NR 511 Final Exam Study Guide
General Study Tips and Recommendations
Topics and content on guides are intended to focus student attention when reading/studying
and some topics may be repeated in multiple chapters.
Multiple test items are derived from the same topic areas to encourage deeper comprehension.
Students must have a broad understanding of content and not simply memorize passages in
textbooks or articles.
Information contained in the chapters as well as boxes and tables within the chapters may
include test items.
Exam questions represent various levels of cognitive learning. You are expected to analyze,
synthesis, and evaluate patient scenarios in order to answer the questions.
Students are expected to use clinical decision making to prioritize treatment actions based on
the information provided in the exam question.
Read all of the answers BEFORE reading the stem of the question. This will help you focus on the
key content and not get distracted by extraneous information. Once you have selected your
answer, read the question one more time to ensure that the best answer has been chosen.
Utilize your time well by not rushing. You will have plenty of time to read each question for
understanding before you select your final answer.
Chapter 38 Common Abdominal Complaints
Work-up of abdominal pain (including differential diagnoses)
History: Onset, location, character, radiation, associated symptoms (e.g., nausea, fever),
aggravating/alleviating factors.
Physical Exam: Inspection, palpation (including guarding and rebound tenderness), percussion,
auscultation for bowel sounds.
Differential Diagnosis:
Upper Abdominal Pain: Peptic ulcer disease, GERD, pancreatitis, biliary colic.
Lower Abdominal Pain: Diverticulitis, appendicitis, gynecological issues in women (e.g., ovarian
torsion).
Diffuse Pain: Peritonitis, mesenteric ischemia, IBS.
Diagnostic Tests: Imaging (e.g., CT scan, ultrasound), lab tests (e.g., CBC, liver function tests), and
endoscopy when needed.
CBC (Complete Blood Count):
Elevated WBC (White Blood Cells): This can be indicative of an infection or inflammation. For
example, elevated WBCs are often seen in cases of peritonitis, which can result from
appendicitis 1.
Low RBC (Red Blood Cells) or Hemoglobin: This can suggest anemia, which might be related to
chronic diseases or nutritional deficiencies 2.
Liver Function Tests:
Elevated Liver Enzymes (e.g., AST, ALT): These can indicate liver damage or inflammation, which
is often seen in conditions like cirrhosis 3.
Bilirubin Levels: Elevated bilirubin can suggest liver dysfunction or bile duct obstruction 3.
,So, in summary:
CBC: Elevated WBCs could point to peritonitis from appendicitis 1.
Liver Function Tests: Elevated liver enzymes and bilirubin levels could be indicative of cirrhosis
Coach Ally- 1. Work-up of Abdominal Pain (Including Differential Diagnoses)
When assessing abdominal pain, it's essential to develop a differential diagnosis. Common
conditions to consider include:
Gastroenteritis: Often presents with diarrhea and vomiting.
Irritable Bowel Syndrome (IBS): Characterized by abdominal pain and changes in bowel habits.
Ulcerative Colitis (UC): An inflammatory bowel disease that can cause abdominal pain and
bloody diarrhea.
Crohn's Disease: Another inflammatory bowel disease that can affect any part of the
gastrointestinal tract.
To narrow down the differential diagnosis, focus on the History of Present Illness (HPI) and Review
of Systems (ROS). Key questions include:
Duration and nature of the pain
Associated symptoms like nausea, vomiting, or changes in bowel movements
1. Work-up of Abdominal Pain
The work-up of abdominal pain involves a systematic approach that includes:
History of Present Illness (HPI): Gathering detailed information about the pain, including its
onset, duration, location, quality, intensity, and any associated symptoms (e.g., nausea,
vomiting, changes in bowel habits). Key questions include:
o When did the pain start?
o How would you describe the pain (sharp, dull, cramping)?
o Does anything make it better or worse?
o Are there any associated symptoms like fever or changes in appetite?
Review of Systems (ROS): A thorough review of other body systems to identify any additional
symptoms that may help narrow down the differential diagnoses. This includes asking about
gastrointestinal symptoms (diarrhea, constipation, blood in stool), urinary symptoms, and
systemic symptoms (fever, weight loss).
