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2023 NR507 MIDTERM CHAMBERLAIN Verified
Answers (Graded A+ )
1
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What is the most common cause of nausea and vomiting? –
CORRECT ANSWERS Acute Gastroenteritis (AGE)
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May also include fatigue, malaise, anorexia, tenesmus and borborygmus
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How is the severity of AGE gauged? - CORRECT ANSWERS Dehydration
secondary to profuse watery diarrhea, fever greater than 101ºF (38
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may also help protect against a future attack by the
same pathogen
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Onset of N/V begin within 6 hours after exposure
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What is the reason? - CORRECT ANSWERS Hypoalbuminemia
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- CORRECT
ANSWERS True
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What is the most common viral pathogen causing AGE in adults? - CORRECT
ANSWERS Norovirus
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This has been greatly reduced since the
introduction of the rotavirus vaccine
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T or F: Stool studies are indicated in the absence of bloody diarrhea or systemic
disease - CORRECT ANSWERS False
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When are stool studies warranted? - CORRECT ANSWERS Severe or
prolonged diarrhea, a fever > 38
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coli
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What should the clinician do if the patient develops diarrhea after initiation of
completion of antibiotic therapy? - CORRECT ANSWERS Test for C
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Sports drinks aren't as effective as
specific electrolyte replenishing drinks
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At what point should a patient be referred to the hospital for dehydration? CORRECT ANSWERS Signs of hypovolemia such as hypotension, tachycardia,
pallor, and poor skin turgor
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T of F: Empiric antimicrobial therapy is recommended for patients with severe
diarrhea suspected form traveling
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Bactrim,
Ciprofloxacin, Norfloxacin, Floxacin
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T or F: Antibiotic prophylaxis for patients traveling to high-risk areas is
appropriate
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How effective is antibiotic prophylaxis for patients traveling to high-risk areas? CORRECT ANSWERS 90% effective
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What is an appropriate symptomatic treatment for patients < 65 years or age with
significant vomiting? - CORRECT ANSWERS Two-day course of Zofran or
Phenergan
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What is the best way to prevent AGE? - CORRECT ANSWERS Hand washing
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T or F: Kids can attend daycare with infectious diarrhea as long as they're
separated from other children
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If pain is present in the left lower quadrant, what might be the etiology related to
bowel disorders? - CORRECT ANSWERS Diverticulitis, IBS, IBD, Constipation,
and Infectious Colitis
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If pain is present in the left upper quadrant, what might be the etiology related to
bowel disorders? - CORRECT ANSWERS Stomach ulcers, pancreatitis, and
gastritis
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If pain is present in the right upper quadrant, what might be the etiology related to
bowel disorders? - CORRECT ANSWERS Gall bladder, hepatitis, and
pancreatitis
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T or F: IBS is a disorder of bowel function in the absence of an atomic
abnormality
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What are common symptoms of IBS? - CORRECT ANSWERS Changes in
bowel habits such as diarrhea (IBS-D), constipation (IBS-C), abdominal pain,
bloating, rectal urgency with diarrhea
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What are some extra-intestinal (outside the intestines) symptoms of IBS? CORRECT ANSWERS Sexual dysfunction, loss of libido, dyspareunia, muscle
aches and pains, fatigue, fibromyalgia, headaches, back pain, urinary urgency,
urinary hesitation, or bladder spasms
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T or F: IBS results in serious medical consequences - CORRECT ANSWERS
False, prognosis for IBS is excellent
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T or F: IBS is a risk factor for IBD (Crohn's and UC) and colon cancer
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What are the two most common types of bowel disorders under the Inflammatory
Bowel Disease (IBD) umbrella? - CORRECT ANSWERS Ulcerative Colitis (UC)
and Crohn's Disease
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T or F: UC extends into the small intestine
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48
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CORRECT ANSWERS True

49
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What are these areas
referred to as? - CORRECT ANSWERS Skipped lesions
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Subsequently, those with a certain genetic predisposition may
produce antibodies that chronically attack the intestine (autoimmune)
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- CORRECT ANSWERS
Disordered sensation or abnormal function of the small or large intestine
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What is the most consistent characteristics of IBS? - CORRECT ANSWERS
Alteration in bowel habits alternating
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Painless
diarrhea may occur
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What are the three most common areas of abdominal tenderness for patients
