MGRADES EXAMS
NURS 5461 GI UPDATED ACTUAL Exam
Questions and CORRECT Answers
dysphagia - CORRECT ANSWER - Subjective sebsation of difficulty swallowing May be
due to physiological or anatomical abnormalities along any portion of the esophagus, including
the upper and lower sphincters An alarm symptom that must prompt evaluation and should
never be attributed to normal aging without an appropriate evaluation
Dysphagia Types - CORRECT ANSWER - oropharyngeal (above the esophagus) and
esophageal-->most common is achalasia-disorder of esophageal nerves preventing food
movement.
Structural starts with solids r/o malignancy (adenocarcinoma distal esophagus)
infection involves PAINFUL swallowing, viral (CMV usually immunosuppressed) or fungal
(candida-inhaled asteroid)
Chewing [mastication] - CORRECT ANSWER - involves CNV [trigeminal], CNVII [facial],
CNIX [glossopharyngeal], and CNXII [hypoglossal], in addition to muscles of jaw, cheeks,
tongue and palate
Clinical characteristics of Dysphagia - CORRECT ANSWER - Problems in the oral phase
include - Poor bolus control - Spillage from lips or into pharynx - Dry oral membranes
(xerostomia) - Pocketing of oral residue - Difficulty with chewing
Pharyngeal dysphagia results from
weakness or poor coordination of pharyngeal
muscles, which can cause→
- Delayed swallowing
- Failure of airway protection
- Nasal or oral regurgitation
- Residue remaining in pharynx after swallowing
manifested as coughing, choking or gurgling
,MGRADES EXAMS
Clinical Presentation - CORRECT ANSWER - - Short duration with weight loss suggests
malignancy - Abrupt onset associated with neuro changes suggests CVA ¼ - ½ of new stoke
patients will have dysphagia
gradual progressive onset-PD, ALS, MG
medications that can contribute to Dysphagia - CORRECT ANSWER - Antidepressants,
Antihistamines, Fosamax, NSAIDS, K, Fe, Nitates, BB, CCB
diagnostics for dysphagia - CORRECT ANSWER - Cineesophagram (video swallow
study or videofluoroscpy) Modified barium swallow, endoscopy NOT helpful, alone but may
need to r/o other causes
DDx dysphagia - CORRECT ANSWER - Acute inflammation [infection; bone and mucosal
disorders] Stroke syndromes and vascular disorders Myasthenia Gravis Dementias Chemical
agents Parkinson's disease Neuromuscular esophageal disorders Multiple Sclerosis Medications
Huntington's disease Scleroderma Tuberculosis Muscle anomalies Tetanus Achalasia Syphilis
Pharyngoesophageal diverticulum ALS Diffuse spasm NeoplasmsCarcinoma Recurrent
laryngeal neuropathies Degenerative disorders Irradiation Guillain-Barre' syndrome
Psychopathology Esophageal stenosis Diabetes Feeding phobias Esophageal webs, rings or
stricture Cerebral palsy Sensory deficits
Management of Dysphagia - CORRECT ANSWER - Medication review, particularly
focusing on anticholinergic drugs Oropharyngeal dysphagia: Swallowing rehabilitation,
dietary modifications such as thickening liquids, or careful hand feeding Achalasia: Surgical
or endoscopic myotomy (SOE=A); injection of the lower esophageal sphincter with botulinum
toxin may provide months of symptomatic relief in patients who are not surgical candidates
Spastic motility disorders: Calcium channel blockers or phosphodiesterase inhibitors may
provide relief (SOE=B) Strictures: Endoscopic dilation has a very high success rate, although
patients often require ongoing medical treatment of the underlying cause as well Aspiration
and Nonoral Feeding in Dysphagia of Functional Origin - Patients with severe aspiration, which
is not treatable with dietary or positional modifications, should receive nonoral feedings to
prevent aspiration Head positioning, swallowing maneuvers and dietary textural
modifications seem to demonstrate clear evidence of benefit in treating functional dysphagia -
Refer to speech pathologist for evaluation
, MGRADES EXAMS
Indications for Hospitalization/Referral - CORRECT ANSWER - Dietary consultation GI
consult Will need intervention if patient has structural problem Speech therapy Neurology may
be needed
Dyspepsia (heartburn) - CORRECT ANSWER - Most commonly associated with peptic
ulcer disease, GERD, biliary colic, or medication-induced discomfort Whether gastritis due
