APEA 3P Exam Prep- GI Questions with 100%
Correct Answers and RATIONALE
A 70-year-old patient states that he had some bright red blood on the toilet tissue
this morning after a bowel movement. He denies pain. What is the LEAST likely
cause in this patient?
Hemorrhoids
Diverticulitis
Colon cancer
Anal fissure
D.
Nearly 1 in 3 patients in this age group with acute lower gastrointestinal bleeding
have bleeding secondary to diverticulitis. Nearly 1 in 5 have colorectal cancer or
polyps, though, polyps usually do not bleed. Patients who have anal fissures often
complain of a tearing pain during bowel movements. Regardless of the etiology, this
patient needs referral for a colonoscopy to identify the cause of bleeding. He is at
high risk for colon cancer because of his age. The appropriate recommendation is
referral to gastroenterology for colonoscopy.
A patient has received a prescription for metronidazole for treatment of C. difficile.
What should be avoided in this patient?
Excess fluids
Vitamin B12
Grapefruit juice
Alcohol
D.
Patients should always be cautioned against alcohol ingestion (in any form) if they
take metronidazole. Alcohol can (and usually does) produce a disulfiram reaction.
This is characterized by abdominal cramps, nausea, vomiting, headache, and
elevated body temperature. Precautions should remain until 72 hours after the last
dose of metronidazole.
,The relationship between colon polyps and colon cancer is those polyps:
eventually, all become malignant.
have a slow progression to colon cancer.
have a rapid progression to colon cancer.
have no relationship to colon cancer.
B.
Colon polyps are usually slow-growing and take a long time to progress to cancer.
This is the reason that a colonoscopy does not need to be repeated annually. While
not all polyps grow slowly, this is the usual progression.
An 82-year-old adult has constipation. A supplement known to cause constipation is:
vitamin A.
calcium.
magnesium.
vitamin B12.
B.
Calcium does produce constipation in many patients. If this is taken as a
supplement for osteoporosis or osteopenia, the patient should be encouraged to
increase fluids and fiber.
A 5-year-old has been diagnosed with pinworms. He lives with his mother. There are
no other members of the household. How should his mother be managed?
Reassure the mother that if she develops symptoms, she will need to be treated.
Visually assess the mother’s rectum for redness or presence of worms.
Have the mother collect a stool specimen and send it to the laboratory.
Perform the “scotch tape” test and look at the collection under the
microscope.
D.
The diagnosis of pinworms (Enterobiasis) is made by using a piece of scotch tape on
a tongue depressor. It is touched against the patient’s rectum. The greatest yield of
eggs will occur during the nighttime or early AM. Eggs will be found here if they are
,present. Worms and eggs are rarely found in stool specimens, so this is not a good
plan. When the scotch tape is examined under a low power microscope, the eggs
will be easily visualized since they are large and bean shaped. The finding of an
adult worm would confirm the diagnosis. These are large enough to be seen with
the naked eye. If the mother is symptomatic, she should be treated with or without
a rectal exam. It is very likely she is infected.
A patient has been diagnosed with hepatitis B. The most commonly reported risk
factor is:
drinking contaminated water.
eating contaminated food.
exposure to blood.
sexual exposure.
D.
Hepatitis B is transmitted by blood and body fluids. While exposure to infected
blood or blood products would significantly increase the risk of infection in
unvaccinated people, this is much less likely than becoming infected via sexual
exposure or IV drug use. Hepatitis A is transmitted via fecal-oral routes. Drinking
contaminated water and eating contaminated food implicate hepatitis A as the
etiologic agent.
The three most common causes of bacterial diarrhea in the US are Salmonella,
Campylobacter, and:
E. coli.
Enterovirus.
Yersinia.
Shigella.
D.
Shigella will be shed continuously in the stool and should be easily identified on
stool culture. When bacterial gastroenteritis is suspected, a stool specimen could be
ordered for confirmation. Generally, these three pathogens are easily identified if
they are present. Enterovirus produces a viral form of diarrhea. Yersinia produces
the deadly disease called bubonic plague. E. coli is a typical colonic pathogen.
An 83-year-old patient is diagnosed with diverticulitis. The most common complaint
is:
, rectal bleeding.
bloating and cramping.
left lower quadrant pain.
frequent belching and flatulence.
C.
Diverticular disease is more common in older adults. About 70% of patients
diagnosed with diverticulitis have left lower quadrant pain. Rectal bleeding may
have varied etiologies, such as rectal carcinoma or hemorrhoids. Bloating and
cramping are often found in patients with diverticular disease (diverticulosis) but
not specifically diverticulitis. Belching and flatulence are not specifically associated
with diverticulosis.
What is true regarding older adults who are overweight?
This is clearly associated with increased mortality in older adults.
Mortality in older adults related to overweight states declines over time.
BMI is a good way to assess nutritional status in older adults.
There are no potential metabolic or functional benefits to weight loss in older adults.
B.
Overweight and obese states are not as important in predicting mortality in older
adults as they are in their younger counterparts. After age 65 years (some studies
demonstrate after age 70), weight is less significant in decreasing risk for mortality
than in younger adults. There are some benefits to weight loss in the obese older
adults. One of them is better balance and decreased risk for falls. Others include
less sleep apnea, decreased risk of diabetes, and decreased rates of shortness of
breath with respiratory and cardiac diseases.
What medication used to treat patients who have GERD provides the fastest relief of
heartburn symptoms?
Calcium carbonate
Ranitidine
Amantadine
Pantoprazole
A.