Physical Examination (PE): A focused abdominal examination that includes:
o Inspection: Looking for distension, scars, or visible masses.
o Auscultation: Listening for bowel sounds, which can indicate the presence of
obstruction or ileus.
o Palpation: Assessing for tenderness, organomegaly, or masses. Special tests like
rebound tenderness can help identify peritoneal irritation.
Common Differential Diagnoses: Based on the findings, common diagnoses may include:
o Gastroenteritis: Often presents with abdominal cramping and diarrhea.
o Irritable Bowel Syndrome (IBS): Characterized by abdominal pain associated with
changes in bowel habits.
o Ulcerative Colitis (UC) and Crohn's Disease: Inflammatory bowel diseases that can
o cause abdominal pain, diarrhea, and systemic symptoms.
,Inflammatory Bowel Disease (IBD): IBD includes conditions such as Crohn's disease and ulcerative
colitis. These are chronic inflammatory conditions that affect the gastrointestinal tract.
Symptoms: Abdominal pain, diarrhea, weight loss, and fatigue.
Diagnosis: Blood tests, stool studies, and imaging such as colonoscopy, endoscopy, and biopsy .
Imaging techniques like MRI and CT scans can also be used to assess the extent of inflammation
and complications.
Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, and dietary modifications.
Surgery may be necessary for complications.
Irritable Bowel Syndrome (IBS): IBS is a functional gastrointestinal disorder characterized by chronic
abdominal pain and altered bowel habits without structural abnormalities. A functional
gastrointestinal (GI) disorder refers to a condition where the gastrointestinal tract appears normal
but doesn't function properly. These disorders are characterized by chronic symptoms without any
structural abnormalities. Common examples include Irritable Bowel Syndrome (IBS) and functional
dyspepsia. Symptoms often include abdominal pain, bloating, and changes in bowel habit.
Symptoms: Chronic abdominal pain and changes in bowel habits .
Diagnosis: IBS is diagnosed using the Rome IV criteria, which include recurrent abdominal pain
occurring on average more than one day per week in the last three months, associated with
changes in stool frequency, appearance, or pain related to defecation 6. Other conditions like
celiac disease or IBD must be ruled out.
he Rome IV criteria are used for diagnosing Irritable Bowel Syndrome (IBS). To establish a
diagnosis, the following must be met:
Recurrent abdominal pain occurring on average more than one day per week in the last three
months 1.
The onset of symptoms must be more than six months prior to diagnosis .
The abdominal pain must be associated with at least two of the following :
Change in stool frequency
Change in stool appearance or form
Pain related to defecation
Management: Dietary changes (e.g., low FODMAP diet), antispasmodics, laxatives, or
antidiarrheal agents, and psychological therapies 8.
From the web:
IBD:
Imaging: MRI and CT scans are commonly used to visualize inflammation and complications in
the gastrointestinal tract. These imaging techniques help in assessing the severity and extent of
the disease 9.
Tests: Blood tests to check for markers of inflammation, stool tests to detect infections or
inflammation, and endoscopic procedures like colonoscopy and endoscopy to directly visualize
the affected areas and obtain biopsies 9.
IBS:
Imaging: Imaging is not typically used for diagnosing IBS, as it is a functional disorder without
structural abnormalities. However, imaging may be used to rule out other conditions 9.
Tests: Diagnosis is primarily based on clinical criteria (Rome IV criteria) and ruling out other
conditions through blood tests, stool tests, and sometimes endoscopy
Scenario 10: Functional Dyspepsia
Feedback: While increasing fluid and fiber and exercise are good recommendations, a
colonoscopy may not be necessary unless alarm symptoms are present. Management may also
include dietary modifications and possibly a trial of PPIs.
, Dietary Changes for Functional Dyspepsia
1. Avoid Trigger Foods: Identify and avoid foods that exacerbate symptoms. Common triggers
include:
o Spicy foods
o Fatty or fried foods
o Acidic foods (e.g., citrus fruits, tomatoes)
o Caffeinated beverages (coffee, tea, soda)
o Carbonated drinks
o Alcohol
2. Eat Smaller, More Frequent Meals: Instead of three large meals, aim for smaller meals
throughout the day. This can help reduce the burden on the digestive system and minimize
symptoms.