to Helicobacter pylori can cause symptoms of dyspepsia is debated Consider prompt
endoscopy in older adults because of the increased rate of organic disease, including malignancy
➢ Associated with significant reduction in PPI use and improved qualify of life (SOE=B) ➢
Safe for older adults who are otherwise healthy ➢
Differential Diagnoses Dyspepsia - CORRECT ANSWER - Heartburn is occasionally
described as extreme—and may make if difficult to differentiate from angina or MI These
folks describe pain as radiating to the back, arms or jaw—which further complicates the
diagnosis Medication induced gastritis - Alcohol; salicylates; corticosteroids; NSAIDs;
erythromycin; theophylline Giardiasis - This patient will have occasional bouts of diarrhea
Nonulcer Dyspepsia [NURD or NERD] - From H. pylori Gastric Cancer - Dyspepsia,
anorexia, weight loss
Dyspepsia presentation - CORRECT ANSWER - Heartburn is common (7% w/qd
complaints-usually GERD), Dyspepsia usually presents with epigastric discomfort, postprandial
fullness, early satiety, anorexia, belching, nausea, vomiting, indigestion, bloating, borborygmi,
dysphagia and abdominal bloating These symptoms can have a functional or organic cause—
organic causes increase with age, if endocopy rules out structural dx=functional dyspepsia
Managing Dyspepsia - CORRECT ANSWER - Perform H pylori testing in all patients,
with a 13C-urea breath test or fecal antigen test along with biopsies at the time of endoscopy ➢
Treatment for H pylori in patients with ulcers will result in healing and elimination of symptoms
in a large majority of patients Patients with large or nonhealing ulcers: biopsy to exclude
malignancy Patients negative for H pylori: 2-month empiric trial of PPI (SOE=B)
Patients with a normal upper endoscopy: consider further testing, including abdominal imaging
and a gastric emptying study Patients with functional dyspepsia (no identified organic
disease): trial of PPI, although the rate of symptom improvement is low
**off label TCA (nortriptyline) functional dyspepsia whith poor response to other Rx-avoid in
elderly
NURS 5461 GI UPDATED ACTUAL Exam
Questions and CORRECT Answers
dysphagia - CORRECT ANSWER - Subjective sebsation of difficulty swallowing May be
due to physiological or anatomical abnormalities along any portion of the esophagus, including
the upper and lower sphincters An alarm symptom that must prompt evaluation and should
never be attributed to normal aging without an appropriate evaluation
Dysphagia Types - CORRECT ANSWER - oropharyngeal (above the esophagus) and
esophageal-->most common is achalasia-disorder of esophageal nerves preventing food
movement.
Structural starts with solids r/o malignancy (adenocarcinoma distal esophagus)
infection involves PAINFUL swallowing, viral (CMV usually immunosuppressed) or fungal
(candida-inhaled asteroid)
Chewing [mastication] - CORRECT ANSWER - involves CNV [trigeminal], CNVII [facial],
CNIX [glossopharyngeal], and CNXII [hypoglossal], in addition to muscles of jaw, cheeks,
tongue and palate
Clinical characteristics of Dysphagia - CORRECT ANSWER - Problems in the oral phase
include - Poor bolus control - Spillage from lips or into pharynx - Dry oral membranes
(xerostomia) - Pocketing of oral residue - Difficulty with chewing
Pharyngeal dysphagia results from
weakness or poor coordination of pharyngeal
muscles, which can cause→
- Delayed swallowing
- Failure of airway protection
- Nasal or oral regurgitation
- Residue remaining in pharynx after swallowing
manifested as coughing, choking or gurgling
,MGRADES EXAMS
Clinical Presentation - CORRECT ANSWER - - Short duration with weight loss suggests
malignancy - Abrupt onset associated with neuro changes suggests CVA ¼ - ½ of new stoke
patients will have dysphagia
gradual progressive onset-PD, ALS, MG
medications that can contribute to Dysphagia - CORRECT ANSWER - Antidepressants,
Antihistamines, Fosamax, NSAIDS, K, Fe, Nitates, BB, CCB
diagnostics for dysphagia - CORRECT ANSWER - Cineesophagram (video swallow
study or videofluoroscpy) Modified barium swallow, endoscopy NOT helpful, alone but may
need to r/o other causes
DDx dysphagia - CORRECT ANSWER - Acute inflammation [infection; bone and mucosal
