NRnj511njDifferentialnjDiagnosisnjandnjPrimarynjCare-
njFinalnjExamnjReview
1.njTopics:
2.GInjDisorders:nj....
3.Ulcerativenjcolitis:
4.Anj38-year-
oldnjmalenjpatientnjhasnjrecentlynjhadnjannjileostomynjfornjulcerativenjcolitis.njW
hichnjself-
carenjmeasuresnjshouldnjthenjcliniciannjteachnjhimnjaboutnjtonjrelievenjfoodnjbl
ockage?:njmassagenjthenjperistomalnjarea
5.Diverticulitis:
6.Whichnjofnjthenjfollowingnjisnjtruenjregardingnjdiverticula:njobesitynjisnjcorrelated
7.Leftnjlowernjquadrantnjabdominalnjpainnjfornj2njdays,njthenjpainnjstartednjsudde
nlynjandnjthennjfever,njchills,njanorexia,njnauseanjandnjpainlessnjbloodynjstools.:nj
Acutenjdiverticulitis
8.Annj82-year-
oldnjfemalenjhasnjbeennjdiagnosednjwithnjirritablenjbowel,njchronicnjcon-
njstipation,njandnjdiverticulosisnjfollowingnjanjcolonoscopy.njWhichnjpharmacologi
calnjagentnjshouldnjthenjcliniciannjrecommend?:njbulknjlaxative
9.Whichnjofnjthenjfollowingnjisnjpartnjofnjthenjtreatmentnjplannjfornjt
henjpatientnjwithnjirritablenjbowelnjsyndrome?:njHighnjfibernjdiet
10.Anj35-year-
oldnjfemalenjpatentnjisnjseennjinnjthenjclinicnjcomplainingnjofnjabdominalnjpain.njWhic
hnjofnjthenjfollowingnjshouldnjbenjincludednjinnjthenjhistorynjandnjphysicalnjexam?:nj
digitalnjrectalnjexam,njSexualnjhistory,njPelvicnjexam
11.Anj28-year-
oldnjpatentnjisnjseennjinnjthenjclinicnjwithnjcolickynjabdominalnjpain,njparticularl
ynjwithnjmeals.njShenjhas
frequentnjconstipation,njflatulence,njandnjabdominalnjdistension.njWhichnjofnjthenjda
anjmakenjanjdiagnosisnjof
diverticulitisnjunlikely?:njHernjage
1nj/
nj50
, NRnj511njDifferentialnjDiagnosisnjandnjPrimarynjCare-
njFinalnjExamnjReview
12.C.njdiffnjDefinitionnjandnjRisknjfactors:
2nj/
nj50
, NRnj511njDifferentialnjDiagnosisnjandnjPrimarynjCare-
njFinalnjExamnjReview
13.njC.njdiffnjSympto
ms:
14.njC.njdiffnjDiagno
sis:
15.njC.njdiffnjTreat
ment:
16.njGERDnjpathophysiol
ogy:
17.njsymptomsnjofnjGE
RD:
18.Anj54-year-
oldnjfemalenjpresentsnjtonjyournjprimarynjcarenjofficenjfornjroutinenjreeval-
njuationnjfornjgastroesophagealnjrefluxnjdiseasenj(GERD).njShenjhasnjbeennjtreated
njwithnjdietnjmodificationsnjandnj6njweeksnjofnjomeprazolenjwithoutnjimprovementnj
ofnjhernjsymptoms.njWhatnjisnjthenjnextnjstepnjinnjthenjmanagementnjofnjthisnjpatient'
snjGERD?:njOrdernjannjendoscopynj(Thisnjisnjthenjnextnjstepnjinnjtreatmentnjinnjord
ernjtonjevaluatenjthenjetiologynjofnjthenjpatient's
GERDnjandnjconsidernjbiopsynjifnjnecessary)
19.Anj67-year-
oldnjfemalenjonnjmultiplenjmedicationsnjfornjchronicnjconditionsnjwasnjjustnjdiagno
sednjwithnjgastroesophagealnjrefluxnjdiseasenj(GERD).njInnjteachingnjthenjpatientnj
aboutnjthenjdisease,njwhatnjmedicationnjshouldnjthenjcliniciannjrecommendnjthatnjt
henjpatientnjrefrainnjfromnjusing?:njnonsteroidalnjanti-inflammatorynjdrugs
20.Thenjpatientnjwithnjgastronjesophagealnjrefluxnjdiseasenj(GERD)
