward gram-negative aerobes and anaerobes are the initial treatment of choice.
Question 4 of 5
A 60-year-old African-American woman with a history of GERD and an extensive smoking and alcohol history presents complaining of dysphagia for the past two months. She also reports weight loss of 15 pounds over that span. A barium swallow is done and reveals narrowing of the mid-esophagus. An endoscopy is performed and is consistent with an esophageal tumor, so biopsies are taken and they reveal squamous cell carcinoma. Which of the following statements is correct?
Correct Answer: C
Rationale: The incidence of squamous cell carcinoma is decreasing in the U.S. while the incidence of adenocarcinoma is increasing. The most important risk factors for SCC in this patient are cigarette and alcohol use. Reflux is a risk factor for adenocarcinoma. Esophagectomy is appropriate for less than half of the patients. The five-year survival after esophagectomy is still only $20 \%$. A CT scan of the chest and endoscopic ultrasound are the best tests to determine the extent of regional spread.
Question 5 of 5
A 78-year-old woman presents to you after having a total body CT scan done at a local facility. She was told that she has a few gallstones in her gallbladder and should discuss this with her primary physician. An ultrasound was apparently also done, which revealed the presence of a few 1-cm gallstones but no ductal dilatation or gallbladder thickening. She denies any abdominal discomfort or pain. Her aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase are normal. She is concerned because her mother died of complications from a 'gallbladder attack.' What course of action would you recommend in this patient?
Correct Answer: D
Rationale: Asymptomatic gallbladder stones usually do not require treatment. Only $13 \%$ of patients with silent gallstones will become symptomatic in future. That is why open or laparoscopic cholecystectomy is not indicated for this patient with a silent gallbladder stone. Oral dissolution is only indicated for small gallstones, preferably less than $5 \mathrm{~mm}$ (smaller stones dissolve faster). Stones larger than $2 \mathrm{~cm}$ will rarely be dissolved. Extracorporeal shock wave lithotripsy has a limited rate of success and a high rate of recurrence; it is rarely used in the United States. Direct dissolution of stones is an option in patients with large stones and at high risk for surgery.