with suspected IBS? - CORRECT ANSWERS LLQ, umbilicus, or epigastrium
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T or F: The physical exam for patients with suspected IBS is usually abnormal CORRECT ANSWERS False: It's usually normal because there is no anatomical
abnormality behind this condition
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T or F: Digital rectal exams are usually normal in patients with suspected IBS but
may exacerbate symptoms
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T or F: Extensive testing such as thyroid testing, abdominal imaging, and stool
studies are indicated in patients with suspected IBS - CORRECT ANSWERS
False: Start with basic labs such as CBC and ESR, although elevated ESR and
leukocytosis is typically seen with IBD, not IBS
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T or F: Colonoscopy and barium enema are abnormal in a patient with suspected
IBS - CORRECT ANSWERS False: Those tests would be normal because there
is no anatomical abnormality behind this condition
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What are 4 main points of diagnosis for patients with suspected IBS? CORRECT ANSWERS 1
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2
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Heightened sensation in bowel activity

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- CORRECT
ANSWERS False
What is the first step to treating a newly diagnosed IBS patient? - CORRECT
ANSWERS Determine whether they are IBS-D, IBS-C, or IBS-M
What are the 4 main points of IBS treatment? - CORRECT ANSWERS 1
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Education
3
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Supportive interventions: i
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reduce stress
T of F: There is proven treatment for IBS - CORRECT ANSWERS False
At what severity are pharmacological measures taken in patients with IBS? Mild,
moderate, or severe? - CORRECT ANSWERS Moderate to severe
What is the first-line treatment for IBS-C? - CORRECT ANSWERS 1
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Exercise
3
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- CORRECT ANSWERS False
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What stimulant laxatives can be used for IBD-D on a short-term basis? And if these fail?
- CORRECT ANSWERS 1
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2
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- CORRECT ANSWERS True
T or F: Tricyclics antidepressants and SSRIs have shown to have favorable outcomes in
patients with IBS - CORRECT ANSWERS True
T or F: APRNs should not be managing patients with IBS and should immediately refer
to a gastroenterologist - CORRECT ANSWERS False
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If these fail, they should then be referred
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Fever
2
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Leukocytosis
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CORRECT ANSWERS True
Crohn's Disease represents an abnormality in intestinal immune response
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Causes fibrosis which thickens the bowel wall
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T or F: Patients with Crohn's are at higher risk than the general population for
developing colon cancer
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What type of tissue damage occurs ulcerative colitis (UC)? - CORRECT ANSWERS 1
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2
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What happens to the mucosa in ulcerative colitis (UC)? - CORRECT ANSWERS It
becomes edematous and thickened, narrowing the lumen of the colon
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Abdominal cramping
2
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Anorexia and weight loss
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RLQ pain or mass
What are the possible components of the stool that show up in patients with Crohn's? CORRECT ANSWERS 1
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Mucus
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T of R: Crohn's is characterized by periods of acute exacerbation alternating with
complete remission
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What are the most common presenting symptoms of ulcerative colitis (UC)? CORRECT ANSWERS 1
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Abdominal cramping
3
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- CORRECT ANSWERS True
How many bowel movements do patients with mild UC report on a daily basis? CORRECT ANSWERS Up to 4 loose BMs associated with abdominal cramps that are
relieved with defecation
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How many bowel movements do patients with severe UC report on a daily basis? CORRECT ANSWERS 6-10 loose BMs per day, abdominal tenderness, and symptoms
of anemia, hypovolemia, and impaired nutrition
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What is the severity of Crohn's based on? - CORRECT ANSWERS Level of
inflammation and intestinal lumen obstruction caused by fibrosis
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Tenderness in the LLQ or across the entire abdomen
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Abdominal distention
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What is an important first step when considering ulcerative colitis as a diagnosis? CORRECT ANSWERS Excluding an infectious cause for the colitis

What tests are used to differentiate UC from CD? - CORRECT ANSWERS 1
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Colonoscopy
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CT
T or F: IBD treatment can be very complex and in generally managed by a
gastroenterologist
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T or F: Antidiarrheals should be used for acute UC and toxic megacolon
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If 5-ASA drugs fail to help treat IBD, what is the next line of drug therapy? - CORRECT
ANSWERS Corticosteroid therapies such as prednisone or hydrocortisone and are very