3. Increase Fiber Intake: Incorporate more fiber-rich foods, such as fruits, vegetables, whole
grains, and legumes. Fiber can help improve digestion and prevent constipation, which may
contribute to dyspeptic symptoms.
4. Stay Hydrated: Drink plenty of water throughout the day. However, it may be helpful to avoid
drinking large amounts of fluids during meals, as this can contribute to a feeling of fullness and
discomfort.
5. Limit High-Fat Foods: Reduce the intake of high-fat foods, as they can slow gastric emptying and
exacerbate symptoms. Opt for lean proteins (e.g., chicken, fish) and healthy fats (e.g., avocados,
nuts) in moderation.
6. Incorporate Probiotics: Foods rich in probiotics, such as yogurt, kefir, and fermented foods, may
help improve gut health and digestion.
7. Monitor Portion Sizes: Eating large portions can lead to discomfort. Pay attention to portion
sizes and eat slowly to allow the body to signal fullness.
8. Consider Food Sensitivities: Some individuals may have sensitivities to certain foods (e.g.,
lactose, gluten). Keeping a food diary can help identify any specific foods that may trigger
symptoms.
9. Limit Processed Foods: Reduce the intake of processed and high-sugar foods, as they can
contribute to digestive issues.
10. Consult a Dietitian: If symptoms persist, consider working with a registered dietitian who can
provide personalized dietary recommendations and help identify specific triggers.
Assessment, diagnosis and management of diarrhea and constipation
Diarrhea:
o Assessment: Stool frequency, consistency, onset, presence of blood/mucus, and triggers
(diet, medications).
o Diagnosis: Stool studies (e.g., culture, microscopy), colonoscopy for chronic or bloody
diarrhea, imaging if suspecting IBD.
o Management: Hydration, antidiarrheal agents (e.g., loperamide), addressing underlying
causes (e.g., infections, malabsorption).
o Constipation:
Assessment: Frequency, consistency, associated symptoms (e.g., pain, bloating).
General Study Tips and Recommendations
Topics and content on guides are intended to focus student attention when reading/studying
and some topics may be repeated in multiple chapters.
Multiple test items are derived from the same topic areas to encourage deeper comprehension.
Students must have a broad understanding of content and not simply memorize passages in
textbooks or articles.
Information contained in the chapters as well as boxes and tables within the chapters may
include test items.
Exam questions represent various levels of cognitive learning. You are expected to analyze,
synthesis, and evaluate patient scenarios in order to answer the questions.
Students are expected to use clinical decision making to prioritize treatment actions based on
the information provided in the exam question.
Read all of the answers BEFORE reading the stem of the question. This will help you focus on the
key content and not get distracted by extraneous information. Once you have selected your
answer, read the question one more time to ensure that the best answer has been chosen.
Utilize your time well by not rushing. You will have plenty of time to read each question for
understanding before you select your final answer.
Chapter 38 Common Abdominal Complaints
Work-up of abdominal pain (including differential diagnoses)
History: Onset, location, character, radiation, associated symptoms (e.g., nausea, fever),
aggravating/alleviating factors.
Physical Exam: Inspection, palpation (including guarding and rebound tenderness), percussion,
auscultation for bowel sounds.
Differential Diagnosis:
Upper Abdominal Pain: Peptic ulcer disease, GERD, pancreatitis, biliary colic.
Lower Abdominal Pain: Diverticulitis, appendicitis, gynecological issues in women (e.g., ovarian
torsion).
Diffuse Pain: Peritonitis, mesenteric ischemia, IBS.
Diagnostic Tests: Imaging (e.g., CT scan, ultrasound), lab tests (e.g., CBC, liver function tests), and
endoscopy when needed.
CBC (Complete Blood Count):
Elevated WBC (White Blood Cells): This can be indicative of an infection or inflammation. For
example, elevated WBCs are often seen in cases of peritonitis, which can result from
appendicitis 1.
Low RBC (Red Blood Cells) or Hemoglobin: This can suggest anemia, which might be related to
chronic diseases or nutritional deficiencies 2.
