Upper GI
What should people avoid eating that have celiac disease?
A. Meats like beef or pork
B. Tree nuts
C. Bread, bran, and wheat
D. Raw vegetables
C.
People with celiac disease need to avoid anything with gluten.
What is one function of the large intestine?
A. Absorption of excess water and electrolytes
B. Absorption of carbohydrates, fats, and proteins
C. Breakdown of most ingested nutrients
D. Emulsifies fat
A.
Most water is absorbed in the small intestine but whatever is left over is absorbed by the large intestine.
What is the main function of the gallbladder?
A. Create bile
B. Detoxify the body
C. Store bile
D. Conjugate bilirubin
C.
The gallbladder stores bile made by the liver to be released when food passes through the small intestine.
What is a cause of pre-renal kidney dysfunction?
A. Obstruction to the outflow of urine
B. Direct trauma to the kidney
C. Severe, prolonged dehydration
D. A kidney stone
C.
Anything that causes low/reduced perfusion to the kidney causes pre-renal dysfunction.
If hydrostatic pressure is greater than osmotic pressure, where would water flow into?
A. ICF
B. ECF
C. ISF
D. No movement would occur
A.
Hydrostatic pressure is the pressure of water pushing out on the walls of blood vessels. Osmotic pressure opposes it.
One of your patients is suspected of having peptic ulcer. What kind of diagnostic procedure will be most helpful in diagnosing this patient with a peptic ulcer?
A. Upper GI series (barium swallow test)
B. Upper endoscopy
C. Colonoscopy
D. Fecal occult blood test (FOBT)
B.
Upper Endoscopies are done to visualize the inside of the esophagus, stomach, and duodenum. These are used to help diagnose someone with peptic ulcers and/or cancer of the stomach or esophagus.
A patient comes to the clinic and says they are having abdominal pain in the RLQ (McBurney's point), are running a fever, and claim to feel bloated. They say it has been going on for about 2 days. What do you most suspect is happening with this patient?
A. Gastroenteritis
B. Ulcerative colitis
C. Large bowel obstruction
D. Appendicitis
D.
Classic s/s of appendicitis are abdominal pain at McBurney's point (the RLQ), fever, abdominal distension, and rebound tenderness on palpation.
Which disease has an unknown etiology but usually has metabolic syndrome as a comorbidity?
A. Alcoholic Hepatitis
B. NAFLD
C. Hepatitis C
D. NASH
B.
Non-alcoholic fatty liver disease has an unknown cause but it is theorized that metabolic syndrome (hypertriglyceridemia, diabetes, and hypertension) may be a cause.
What is the main purpose of the RAAS system?
A. Help raise blood pressure in time of stress/dehydration
B. Help lower blood pressure in times of stress/dehydration
C. Cause excretion of extra water from the body
D. Increase GFR
A.
The RAAS system helps maintain and raise BP in times of stress, dehydration, blood loss, etc. by helping retain extra fluid and electrolytes.
Which blood lab value indicates hypercalcemia?
A. >145 mEq/L
B. >5.0 mEq/L
C. <8.5 mg/dL
D. >10.5 mg/dL
D.
Normal calcium ranges from 8.5-10.5 mg/dL
One of your patients is in the hospital to treat a gastric ulcer. On assessment in the morning, you find that they have a rigid, board-like abdomen that is painful to the touch and they are complaining of severe pain. What do you suspect is happening to this patient?
A. This is a normal finding for an ulcer of this type
B. The ulcer caused a gastric rupture and they now have peritonitis
C. They are having an episode of gastroenteritis
D. They now have gastritis
B.
Peritonitis is a life-threatening emergency and is usually caused from infections that have spread from other parts of the body or from ruptured GI organs like the stomach, small intestine, and large intestine.
Which bowel disease causes episodes of diarrhea and abdominal pain, has remissions and exacerbations, and can affect anywhere in the small and large intestines?
A. Ulcerative Colitis
B. Irritable Bowel Syndrome (IBS)
C. Crohn’s Disease
D. Gastroenteritis
C.
Crohn’s is an inflammatory bowel disease (IBD) that can cause bouts of abdominal pain and diarrhea, dehydration, loss of electrolytes and nutrients, etc.
