NR546 NR 546 MIDTERM FINAL
EXAM 2026 STUDY GUIDE
COMPREHENSIVE QUESTIONS
ANSWERS GRADED A+
◉ Irritable bowel syndrome.
Answer: disorder of the bowel function not from anatomic abnormality--
constipation, diarrhea, bloating, urgency w/diarrhea
+s/s--result from disordered sensations or abnormal function of the small
and large bowel
NOT associated with serious medical conditions, IBD, CA
◉ Inflammatory bowel disorder.
Answer: chronic immunologic disease that manifests in intestinal
inflammation
Ulcerative colitis
crohn's disease
◉ Two common inflammatory bowel diseases.
Answer: Ulcerative colitis-mucosal surface of the colon is inflamed and
ultimately results in frability, erosions, and bleeding--most common in
recto-sigmoid colon. Can involve entire colon, pain in RLQ
Crohns disease-inflammation extends deeper into the intestional wall
and can involve all or any layer of the bowel wall and any portion of the
GI tract from the mouth to the anus--skipped lesions, pain in LLQ
,◉ Diverticulitis.
Answer: Symptoms: LLQ pain/tenderness, fever, N/V/D
Need imagining especially if perforation or peritonitis is suspected--free
air=perforation; patient may have ileus, small or large bowel obstruction
Can use plain x-ray
CT or Barium enema are preferred
CT with contrast is more sensitive and accurate
◉ Identify the significance of Barrett's esophagus.
Answer: After repeated exposure to gastric contents, inflammation of the
esophageal mucosa becomes chronic
Blood flow increases, erosion occurs
As erosion heals, normal squamous epithelium replaced with metaplastic
columnar epithelium containing goblet and columnar cells.
More resistant to acid and supports esophageal healing
Premalignant tissue
40-fold frisk for developing esophageal adenocarcinma
Fibrosis and scarring during healing of erosions; leads to strictures
◉ Diagnosis of GERD.
Answer: made on history alone: sensitivity of 80%
if symptoms are unclear/patient does not respond to 4 weeks of empiric
tx
,made by ambulatory esophageal pH monitoring
pH <4 above the lower esophageal sphincter correlates with symptoms =
GERD
EDG with biopsy-Barrett's esohagus
Normal results in 50% of symptomatic patients
◉ Risks of GERD.
Answer: Obesity
Increase after age 50
Equal across gender, ethnic, and cultural groups
◉ Treatments of GERD.
Answer: Small frequent meals-main meal in midday
Avoid trigger foods
No bedtime snacks: no eating <4 hours prior to bed
Eliminate caffeine, stop smoking, avoid tight fitting clothing, sleep with
head of the bed elevated.
◉ Medications for GERD.
Answer: antacids or OTC H2 (Tagamet, zantac, axid)
Rx-strength H2 (ranitidine 150mg BID, famotidine 20mg BID) or PPI
(pantoprazole 40mg daily, omeprazole 20mg daily)
PPI (Omeprazole 40mg daily)
Surgery (fundoplication)
, ◉ Differential diagnosis of acute abd pain.
Answer: Acute appendicitis
Acute pancreatitis
Acute cholecystitis
◉ Acute appendicitis.
Answer: Inflammation of the vermiform appendix; due to obstruction or
infection
Most common surgical emergency of the abdomen
Hollow tube - most common cause is obstruction of appendix
Fecaltih - hard lump of fecal matter
Undigested seeds
Pinworm infections
Lymphoid follicle growth/lymphoid hyperplasia Symptoms
4. Symptoms
Nausea/vomiting
RLQ pain
Guarding
◉ Acute pancreatitis.
Answer: Sudden inflammation and hemorrhaging of the pancreas due to
destruction by its own digestive enzymes
1. Autodigestion
EXAM 2026 STUDY GUIDE
COMPREHENSIVE QUESTIONS
ANSWERS GRADED A+
◉ Irritable bowel syndrome.
Answer: disorder of the bowel function not from anatomic abnormality--
constipation, diarrhea, bloating, urgency w/diarrhea
+s/s--result from disordered sensations or abnormal function of the small
and large bowel
NOT associated with serious medical conditions, IBD, CA
◉ Inflammatory bowel disorder.
Answer: chronic immunologic disease that manifests in intestinal
inflammation
Ulcerative colitis
crohn's disease
◉ Two common inflammatory bowel diseases.
Answer: Ulcerative colitis-mucosal surface of the colon is inflamed and
ultimately results in frability, erosions, and bleeding--most common in
recto-sigmoid colon. Can involve entire colon, pain in RLQ
Crohns disease-inflammation extends deeper into the intestional wall
and can involve all or any layer of the bowel wall and any portion of the
GI tract from the mouth to the anus--skipped lesions, pain in LLQ
,◉ Diverticulitis.
Answer: Symptoms: LLQ pain/tenderness, fever, N/V/D
Need imagining especially if perforation or peritonitis is suspected--free
air=perforation; patient may have ileus, small or large bowel obstruction
Can use plain x-ray
CT or Barium enema are preferred
CT with contrast is more sensitive and accurate
◉ Identify the significance of Barrett's esophagus.
Answer: After repeated exposure to gastric contents, inflammation of the
esophageal mucosa becomes chronic
Blood flow increases, erosion occurs
As erosion heals, normal squamous epithelium replaced with metaplastic
columnar epithelium containing goblet and columnar cells.
More resistant to acid and supports esophageal healing
Premalignant tissue
40-fold frisk for developing esophageal adenocarcinma
Fibrosis and scarring during healing of erosions; leads to strictures
◉ Diagnosis of GERD.
Answer: made on history alone: sensitivity of 80%
if symptoms are unclear/patient does not respond to 4 weeks of empiric
tx
,made by ambulatory esophageal pH monitoring
pH <4 above the lower esophageal sphincter correlates with symptoms =
GERD
EDG with biopsy-Barrett's esohagus
Normal results in 50% of symptomatic patients
◉ Risks of GERD.
Answer: Obesity
Increase after age 50
Equal across gender, ethnic, and cultural groups
◉ Treatments of GERD.
Answer: Small frequent meals-main meal in midday
Avoid trigger foods
No bedtime snacks: no eating <4 hours prior to bed
Eliminate caffeine, stop smoking, avoid tight fitting clothing, sleep with
head of the bed elevated.
◉ Medications for GERD.
Answer: antacids or OTC H2 (Tagamet, zantac, axid)
Rx-strength H2 (ranitidine 150mg BID, famotidine 20mg BID) or PPI
(pantoprazole 40mg daily, omeprazole 20mg daily)
PPI (Omeprazole 40mg daily)
Surgery (fundoplication)
, ◉ Differential diagnosis of acute abd pain.
Answer: Acute appendicitis
Acute pancreatitis
Acute cholecystitis
◉ Acute appendicitis.
Answer: Inflammation of the vermiform appendix; due to obstruction or
infection
Most common surgical emergency of the abdomen
Hollow tube - most common cause is obstruction of appendix
Fecaltih - hard lump of fecal matter
Undigested seeds
Pinworm infections
Lymphoid follicle growth/lymphoid hyperplasia Symptoms
4. Symptoms
Nausea/vomiting
RLQ pain
Guarding
◉ Acute pancreatitis.
Answer: Sudden inflammation and hemorrhaging of the pancreas due to
destruction by its own digestive enzymes
1. Autodigestion
