NURS 5463 Test 5 Questions And 100% Correct
Answers 100% Pass
Symptoms of retroperitoneal hemorrhage - Cullen's - periumbilical bruising; Grey
Turner'sbruising in flank area
In a pt > 40 yrs with acute pancreatitis - Consider pancreatic tumor
Pancreatitis DX -Must have 2/3 Characteristic abdominal pain, biochemical evidence of
pancreatitis with lipase or amylase elevation > 3 times upper limit of normal; And/or
Radiological evidence of pancreatitis on crosssectional imaging
Lab Diagnosis of Pancreatitis - Answer Lipase 99% Sensitive & Specific
Imaging Diagnosis of Pancreatitis - Answer MRI/MRCP: dedicated MR that evaluated the
biliary tract, detects necrosis
Management of Pancreatitis - Answer IV fluids=250-500 ml per hour within 12-24 hrs
Hydration goal in Pancreatitis - Answer decrease the BUN which is elevated with volume
depletion; NPO (if pt is having N/V),
Early feeding in Pancreatitis - Answer help protect the gut - mucosal barrier and reduce
bacterial translocation
Pancreatitis Diet Reccs - Answer low-fat solid diet ; nasojejunal
Pancreatitis Analgesia - Answer (opioids Dilaudid, Morphine)
,Gallstone pancreatitis - Answer urgent ERCP recommended
Hypertriglyceridemia-induced acute pancreatitis TX - Answer Insulin gtt rate of 0.1 to
0.3 Units/Kg/Hr, (activate Lipoprotein Lipase which help decrease the Trg) Insulin gtt
can be stopped once Trg < 500
Hypertriglyceridemia PO TX - Answer Apherisis when available, Fibrates (Gemfibrozil
600 mg BID)
Necrotising pancreatic infection-Consider pts with pancreatic or extrapancreatic
necrosis who deteriorate or fail to improve after 7-10 days of hospitalization.
ABX in Infected Necrosis- Carbapenems, Quinolones & Metronidazole may be useful in
delaying or totally avoiding intervention such as IR drainage
Complication of Infected Necrosis- ARDS, abdominal compartment syndrome, DIC,
Hypocalcemia, hyperglycemia, Fluid collections, Acute fluid collection; Pancreatic
pseudocyst
Ulcerative Colitis S/S - Answer Watery diarrhea, Bloody diarrhea, Frequent small BM
Crohn's Disease S/S - Answer No gross bleeding, Fistulas, Malnutrition, Severe oral
aphthous ulcers (Cancker Sores), Dysphagia/odynophagia, Fatigue, fevers
Differences between Crohn's and UC - Answer Cronhn's has fistulas whereas UC does
not
Ulcerative Colitis Mild - Answer < 4 stool per day with or without blood. Normal SED rate.
Mild cramping, tenesmus, even period of constipation.
,U C Moderate disease-Answer > 4 per day, mild anemia. Abdominal pain, low grade
temp, SED rate > 30 mm/hr
U C Severe disease-Answer > 6 per day. Severe cramping. + systemic symptoms > 37.5,
HR > 90, anemia, elevated SED rate 30.
Ulcerative Colitis Complications-Answer Fulminant colitis /Toxic Megacolon (colonic
diameter > 6cm or cecal diameter > 9cm), 10 stools per day or more
UC Perforation consequence of - Answer toxic megacolon.
Ulcerative Colitis Extra intestinal S/S - Answer Inflammation
UC labs and imaging - Answer Raised SED rate > 30 mm/hr, CRP can show severity of
the inflammation, Low albumin,
UC Imaging - Answer Double contrast barium enema may be normal in mild UC, CT scan
or MRI can show thickening of bowel wall
UC Colonoscopy findings - Answer Mucosa can have a petechiae, exudates, edema,
erosions, touch friability, and spontaneous bleeding.
Mild to Moderate UC stool - Answer C diff, WBC, O/P ~ Shigella, Salmonella, Yersinia
UC TX - Answer Topical 5-Aminosalicylic acid (5 ASA) suppositories/enema, Mesalamine
(Sulfasalazine), 6-MP & Azathiaprine if not responding to steroids, Infliximab refractory
to steroids
2 systems for Crohn's Disease - Answer Chrone's DX Activity Index CDAI < 150 &
Harvery-Bradshaw Index HBI < 4
, Asymptomatic remission - Answer CDAI < 150
Mild to Moderate CDAI 150-220 - Answer dehydration, toxicity abdominal pain, masses,
weight loss
Moderate to Severe CDAI 220-450 - Answer :fever, weight loss, abdominal pain, NV,
anemia
Severe-fulminant disease CDAI > 450 has symptoms - Answer continue despite steroids
or biologic (Infliximab, Adalimumab, Certolizumab)
Labs-CD Ans CBC ck for anemia, BMP, Elevated SED rate, CRP, Iron studies, B12
CD Primary dx- Ans Colonoscopy: cobblestone appearance
Before starting On Immunosuppressive therapy (biologics) must checks- Ans Viral labs
CD TX- Ans Sulfasalazine is effective; Oral Mesalamine should not be used in active
flare, Oral Steroids effective & used short-term
CD TX to spare steroid use- Ans Azathioprine & 6-Mercaptopurine
CD TX for steroid dependent pts Answer Methotraxate
Severe treatment of CD Answer Anti-TF agents = Infliximab, Adalimumab, Certolizumab
Pegol which are resistant to steroids
Severe/Fulminant CD Answer IV Corticosteroids, anti-TNF agents Infliximab,