Liver Function Tests:
Elevated Liver Enzymes (e.g., AST, ALT): These can indicate liver damage or inflammation, which
is often seen in conditions like cirrhosis 3.
Bilirubin Levels: Elevated bilirubin can suggest liver dysfunction or bile duct obstruction 3.
,So, in summary:
CBC: Elevated WBCs could point to peritonitis from appendicitis 1.
Liver Function Tests: Elevated liver enzymes and bilirubin levels could be indicative of cirrhosis
Coach Ally- 1. Work-up of Abdominal Pain (Including Differential Diagnoses)
When assessing abdominal pain, it's essential to develop a differential diagnosis. Common
conditions to consider include:
Gastroenteritis: Often presents with diarrhea and vomiting.
Irritable Bowel Syndrome (IBS): Characterized by abdominal pain and changes in bowel habits.
Ulcerative Colitis (UC): An inflammatory bowel disease that can cause abdominal pain and
bloody diarrhea.
Crohn's Disease: Another inflammatory bowel disease that can affect any part of the
gastrointestinal tract.
To narrow down the differential diagnosis, focus on the History of Present Illness (HPI) and Review
of Systems (ROS). Key questions include:
Duration and nature of the pain
Associated symptoms like nausea, vomiting, or changes in bowel movements
1. Work-up of Abdominal Pain
The work-up of abdominal pain involves a systematic approach that includes:
History of Present Illness (HPI): Gathering detailed information about the pain, including its
onset, duration, location, quality, intensity, and any associated symptoms (e.g., nausea,
vomiting, changes in bowel habits). Key questions include:
o When did the pain start?
o How would you describe the pain (sharp, dull, cramping)?
o Does anything make it better or worse?
o Are there any associated symptoms like fever or changes in appetite?
Review of Systems (ROS): A thorough review of other body systems to identify any additional
symptoms that may help narrow down the differential diagnoses. This includes asking about
gastrointestinal symptoms (diarrhea, constipation, blood in stool), urinary symptoms, and
systemic symptoms (fever, weight loss).
Physical Examination (PE): A focused abdominal examination that includes:
o Inspection: Looking for distension, scars, or visible masses.
o Auscultation: Listening for bowel sounds, which can indicate the presence of
obstruction or ileus.
o Palpation: Assessing for tenderness, organomegaly, or masses. Special tests like
rebound tenderness can help identify peritoneal irritation.
Common Differential Diagnoses: Based on the findings, common diagnoses may include:
o Gastroenteritis: Often presents with abdominal cramping and diarrhea.
o Irritable Bowel Syndrome (IBS): Characterized by abdominal pain associated with
changes in bowel habits.
o Ulcerative Colitis (UC) and Crohn's Disease: Inflammatory bowel diseases that can
o cause abdominal pain, diarrhea, and systemic symptoms.
,Inflammatory Bowel Disease (IBD): IBD includes conditions such as Crohn's disease and ulcerative
colitis. These are chronic inflammatory conditions that affect the gastrointestinal tract.
Symptoms: Abdominal pain, diarrhea, weight loss, and fatigue.
Diagnosis: Blood tests, stool studies, and imaging such as colonoscopy, endoscopy, and biopsy .
Imaging techniques like MRI and CT scans can also be used to assess the extent of inflammation
and complications.
Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, and dietary modifications.
Surgery may be necessary for complications.
Irritable Bowel Syndrome (IBS): IBS is a functional gastrointestinal disorder characterized by chronic
abdominal pain and altered bowel habits without structural abnormalities. A functional
gastrointestinal (GI) disorder refers to a condition where the gastrointestinal tract appears normal
but doesn't function properly. These disorders are characterized by chronic symptoms without any
structural abnormalities. Common examples include Irritable Bowel Syndrome (IBS) and functional
dyspepsia. Symptoms often include abdominal pain, bloating, and changes in bowel habit.
Symptoms: Chronic abdominal pain and changes in bowel habits .
