FNP2 Quiz 8 GI

  1. Sudden attacks of paroxysmal abdominal pain and severe loud crying that may persist for hours.
  2. Earliest sign of appendicitis.
    periumbilical pain
  3. s/s of appendicitis other than periumbilical pain.
    • child awakens with pain that peaks, then subsides and migrates to the RLQ
    • vomiting
    • low stool volume w/ mucus
    • evolves over 12 hours
  4. When may symptoms lessen w/ appendicitis?
    • following perforation
    • (also, child may be quiet b/c movement hurts)
  5. Most common cause of intestinal obstruction in children between 3 months and 6 yrs of age.
  6. Most common age and gender for intussusception occurence.
    • younger than 2 yrs
    • male
  7. What is the "rule of threes"?
    • crying for more than 3 hrs, more than 3 days/week, & more than 3 weeks
    • refers to Colic
  8. Three s/s of Colic (other than crying).
    • distended abdomen
    • drawn up legs
    • clenched hands
  9. What is the first thing you should check with suspicion of colic?
    check stool for occult blood to r/o diary allergy
  10. Most common cause of intestinal obstruction b/w 3 mos-6 yrs old.
  11. Intermittent colicky pain (spasms), with vomiting q 5-30 min.
  12. What will stools be like with intussusception?
    • currant jelly
    • bloody w/ mucus
  13. Sausage-like mass in URQ with distended, tender abdomen in young child.
  14. Functional abdominal pain must be at least _____ per week for at least _______ prior to dx.
    • once
    • 2 months
  15. Age of kids who are typically dx w/ functional abdominal pain
    < 2 yrs
  16. Two important questions to ask to r/o functional abdominal pain.
    • Nighhttime awakenings?
    • Repetitive emesis?
  17. Where is the pain with functional abdominal pain?
  18. At what age is pyloric stenosis typically dx?
    3 weeks
  19. What imbalances can occur w/ pyloric stenosis?
    • hypochloremia
    • metabolic acidosis
  20. What might you palpate with pyloric stenosis?
    olive shaped mass
  21. What race is pyloric stenosis most common?
  22. Management of pyloric stenosis.
    • send to radiology for upper GI
    • surgical repair
  23. Other name for Hirschsprung's Disease.
    congenital aganglionic megacolon
  24. What else needs to be done with a dx of Hirschsprung's?
    cardiac echo
  25. Most common cause of lower intestinal obstruction in babies.
    Hirschsprung's Disease
  26. Suspect _________ if no meconium w/in first 48 hours of life.
    Hirschsprung's Disease
  27. Generally no intervention is needed if a foreign body has been swallowed and what? Unless what?
    • it is in stomach or intestines & asymptomatic
    • no passage w/in two weeks; or it was a battery
  28. A swallowed foreign body should be removed if it has been in the esophagus for _____ or small intestine for ________.
    • > 3 hrs
    • > 5 days
  29. Failure to thrive, food refusal, vomiting, epigastric pain, PPIs don't work, can happen in kids or adults. What is it and what is the tx?
    • eosinophilic esophagitis
    • id food allergies, work w/ allergist
    • consider amino acid based formula
    • inhaled steroids swallowed
  30. Abrupt onset of abdominal pain is < ______.
    48 hours
  31. Severe pain, very still and ill.
    • peritonitis or appendicitis
    • emergency
  32. Why would you check the eyes & skin with abdominal pain?
    • pallor (anemia, GI bleed)
    • jaundice
  33. Why would you do a rectal exam with c/o abdominal pain?
    anterior wall tenderness can mean peritonitis or other emergency
  34. What are some red flags for abdominal pain?
    • awaken from sleep
    • pain > 6 hrs, change from original pattern
    • syncope, vaginal or GI bleeding
    • rebound tenderness, diminished BS
    • chest or back pain
  35. First signs of appendicitis in adults.
    • anorexia & pain
    • pain starts epigastric or periumbilical then
    • RLQ w/ n & v
  36. Six F's for cholelithiasis.
    • Fair
    • Fat
    • Female
    • Fertile
    • Forty
    • Flatulant
  37. Who is at higher risk for cholelithiasis (other than 6 f's)?
    • women on OCs
    • pts taking thiazides
    • obese pregnant
    • high fat diet
    • Native Americans
  38. Where and when is the pain with a biliary stone?
    • RUQ, radiates to scapula
    • ~1 hr after meals, lasts up to 6 hrs
    • if > 6hrs, can be infection
  39. Positive Murphy's sign indicates?
  40. RF for diverticulosis.
    • low fiber diet, red meat, processed foods
    • obesity
    • smoking
  41. What can be a cause of acute pancreatitis in females?
  42. What can be a typical cause of acute pancreatitis in males?
    heavy alcohol abuse
  43. How can acute pancreatitis lead to atelectasis?
    b/c pain is so severe, pt shallow breaths
  44. Two enzymes drawn with suspected acute pancreatitis. Which is more specific?
    • amylase & lipase
    • lipase
  45. Why would you do a chest x-ray with suspected acute pancreatitis?
    to r/o pna
  46. What three things does IBD encompass?
    • ulcerative colitis
    • Crohn's
    • Colitis
  47. Typical age of onset for IBD.
    15-25 yrs
  48. Colonoscopy or sigmoidoscopy for Crohns and colitis?
    • Crohns = colonoscopy
    • Colitis = sigmoidoscopy (avoid colonoscopy!!)
