A 45-year-old male comes to the clinic with a chief complaint ?????of epigastric abdominal pain that has persisted for 2 weeks. He describes ?????the pain as burning, non-radiating and

 

Test: Module 3 Knowledge Check

  

QUESTION 1

1. A 45-year-old male comes to the clinic with a chief complaint      of epigastric abdominal pain that has persisted for 2 weeks. He describes      the pain as burning, non-radiating and is worse after meals. He denies      nausea, vomiting, weight loss or obvious bleeding. He admits to bloating      and frequent belching.  

PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.  

Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain 

Family Hx-non contributary  

Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use, vaping or unprotected sexual encounters.  

Breath test in the office revealed + urease. 

The healthcare provider suspects the client has peptic ulcer disease.

1 of 2 Questions:

What factors may have contributed to the development of PUD? 

             

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QUESTION 2

1. A 45-year-old male comes to the clinic with a chief complaint      of epigastric abdominal pain that has persisted for 2 weeks. He describes      the pain as burning, non-radiating and is worse after meals. He denies      nausea, vomiting, weight loss or obvious bleeding. He admits to bloating      and frequent belching.  

PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.  

Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain 

Family Hx-non contributary  

Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use, vaping or unprotected sexual encounters.  

Breath test in the office revealed + urease. 

The healthcare provider suspects the client has peptic ulcer disease.

2 of 2 Questions:

How do these factors contribute to the formation of peptic ulcers? 

             

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QUESTION 3

1. A      36-year-old morbidly obese female comes to the office with a chief      complaint of “burning in my chest and a funny taste in my mouth”. The      symptoms have been present for years but patient states she had been      treating the symptoms with antacid tablets which helped until the last 4      or 5 weeks. She never saw a healthcare provider for that. She      says the symptoms get worse at night when she is lying down and has had to      sleep with 2 pillows. She says she has started coughing at night which has      been interfering with her sleep. She denies palpitations, shortness      of breath, or nausea. 

PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2) 

Family history-non contributary   

Medications-amlodipine 10 mg po qd, dicyclomine 20 mg po, ibuprofen 600 mg po q 6 hr prn 

Social hx- 15 pack/year history of smoking, occasional alcohol use, denies vaping    

The health care provider diagnoses the patient with gastroesophageal reflux disease (GERD). 

Question:

The client asks the APRN what causes GERD. What is the APRN’s best response? 

             

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QUESTION 4

1. A 34-year-old construction worker presents to his Primary Care Provider      (PCP) with a chief complaint of passing foul smelling dark, tarry      stools. He stated the first episode occurred last week, but it      was only a small amount after he had eaten a dinner of beets and beef. The      episode today was accompanied by nausea, sweating, and weakness. He states      he has had some mid epigastric pain for several weeks and has been taking      OTC antacids. The most likely diagnosis is upper GI bleed which won’t be      confirmed until further endoscopic procedures are performed.

Question:

What factors can contribute to an upper GI bleed? 

             

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QUESTION 5

1. A 64-year-old steel worker presents to his Primary Care      Provider (PCP) with a chief complaint of passing bright red blood      when he had a bowel movement that morning. He stated the first episode      occurred last week, but it was only a small amount after he had eaten a      dinner of beets and beef. The episode today was accompanied by nausea,      sweating, and weakness. He states he has had some left lower      quadrant pain for several weeks but described it as “coming and      going”. He says he has had a fever and abdominal cramps that have      worsened this morning. The likely diagnosis is lower GI bleed secondary to      diverticulitis.

Question:

What can cause diverticulitis in the lower GI tract? 

             

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QUESTION 6

1. A      48-year-old man presents to his gastroenterologist for increasing      abdominal girth and increasing jaundice. He has a long history of      alcoholic cirrhosis and has multiple admissions for encephalopathy      and GI bleeding from esophageal varices. He has been diagnosed with portal      hypertension and tells the APRN that he was told he had chronic,      non-curable cirrhosis.    

Question:

How does cirrhosis cause portal hypertension? 

             

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QUESTION 7

1. A 48-year-old man presents to his gastroenterologist for      increasing abdominal girth and increasing jaundice. He has a long history      of alcoholic cirrhosis and has multiple admissions for encephalopathy and      GI bleeding from esophageal varices. He has been diagnosed with portal      hypertension. The increased abdominal girth has been progressive, and he      says it is getting hard to breathe. The APRN reviews his last      laboratory data and notes that the total protein is 4.6 gm/dl      and the albumin is 2.9 g/dl. Upon exam, he has icteric sclera,      jaundice, and abdominal spider angiomas. There is a significant fluid wave      when percussed. The APRN tells the patient that he has      ascites.  

Question:

Discuss how ascites develops as a result of portal hypertension. 

             

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QUESTION 8

1. A 45-year-old man      with known alcoholic cirrhosis, portal hypertension, and ascites is      brought to the ED by his family due to increasing confusion. The family      states that he had been stumbling for several days but had not      fallen. The family also noted that he had been “flapping his hands” as      well. Labs in the ED reveal Hgb 9.4 g/dl, Hct 28.0 %, ammonia      (NH3) level is 159 μmol/L. The APRN informs      the family that the patient has developed hepatic encephalopathy      (HE). 

