NR576 / NR 576 Final Exam (
Newly Updated): Differential Diagnosis
in Adult-Gerontology Primary Care |
Guide with Verified Answers -
Chamberlain
Assessing for prior antibiotic use is a critical part of the history in patients with
presenting with _______________ due to_________________ - Correct Answer-
✔✔Diarrhea/CDiff
Irritable bowel syndrome - Correct Answer-✔✔disorder of the bowel function not
from anatomic abnormality--constipation, diarrhea, bloating, urgency w/diarrhea
+s/s--result from disordered sensations or abnormal function of the small and large
bowel
NOT associated with serious medical conditions, IBD, CA
Inflammatory bowel disorder - Correct Answer-✔✔chronic immunologic disease that
manifests in intestinal inflammation
Ulcerative colitis
crohn's disease
Two common inflammatory bowel diseases - Correct Answer-✔✔Ulcerative colitis-
mucosal surface of the colon is inflamed and ultimately results in frability, erosions,
and bleeding--most common in recto-sigmoid colon. Can involve entire colon, pain in
RLQ
,Crohns disease-inflammation extends deeper into the intestional wall and can
involve all or any layer of the bowel wall and any portion of the GI tract from the
mouth to the anus--skipped lesions, pain in LLQ
Diverticulitis - Correct Answer-✔✔Symptoms: LLQ pain/tenderness, fever, N/V/D
Need imagining especially if perforation or peritonitis is suspected--free
air=perforation; patient may have ileus, small or large bowel obstruction
Can use plain x-ray
CT or Barium enema are preferred
CT with contrast is more sensitive and accurate
Identify the significance of Barrett's esophagus - Correct Answer-✔✔After repeated
exposure to gastric contents, inflammation of the esophageal mucosa becomes
chronic
Blood flow increases, erosion occurs
As erosion heals, normal squamous epithelium replaced with metaplastic columnar
epithelium containing goblet and columnar cells.
More resistant to acid and supports esophageal healing
Premalignant tissue
40-fold frisk for developing esophageal adenocarcinma
Fibrosis and scarring during healing of erosions; leads to strictures
Diagnosis of GERD - Correct Answer-✔✔made on history alone: sensitivity of 80%
if symptoms are unclear/patient does not respond to 4 weeks of empiric tx
made by ambulatory esophageal pH monitoring
,pH <4 above the lower esophageal sphincter correlates with symptoms = GERD
EDG with biopsy-Barrett's esohagus
Normal results in 50% of symptomatic patients
Risks of GERD - Correct Answer-✔✔Obesity
Increase after age 50
Equal across gender, ethnic, and cultural groups
Treatments of GERD - Correct Answer-✔✔Small frequent meals-main meal in
midday
Avoid trigger foods
No bedtime snacks: no eating <4 hours prior to bed
Eliminate caffeine, stop smoking, avoid tight fitting clothing, sleep with head of the
bed elevated.
