NR511 Exam Review Questions with Correct
Answers
Appendicitis
-Risk: 10-30yo, men, low fiber, high fat/sugar/carb diet
-S: Mild to severe colicky epigastric or periumbilical pain, but in 24 hours, moves to RLQ
and exacerbated by walking or coughing.May radiate to testicles. maybe vomiting, sensation
of constipation, but diarrhea present. low grade temp. chills & sudden cessation of
pain=perforation
-O: HTN/Tachy, flex R knee up to relieve pain when recumbent, guarding, rebound
tenderness.
-Dx: + Rovsing, Psoas, Obturator, McBurney's sign
-Tx: Appendectomy
-Edu: avoid lifting for 2 weeks.
Celiac Disease
-Risk:family hx, downs syndrome, HLA-DQ2(or 8), turners syndrome, type 2 DM or
thyroiditis
-S:asymptomatic OR diarrhea, wt loss, dyspepsia, flatulence, fatigue, joint pain, depressed
mood, amenorrhea, difficulty getting pregnant, early menopause
-O: may be normal, OR muscle wasting, pallow, reduced sub q fat, ataxia, peripheral
neuropathy
-Dx: Serologic testing for anti-tTG IgA antibodies, Total IgA, Upper GI scope (look at
damage). or no Dx- just try diet changes
-Tx: gluten free diet
cholelithiasis (gallstones)
,-Risk: Female, obese, pregnant, incr age, drug induced, rapid wt loss, spinal cord injury, DM,
Sickle cell anemia. Pigmented stones: hemolytic disease, icr age, hyperalimentation,
cirrhosis, biliary stasis
-S:indigestion, n/v, colicky-type pain, RUQ or epigastric pain, referred pain to middle back, r
shoulder, or infrascapular area, pain incr by movement (breathing)
-O: + murphy's sign (hold deep breath, palpate R subcostal area), low fever, mild jaundice,
edema, dim BS
-Dx: ABD ultrasound
-Tx: low fat diet, cholecystectomy, lithotripsy
-Edu:wt loss, avoid fatty food, avoid OCs and estrogen
Crohn's disease
-Risk: family hx, smoking, genetics, early adulthood
-S:Abd cramping, tenderness, fever, anorexia, wt loss, flatulence, RLQ pain or mass. Semi
liquid stools (may have blood), steatorrhea, gradual onset
-O: LLQ or entire abd tenderness, duarding, distentionanal gissures, skin tags
-Dx:stool analysis & culture (to r/o other cause), barium upper GI series (aphthous and linear
ulcers. Late- "string sign"), Colonoscopy, Ct scan
-Tx: sulfasalazine (but not beneficial). glucocorticoids (prednisone), metronidazole,
immunosuppressants
-Edu: low-residue diet when obstructive symptoms present, avoid all fiber. eat what they
want when no attack
Diverticulitis
-risk: >40yo, low fiber diet, chronic constipation, straining, irregular BMs, diverticula in the
colon
, -S: Fever, chills, tachycardia, LLQ pain,n/v,anorexia, pain is relieved with BM, constipation
& diarrhea, abd tenderness & distention. *may present with bleeding not associated with
pain*
-O: LLQ pain, firm, fixed mass in the area of the diverticula. rebound tenderness, guarding,
tender rectum, + blood in BM
-dx:mild leukocytosis, low H&H, ABD X-ray if perforation or peritonitis suspected. CT scan
most accurate
-tx: no routine ATB (but augmentin or metronidazole when needed),
-edu: high fiber diet
Peptic Ulcer Disease
-risk: H.pylori, NSAIDs, ASA, stress, 55-70yo, blood type, genetics, smoking, COPD,
cirrhosis, renal failure & transplant, caffeine, ETOH, spicy foods
-S: epigastric burning or gnawing pain relieved by food or antacids. nocturnal pain,
-O:not useful. epigastric pain 2.5cm to the R of midline
-dx: CBC, BMP, urea breath test, stool test, EGD biopsy,
-tx: PPI (-prazole) 4-8 weeks. H2-RA x 8 weeks. Clarithromycin & amoxicillin or
metronidazole and a PPI BID x 14 days.
-edu: change in fecal color when taking bismuth preparations. Sucralfate cannot be taken at
the same time as other medications or dig, cipro or phenytoin.
