NS 832 EXAM 4 QUESTIONS AND ANSWERS
Approximately what % of the population will develop diverticulosis by the time they
reach 50 years of age?` - Answer -33%
A 43 year old woman has a 12 hour hx of sudden onset of RUQ abdominal pain w/
radiation to the shoulder, fever and chills. She has had similar, milder episodes in the
past, especially after eating fatty foods. Examination reveals marked tenderness to
RUQ abdominal palpitation. Her most likely dx is? - Answer -Acute cholecystits
Which of the following is not usually seen in dx of acute cholecystitis?
elevated serum creatinine
inc. alkaline phosphate level
leukocytosis
elevated AST - Answer -elevated serum creatinine
Murphy's sign can be best described as abdominal pain elicited by - Answer -RUQ
abdominal palpitation
Most serious complication of cholecystitis - Answer -pancreatitis
A 58 year old man reports intermittent RUQ abdominal pain. He has obesity and being
actively treated for hyperlipidemia. Imaging in a pt with suspected symptomatic
cholelithiasis usually includes obtaining an abdominal - Answer -CT scan
Which of the following is most likely to be found with acute cholecystitis?
fever
vomiting
jaundice
palpable gallbladder - Answer -vomiting
Risk factors for developing cholelithiasis include all of the following except?
rapid weight loss
male gender
obesity
Native American Ancestry - Answer -male gender
A gallstone that is not visualized on standard XR is said to be - Answer -radiolucent
Colonic diverticulosis most commonly occurs in the walls of the - Answer -sigmoid
colon
,Which of the following is most consistent with the presentation of a patient with acute
colonic diverticulitis? - Answer -cramping, diarrhea, and leukocytosis
Major risk factors for diverticulosis include all of the following except?
low-fiber diet
older age
family hx of diverticulosis
select connective tissue disorders - Answer -low-fiber diet
To avoid the development of acute diverticulitis, tx of diverticulosis can include -
Answer -the use of fiber supplements
The location of discomfort w/ acute diverticulitis is usually in which of the following areas
of the abdomen? - Answer -LLQ
Which of the following best describes colonic diverticulosis? - Answer -bulging pockets
in the abdominal wall
You are seeing Mr. Lopez, a 68 y/o man with suspected acute colonic diverticulitis. In
choosing an appropriate imaging study to support this dx, what would be the most
appropriate imaging? - Answer -CT w/ contrast
In the evaluation of acute diverticulitis the most appropriate diagnostic approach to rule
out free air in the abdomen includes - Answer -plain abdominal film
A 56 y/o woman is dx with moderate diverticulitis. This is her second episode in the past
6 weeks. In addition to counseling her about inc. fluid intake and adequate rest, you
recommend antimicrobial tx with - Answer -ciprofloxacin with metronidazole
A complication of colonic diverticulitis can include - Answer -diverticular hemorrhage
Long term effects of PPI use includes all of the following except?
inc. risk of hip fx
inc. risk of IBD
inc risk of C-Diff
dec. absorption of iron - Answer -inc risk of ibd
Antiprostaglandin drugs such as systemic corticosteroids and NSAIDS can cause
stomach mucosal injuray primarily by - Answer -altering the thickness of the mucosal
layer
A 24 y/o man presents w/ 3 month hx of upper abd pain. He describes it as an
intermittent, centrally located burning feeling in hi supper abdomen, most often
occurring 2-3 hours after meals. He denies taking NSAIDS, aspirin or systemic
, corticosteroids and drinks approximately one to two 12 oz beers per week. His
presentation is most consistent with clinical presentation of - Answer -duodenal ulcer
When choosing pharmacological intervention to prevent recurrence of duodenal ulcer in
a middle aged man you prescribe - Answer -tetracycline plus metronidazole
The H2RA most likely to cause drug interactions with phenytoin and theophylline is -
Answer -cimetidine
Which of the following is least likely to be found in a patient with a gastric ulcer -
Answer -age younger than 50 years
NSAID induced PUD can be best imited by the use of - Answer -taking the medication
with food
A 64 y/o woman presents with a 3 month hx of upper abd pain. She describes the
discomfort as intermittent, centrally located burning feeling in the upper abdomen, most
often with meals and often accompanied by mild nausea. Use of an OTC H2RA affords
partial symptom relief. She also uses diclofenac on a regular basis for the control of
osteoarthritis pain. Her clinical presentation is most consistent with - Answer -gastric
ulcer
To minimize the risk of adverse effects, PPI use should be limited to no longer than -
Answer -2 months
PUD can occur in any of the following locations except - Answer -lg intestine
An ulcer that is noted to be located in the region below
the lower esophageal sphincter and before the pylorus
is usually referred to as a(n) ________ ulcer.
A. duodenal
B. esophageal
C. gastric
D. stomach - Answer -duodenal
A 56 y/o man with 60 pack/year cigarette smoking hx, recent 5 lb unintended wt loss, &
3 month hx of new onset symptoms of peptic ulcer disease presents for care. He is
taking no medications on a regular basis and reports drinking approximately six 12 oz
beers per week w/ no more than three beers per day. Physical exam is unremarkable
except for mild pharyngeal erythema and moderate epigastric tenderness w/o rebound.