Medications for GERD - Correct Answer-✔✔antacids or OTC H2 (Tagamet, zantac,
axid)
Rx-strength H2 (ranitidine 150mg BID, famotidine 20mg BID) or PPI (pantoprazole
40mg daily, omeprazole 20mg daily)
PPI (Omeprazole 40mg daily)
Surgery (fundoplication)
Differential diagnosis of acute abd pain - Correct Answer-✔✔Acute appendicitis
Acute pancreatitis
, Acute cholecystitis
Acute appendicitis - Correct Answer-✔✔Inflammation of the vermiform appendix;
due to obstruction or infection
Most common surgical emergency of the abdomen
Hollow tube - most common cause is obstruction of appendix
Fecaltih - hard lump of fecal matter
Undigested seeds
Pinworm infections
Lymphoid follicle growth/lymphoid hyperplasia Symptoms
4. Symptoms
Nausea/vomiting
RLQ pain
Guarding
Acute pancreatitis - Correct Answer-✔✔Sudden inflammation and hemorrhaging of
the pancreas due to destruction by its own digestive enzymes
1. Autodigestion
Most of the time mild, but can be severe
Pancreas
Long skinny gland, length of dollar bill
Located in upper abdomen
Behind the stomach
Endocrine
Newly Updated): Differential Diagnosis
in Adult-Gerontology Primary Care |
Guide with Verified Answers -
Chamberlain
Assessing for prior antibiotic use is a critical part of the history in patients with
presenting with _______________ due to_________________ - Correct Answer-
✔✔Diarrhea/CDiff
Irritable bowel syndrome - Correct Answer-✔✔disorder of the bowel function not
from anatomic abnormality--constipation, diarrhea, bloating, urgency w/diarrhea
+s/s--result from disordered sensations or abnormal function of the small and large
bowel
NOT associated with serious medical conditions, IBD, CA
Inflammatory bowel disorder - Correct Answer-✔✔chronic immunologic disease that
manifests in intestinal inflammation
Ulcerative colitis
crohn's disease
Two common inflammatory bowel diseases - Correct Answer-✔✔Ulcerative colitis-
mucosal surface of the colon is inflamed and ultimately results in frability, erosions,
and bleeding--most common in recto-sigmoid colon. Can involve entire colon, pain in
RLQ
,Crohns disease-inflammation extends deeper into the intestional wall and can
involve all or any layer of the bowel wall and any portion of the GI tract from the
mouth to the anus--skipped lesions, pain in LLQ
Diverticulitis - Correct Answer-✔✔Symptoms: LLQ pain/tenderness, fever, N/V/D
Need imagining especially if perforation or peritonitis is suspected--free
air=perforation; patient may have ileus, small or large bowel obstruction
Can use plain x-ray
CT or Barium enema are preferred
CT with contrast is more sensitive and accurate
Identify the significance of Barrett's esophagus - Correct Answer-✔✔After repeated
exposure to gastric contents, inflammation of the esophageal mucosa becomes
chronic
Blood flow increases, erosion occurs
As erosion heals, normal squamous epithelium replaced with metaplastic columnar
epithelium containing goblet and columnar cells.
More resistant to acid and supports esophageal healing
Premalignant tissue
40-fold frisk for developing esophageal adenocarcinma
Fibrosis and scarring during healing of erosions; leads to strictures
Diagnosis of GERD - Correct Answer-✔✔made on history alone: sensitivity of 80%
if symptoms are unclear/patient does not respond to 4 weeks of empiric tx
made by ambulatory esophageal pH monitoring
,pH <4 above the lower esophageal sphincter correlates with symptoms = GERD
EDG with biopsy-Barrett's esohagus
Normal results in 50% of symptomatic patients
Risks of GERD - Correct Answer-✔✔Obesity
Increase after age 50
Equal across gender, ethnic, and cultural groups
Treatments of GERD - Correct Answer-✔✔Small frequent meals-main meal in
midday
Avoid trigger foods
No bedtime snacks: no eating <4 hours prior to bed
Eliminate caffeine, stop smoking, avoid tight fitting clothing, sleep with head of the
bed elevated.
Medications for GERD - Correct Answer-✔✔antacids or OTC H2 (Tagamet, zantac,
axid)
Rx-strength H2 (ranitidine 150mg BID, famotidine 20mg BID) or PPI (pantoprazole
40mg daily, omeprazole 20mg daily)
PPI (Omeprazole 40mg daily)
Surgery (fundoplication)
Differential diagnosis of acute abd pain - Correct Answer-✔✔Acute appendicitis
Acute pancreatitis
, Acute cholecystitis
Acute appendicitis - Correct Answer-✔✔Inflammation of the vermiform appendix;
due to obstruction or infection
Most common surgical emergency of the abdomen
Hollow tube - most common cause is obstruction of appendix
Fecaltih - hard lump of fecal matter
Undigested seeds
Pinworm infections
Lymphoid follicle growth/lymphoid hyperplasia Symptoms
4. Symptoms
Nausea/vomiting
RLQ pain
Guarding
Acute pancreatitis - Correct Answer-✔✔Sudden inflammation and hemorrhaging of
the pancreas due to destruction by its own digestive enzymes
1. Autodigestion
Most of the time mild, but can be severe
Pancreas
Long skinny gland, length of dollar bill
Located in upper abdomen
Behind the stomach
Endocrine