GERD
-Risk: incr with age, obesity, relaxation of the LES, ETOH, coffee, chocolate, hiatal hernia,
delayed gastric emptying
-S:heartburn, regurgitation, sour taste in mouth in morning, belching, coughing, hoarseness,
wheezing usually at night. substernal pain. dysphagia
Answers
Appendicitis
-Risk: 10-30yo, men, low fiber, high fat/sugar/carb diet
-S: Mild to severe colicky epigastric or periumbilical pain, but in 24 hours, moves to RLQ
and exacerbated by walking or coughing.May radiate to testicles. maybe vomiting, sensation
of constipation, but diarrhea present. low grade temp. chills & sudden cessation of
pain=perforation
-O: HTN/Tachy, flex R knee up to relieve pain when recumbent, guarding, rebound
tenderness.
-Dx: + Rovsing, Psoas, Obturator, McBurney's sign
-Tx: Appendectomy
-Edu: avoid lifting for 2 weeks.
Celiac Disease
-Risk:family hx, downs syndrome, HLA-DQ2(or 8), turners syndrome, type 2 DM or
thyroiditis
-S:asymptomatic OR diarrhea, wt loss, dyspepsia, flatulence, fatigue, joint pain, depressed
mood, amenorrhea, difficulty getting pregnant, early menopause
-O: may be normal, OR muscle wasting, pallow, reduced sub q fat, ataxia, peripheral
neuropathy
-Dx: Serologic testing for anti-tTG IgA antibodies, Total IgA, Upper GI scope (look at
damage). or no Dx- just try diet changes
-Tx: gluten free diet
cholelithiasis (gallstones)
,-Risk: Female, obese, pregnant, incr age, drug induced, rapid wt loss, spinal cord injury, DM,
Sickle cell anemia. Pigmented stones: hemolytic disease, icr age, hyperalimentation,
cirrhosis, biliary stasis
-S:indigestion, n/v, colicky-type pain, RUQ or epigastric pain, referred pain to middle back, r
shoulder, or infrascapular area, pain incr by movement (breathing)
-O: + murphy's sign (hold deep breath, palpate R subcostal area), low fever, mild jaundice,
edema, dim BS
-Dx: ABD ultrasound
-Tx: low fat diet, cholecystectomy, lithotripsy
-Edu:wt loss, avoid fatty food, avoid OCs and estrogen
Crohn's disease
-Risk: family hx, smoking, genetics, early adulthood
-S:Abd cramping, tenderness, fever, anorexia, wt loss, flatulence, RLQ pain or mass. Semi
liquid stools (may have blood), steatorrhea, gradual onset
-O: LLQ or entire abd tenderness, duarding, distentionanal gissures, skin tags
-Dx:stool analysis & culture (to r/o other cause), barium upper GI series (aphthous and linear
ulcers. Late- "string sign"), Colonoscopy, Ct scan
-Tx: sulfasalazine (but not beneficial). glucocorticoids (prednisone), metronidazole,
immunosuppressants
-Edu: low-residue diet when obstructive symptoms present, avoid all fiber. eat what they
want when no attack
Diverticulitis
-risk: >40yo, low fiber diet, chronic constipation, straining, irregular BMs, diverticula in the
colon
, -S: Fever, chills, tachycardia, LLQ pain,n/v,anorexia, pain is relieved with BM, constipation
& diarrhea, abd tenderness & distention. *may present with bleeding not associated with
pain*
-O: LLQ pain, firm, fixed mass in the area of the diverticula. rebound tenderness, guarding,
tender rectum, + blood in BM
-dx:mild leukocytosis, low H&H, ABD X-ray if perforation or peritonitis suspected. CT scan
most accurate
-tx: no routine ATB (but augmentin or metronidazole when needed),
-edu: high fiber diet
Peptic Ulcer Disease
-risk: H.pylori, NSAIDs, ASA, stress, 55-70yo, blood type, genetics, smoking, COPD,
cirrhosis, renal failure & transplant, caffeine, ETOH, spicy foods
-S: epigastric burning or gnawing pain relieved by food or antacids. nocturnal pain,
-O:not useful. epigastric pain 2.5cm to the R of midline
-dx: CBC, BMP, urea breath test, stool test, EGD biopsy,
-tx: PPI (-prazole) 4-8 weeks. H2-RA x 8 weeks. Clarithromycin & amoxicillin or
metronidazole and a PPI BID x 14 days.
-edu: change in fecal color when taking bismuth preparations. Sucralfate cannot be taken at
the same time as other medications or dig, cipro or phenytoin.
GERD
-Risk: incr with age, obesity, relaxation of the LES, ETOH, coffee, chocolate, hiatal hernia,
delayed gastric emptying
-S:heartburn, regurgitation, sour taste in mouth in morning, belching, coughing, hoarseness,
wheezing usually at night. substernal pain. dysphagia