effective in reducing inflammation
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Note: These drugs cause bone marrow suppression which
increased the risk of infection
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What disease is present when inflammatory changes within diverticula mucosa of the
intestines arises? - CORRECT ANSWERS Diverticular Disease
What does diverticular disease, or diverticulosis, look like upon examination of the
bowels? - CORRECT ANSWERS Small outpouchings or sacs in the wall of the colon
are present, usually at the location of weakened areas of the bowel wall where arterial
vessels perforate the colon
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- CORRECT ANSWERS True
Although diverticula con occur anywhere in the intestines, where is the most common
place for them to arise? - CORRECT ANSWERS Descending and sigmoid colon

How does diverticulosis differ from diverticulitis? - CORRECT ANSWERS The latter
occurs when the former becomes inflamed and subsequently has the potential to
rupture
Where does acute diverticulitis usually show up during an abdominal exam? CORRECT ANSWERS LLQ abdominal pain and tenderness
If a perforation of a diverticula occurs and is not isolated, signs and symptoms of
_________________ may be present
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think
rebound tenderness!
What are common signs and symptoms of diverticulitis? - CORRECT ANSWERS 1
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Fever
3
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N/V
T or F: Occult blood can usually be found in the presence of diverticulitis
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CBC: can show mild to moderate leukocytosis
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T or F: Abdominal x-rays should be obtained on all patients with suspected diverticulitis
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Which clinical test is very sensitive and accurate for definitive diagnosis of diverticulitis?
- CORRECT ANSWERS CT scan with oral and IV contrast
If evidence of diverticulitis is found on x-ray, what would be the next step? - CORRECT
ANSWERS Treat empirically, do NOT wait for confirmation with CT
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Idiopathic
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Tricyclics antidepressants
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Anticholinergics
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Antipsychotics
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Can be a symptom of colorectal cancer
How is constipation treated? - CORRECT ANSWERS 1
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Bulking agents: psyllium and methylcellulose
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They're softer and easier to pass
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Laxatives & stool softeners if diet changes aren't sufficient
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Personal history of CC or adenomatous polyps
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3
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A known family history of hereditary colorectal cancer syndromes such as familial
adenomatous polyposis or Lynch Syndrome (hereditary nonpolyposis colorectal
cancer)
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- CORRECT ANSWERS True
What are some red flag symptoms of colorectal cancer? - CORRECT ANSWERS 1
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Rectal bleeding
3
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New onset of severe diarrhea or constipation
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Loss of appetite
What are two possible functions of the appendix? - CORRECT ANSWERS 1
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Immune system role
What percentage of the populations experiences appendicitis at some point in their life?
- CORRECT ANSWERS 10%

T or F: Appendectomy is the most common surgery of the abdomen
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Fecalith or "poop rock"
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Pinworm infection
4
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How does the appendix become inflamed and what nerves does it affect? - CORRECT
ANSWERS Mucus is continually produced by intestinal tissue
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As it inflames, it pushes on the visceral nerve fibers causing abdominal
pain
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coli and Bacteroids fragilis multiply and
causes the immune system to respond
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RLQ pain --> McBurney's Point
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N/V
What is the pathology of appendicitis from onset to peritonitis? - CORRECT ANSWERS
Increasing inflammation causes blood vessels to become compressed --> ischemia of
the appendiceal tissue --> tissues necrosis --> bacterial invasion of appendiceal tissue
and pus formation--> appendiceal tissue rupture --> peritonitis with rebound tenderness
What are two possible complications of a ruptured appendix beyond peritonitis? CORRECT ANSWERS 1
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Subphrenic abcess
What treatment is usually performed when appendicitis is present? - CORRECT
ANSWERS Appendectomy + Antibiotics
Describe acute pancreatitis in one sentence
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What are the main endocrine functions of the pancreas? - CORRECT ANSWERS
Alpha and beta cells secret hormones into the bloodstream, namely glucagon and
insulin, respectively
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How does the pancreas protect itself from its own enzymes? - CORRECT ANSWERS
By producing inactive forms of enzymes called proenzymes, known more specifically as
zymogens
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Where is zymogen stored to keep it away from sensitive tissues? - CORRECT
ANSWERS In vesicles called zymogen granules
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How are zymogens used to digest food? - CORRECT ANSWERS They are secreted