  49. Tx for UC and CD can include Azo-compounds. If so, what else should they be on and why?
    Folic acid b/c they interfere w/ absorption
  50. What meds should be avoided with ulcerative colitis?
    • anti-diarrheals
    • NSAIDs
    • anticholinergics
    • opioids
  51. Avoid what kind of drugs with diarrhea?
  52. Stool studies should be done if diarrhea lasts how long?
    >14 days? or >7?
  53. A full workup for diarrhea should be done when?
    • fever >102
    • > 6 stools in 24 hours
    • elderly or immunocompromised
    • diarrhea w/in 3 days of hospitalization
    • bloody or profuse watery stool
  54. Most common pathogen for travelers diarrhea.
    Enterotoxigenic e. coli
  55. Increased risk of travelers diarrhea when traveling where?
    • Latin America
    • Africa
    • Middle East
    • Asia
  56. Who is at higher risk for travelers diarrhea?
    • IBS
    • DM
    • taking H2 blockers or antacids
  57. What defines travelers diarrhea?
    > 10 loose stools in 8 hrs
  58. If a pt with diarrhea is on abx and not doing better, what should you do?
    Check for parasitic infections
  59. Constipation is less than _______ in _______.
    • 3
    • one week
  60. What two endocrine DO can cause constipation?
    • hypothyroidism
    • hyperparathyroidism
  61. When is it not recommended to introduce a high fiber diet to treat constipation?
    pts who have had a life long hx & have slow transit
  62. What laxatives are recommended for constipation?
    • Dulcolax
    • Miralax
    • Lactulose
  63. What should pts with constipation NOT be using OTC? Why?
    • hyperosmolar saline meds
    • can cause extensive dehydration or
    • acute kidney injury or
    • worsen HF
  64. When should hyperosmolar saline meds especially be avoided?
    • over 55
    • take BP meds, NSAIDs, or diuretics
  65. A neuro-endocrine gut tumor that causes PUD.
    Zollinger-Ellison syndrome
  66. ______ used to be considered a RF for PUD but is not longer.
  67. Burning, nonradiating upper abdominal pain can be a sign of?
  68. Eating often relieves pain with this type of ulcer. What is typical age?
    • duodenal
    • 20-50
  69. _______ ulcers typically present with nausea & anorexia, and food worsens pain. Typical age?
    • Gastric
    • older patients
    • *elderly may be asymptomatic until perforation or GI bleed*
  70. _________ should never be mixed with NSAIDs or ASA and pose a risk for PUD; when combined they are high risk for what?
    • Corticosteroids
    • GI bleed
  71. PE for PUD should include any s/s of __________ in case of GI bleed or perforation.
  72. For PUD, if over _______ or _________, refer to endoscopy.
    • 55
    • new onset of symptoms or red flags
  73. For PUD and under 55 with no red flags, what should you do?
    test for H. pylori
  74. When might you get a false negative result for H. pylori?
    if pt has been on PPIs or abx in the last 2 wks
  75. Tx for H. pylori
    PPI or H2 blocker + two abx x 10 or more days
  76. After tx for H. pylori, pt tests neg on 4-week follow up. Then what?
    • Continue 4 weeks acid suppression
    • if doing better, continue for 2 more weeks
  77. If H.pylori negative for PUD, assume what is cause? How to treat?
    • NSAIDs
    • PPI or H2 blocker
  78. IF pos for H. pylori, when do you retest?
    four weeks after treatment
  79. Board-like rigid abdomen, low grade fever, s/s hypovolemia, absent BS.
    perforate peptic ulcer - call EMS
  80. Perforated peptic ulcers are more common in which type of ulcers?
  81. What are lower GI bleeds usually due to?
    • infectious colitis
    • IBS if < 50 yo
    • diverticular hemorrage if > 50 yo
  82. How long should you tx GERD with PPIs? Why not longer?
    • 8 weeks
    • to avoid rebound hypersecretion
  83. What are some safety concerns with PPIs, especially long-term use?
    • increased fracture risk, osteoporosis
    • decreased Mg++ absorption
    • pna
    • c-diff
  84. Criteria for functional abdominal pain.
    • All other things ruled out
    • at least once/week for at least 2 mos
  85. In malabsorption DO, ________ drops before ____.
    • weight
    • height
Card Set
FNP2 Quiz 8 GI