ATI LPN
NCLEX Questions on Gastrointestinal System Questions
Question 1 of 5
Which of the following would confirm the diagnosis of diabetes in a patient with symptoms of hyperglycaemia?
Correct Answer: A
Rationale: Fasting plasma glucose>=7.0 mmol/l with symptoms confirms diabetes per WHO criteria, making A the correct answer.
Question 2 of 5
A 36-year-old woman complains of reflux symptoms and intermittent diarrhea. The diagnosis of gastrinoma is suspected so a fasting serum gastrin is obtained and found to be 280 pg/mL (normal <115 pg/mL). An abdominal CT is negative. What would you do now?
Correct Answer: D
Rationale: Although the fasting serum gastrin is elevated, this finding alone is insufficient for establishing the diagnosis of gastrinoma. The serum gastrin can be elevated in other conditions, most notably recent therapy with proton-pump inhibitors or H2 antagonists and gastric achlorhydria. In fact, the serum gastrin has been reported to be elevated over 1000 pg/mL in patients with pernicious anemia. Thus, a measurement of basal acid output is required. If the gastric pH is less than 2, the diagnosis of gastrinoma is highly suspicious, and a serum secretin test should be performed. Secretin 2 IU/kg is given over 2 minutes and measurements of the serum gastrin are obtained 2.5, 5, 10, 15, and 30 minutes after infusion. A paradoxical increase in the serum gastrin of greater than 200 pg/mL is diagnostic of Z-E syndrome.
Question 3 of 5
A 65-year-old man frequently regurgitates food several hours after eating, and experiences chest pain and dysphagia to both liquids and solids. He has lost 20 pounds. A CXR shows an air/fluid level in a dilated esophagus and an absent gastric air bubble. No mass in the distal esophagus or proximal stomach is identified at upper endoscopy. The best therapy for this patient is
Correct Answer: B
Rationale: The patient has the classic presentation and radiologic findings of achalasia. The upper endoscopy and CT scan are important for ruling out secondary achalasia which is caused by a malignant growth at the GE junction, producing symptoms and findings that mimic primary achalasia. Patients with achalasia typically do not suffer from GERD since they have a lower esophageal sphincter that fails to relax appropriately. However, achalasia patients can describe heartburn and chest pain due to the accumulation of ingested material in a massively dilated esophagus. Achalasia responds well to endoscopic balloon dilatation and to myotomy. Injection of botulinum toxin at the GE junction has been helpful in nonsurgical candidates. Esophageal resection is not indicated for achalasia unless malignancy has developed.
Question 4 of 5
An 82-year-old female nursing home resident was admitted with left-sided aspiration pneumonia. She improved quickly on intravenous antibiotics. During her admission, a chest x-ray incidentally revealed a large calcification in the right upper quadrant of the abdomen. Subsequent abdominal ultrasound confirmed the presence of a single large stone in the gallbladder (3 cm in diameter). She denies any abdominal discomfort or pain. What would be the best course of treatment for her gallstone disease?
Correct Answer: C
Rationale: Asymptomatic gallbladder stones do not require treatment. Only $13 \%$ of patients with silent gallstones will become symptomatic in the future. For this reason, open or laparoscopic cholecystectomy is not indicated for this patient with a silent gallbladder stone. Oral dissolution is only beneficial for small gallstones, preferably less than $5 \mathrm{~mm}$ (smaller stones dissolve faster). Stones larger than $2 \mathrm{~cm}$ will rarely be dissolved with this method. Extracorporeal shock wave lithotripsy has limited rate of success and high rate of recurrence and is rarely used in the United States.
Question 5 of 5
A 47-year-old web designer has a 14-year history of ulcerative colitis. He recently moved to your area and presents to your office for continued management of his ulcerative colitis. He has been asymptomatic for the past two years and off all medications for one year with no rectal bleeding, diarrhea, abdominal pain, tenesmus, or fever. Before that he had very active colitis requiring steroids and immunosuppressants. He brings records from his previous physician that include his last three colonoscopy and pathology reports. The reports from 6 and 12 years ago documented active colitis with friable mucosa from the mid-transverse colon to the rectum, superficial ulcerations, crypt abscesses and crypt distortion, and acute and chronic inflammation. The most recent report, from almost three years ago, was fairly unremarkable endoscopically. Numerous random biopsies had been obtained. They showed mucosal changes on histology also consistent with a history of ulcerative colitis, but there was no evidence of active disease. What do you recommend?
Correct Answer: D
Rationale: The patient has not had active disease for several years and remains well despite being off medications for the past year. Steroids are indicated for active disease only, and steroids do not prevent recurrence. Ulcerative colitis is a chronic disease with recurrence expected. An argument can be made for azulfidine or mesalamine; 5-ASA agents have been documented to decrease flares and appear to decrease the risk of dysplasia and eventual colon cancer. Patients with ulcerative colitis for more than eight years should undergo colonoscopy every two years with random biopsies taken every $10 \mathrm{~cm}$ to rule out dysplasia; then more frequently after 20 years of disease. Definitive evidence of dysplasia requires referral for colectomy to avoid the extremely high risk of colon cancer. Presence of occult blood in the stool will not change endoscopic management because this patient needs to be on a regular screening protocol regardless of heme-occult status.