Diagnosis: IBS is diagnosed using the Rome IV criteria, which include recurrent abdominal pain
occurring on average more than one day per week in the last three months, associated with
changes in stool frequency, appearance, or pain related to defecation 6. Other conditions like
celiac disease or IBD must be ruled out.
he Rome IV criteria are used for diagnosing Irritable Bowel Syndrome (IBS). To establish a
diagnosis, the following must be met:
Recurrent abdominal pain occurring on average more than one day per week in the last three
months 1.
The onset of symptoms must be more than six months prior to diagnosis .
The abdominal pain must be associated with at least two of the following :
Change in stool frequency
Change in stool appearance or form
Pain related to defecation
Management: Dietary changes (e.g., low FODMAP diet), antispasmodics, laxatives, or
antidiarrheal agents, and psychological therapies 8.
From the web:
IBD:
Imaging: MRI and CT scans are commonly used to visualize inflammation and complications in
the gastrointestinal tract. These imaging techniques help in assessing the severity and extent of
the disease 9.
Tests: Blood tests to check for markers of inflammation, stool tests to detect infections or
inflammation, and endoscopic procedures like colonoscopy and endoscopy to directly visualize
the affected areas and obtain biopsies 9.
IBS:
Imaging: Imaging is not typically used for diagnosing IBS, as it is a functional disorder without
structural abnormalities. However, imaging may be used to rule out other conditions 9.
Tests: Diagnosis is primarily based on clinical criteria (Rome IV criteria) and ruling out other
conditions through blood tests, stool tests, and sometimes endoscopy
Scenario 10: Functional Dyspepsia
Feedback: While increasing fluid and fiber and exercise are good recommendations, a
colonoscopy may not be necessary unless alarm symptoms are present. Management may also
include dietary modifications and possibly a trial of PPIs.
, Dietary Changes for Functional Dyspepsia
1. Avoid Trigger Foods: Identify and avoid foods that exacerbate symptoms. Common triggers
include:
o Spicy foods
o Fatty or fried foods
o Acidic foods (e.g., citrus fruits, tomatoes)
o Caffeinated beverages (coffee, tea, soda)
o Carbonated drinks
o Alcohol
2. Eat Smaller, More Frequent Meals: Instead of three large meals, aim for smaller meals
throughout the day. This can help reduce the burden on the digestive system and minimize
symptoms.
3. Increase Fiber Intake: Incorporate more fiber-rich foods, such as fruits, vegetables, whole
grains, and legumes. Fiber can help improve digestion and prevent constipation, which may
contribute to dyspeptic symptoms.
4. Stay Hydrated: Drink plenty of water throughout the day. However, it may be helpful to avoid
drinking large amounts of fluids during meals, as this can contribute to a feeling of fullness and
discomfort.
5. Limit High-Fat Foods: Reduce the intake of high-fat foods, as they can slow gastric emptying and
exacerbate symptoms. Opt for lean proteins (e.g., chicken, fish) and healthy fats (e.g., avocados,
nuts) in moderation.
6. Incorporate Probiotics: Foods rich in probiotics, such as yogurt, kefir, and fermented foods, may
help improve gut health and digestion.
7. Monitor Portion Sizes: Eating large portions can lead to discomfort. Pay attention to portion
sizes and eat slowly to allow the body to signal fullness.
8. Consider Food Sensitivities: Some individuals may have sensitivities to certain foods (e.g.,
lactose, gluten). Keeping a food diary can help identify any specific foods that may trigger
symptoms.
9. Limit Processed Foods: Reduce the intake of processed and high-sugar foods, as they can
contribute to digestive issues.
10. Consult a Dietitian: If symptoms persist, consider working with a registered dietitian who can
provide personalized dietary recommendations and help identify specific triggers.
Assessment, diagnosis and management of diarrhea and constipation
Diarrhea:
o Assessment: Stool frequency, consistency, onset, presence of blood/mucus, and triggers
(diet, medications).
o Diagnosis: Stool studies (e.g., culture, microscopy), colonoscopy for chronic or bloody
diarrhea, imaging if suspecting IBD.
o Management: Hydration, antidiarrheal agents (e.g., loperamide), addressing underlying
causes (e.g., infections, malabsorption).
o Constipation:
Assessment: Frequency, consistency, associated symptoms (e.g., pain, bloating).
