CMN 568 FINAL PAPER 2026 FULL
QUESTIONS AND CORRECT ANSWERS
◉ Diverticulitis - Symptoms.
Answer: Mild to moderate aching ABD pain, usually in LLQ,
consipation or loose stools, N&V may occur, usually symptoms are
mild and patients do not seek medical attention until several days
after onset.
◉ Diverticulitis - Signs.
Answer: Low grade fever, LLQ tenderness, palpable mass, stool of
occult blood, mild to moderate increased WBC
Patients with perforation with have more severe symptoms
Differential diagnosis - perforated colonic carcinoma, crohn's
disease, appendicitis (Apndx can be on left) ischemic colitis, and gyn
disorders.
◉ Diverticulitis - Diagnostic testing.
Answer: Mild cases: empiric abx treatment without imaging
Colonic evaluation to confirm diagnosis and r/o colon cancer done
after symptoms resolve. colonoscopy, CT colonoscopy or barium
enema.
,Patient with more severe symptoms may need CT of the abdomen in
acute stage to evaluate severity
◉ Diverticulitis - Treatement.
Answer: Mild symptoms - out patient treatment with clear liquid
diet
Use of antibiotics in selected cases:
Amoxicillin-clavulanate BID
trimethoprim-sulfamethoxazole BID PLUS Metronidazole TID
Ciprofloxacin BID PLUS Metronidazole TID
Antibiotics for 7-10 days or until afebrile 3-5 days
Advance diet after 3 days if symptoms improve
high fiber diet after resolution.
Severe symptoms - refer for inpatient treatment, IV antibiotics,
possible surgery.
◉ Disorders caused by disruption of the mucosal lining.
Answer: GERD
Peptic ulcer disease (PUD)
◉ GERD - Definition.
,Answer: Heartburn is the typical symptom, usually occurs 30-60 min
after meals and with reclining. Pain may be relieved by antacids.
Most have no structural defects
◉ GERD - Symptoms.
Answer: Burning chest pain and regurgitation are common.
Non-GI symptoms - asthma, chronic cough, laryngitis, sore throat or
non-cardiac chest pain and sleep disturbances.
"Alarm" symptoms - age >55 (new onset), anemia, melena or
hemotemesis, dysphagia, significant weight loss or difficult/painful
swallowing.
◉ GERD - diagnostics.
Answer: Patients <55 without alarm symptoms may be treated
empirically without further testing.
Patients with alarm symptoms or poor response to empiric therapy
should be referred for upper GI endoscopy.
◉ GERD- Treatment Mild intermittent symptoms.
Answer: Lifestyle modification (smaller meals, eliminate
spicy/acidic foods), eliminate foods that increase reflux (fatty, ETOH,
peppermint, chocolate), Elevate head of bed, do not lay down for 3
hours after meals.
Weight loss if appropriate.
, PRN antacids or H2 receptor blockers, Famotadine, rantitidine,
cimetidine
◉ GERD - Treatment Empiric therapy troublesome symptoms.
Answer: PPI QD for 4-8 weeks, preferred over H2 blockers for acute
and chronic GERD
PPI should be taken 30 minutes before breakfast **
10-20% will need BID PPI
If no response refer for upper GI endoscopy
Patients with good symptom control on empiric therapy should be
continued on PPI for 8-12 weeks
◉ PUD - Definition.
Answer: Peptic ulcer disease
Two major causes:
NSAIDS (ASA, ibuprofen, naproxen, melixicam)
H Pylori infection
◉ PUD - Symptoms.
Answer: Dyspepsia, described as gnawing, hunger-like, burning pain
in epigastric area. Pain may awaken patient. Symptoms wax and
wane. May have relief with food intake or antacids and return of pain
2-4 hours later. Up to 60% NSAID induced PUD have no symptoms.
QUESTIONS AND CORRECT ANSWERS
◉ Diverticulitis - Symptoms.
Answer: Mild to moderate aching ABD pain, usually in LLQ,
consipation or loose stools, N&V may occur, usually symptoms are
mild and patients do not seek medical attention until several days
after onset.
◉ Diverticulitis - Signs.
Answer: Low grade fever, LLQ tenderness, palpable mass, stool of
occult blood, mild to moderate increased WBC
Patients with perforation with have more severe symptoms
Differential diagnosis - perforated colonic carcinoma, crohn's
disease, appendicitis (Apndx can be on left) ischemic colitis, and gyn
disorders.
◉ Diverticulitis - Diagnostic testing.
Answer: Mild cases: empiric abx treatment without imaging
Colonic evaluation to confirm diagnosis and r/o colon cancer done
after symptoms resolve. colonoscopy, CT colonoscopy or barium
enema.
,Patient with more severe symptoms may need CT of the abdomen in
acute stage to evaluate severity
◉ Diverticulitis - Treatement.
Answer: Mild symptoms - out patient treatment with clear liquid
diet
Use of antibiotics in selected cases:
Amoxicillin-clavulanate BID
trimethoprim-sulfamethoxazole BID PLUS Metronidazole TID
Ciprofloxacin BID PLUS Metronidazole TID
Antibiotics for 7-10 days or until afebrile 3-5 days
Advance diet after 3 days if symptoms improve
high fiber diet after resolution.
Severe symptoms - refer for inpatient treatment, IV antibiotics,
possible surgery.
◉ Disorders caused by disruption of the mucosal lining.
Answer: GERD
Peptic ulcer disease (PUD)
◉ GERD - Definition.
,Answer: Heartburn is the typical symptom, usually occurs 30-60 min
after meals and with reclining. Pain may be relieved by antacids.
Most have no structural defects
◉ GERD - Symptoms.
Answer: Burning chest pain and regurgitation are common.
Non-GI symptoms - asthma, chronic cough, laryngitis, sore throat or
non-cardiac chest pain and sleep disturbances.
"Alarm" symptoms - age >55 (new onset), anemia, melena or
hemotemesis, dysphagia, significant weight loss or difficult/painful
swallowing.
◉ GERD - diagnostics.
Answer: Patients <55 without alarm symptoms may be treated
empirically without further testing.
Patients with alarm symptoms or poor response to empiric therapy
should be referred for upper GI endoscopy.
◉ GERD- Treatment Mild intermittent symptoms.
Answer: Lifestyle modification (smaller meals, eliminate
spicy/acidic foods), eliminate foods that increase reflux (fatty, ETOH,
peppermint, chocolate), Elevate head of bed, do not lay down for 3
hours after meals.
Weight loss if appropriate.
, PRN antacids or H2 receptor blockers, Famotadine, rantitidine,
cimetidine
◉ GERD - Treatment Empiric therapy troublesome symptoms.
Answer: PPI QD for 4-8 weeks, preferred over H2 blockers for acute
and chronic GERD
PPI should be taken 30 minutes before breakfast **
10-20% will need BID PPI
If no response refer for upper GI endoscopy
Patients with good symptom control on empiric therapy should be
continued on PPI for 8-12 weeks
◉ PUD - Definition.
Answer: Peptic ulcer disease
Two major causes:
NSAIDS (ASA, ibuprofen, naproxen, melixicam)
H Pylori infection
◉ PUD - Symptoms.
Answer: Dyspepsia, described as gnawing, hunger-like, burning pain
in epigastric area. Pain may awaken patient. Symptoms wax and
wane. May have relief with food intake or antacids and return of pain
2-4 hours later. Up to 60% NSAID induced PUD have no symptoms.