shouldnjbenjinstructednjtonjeliminatenjwhichnjofnjthesenjactivities?:njWeightnjlifting
21.Anjpatientnjisnjseennjwithnjanjsuddennjonsetnjofnjflanknjpainnjaccomp
aniednjbynjnausea,njvomiting,njandnjdiaphoresis,njinnjadditionnjtonjneph
rolithiasis,njwhichnjofnjthenjfollowingnjshouldnjbenjaddednjtonjthenjlist
3nj/
nj50
, NRnj511njDifferentialnjDiagnosisnjandnjPrimarynjCare-
njFinalnjExamnjReview
ofnjdifferentialnjdiagnoses?:njPancreatitis,njpepticnjulcernjdisease,njdiverticuliti
s,njAllnjofnjthenjabove
22.AnjpatientnjisnjdiagnosednjwithnjGiardianjafternjanjbackpackingnjtripn
jinnjthenjmountains.njWhichnjofnjthenjfollowingnjwouldnjbenjthenjappropr
iatenjtreatment?:njMetrinidazole
23.Anjpatientnjisnjseennjinnjthenjclinicnjwithnjrightnjuppernjquadrantnj(RU
Q)njpainnjthatnjisnjradiatingnjtonjthenjmiddlenjofnjthenjback.njThenjcliniciannj
suspectsnjacutenjcholelithiasis.njThenjcliniciannjshouldnjexpectnjwhichnj
ofnjthenjfollowingnjlaboratorynjfindings?:njElevatednjalkalinenjphosph
atase
24.Anjpatientnjisnjdiagnosednjwithnjgastroesophagealnjrefluxnjdisease
nj(GERD),njandnjhisnjendoscopicnjreportnjrevealsnjthenjpresencenjofnjBa
rrettsnjepithelium.njWhichnjofnjthenjfollowingnjinformationnjshouldnjthe
cliniciannjincludenjinnjthenjexplanationnjofnjthenjpathology:njThisnjisnjanjpremalignan
njtissue, njThisnjtissuenjisnjresistant njto
gastricnjacid,njThisnjtissuenjsupportsnjhealingnjofnjthenjesop
hagus:njAllnjofnjthenjabove
25.whichnjofnjthenjfollowingnjdietarynjinformationnjshouldnjbenjgivennjtonjan
jpatientnjwithnjgastroesophagealnjrefluxnjdiseasenj(GERD):njEliminatenjco
ffee
26.Marknjhasnjnecrotizingnjfasciitisnjofnjhisnjleftnjlowernjextremity.
Pressurenjonnjthenjskinnjrevealsnjcrepitusnjdue
tonjgasnjproductionnjbynjwhichnjanaerobicnjbacteria?:njClostridiumnjperfringens
27.AnjpatientnjisnjdiagnosednjwithnjGERD,njthenjcliniciannjknowsnjthatnjshenjmisund
er-njstandsnjthenjteachingnjwhennjshenjsays::njstopnjsmoking
eatnjsmallernjmeals
-havenjanjsnacknjbeforenjretiringnjfornjbed.
28.anjpatientnjpresentsnjtonjthenjclinicnjwithnjanjdrynjcough,njnonnjsmoker,njfornj5njwe
eks.njthenjcoughnjincreasesnjatnjnight,njhenjreportsnjepisodesnjofnjheartburnnjafternj
meals.njwhatnjshouldnjthenjdifferentialnjinclude?:njGERD
29.Anj64-year-
oldnjobesenjwomannjcomesnjinnjcomplainingnjofnjdifficultynjswallowingnjfornjthenjpa
stnj3njweeks.njShenjstatesnjthatnj"somenjfoodsnjgetnjstuck"njandnjshenjhasnjbeennjhav
ingnj"heartburn"njatnjnightnjwhennjshenjliesnjdown,njespeciallynjifnjshenjhasnjhadnjanj
heavynjmeal.njOccasionally,njshenjawakesnjatnjnightnjcoughing.njShenjdeniesnjweig
htnjgainnjand/
ornjweightnjloss,njvomiting,njornjchangenjinnjbowelnjmovementsnjornjcolornjofnjstool
s.njShenjdeniesnjalcoholnjandnjtobacconjuse.njTherenjisnjnonjpertinentnjfamilynjhistor
ynjornjfindingsnjonnjreviewnjofnjsystemsnj(ROS).njPhysicalnjexaminationnjisnjnormal,
4nj/
nj50
njFinalnjExamnjReview
1.njTopics:
2.GInjDisorders:nj....
