NSG 555 Quiz 2 module 3 GI/GU UPDATED
ACTUAL Exam Questions and CORECT
Answers
cranial nerve function - CORRECT ANSWER - Reflects brainstem function
Pupil response, eye movement, cough/gag/corneal reflexes
external vs internal hemorrhoids s/s - CORRECT ANSWER - external: usually
asymptomatic unless a small thrombus , then acutely painful and itchy and edema
internal: painless bright red blood with BMs and occ. a reducible prolapse.
hemorrhoids definition - CORRECT ANSWER - increased pressure-->vascular
engorgement-->trauma to vessels-->pain and prolaps of tissue
4 degrees of internal hemorrhoids - CORRECT ANSWER - 1. painless bleeding, bulge but
no prolapse
2. prolapse during defacation, reduce spontaniously, bleeding/itching
3. prolapse with defacation+manual reduction needed. pain
4th degree: permanently prolapsed and not reducible.
diagnostics of hemorrhoids - CORRECT ANSWER - clinical one. further testing not
needed but if pt over 50 or concern re cancer should get colonoscopy.
management of hemorrhoids - CORRECT ANSWER - high fiber diet, increased fluid.
fiber 20-30 g/day
sitz baths
stool softeners (not laxatives, can make it worse because of variable consistency)
topical analgescis reduce inflammation.
,vasoconstrictive preps cnan help too
can do rubber band ligation if still symptomatic after dietary/lifestyle change
complications of hemorrhoids - CORRECT ANSWER - 4th degree can be at risk for
strangulation and can become gangrenous and need surgery. use rubber band ligation.
s/s perianal sepsis: urinary retention and fever after rubber band ligation
anal fissure - CORRECT ANSWER - painful linear cracks common in kids and middle
age adults.
if present <6 weeks it's acut if >6 weeks it's chronic
caused by trauma from constipationor diarrhea which causes a chemical burn or anal stenosis
anal fissure that is NOT posterior midline - CORRECT ANSWER - suspect STI, TB, HIV,
infection, UC, crohns, malignant neoplasm, etc REFER THESE PTS
s/s and PE of anal fissure - CORRECT ANSWER - tearing with passing stool, pain, small
amounts of blood on TP.
differential dx anal fissure - CORRECT ANSWER - anal cancer, perianal abscess,
thrombosed hemorrhoid
RED FLAG s/s: anal carcinoma hx, persistent anorectal pain/bleeding, bloody diarrhea, wt loss
management of anal fissures - CORRECT ANSWER - usually resolve without tx.
Inc fiber, stool softeners, sitz baths, supps or foam antiinflammatory agents
lidocaine gel before BMs
,topical nitrates or oral CCBs (diltiazem) helps healing of fissures
Gold standard treatment of CHRONIC anal fissure - CORRECT ANSWER - lateral
internal sphincerotomy: reduces internal sphincter tone allowing fissure to heal
Pruritis ani - CORRECT ANSWER - RED FLAG IF wieght loss or refractory s/s to rule
on cancer
Itching. very common. caused by hundreds of things.
dx: ITCH: infection, topical irritan, cutaneous/cancer, hypersensitivite. rule out STI, may need
biopsy if no relief, assess if food alergy or detergent allergy, pin worms, yest, etc.
management of pruritis ani - CORRECT ANSWER - hygien. increase fiber if there are
loos stools. Use a hair dryer on cool setting to dry anus. avoid perfumes.
1% hydrocortisone cream (d/c after 2 weeks to avoid skin atrophy)
antihistamine with antipruritic (Atarax/hydroxyzine)
Witch hazel
relief in 4-6 weeks
anorectal abscess or fistula - CORRECT ANSWER - common in crohns patients. pus from
internal opening of fistual tract, purulent drainage or a sinus.
dx: CT or MRI both good. small bowel exam to assess crohns, colonoscopy
Mgt: incision and drainage is first line treatment
pharm mgt: abx usually not needed unless infection. if infection with cellullitis or
immunosuppression cipro or metronidazole
cirrhosis - CORRECT ANSWER - end stage consequence of hepatic fibrosis.
, Irreversible
commonly from BV or HCV, ETOH liver disease, NAFLD, and NASH
apap, amiodarone, methotrexate, isoniazid, abx, arbon tetrachloride can also cause.
portal hypertension - CORRECT ANSWER - the elevation of blood pressure within the
portal venous system due to shunting of portal/arterial blood supplies
fibrosis in the liver causes - CORRECT ANSWER - portal HTN, obstructive biliary
channels, destruction of liver cells, liver cancer, liver failure
As increased portal pressure occurs new collateral circulation/vascular channels created in
peritoneum, retroperitoneum, thorax, esophagus, etc. This can cause ascites, splenomegay,
esophageal varices and can rupture-->death
primary biliary cirrhosis - CORRECT ANSWER - autoimmune destruction of bild ducts
pathophys cirrhosis - CORRECT ANSWER - hepatocellular injury-->inflammation-->new
liver cells generated by fibrotic scar tissue00>nodules which deform normal hepatic dissue--
>increased resistance to circulation, decreased blood flow, obstruction to portal vein and
decreased liver function
early symtoms of primary biliary cirrhosis - CORRECT ANSWER - itching, weight loss,
fatigue
general cirrhosis s/s - CORRECT ANSWER - weakness, malaise, dark urine, pale stools,
anorexia, n/v, hematemesis, abdominal pain because of stretching of muscled d/t enlarged liver,
chest pain d/t cardiomegalyk
physical exam cirrhosis - CORRECT ANSWER - jaundice, spider angiomata,
gynecomastia, ascites, enlarged spleen, palmar erythema, digital clubbin, asterixis
ACTUAL Exam Questions and CORECT
Answers
cranial nerve function - CORRECT ANSWER - Reflects brainstem function
Pupil response, eye movement, cough/gag/corneal reflexes
external vs internal hemorrhoids s/s - CORRECT ANSWER - external: usually
asymptomatic unless a small thrombus , then acutely painful and itchy and edema
internal: painless bright red blood with BMs and occ. a reducible prolapse.