into the pancreatic duct and enter the duodenum where they are activated by the
protease trypsin
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It is activated by enteropepidase
which is produced in the duodenum
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What is the results of trypsinogen and other zymogens becoming active prematurely? CORRECT ANSWERS Acute Pancreatitis
Acute pancreatitis may be a result from what two physical circumstances? - CORRECT
ANSWERS 1
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Impaired secretion of proenzymes
What are the leading causes of impaired secretion of proenzymes from the pancreas? CORRECT ANSWERS 1
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Gallstones
How does alcohol induce acute pancreatitis? - CORRECT ANSWERS 1
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Simultaneously, it decreases fluid and
bicarbonate in the ducts of the pancreas
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2
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Membrane
trafficking* becomes chaotic
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This brings
trypsinogen into contact with lysosomal digestive enzymes
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3
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Neutrophils arrive and release superoxide and proteases which contributes to the
problem
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High alcohol consumption and oxidative metabolism of alcohol produces reactive
oxygen species which may overwhelm cellular defenses
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Membrane trafficking uses membrane-bound vesicles as transport
intermediaries
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This results in much the same results as alcohol induced acute
pancreatitis (because of the plug)
Fill out the acronym "I GET SMASHED" in order to show the varied causes of acute
pancreatitis
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e
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D: drugs --> sulfa, reverse transcriptase inhibitors and protease inhibitors
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What happens when lipases are activated in the pancreas as a result of the
inflammatory process? - CORRECT ANSWERS They can destroy the fat surrounding
the pancreas known as the peripancreatic fat
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One complication of acute pancreatitis is a pseudocyst
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Symptoms: abdominal pain, loss of appetite, palpable
mass, serum amylase/lipase/bilirubin elevation
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They can become infected, often by E
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How is a pancreatic pseudocyst distinguished from a pancreatic abscess since they
present similarly in symptoms and imaging? - CORRECT ANSWERS 1
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2
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Immobile tympanic membrane
Weber and Rinne tests in patients with eustachian tube disorder (ETD) will show
___________ hearing loss on the affected side
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cold, AOM, AR,
T o F: Holding nose and blowing out is an effective way to help clear and equalize the
eustachian tube
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Sometimes tympanostomy tubes are placed to relieve pressure
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What
causes this sensation? - CORRECT ANSWERS 1
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Poorly understood, might be from chronic noise exposure that may damage the cilia
and auditory hair cells or spontaneous activity in individual auditory nerve fibers
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Age and
hearing loss
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Metabolic disorders
4
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Trauma
6
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Vascular and neurogenic causes
What is the differential diagnosis for tinnitus? - CORRECT ANSWERS 1
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Acoustic neuroma
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Otosclerosis
5
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Salicylate overdose
What should be included in the physical exam and what tests should be used when a
patient presents with tinnitus? - CORRECT ANSWERS 1
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Weber
3
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Pneumatic otoscopy
What labs should be drawn when a patient presents with idiopathic tinnitus? CORRECT ANSWERS TSH, CBC, B12, Lipids
Ménière's disease is a sensory disorder of the _____________ and _____________
and is idiopathic
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Genetics may play a role
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What is the differential diagnosis for Ménière's disease? - CORRECT ANSWERS 1
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Vesibular neuritis
3
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Acoustic neuroma
5
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Acute vestibular labyrinthitis
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Diuretics often used to reduce lymphatic pressure and
volume
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- CORRECT ANSWERS False, but there is a
vaccination
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Starts on head/face or behind the ears and then
spreads
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drug reaction
2
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other viral exanthem
What bloodwork should be drawn for suspected rubeola? - CORRECT ANSWERS IgG,
IgM, RT-PCR
T or F: Rubeola is not a reportable disease - CORRECT ANSWERS False, must be
reported to the CDC
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When is a person with rubeola contagious? - CORRECT ANSWERS 4 days before
onset and 4 days after

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