The most helpful diagnostic tool at this point is - Answer -an upper endoscopy
Which of the following can be considered an alternative to PPI for protection against
NSAID induced gastropathy
sucralfate
Approximately what % of the population will develop diverticulosis by the time they
reach 50 years of age?` - Answer -33%
A 43 year old woman has a 12 hour hx of sudden onset of RUQ abdominal pain w/
radiation to the shoulder, fever and chills. She has had similar, milder episodes in the
past, especially after eating fatty foods. Examination reveals marked tenderness to
RUQ abdominal palpitation. Her most likely dx is? - Answer -Acute cholecystits
Which of the following is not usually seen in dx of acute cholecystitis?
elevated serum creatinine
inc. alkaline phosphate level
leukocytosis
elevated AST - Answer -elevated serum creatinine
Murphy's sign can be best described as abdominal pain elicited by - Answer -RUQ
abdominal palpitation
Most serious complication of cholecystitis - Answer -pancreatitis
A 58 year old man reports intermittent RUQ abdominal pain. He has obesity and being
actively treated for hyperlipidemia. Imaging in a pt with suspected symptomatic
cholelithiasis usually includes obtaining an abdominal - Answer -CT scan
Which of the following is most likely to be found with acute cholecystitis?
fever
vomiting
jaundice
palpable gallbladder - Answer -vomiting
Risk factors for developing cholelithiasis include all of the following except?
rapid weight loss
male gender
obesity
Native American Ancestry - Answer -male gender
A gallstone that is not visualized on standard XR is said to be - Answer -radiolucent
Colonic diverticulosis most commonly occurs in the walls of the - Answer -sigmoid
colon
,Which of the following is most consistent with the presentation of a patient with acute
colonic diverticulitis? - Answer -cramping, diarrhea, and leukocytosis
Major risk factors for diverticulosis include all of the following except?
low-fiber diet
older age
family hx of diverticulosis
select connective tissue disorders - Answer -low-fiber diet
To avoid the development of acute diverticulitis, tx of diverticulosis can include -
Answer -the use of fiber supplements
The location of discomfort w/ acute diverticulitis is usually in which of the following areas
of the abdomen? - Answer -LLQ
Which of the following best describes colonic diverticulosis? - Answer -bulging pockets
in the abdominal wall
You are seeing Mr. Lopez, a 68 y/o man with suspected acute colonic diverticulitis. In
choosing an appropriate imaging study to support this dx, what would be the most
appropriate imaging? - Answer -CT w/ contrast
In the evaluation of acute diverticulitis the most appropriate diagnostic approach to rule
out free air in the abdomen includes - Answer -plain abdominal film
A 56 y/o woman is dx with moderate diverticulitis. This is her second episode in the past
6 weeks. In addition to counseling her about inc. fluid intake and adequate rest, you
recommend antimicrobial tx with - Answer -ciprofloxacin with metronidazole
A complication of colonic diverticulitis can include - Answer -diverticular hemorrhage
Long term effects of PPI use includes all of the following except?
inc. risk of hip fx
inc. risk of IBD
inc risk of C-Diff
dec. absorption of iron - Answer -inc risk of ibd
Antiprostaglandin drugs such as systemic corticosteroids and NSAIDS can cause
stomach mucosal injuray primarily by - Answer -altering the thickness of the mucosal
layer
A 24 y/o man presents w/ 3 month hx of upper abd pain. He describes it as an
intermittent, centrally located burning feeling in hi supper abdomen, most often
occurring 2-3 hours after meals. He denies taking NSAIDS, aspirin or systemic
, corticosteroids and drinks approximately one to two 12 oz beers per week. His
presentation is most consistent with clinical presentation of - Answer -duodenal ulcer
When choosing pharmacological intervention to prevent recurrence of duodenal ulcer in
a middle aged man you prescribe - Answer -tetracycline plus metronidazole
The H2RA most likely to cause drug interactions with phenytoin and theophylline is -
Answer -cimetidine
Which of the following is least likely to be found in a patient with a gastric ulcer -
Answer -age younger than 50 years
NSAID induced PUD can be best imited by the use of - Answer -taking the medication
with food
A 64 y/o woman presents with a 3 month hx of upper abd pain. She describes the
discomfort as intermittent, centrally located burning feeling in the upper abdomen, most
often with meals and often accompanied by mild nausea. Use of an OTC H2RA affords
partial symptom relief. She also uses diclofenac on a regular basis for the control of
osteoarthritis pain. Her clinical presentation is most consistent with - Answer -gastric
ulcer
To minimize the risk of adverse effects, PPI use should be limited to no longer than -
Answer -2 months
PUD can occur in any of the following locations except - Answer -lg intestine
An ulcer that is noted to be located in the region below
the lower esophageal sphincter and before the pylorus
is usually referred to as a(n) ________ ulcer.
A. duodenal
B. esophageal
C. gastric
D. stomach - Answer -duodenal
A 56 y/o man with 60 pack/year cigarette smoking hx, recent 5 lb unintended wt loss, &
3 month hx of new onset symptoms of peptic ulcer disease presents for care. He is
taking no medications on a regular basis and reports drinking approximately six 12 oz
beers per week w/ no more than three beers per day. Physical exam is unremarkable
except for mild pharyngeal erythema and moderate epigastric tenderness w/o rebound.
The most helpful diagnostic tool at this point is - Answer -an upper endoscopy
Which of the following can be considered an alternative to PPI for protection against
NSAID induced gastropathy
sucralfate