hemorrhoids definition - CORRECT ANSWER - increased pressure-->vascular
engorgement-->trauma to vessels-->pain and prolaps of tissue
4 degrees of internal hemorrhoids - CORRECT ANSWER - 1. painless bleeding, bulge but
no prolapse
2. prolapse during defacation, reduce spontaniously, bleeding/itching
3. prolapse with defacation+manual reduction needed. pain
4th degree: permanently prolapsed and not reducible.
diagnostics of hemorrhoids - CORRECT ANSWER - clinical one. further testing not
needed but if pt over 50 or concern re cancer should get colonoscopy.
management of hemorrhoids - CORRECT ANSWER - high fiber diet, increased fluid.
fiber 20-30 g/day
sitz baths
stool softeners (not laxatives, can make it worse because of variable consistency)
topical analgescis reduce inflammation.
,vasoconstrictive preps cnan help too
can do rubber band ligation if still symptomatic after dietary/lifestyle change
complications of hemorrhoids - CORRECT ANSWER - 4th degree can be at risk for
strangulation and can become gangrenous and need surgery. use rubber band ligation.
s/s perianal sepsis: urinary retention and fever after rubber band ligation
anal fissure - CORRECT ANSWER - painful linear cracks common in kids and middle
age adults.
if present <6 weeks it's acut if >6 weeks it's chronic
caused by trauma from constipationor diarrhea which causes a chemical burn or anal stenosis
anal fissure that is NOT posterior midline - CORRECT ANSWER - suspect STI, TB, HIV,
infection, UC, crohns, malignant neoplasm, etc REFER THESE PTS
s/s and PE of anal fissure - CORRECT ANSWER - tearing with passing stool, pain, small
amounts of blood on TP.
differential dx anal fissure - CORRECT ANSWER - anal cancer, perianal abscess,
thrombosed hemorrhoid
RED FLAG s/s: anal carcinoma hx, persistent anorectal pain/bleeding, bloody diarrhea, wt loss
management of anal fissures - CORRECT ANSWER - usually resolve without tx.
Inc fiber, stool softeners, sitz baths, supps or foam antiinflammatory agents
lidocaine gel before BMs
,topical nitrates or oral CCBs (diltiazem) helps healing of fissures
Gold standard treatment of CHRONIC anal fissure - CORRECT ANSWER - lateral
internal sphincerotomy: reduces internal sphincter tone allowing fissure to heal
Pruritis ani - CORRECT ANSWER - RED FLAG IF wieght loss or refractory s/s to rule
on cancer
Itching. very common. caused by hundreds of things.
dx: ITCH: infection, topical irritan, cutaneous/cancer, hypersensitivite. rule out STI, may need
biopsy if no relief, assess if food alergy or detergent allergy, pin worms, yest, etc.
management of pruritis ani - CORRECT ANSWER - hygien. increase fiber if there are
loos stools. Use a hair dryer on cool setting to dry anus. avoid perfumes.
1% hydrocortisone cream (d/c after 2 weeks to avoid skin atrophy)
antihistamine with antipruritic (Atarax/hydroxyzine)
Witch hazel
relief in 4-6 weeks
anorectal abscess or fistula - CORRECT ANSWER - common in crohns patients. pus from
internal opening of fistual tract, purulent drainage or a sinus.
dx: CT or MRI both good. small bowel exam to assess crohns, colonoscopy
Mgt: incision and drainage is first line treatment
pharm mgt: abx usually not needed unless infection. if infection with cellullitis or
immunosuppression cipro or metronidazole
cirrhosis - CORRECT ANSWER - end stage consequence of hepatic fibrosis.
, Irreversible
commonly from BV or HCV, ETOH liver disease, NAFLD, and NASH
apap, amiodarone, methotrexate, isoniazid, abx, arbon tetrachloride can also cause.
portal hypertension - CORRECT ANSWER - the elevation of blood pressure within the
portal venous system due to shunting of portal/arterial blood supplies
fibrosis in the liver causes - CORRECT ANSWER - portal HTN, obstructive biliary
channels, destruction of liver cells, liver cancer, liver failure
As increased portal pressure occurs new collateral circulation/vascular channels created in
peritoneum, retroperitoneum, thorax, esophagus, etc. This can cause ascites, splenomegay,
esophageal varices and can rupture-->death
primary biliary cirrhosis - CORRECT ANSWER - autoimmune destruction of bild ducts
pathophys cirrhosis - CORRECT ANSWER - hepatocellular injury-->inflammation-->new
liver cells generated by fibrotic scar tissue00>nodules which deform normal hepatic dissue--
>increased resistance to circulation, decreased blood flow, obstruction to portal vein and
decreased liver function
early symtoms of primary biliary cirrhosis - CORRECT ANSWER - itching, weight loss,
fatigue
general cirrhosis s/s - CORRECT ANSWER - weakness, malaise, dark urine, pale stools,
anorexia, n/v, hematemesis, abdominal pain because of stretching of muscled d/t enlarged liver,
chest pain d/t cardiomegalyk
physical exam cirrhosis - CORRECT ANSWER - jaundice, spider angiomata,
gynecomastia, ascites, enlarged spleen, palmar erythema, digital clubbin, asterixis