disorders] Stroke syndromes and vascular disorders Myasthenia Gravis Dementias Chemical
agents Parkinson's disease Neuromuscular esophageal disorders Multiple Sclerosis Medications
Huntington's disease Scleroderma Tuberculosis Muscle anomalies Tetanus Achalasia Syphilis
Pharyngoesophageal diverticulum ALS Diffuse spasm NeoplasmsCarcinoma Recurrent
laryngeal neuropathies Degenerative disorders Irradiation Guillain-Barre' syndrome
Psychopathology Esophageal stenosis Diabetes Feeding phobias Esophageal webs, rings or
stricture Cerebral palsy Sensory deficits
Management of Dysphagia - CORRECT ANSWER - Medication review, particularly
focusing on anticholinergic drugs Oropharyngeal dysphagia: Swallowing rehabilitation,
dietary modifications such as thickening liquids, or careful hand feeding Achalasia: Surgical
or endoscopic myotomy (SOE=A); injection of the lower esophageal sphincter with botulinum
toxin may provide months of symptomatic relief in patients who are not surgical candidates
Spastic motility disorders: Calcium channel blockers or phosphodiesterase inhibitors may
provide relief (SOE=B) Strictures: Endoscopic dilation has a very high success rate, although
patients often require ongoing medical treatment of the underlying cause as well Aspiration
and Nonoral Feeding in Dysphagia of Functional Origin - Patients with severe aspiration, which
is not treatable with dietary or positional modifications, should receive nonoral feedings to
prevent aspiration Head positioning, swallowing maneuvers and dietary textural
modifications seem to demonstrate clear evidence of benefit in treating functional dysphagia -
Refer to speech pathologist for evaluation
, MGRADES EXAMS
Indications for Hospitalization/Referral - CORRECT ANSWER - Dietary consultation GI
consult Will need intervention if patient has structural problem Speech therapy Neurology may
be needed
Dyspepsia (heartburn) - CORRECT ANSWER - Most commonly associated with peptic
ulcer disease, GERD, biliary colic, or medication-induced discomfort Whether gastritis due
to Helicobacter pylori can cause symptoms of dyspepsia is debated Consider prompt
endoscopy in older adults because of the increased rate of organic disease, including malignancy
➢ Associated with significant reduction in PPI use and improved qualify of life (SOE=B) ➢
Safe for older adults who are otherwise healthy ➢
Differential Diagnoses Dyspepsia - CORRECT ANSWER - Heartburn is occasionally
described as extreme—and may make if difficult to differentiate from angina or MI These
folks describe pain as radiating to the back, arms or jaw—which further complicates the
diagnosis Medication induced gastritis - Alcohol; salicylates; corticosteroids; NSAIDs;
erythromycin; theophylline Giardiasis - This patient will have occasional bouts of diarrhea
Nonulcer Dyspepsia [NURD or NERD] - From H. pylori Gastric Cancer - Dyspepsia,
anorexia, weight loss
Dyspepsia presentation - CORRECT ANSWER - Heartburn is common (7% w/qd
complaints-usually GERD), Dyspepsia usually presents with epigastric discomfort, postprandial
fullness, early satiety, anorexia, belching, nausea, vomiting, indigestion, bloating, borborygmi,
dysphagia and abdominal bloating These symptoms can have a functional or organic cause—
organic causes increase with age, if endocopy rules out structural dx=functional dyspepsia
Managing Dyspepsia - CORRECT ANSWER - Perform H pylori testing in all patients,
with a 13C-urea breath test or fecal antigen test along with biopsies at the time of endoscopy ➢
Treatment for H pylori in patients with ulcers will result in healing and elimination of symptoms
in a large majority of patients Patients with large or nonhealing ulcers: biopsy to exclude
malignancy Patients negative for H pylori: 2-month empiric trial of PPI (SOE=B)
Patients with a normal upper endoscopy: consider further testing, including abdominal imaging
and a gastric emptying study Patients with functional dyspepsia (no identified organic
disease): trial of PPI, although the rate of symptom improvement is low
**off label TCA (nortriptyline) functional dyspepsia whith poor response to other Rx-avoid in
elderly
