NR 511 Midterm Exam Q & A Differential Diagnosis & Primary Care P... file:///C:/Users/HP/Desktop/New%20folder%20(2)/NR%20511%20M
NR511 Midterm Exam Q & A Differential
Diagnosis & Primary Care Practicum
1. Appendicitis: -Risk: 10-30yo, men, low fiber, high fat/sugar/carb diet
-S: Mild to severe colicky epigastric or periumbilical pain, but in 24 hours, movesto
RLQ and exacerbated by walking or coughing.May radiate to testicles. maybe
vomiting, sensation of constipation, but diarrhea present. low grade temp. chills &
sudden cessation of pain=perforation
-O: HTN/Tachy, flex R knee up to relieve pain when recumbent, guarding, rebound
tenderness.
-Dx: + Rovsing, Psoas, Obturator, McBurney's sign
-Tx: Appendectomy
-Edu: avoid lifting for 2 weeks.
2. Celiac Disease: -Risk:family hx, downs syndrome, HLA-DQ2(or 8), turners syn-
drome, type 2 DM or thyroiditis
-S:asymptomatic OR diarrhea, wt loss, dyspepsia, flatulence, fatigue, joint pain,
depressed mood, amenorrhea, difficulty getting pregnant, early menopause
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,NR 511 Midterm Exam Q & A Differential Diagnosis & Primary Care P... file:///C:/Users/HP/Desktop/New%20folder%20(2)/NR%20511%20M
-O:may be normal, OR muscle wasting, pallow, reduced sub q fat, ataxia, peripheral
neuropathy
-Dx: Serologic testing for anti-tTG IgA antibodies, Total IgA, Upper GI scope (look at
damage). or no Dx- just try diet changes
-Tx: gluten free diet
3. cholelithiasis (gallstones): -Risk: Female, obese, pregnant, incr age, drug in-
duced, rapid wt loss, spinal cord injury, DM, Sickle cell anemia. Pigmented stones:
hemolytic disease, icr age, hyperalimentation, cirrhosis, biliary stasis
-S:indigestion, n/v, colicky-type pain, RUQ or epigastric pain, referred pain to middle
back, r shoulder, or infrascapular area, pain incr by movement (breathing)
-O: + murphy's sign (hold deep breath, palpate R subcostal area), low fever, mild
jaundice, edema, dim BS
-Dx: ABD ultrasound
-Tx: low fat diet, cholecystectomy, lithotripsy
-Edu:wt loss, avoid fatty food, avoid OCs and estrogen
4. Crohn's disease: -Risk: family hx, smoking, genetics, early adulthood
-S:Abd cramping, tenderness, fever, anorexia, wt loss, flatulence, RLQ pain or mass.Semi
liquid stools (may have blood), steatorrhea, gradual onset
-O: LLQ or entire abd tenderness, duarding, distentionanal gissures, skin tags
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,NR 511 Midterm Exam Q & A Differential Diagnosis & Primary Care P... file:///C:/Users/HP/Desktop/New%20folder%20(2)/NR%20511%20M
-Dx:stool analysis & culture (to r/o other cause), barium upper GI series (aphthous
and linear ulcers. Late- "string sign"), Colonoscopy, Ct scan
-Tx: sulfasalazine (but not beneficial). glucocorticoids (prednisone), metronidazole,
immunosuppressants
-Edu: low-residue diet when obstructive symptoms present, avoid all fiber. eat what
they want when no attack
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,NR 511 Midterm Exam Q & A Differential Diagnosis & Primary Care P... file:///C:/Users/HP/Desktop/New%20folder%20(2)/NR%20511%20M
5. Diverticulitis: -risk: >40yo, low fiber diet, chronic constipation, straining, irregular
BMs, diverticula in the colon
-S: Fever, chills, tachycardia, LLQ pain,n/v,anorexia, pain is relieved with BM, con-
stipation & diarrhea, abd tenderness & distention. **may present with bleeding not
associated with pain**
-O: LLQ pain, firm, fixed mass in the area of the diverticula. rebound tenderness,
guarding, tender rectum, + blood in BM
-dx:mild leukocytosis, low H&H, ABD X-ray if perforation or peritonitis suspected.CT
scan most accurate
-tx: no routine ATB (but augmentin or metronidazole when needed),
-edu: high fiber diet
6. Peptic Ulcer Disease: -risk: H.pylori, NSAIDs, ASA, stress, 55-70yo, blood type,
genetics, smoking, COPD, cirrhosis, renal failure & transplant, caffeine, ETOH, spicy
foods
-S: epigastric burning or gnawing pain relieved by food or antacids. nocturnal pain,
-O:not useful. epigastric pain 2.5cm to the R of midline
-dx: CBC, BMP, urea breath test, stool test, EGD biopsy,
-tx: PPI (-prazole) 4-8 weeks. H2-RA x 8 weeks. Clarithromycin & amoxicillin or
metronidazole and a PPI BID x 14 days.
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