Calcium carbonate is an antacid. It provides rapid changes in gastric pH. This
Correct Answers and RATIONALE
A 70-year-old patient states that he had some bright red blood on the toilet tissue
this morning after a bowel movement. He denies pain. What is the LEAST likely
cause in this patient?
Hemorrhoids
Diverticulitis
Colon cancer
Anal fissure
D.
Nearly 1 in 3 patients in this age group with acute lower gastrointestinal bleeding
have bleeding secondary to diverticulitis. Nearly 1 in 5 have colorectal cancer or
polyps, though, polyps usually do not bleed. Patients who have anal fissures often
complain of a tearing pain during bowel movements. Regardless of the etiology, this
patient needs referral for a colonoscopy to identify the cause of bleeding. He is at
high risk for colon cancer because of his age. The appropriate recommendation is
referral to gastroenterology for colonoscopy.
A patient has received a prescription for metronidazole for treatment of C. difficile.
What should be avoided in this patient?
Excess fluids
Vitamin B12
Grapefruit juice
Alcohol
D.
Patients should always be cautioned against alcohol ingestion (in any form) if they
take metronidazole. Alcohol can (and usually does) produce a disulfiram reaction.
This is characterized by abdominal cramps, nausea, vomiting, headache, and
elevated body temperature. Precautions should remain until 72 hours after the last
dose of metronidazole.
,The relationship between colon polyps and colon cancer is those polyps:
eventually, all become malignant.
have a slow progression to colon cancer.
have a rapid progression to colon cancer.
have no relationship to colon cancer.
B.
Colon polyps are usually slow-growing and take a long time to progress to cancer.
This is the reason that a colonoscopy does not need to be repeated annually. While
not all polyps grow slowly, this is the usual progression.
An 82-year-old adult has constipation. A supplement known to cause constipation is:
vitamin A.
calcium.
magnesium.
vitamin B12.
B.
Calcium does produce constipation in many patients. If this is taken as a
supplement for osteoporosis or osteopenia, the patient should be encouraged to
increase fluids and fiber.
A 5-year-old has been diagnosed with pinworms. He lives with his mother. There are
no other members of the household. How should his mother be managed?
Reassure the mother that if she develops symptoms, she will need to be treated.
Visually assess the mother’s rectum for redness or presence of worms.
Have the mother collect a stool specimen and send it to the laboratory.
Perform the “scotch tape” test and look at the collection under the
microscope.
D.
The diagnosis of pinworms (Enterobiasis) is made by using a piece of scotch tape on
a tongue depressor. It is touched against the patient’s rectum. The greatest yield of
eggs will occur during the nighttime or early AM. Eggs will be found here if they are
,present. Worms and eggs are rarely found in stool specimens, so this is not a good
plan. When the scotch tape is examined under a low power microscope, the eggs
will be easily visualized since they are large and bean shaped. The finding of an
adult worm would confirm the diagnosis. These are large enough to be seen with
the naked eye. If the mother is symptomatic, she should be treated with or without
a rectal exam. It is very likely she is infected.
A patient has been diagnosed with hepatitis B. The most commonly reported risk
factor is:
drinking contaminated water.
eating contaminated food.
exposure to blood.
sexual exposure.
D.
Hepatitis B is transmitted by blood and body fluids. While exposure to infected
blood or blood products would significantly increase the risk of infection in
unvaccinated people, this is much less likely than becoming infected via sexual
exposure or IV drug use. Hepatitis A is transmitted via fecal-oral routes. Drinking
contaminated water and eating contaminated food implicate hepatitis A as the
etiologic agent.
The three most common causes of bacterial diarrhea in the US are Salmonella,
Campylobacter, and:
E. coli.
Enterovirus.
Yersinia.
Shigella.
D.
Shigella will be shed continuously in the stool and should be easily identified on
stool culture. When bacterial gastroenteritis is suspected, a stool specimen could be
ordered for confirmation. Generally, these three pathogens are easily identified if
they are present. Enterovirus produces a viral form of diarrhea. Yersinia produces
the deadly disease called bubonic plague. E. coli is a typical colonic pathogen.
An 83-year-old patient is diagnosed with diverticulitis. The most common complaint
is:
, rectal bleeding.
bloating and cramping.
left lower quadrant pain.
frequent belching and flatulence.
C.
Diverticular disease is more common in older adults. About 70% of patients
diagnosed with diverticulitis have left lower quadrant pain. Rectal bleeding may
have varied etiologies, such as rectal carcinoma or hemorrhoids. Bloating and
cramping are often found in patients with diverticular disease (diverticulosis) but
not specifically diverticulitis. Belching and flatulence are not specifically associated
with diverticulosis.
What is true regarding older adults who are overweight?
This is clearly associated with increased mortality in older adults.
Mortality in older adults related to overweight states declines over time.
BMI is a good way to assess nutritional status in older adults.
There are no potential metabolic or functional benefits to weight loss in older adults.
B.
Overweight and obese states are not as important in predicting mortality in older
adults as they are in their younger counterparts. After age 65 years (some studies
demonstrate after age 70), weight is less significant in decreasing risk for mortality
than in younger adults. There are some benefits to weight loss in the obese older
adults. One of them is better balance and decreased risk for falls. Others include
less sleep apnea, decreased risk of diabetes, and decreased rates of shortness of
breath with respiratory and cardiac diseases.
What medication used to treat patients who have GERD provides the fastest relief of
heartburn symptoms?
Calcium carbonate
Ranitidine
Amantadine
Pantoprazole
A.
Calcium carbonate is an antacid. It provides rapid changes in gastric pH. This
