ATI LPN
Gastrointestinal System Questions and Answers Questions
Question 1 of 5
Which of the following drug and loading dose combinations are recommended for immediate antiplatelet therapy of an NSTEMI?
Correct Answer: A
Rationale: For NSTEMI, guidelines recommend aspirin 300 mg and clopidogrel 300 mg loading doses, making A the correct answer.
Question 2 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 3 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 4 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 5 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.