3.Ulcerativenjcolitis:
4.Anj38-year-
oldnjmalenjpatientnjhasnjrecentlynjhadnjannjileostomynjfornjulcerativenjcolitis.njW
hichnjself-
carenjmeasuresnjshouldnjthenjcliniciannjteachnjhimnjaboutnjtonjrelievenjfoodnjbl
ockage?:njmassagenjthenjperistomalnjarea
5.Diverticulitis:
6.Whichnjofnjthenjfollowingnjisnjtruenjregardingnjdiverticula:njobesitynjisnjcorrelated
7.Leftnjlowernjquadrantnjabdominalnjpainnjfornj2njdays,njthenjpainnjstartednjsudde
nlynjandnjthennjfever,njchills,njanorexia,njnauseanjandnjpainlessnjbloodynjstools.:nj
Acutenjdiverticulitis
8.Annj82-year-
oldnjfemalenjhasnjbeennjdiagnosednjwithnjirritablenjbowel,njchronicnjcon-
njstipation,njandnjdiverticulosisnjfollowingnjanjcolonoscopy.njWhichnjpharmacologi
calnjagentnjshouldnjthenjcliniciannjrecommend?:njbulknjlaxative
9.Whichnjofnjthenjfollowingnjisnjpartnjofnjthenjtreatmentnjplannjfornjt
henjpatientnjwithnjirritablenjbowelnjsyndrome?:njHighnjfibernjdiet
10.Anj35-year-
oldnjfemalenjpatentnjisnjseennjinnjthenjclinicnjcomplainingnjofnjabdominalnjpain.njWhic
hnjofnjthenjfollowingnjshouldnjbenjincludednjinnjthenjhistorynjandnjphysicalnjexam?:nj
digitalnjrectalnjexam,njSexualnjhistory,njPelvicnjexam
11.Anj28-year-
oldnjpatentnjisnjseennjinnjthenjclinicnjwithnjcolickynjabdominalnjpain,njparticularl
ynjwithnjmeals.njShenjhas
frequentnjconstipation,njflatulence,njandnjabdominalnjdistension.njWhichnjofnjthenjda
anjmakenjanjdiagnosisnjof
diverticulitisnjunlikely?:njHernjage
1nj/
nj50
, NRnj511njDifferentialnjDiagnosisnjandnjPrimarynjCare-
njFinalnjExamnjReview
12.C.njdiffnjDefinitionnjandnjRisknjfactors:
2nj/
nj50
, NRnj511njDifferentialnjDiagnosisnjandnjPrimarynjCare-
njFinalnjExamnjReview
13.njC.njdiffnjSympto
ms:
14.njC.njdiffnjDiagno
sis:
15.njC.njdiffnjTreat
ment:
16.njGERDnjpathophysiol
ogy:
17.njsymptomsnjofnjGE
RD:
18.Anj54-year-
oldnjfemalenjpresentsnjtonjyournjprimarynjcarenjofficenjfornjroutinenjreeval-
njuationnjfornjgastroesophagealnjrefluxnjdiseasenj(GERD).njShenjhasnjbeennjtreated
njwithnjdietnjmodificationsnjandnj6njweeksnjofnjomeprazolenjwithoutnjimprovementnj
ofnjhernjsymptoms.njWhatnjisnjthenjnextnjstepnjinnjthenjmanagementnjofnjthisnjpatient'
snjGERD?:njOrdernjannjendoscopynj(Thisnjisnjthenjnextnjstepnjinnjtreatmentnjinnjord
ernjtonjevaluatenjthenjetiologynjofnjthenjpatient's
GERDnjandnjconsidernjbiopsynjifnjnecessary)
19.Anj67-year-
oldnjfemalenjonnjmultiplenjmedicationsnjfornjchronicnjconditionsnjwasnjjustnjdiagno
sednjwithnjgastroesophagealnjrefluxnjdiseasenj(GERD).njInnjteachingnjthenjpatientnj
aboutnjthenjdisease,njwhatnjmedicationnjshouldnjthenjcliniciannjrecommendnjthatnjt
henjpatientnjrefrainnjfromnjusing?:njnonsteroidalnjanti-inflammatorynjdrugs
20.Thenjpatientnjwithnjgastronjesophagealnjrefluxnjdiseasenj(GERD)
shouldnjbenjinstructednjtonjeliminatenjwhichnjofnjthesenjactivities?:njWeightnjlifting