Question:

Explain how hepatic encephalopathy develops in patients with cirrhosis of the liver.

             

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QUESTION 9

1. A 65-year-old      man with a history of atrial fibrillation presents to his PCP’s      office 2 months after suffering from a myocardial      infarction.  He declined anticoagulation due to fear he would      bleed to death. He has had sudden-onset, moderately      severe diffuse abdominal pain that began 18 hours ago. He has been      vomiting, and he has had several episodes of diarrhea, the last      of which was bloody. He has a fever of 100.9 ˚ F. CBC reveals WBC of      15,000/mm3. 

Question:

What is the most likely mechanism behind his current symptoms?  

             

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QUESTION 10

1. A 46-year-old Caucasian female presents to the PCP’s office      with a chief complaint of severe, intermittent right upper quadrant pain      for the last 3 days. The pain is described as sharp and has occurred      after eating french fries and cheeseburgers and radiates to      her right shoulder. She has had a few episodes of vomiting “green stuff”.      States had fever and chills last night which precipitated her trip to the      office. She also had some dark orange urine, but she thought she was      dehydrated.  

Physical exam: slightly obese female with icteric sclera as well as generalized jaundice. Temp 101˚F, pulse 108, respirations 18. Abdominal exam revealed rounded abdomen with slightly hypoactive bowel sounds. + rebound tenderness on palpation of right upper quadrant. No tenderness or rebound in epigastrium or other quadrants. Labs demonstrate elevated WBC, elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Serum bilirubin (indirect) 2.5 mg/dl.  Abdominal ultrasound demonstrated enlarged gall bladder, dilated common bile duct and multiple stones in the bile duct. The APRN diagnoses the patient with acute cholecystitis and refers her to the ED for further treatment. 

Question 1 of 2:

Describe how gallstones are formed and why they caused the symptoms that the patient presented with. 

             

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QUESTION 11

1. A 46-year-old Caucasian female presents to the PCP’s office      with a chief complaint of severe, intermittent right upper quadrant pain      for the last 3 days. The pain is described as sharp and has occurred      after eating french fries and cheeseburgers and radiates to      her right shoulder. She has had a few episodes of vomiting “green stuff”.      States had fever and chills last night which precipitated her trip to the      office. She also had some dark orange urine, but she thought she was      dehydrated.  

Physical exam: slightly obese female with icteric sclera as well as generalized jaundice. Temp 101˚F, pulse 108, respirations 18. Abdominal exam revealed rounded abdomen with slightly hypoactive bowel sounds. + rebound tenderness on palpation of right upper quadrant. No tenderness or rebound in epigastrium or other quadrants. Labs demonstrate elevated WBC, elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Serum bilirubin (indirect) 2.5 mg/dl.  Abdominal ultrasound demonstrated enlarged gall bladder, dilated common bile duct and multiple stones in the bile duct. The APRN diagnoses the patient with acute cholecystitis and refers her to the ED for further treatment. 

Question 2 of 2:

Explain how the patient became jaundiced.

             

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QUESTION 12

1. Ruth is a 49-year-old office worker who presents to the clinic      with a chief complaint of abdominal pain x 2 days. The pain has      significantly increased over the past 6 hours and is now accompanied by      nausea and vomiting. The pain is described as “sharp and boring” in      mid epigastrum and radiates to the back. Ruth admits      to a long history of alcohol use, and often drinks up to a fifth of vodka      every day.  

Physical Exam: 

Temp 102.2F, BP 90/60, respirations 22. Pulse Oximetry 92% on room air. 

General: thin, pale white female in obvious pain and leaning forward. Moving around on exam table and unable to sit quietly. 

CV-tachycardic. RRR without gallops, rubs, clicks or murmurs 

Resp-decreased breath sounds in both bases with poor inspiratory effort 

Abd- epigastric guarding with tenderness. No rebound tenderness. Negative Cullen’s and + Turner’s signs observed.  Hypoactive bowel sounds x 2 upper quadrants, and no bowel sounds heard in both lower quadrants.  

The APRN makes a tentative diagnosis of acute pancreatitis based on history and physical exam and has the patient transferred to the ER where laboratory and radiographic exams reveal acute pancreatitis. 

Question:

Explain how pancreatitis develops and the role alcohol played in this patient’s case.

             

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QUESTION 13

1. A 23-year-old bisexual man with a history      of intravenous drug abuse presents to the clinic with a chief complaint      of fever, fatigue, loss of appetite, nausea, vomiting, abdominal      pain, and dark urine. He says the symptoms started about a month ago      and have gotten steadily worse. He admits to reusing needles and had      unprotected sexual relations with a man “a couple months ago”.  

PMH-noncontributory.   

Social/family history-works occasionally as a night clerk in a hotel. Parents without illnesses. Admits to bisexual sexual relations and intravenous heroin use. He has refused drug rehabilitation. 3 year/pack history of tobacco but denies vaping.  

Physical exam unremarkable except for palpable liver edge 2 fingerbreadths below costal margin. No ascites or jaundice appreciated.  

The APRN suspects the patient has Hepatitis B given the strong history of risk factors

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