Adalimumab, Certolizumab Pegol
Answers 100% Pass
Symptoms of retroperitoneal hemorrhage - Cullen's - periumbilical bruising; Grey
Turner'sbruising in flank area
In a pt > 40 yrs with acute pancreatitis - Consider pancreatic tumor
Pancreatitis DX -Must have 2/3 Characteristic abdominal pain, biochemical evidence of
pancreatitis with lipase or amylase elevation > 3 times upper limit of normal; And/or
Radiological evidence of pancreatitis on crosssectional imaging
Lab Diagnosis of Pancreatitis - Answer Lipase 99% Sensitive & Specific
Imaging Diagnosis of Pancreatitis - Answer MRI/MRCP: dedicated MR that evaluated the
biliary tract, detects necrosis
Management of Pancreatitis - Answer IV fluids=250-500 ml per hour within 12-24 hrs
Hydration goal in Pancreatitis - Answer decrease the BUN which is elevated with volume
depletion; NPO (if pt is having N/V),
Early feeding in Pancreatitis - Answer help protect the gut - mucosal barrier and reduce
bacterial translocation
Pancreatitis Diet Reccs - Answer low-fat solid diet ; nasojejunal
Pancreatitis Analgesia - Answer (opioids Dilaudid, Morphine)
,Gallstone pancreatitis - Answer urgent ERCP recommended
Hypertriglyceridemia-induced acute pancreatitis TX - Answer Insulin gtt rate of 0.1 to
0.3 Units/Kg/Hr, (activate Lipoprotein Lipase which help decrease the Trg) Insulin gtt
can be stopped once Trg < 500
Hypertriglyceridemia PO TX - Answer Apherisis when available, Fibrates (Gemfibrozil
600 mg BID)
Necrotising pancreatic infection-Consider pts with pancreatic or extrapancreatic
necrosis who deteriorate or fail to improve after 7-10 days of hospitalization.
ABX in Infected Necrosis- Carbapenems, Quinolones & Metronidazole may be useful in
delaying or totally avoiding intervention such as IR drainage
Complication of Infected Necrosis- ARDS, abdominal compartment syndrome, DIC,
Hypocalcemia, hyperglycemia, Fluid collections, Acute fluid collection; Pancreatic
pseudocyst
Ulcerative Colitis S/S - Answer Watery diarrhea, Bloody diarrhea, Frequent small BM
Crohn's Disease S/S - Answer No gross bleeding, Fistulas, Malnutrition, Severe oral
aphthous ulcers (Cancker Sores), Dysphagia/odynophagia, Fatigue, fevers
Differences between Crohn's and UC - Answer Cronhn's has fistulas whereas UC does
not
Ulcerative Colitis Mild - Answer < 4 stool per day with or without blood. Normal SED rate.
Mild cramping, tenesmus, even period of constipation.
,U C Moderate disease-Answer > 4 per day, mild anemia. Abdominal pain, low grade
temp, SED rate > 30 mm/hr
U C Severe disease-Answer > 6 per day. Severe cramping. + systemic symptoms > 37.5,
HR > 90, anemia, elevated SED rate 30.
Ulcerative Colitis Complications-Answer Fulminant colitis /Toxic Megacolon (colonic
diameter > 6cm or cecal diameter > 9cm), 10 stools per day or more
UC Perforation consequence of - Answer toxic megacolon.
Ulcerative Colitis Extra intestinal S/S - Answer Inflammation
UC labs and imaging - Answer Raised SED rate > 30 mm/hr, CRP can show severity of
the inflammation, Low albumin,
UC Imaging - Answer Double contrast barium enema may be normal in mild UC, CT scan
or MRI can show thickening of bowel wall
UC Colonoscopy findings - Answer Mucosa can have a petechiae, exudates, edema,
erosions, touch friability, and spontaneous bleeding.
Mild to Moderate UC stool - Answer C diff, WBC, O/P ~ Shigella, Salmonella, Yersinia
UC TX - Answer Topical 5-Aminosalicylic acid (5 ASA) suppositories/enema, Mesalamine
(Sulfasalazine), 6-MP & Azathiaprine if not responding to steroids, Infliximab refractory
to steroids
2 systems for Crohn's Disease - Answer Chrone's DX Activity Index CDAI < 150 &
Harvery-Bradshaw Index HBI < 4
, Asymptomatic remission - Answer CDAI < 150
Mild to Moderate CDAI 150-220 - Answer dehydration, toxicity abdominal pain, masses,
weight loss
Moderate to Severe CDAI 220-450 - Answer :fever, weight loss, abdominal pain, NV,
anemia
Severe-fulminant disease CDAI > 450 has symptoms - Answer continue despite steroids
or biologic (Infliximab, Adalimumab, Certolizumab)
Labs-CD Ans CBC ck for anemia, BMP, Elevated SED rate, CRP, Iron studies, B12
CD Primary dx- Ans Colonoscopy: cobblestone appearance
Before starting On Immunosuppressive therapy (biologics) must checks- Ans Viral labs
CD TX- Ans Sulfasalazine is effective; Oral Mesalamine should not be used in active
flare, Oral Steroids effective & used short-term
CD TX to spare steroid use- Ans Azathioprine & 6-Mercaptopurine
CD TX for steroid dependent pts Answer Methotraxate
Severe treatment of CD Answer Anti-TF agents = Infliximab, Adalimumab, Certolizumab
Pegol which are resistant to steroids
Severe/Fulminant CD Answer IV Corticosteroids, anti-TNF agents Infliximab,
Adalimumab, Certolizumab Pegol
