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NUR 915 Final Exam GI - GU With Complete Solution
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NUR 915 Final Exam GI - GUWith Complete Solution
Common age presentation of appendicitis. - ANSWER 15-30
Describe the pain commonly associated with appendicitis. - ANSWER
Peri-umbilical, diffuse, dull, and achy pain that intensifies becoming sharp
and localized to the RLQ over 24 hours.
Diffuse abdominal pain generally indicates... - ANSWER inflammation
Recurrent, acute abdominal pain generally indicates... - ANSWER a flare up of
a chronic condition such as diverticulitis, IBS, chronic pancreatitis, etc
Severe abdominal pain that starts within 24 hours of presentation generally
indicates the need for and is relieved by... - ANSWER Surgery
When a patient complians of abdominal pain and they are "afraid to eat",
what can you generally assume is cause of the pain? - ANSWER GI tract
Other than abdominal pain, what other symptoms would be a normal part of
a patient's presentation with appendicitis? - ANSWER Anorexia, N/V/D, low
grade fever, slightly elevated WBCs
Name 4 physical exam findings that could be present in the patient with
appendicitis. - ANSWER "PROM"
Psoas sign - Rovsing sign - Obturator sign - McBurney point tenderness
What is the difference between the performing the psoas sign and the
obturator sign for appendicitis? - ANSWER Psoas sign: lay on left hip; extend
,right leg backwards. If pain is elicited = positive.
Obturator sign: pt flat on back, rt knee flexed, passively bring rt foot away
from body. If pain is elicited = positive.
What is the differrence between McBurney point tenderness and Rovsing's
sign? - ANSWER McBurney point tenderness = RLQ pain with palpation;
rebound or guarding pain may be present in a positive test.
Rovsing's sign = Pain in the RLQ when LLQ is palpated.
In addition to the physical exam tests, what else elicits appencitis pain? -
ANSWER Walking or movement, coughing
What labs should be ordered if you suspect appendicitis? - ANSWER
Preganacy test, CBC, CRP
Discuss the use of radiology in the diagnosis and treatment of appendicitis. -
ANSWER US is first line to confirm suspected appendicitis and should be
used if available.
However, CT abd/pelvis is more accurate to confirm suspisions and required
prior to surgery.
Consider time, availability, radiation exposure, and management strategy
when selecting modality.
You confirm your patient has appendicitis with an in-office ultrasound and
tell them to prepare to go to the ER. What education can you provide so they
know what to expect? - ANSWER Let them know the ER will be able to give
MSO4 for pain control. They will do a CT to confirm what was seen on the
in-office ultrasound. Antibiotics will be given prior to surgery and surgery
will be within the next 24 hours.
,Your patient calls the office after leaving the hospital following
appendectomy. What can you tell them about recovery and returning to
school? - ANSWER Support the abdomen with a pillow and cough/deep
breath several times per day.
Finish all antibiotics.
Avoid strenuous activity for 3-5 days if it was laproscopic surgery and 10-14
days if open abd surgery.
Return to school in one week.
How does presentation of appendicitis change in a child? - ANSWER "Classic
presentation" (periumbilical pain moving to RLQ with anorexia, N/V/D and
rebound tenderness and guarding) is the same in children as it is in adults,
however, only about 50% of kids present "classicly".
Name some risk factors for the development of diverticulitis. - ANSWER
Increasing age
Female
Obesity
Low dietary fiber intake.
High consumption of red meat.
Smoking
Sedentary lifestyle
Use of steroids/NSAIDs
Where would pain be expected in a diverticulitis flair? - ANSWER LLQ
, What symptoms, in addition to pain, does a patient with diverticulitis
typically present with? - ANSWER Fever, leukocytosis, elevated ESR. No
flatus, no diarrhea. Change in bowel habits - may contain blood or mucous.
What imaging should be done to confirm the diagnosis if diverticulitis is
suspected? - ANSWER CT abd/pelvis with contrast
Your 50 year old patient has recovered from a recent, complicated, newly
diagnosed diverticulitis flair. What testing should be discussed and what
should be considered in regards to the timing of that test? - ANSWER
Colonoscopy.
Should be completed 4-6 weeks after resolution of symptoms after an initial
episode of complicated diverticulitis and if they havent had one in the past 3
years.
(Pts should have another reason - such as age - to obtain colonoscopy.
Uncomplicated diverticulitis does not warrant colonscopy.)
What patient education should be given to a patient experiencing a
diverticulitis flair? - ANSWER Eat a high fiber diet and drink lots of fluids
Get regular exercise
When is it appropriate to refer a patient with diverticulitis to a GI specialist? -
ANSWER After 3 episodes
How long does it take a diverticulitis flair to improve? - ANSWER It should
improve after 2-3 days of treatment (bowel rest, increased hydration)
What "extraesophogeal" symptoms are common in GERD? - ANSWER
hoarseness
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