21.Anjpatientnjisnjseennjwithnjanjsuddennjonsetnjofnjflanknjpainnjaccomp
aniednjbynjnausea,njvomiting,njandnjdiaphoresis,njinnjadditionnjtonjneph
rolithiasis,njwhichnjofnjthenjfollowingnjshouldnjbenjaddednjtonjthenjlist
3nj/
nj50
, NRnj511njDifferentialnjDiagnosisnjandnjPrimarynjCare-
njFinalnjExamnjReview
ofnjdifferentialnjdiagnoses?:njPancreatitis,njpepticnjulcernjdisease,njdiverticuliti
s,njAllnjofnjthenjabove
22.AnjpatientnjisnjdiagnosednjwithnjGiardianjafternjanjbackpackingnjtripn
jinnjthenjmountains.njWhichnjofnjthenjfollowingnjwouldnjbenjthenjappropr
iatenjtreatment?:njMetrinidazole
23.Anjpatientnjisnjseennjinnjthenjclinicnjwithnjrightnjuppernjquadrantnj(RU
Q)njpainnjthatnjisnjradiatingnjtonjthenjmiddlenjofnjthenjback.njThenjcliniciannj
suspectsnjacutenjcholelithiasis.njThenjcliniciannjshouldnjexpectnjwhichnj
ofnjthenjfollowingnjlaboratorynjfindings?:njElevatednjalkalinenjphosph
atase
24.Anjpatientnjisnjdiagnosednjwithnjgastroesophagealnjrefluxnjdisease
nj(GERD),njandnjhisnjendoscopicnjreportnjrevealsnjthenjpresencenjofnjBa
rrettsnjepithelium.njWhichnjofnjthenjfollowingnjinformationnjshouldnjthe
cliniciannjincludenjinnjthenjexplanationnjofnjthenjpathology:njThisnjisnjanjpremalignan
njtissue, njThisnjtissuenjisnjresistant njto
gastricnjacid,njThisnjtissuenjsupportsnjhealingnjofnjthenjesop
hagus:njAllnjofnjthenjabove
25.whichnjofnjthenjfollowingnjdietarynjinformationnjshouldnjbenjgivennjtonjan
jpatientnjwithnjgastroesophagealnjrefluxnjdiseasenj(GERD):njEliminatenjco
ffee
26.Marknjhasnjnecrotizingnjfasciitisnjofnjhisnjleftnjlowernjextremity.
Pressurenjonnjthenjskinnjrevealsnjcrepitusnjdue
tonjgasnjproductionnjbynjwhichnjanaerobicnjbacteria?:njClostridiumnjperfringens
27.AnjpatientnjisnjdiagnosednjwithnjGERD,njthenjcliniciannjknowsnjthatnjshenjmisund
er-njstandsnjthenjteachingnjwhennjshenjsays::njstopnjsmoking
eatnjsmallernjmeals
-havenjanjsnacknjbeforenjretiringnjfornjbed.
28.anjpatientnjpresentsnjtonjthenjclinicnjwithnjanjdrynjcough,njnonnjsmoker,njfornj5njwe
eks.njthenjcoughnjincreasesnjatnjnight,njhenjreportsnjepisodesnjofnjheartburnnjafternj
meals.njwhatnjshouldnjthenjdifferentialnjinclude?:njGERD
29.Anj64-year-
oldnjobesenjwomannjcomesnjinnjcomplainingnjofnjdifficultynjswallowingnjfornjthenjpa
stnj3njweeks.njShenjstatesnjthatnj"somenjfoodsnjgetnjstuck"njandnjshenjhasnjbeennjhav
ingnj"heartburn"njatnjnightnjwhennjshenjliesnjdown,njespeciallynjifnjshenjhasnjhadnjanj
heavynjmeal.njOccasionally,njshenjawakesnjatnjnightnjcoughing.njShenjdeniesnjweig
htnjgainnjand/
ornjweightnjloss,njvomiting,njornjchangenjinnjbowelnjmovementsnjornjcolornjofnjstool
s.njShenjdeniesnjalcoholnjandnjtobacconjuse.njTherenjisnjnonjpertinentnjfamilynjhistor
ynjornjfindingsnjonnjreviewnjofnjsystemsnj(ROS).njPhysicalnjexaminationnjisnjnormal,
4nj/
nj50
