Deck 11: Abdominal Problems

Question 1

A patient is diagnosed with giardia after a backpacking trip in the mountains.Which of the following would be an appropriate treatment?

A)Vancomycin
B)Penicillin
C)Metronidazole
D)Bactrim

Answer 1

Metronidazole

Question 2

A patient comes to the office complaining of constipation.The patient lists all of the following medications.Which drug could be responsible for the constipation?

A)Multivitamin
B)Magnesium hydroxide
C)Pepto-Bismol¨
D)Ibuprofen

Answer 2

Pepto-Bismol¨

Question 3

A patient is seen with complaints of diarrhea.Which of the following should be included in the patientÕs differential diagnosis?

A)Gastroenteritis
B)Inflammatory bowel disease
C)Lactase deficiency
D)All of the above

Answer 3

All of the above

Question 4

The nurse practitioner (NP) suspects a patient has a peptic ulcer.Which of the following items on the history would lead the NP to this conclusion?

A)Use of NSAIDs
B)Cigarette smoker
C)Ethanol consumption
D)All of the above

Question 5

A 35-year-old female patient is seen in the clinic complaining of abdominal pain.Which of the following should be included in the history and physical examination?

A)Digital rectal exam
B)Pelvic exam
C)Sexual history
D)All of the above

Question 6

A 45-year-old patient presents with a chief complaint of generalized abdominal pain.Her physical examination is remarkable for left lower quadrant tenderness.At this time, which of the following should be considered in the differential diagnosis?

A)Endometriosis
B)Colon cancer
C)Diverticulitis
D)All of the above

Question 7

A 25-year-old accountant is seen in the clinic complaining of crampy abdominal pain after meals.She is often constipated and takes laxatives, which are followed by a couple of days of diarrhea.She temporarily feels better after a bowel movement.She states she is embarrassed by flatulence and has abdominal distension.She has had no weight loss or blood in her stool.This problem has gone on for about 6 months.What should the next step be?

A)Obtain a complete history.
B)Order a barium enema.
C)Schedule a BernsteinÕs test.
D)Prescribe a trial of antispasmodics.

Question 8

Which of the following dietary instructions should be given to a patient with GERD?

A)Eliminate coffee.
B)Drink peppermint tea to relieve stomach distress.
C)Recline and rest after meals.
D)Limit the amount of antacids.

Question 9

A patient is diagnosed with GERD, and his endoscopic report reveals the presence of Barrett's epithelium.Which of the following should the PCP include in the explanation of the pathology report?

A)This is a premalignant tissue.
B)This tissue is resistant to gastric acid.
C)This tissue supports healing of the esophagus.
D)All of the above

Question 10

A 22-year-old is seen complaining of vague belly pain.This type of pain is seen at what point in appendicitis?

A)Very early
B)3 to 4 hours after perforation
C)Late in inflammation
D)Appendicitis never presents with vague pain.

Question 11

A 28-year-old patient is seen in the clinic with colicky abdominal pain particular with meals.She has frequent constipation, flatulence, and abdominal distension.Which of the data make a diagnosis of diverticulitis unlikely?

A)Her age
B)Frequent constipation
C)Flatulence
D)Colicky abdominal pain

Question 12

A 46-year-old patient is seen in the clinic with abdominal pain.Which of the following tests is essential for this patient?

A)CBC with differential
B)Urine human chorionic gonadotropin
C)Barium enema
D)Computed tomography of the abdomen

Question 13

Mr.J.K., 38 years old, is 5 feet 8 inches tall and weighs 189 pounds.He reports that he has had intermittent heartburn for several months and takes Tums¨ with temporary relief.He has been waking during the night with a burning sensation in his chest.Which additional information would lead you to believe that gastroesophageal reflux disease (GERD) is the cause of his pain?

A)The pain seems better when he smokes to relieve his nerves.
B)Coffee and fried foods donÕt bother him,
C)He wakes at night coughing with a bad taste in his mouth.
D)All of the above

Question 14

Which of the following is associated with celiac disease (celiac sprue)?

A)Malabsorption
B)Constipation
C)Rectal bleeding
D)Esophageal ulceration

Question 15

The patient with GERD should be instructed to eliminate which of these activities?

A)Swimming
B)Weight lifting
C)Golfing
D)Walking

Question 16

A 21-year-old student presents with complaints of fatigue, headache, anorexia, and a runny nose, all of which began about 2 weeks ago.She started taking vitamins and over-the-counter cold preparations but feels worse.The smell of food makes her nauseated.Her boyfriend had mononucleosis about a month ago, and she wonders if she might have it also.Examination reveals cervical adenopathy and an enlarged liver and spleen.Which of the following labs would be most helpful in the differential diagnosis at this point?

A)Stool culture
B)Liver enzymes
C)Antihepatitis D virus
D)Thyroid-stimulating hormone test

Question 17

A 29-year-old Englishman is seen in the office with complaints of pain in his chest and belly.He has been suffering the pain for 2 weeks and gets temporary relief from Alka-Seltzer¨.The burning pain wakes him at night and radiates up to his chest.Which factor favors a diagnosis of gastric ulcer?

A)His gender
B)His age
C)His use of Alka-Seltzer
D)His ethnic origin

Question 18

Which of the following is most effective in diagnosing appendicitis?

A)History and physical
B)Sedimentation rate
C)Kidney, ureter, and bladder x-ray
D)Complete blood count (CBC) with differentials

Question 19

A 28-year-old patient is seen with complaints of diarrhea.Which of the following responses to the history questions would help the primary care physician (PCP) establish the diagnosis of irritable bowel syndrome?

A)Feels relief after a bowel movement
B)Sometimes is constipated
C)Does not defecate in the middle of the night
D)All of the above

Question 20

A patient is seen with dark-colored urine, and the urine dipstick reveals a high level of bilirubin.Which of the following could be a cause of this problem?

A)Increased breakdown of red blood cells
B)Inadequate hepatocyte function
C)Biliary obstruction
D)All of the above

Question 21

A patient has acute pancreatitis with seven of the diagnostic criteria from Ranson's criteria.In order to plan care, the NP must understand that this criteria score has which of the following meanings?

A)A high mortality rate
B)An increased chance of recurrence
C)A 7% chance of the disease becoming chronic
D)All of the above

Question 22

Which of the following is part of the treatment plan for the patient with irritable bowel syndrome?

A)High fiber diet
B)Tylenol with codeine
C)Daily laxatives
D)All of the above .

Question 23

A patient is seen in the office with complaints of six to seven liquid bowel movements per day.Which of the following assessment findings would lead the NP to a diagnosis of inflammatory bowel disease?

A)Intermittent constipation with periods of diarrhea
B)Wakens at night with diarrhea
C)History of international travel
D)All of the above

Question 24

On further questioning, the 21-year-old patient with complaints of fatigue, headache, anorexia, and a runny nose explains that she is sexually active only with her boyfriend, does not use injectable drugs, and works as an aide in a day-care center.Which of the following tests would be most helpful in confirming your diagnosis?

A)Hepatitis A virus (HAV) IgM
B)HAV IgG
C)Anti-HAcAg
D)Anti-HAsAg

Question 25

A patient is seen in the clinic with right upper quadrant pain that is radiating to the middle of the back.The NP suspects acute cholelithiasis.The NP should expect which of the following laboratory findings?

A)Decreased alanine aminotransferase and decreased aspartate aminotransferase
B)Elevated alkaline phosphatase
C)Elevated indirect bilirubin
D)Decreased white blood cells