ATI LPN
Questions for Review of Systems Gastrointestinal Questions
Question 1 of 5
Which of the following factors is used to estimate an increased the risk of stroke in atrial fibrillation?
Correct Answer: D
Rationale: The CHA2DS2-VASc score includes prior TIA as a strong risk factor (2 points), making D the best answer.
Question 2 of 5
It is 6 pm; a patient presents to you with sudden onset shortness of breath since 5 pm. Which of the following is LEAST likely to be the underlying diagnosis?
Correct Answer: D
Rationale: Anxiety is less likely to cause sudden onset shortness of breath within an hour compared to acute physiological causes like pneumothorax, making E the least likely.
Question 3 of 5
The patient described in the preceding questions has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?
Correct Answer: C
Rationale: Reinfection by H. pylori is rare, and the persistence of infection usually indicates poor compliance with the medical regimen or antibiotic resistance. The serum IgG may remain positive indefinitely and cannot be used to determine failure of eradication; however, a fall in quantitative IgG levels has been used to document treatment success. If available, either the stool antigen or urease breath test is ideal to document treatment failure because of their high sensitivity and specificity and because they are easy to perform. The association between dyspepsia and H. pylori is hotly debated, but for the most part, dyspepsia does not usually improve with H. pylori eradication.
Question 4 of 5
A 45-year-old woman with a history of arthritis has had severe heartburn and indigestion for six months, which has been refractory to antacid use. Her history is remarkable for arthritic pain in her hands and Raynaud's phenomenon. Her physical examination shows multiple telangectasias on her face and arms. You obtain an esophageal manometry study. What findings are consistent with this diagnosis?
Correct Answer: C
Rationale: The patient has scleroderma esophagus, which results in atrophy of the esophageal smooth muscle. As a result, such patients lose peristalsis and LES tone, leading to severe GERD symptoms and esophagitis.
Question 5 of 5
A 56-year-old woman presents complaining of chest discomfort. She had seen a cardiologist who performed a stress test and reported that the problem was not cardiac in nature. She notes that the pain is worse at times of stress. There is no relationship with eating but sometimes it can occur while lying flat. A barium swallow reveals uncoordinated contractions along the esophageal wall consistent with 'corkscrew esophagus.' All of the following are appropriate therapies to try for this condition except:
Correct Answer: B
Rationale: This patient has chest pain due to diffuse esophageal spasm. Given that there is often underlying gastroesophageal reflux, it is appropriate to try proton-pump inhibitors. Other therapies are geared to relaxing the smooth muscle. Nitrates, calcium channel-blockers, and benzodiazepines may be helpful in individual patients. Additionally, antidepressants (e.g., SSRIs, tricyclics) and antipsychotic medications have been used. Pseudoephedrine has not been found to be helpful for this condition. It can cause some degree of smooth-muscle contraction, so theoretically it should not be used.