One of your patients has chronic cholecystitis and is asking about ways to help prevent symptoms. What is one education point to go over with them about helping prevent further irritation of the gallbladder?
A. Consume a low-fat, low-calorie diet
B. Lose weight rapidly
C. Take oral contraceptives
D. Gain a few pounds over the next few weeks
A.
Risk factors for gallbladder disease are female gender, genetics, age 40+, oral contraceptive use, obesity, high fat, high calorie diets and rapid weight loss.
What is something you may see on a urinalysis of someone with a urinary tract infection (UTI)?
A. Crystals
B. Ketones
C. Leukocyte esterase
D. Bilirubin
C.
Which is an example of a hypertonic solution?
A. 0.9% Normal saline
B. 0.45% Normal saline
C. 3% Normal saline
D. Lactated Ringer's
C.
0.9% normal saline is isotonic, 0.45% NS is hypotonic, lactated ringer's is isotonic, and 3% NS is hyperonic.
A patient of yours was just diagnosed with GERD and you are about to go over some teaching points with them about managing this disease. What should you teach them about managing GERD? (select all that apply)
A. Eat smaller, more frequent meals
B. Include more citrus fruit in your diet
C. Stop using tobacco products
D. Limit coffee intake to 3 cups a day
E. Avoid alcohol and carbonated drinks
A, C, E
Other teaching points can be avoiding citrus/acidic foods, remaining upright fro ~ 2 hours after meals, limiting all caffeine/coffee intake, and avoid eating 2 hours before bedtime.
What are some s/s of a large bowel obstruction? (select all)
A. Abscent bowel sounds
B. Abdominal distension
C. Excessive flatus
D. Passage of impacted stool
E. Abdominal pain/tenderness
A, B, E
Other s/s are: abdominal rigidity and high pitched bowel sounds on a partial obstruction.
Which of the following are common signs of liver disorders? (Select all that apply)
A. Jaundice
B. Elevated AST and ALT
C. Hepatomegaly
D. Dark stool
E. LUQ pain
A, B, C
Other s/s are poor wound healing, ascites/edema, dark urine, nausea, fever, etc.
One of your patients has acute glomerulonephritis. What are some things you can expect to see in a patient with this? (select all)
A. Hypotension
B. Hematuria
C. Edema
D. Urine negative for protein
E. Recent strep throat infection
B, C, E
Proteinuria, edema, hypertension, hematuria, and tea/cola colored urine are all signs of acute glomerulonephritis.
What are some s/s of hyperkalemia? (select all)
A. Heart rhythm changes
B. Tingling/numbness of the extremities
C. N/V
D. Oliguria
E. Confusion
A, B, E
Other symptoms are diarrhea, apathy, and muscle cramps
What is a hiatal hernia and what kind of symptoms may you see in someone that has one?
I hiatal hernia is when part of the stomach herniates through the diaphragm. Symptoms that can be seen are similar to GERD like heartburn, indigestion, epigastric pain, dysphagia, and epigastric discomfort.
What is the difference between diverticulitis and diverticulosis and what causes each?
Diverticulitis is inflammation/infection of the diverticula, or small herniations within the large intestine, that is usually caused by food getting stuck in them.
Diverticulosis is a condition when someone has multiple diverticula in their large intestine; usually from straining when trying to have a bowel movement.
Tell how Hepatitis B is spread and name what happens in 2 of the 4 stages.
It is spread by way of blood, bodily fluids, and sexual contact.
Stage 1 is the incubation period where there are no symptoms but the person can spread it.
Stage 2 is the inflammatory reaction phase and is the phase of active disease.
Stage 3 is when the immune system reacts to the virus and virus levels begin to fall.
Stage 4 is when the virus can no longer be detected and the person has anti-HBV antibodies
What is the role of ADH in the body and what system is it released as a part of?
ADH causes the kidneys to reabsorb more water to help maintain blood pressure in times of dehydration and stress. It is released as a part of the renin-angiotensin-aldosterone sytem (RAAS)
What is an example of an IV fluid you would give someone to help treat someone with cellular dehydration and why?
Hypotonic solutions: 0.33% NS or 0.45% NS are examples
This will lower the tonicity of the blood, lowering osmotic pressure and allowing hydrostatic pressure to overcome osmotic pressure. This will cause water to flow into the cells.