Exam (elaborations)
Module 4. CMN 568 Questions and Answers 2024
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Exam of 17 pages for the course CMN 568 at CMN 568 (Module 4. CMN 568)
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Module 4. CMN 568Another word for indigestion - answer dyspepsia = a symptom
Main causes of dyspepsia - answer stomach ulcer or acid reflux
PUD or GERD
Patients who should have an endoscopy due to dyspepsia? - answer> 60 yo
younger if have alarm symptoms
Patients who test negative for h. pylori or was treated for h. pylori and still have not
improved after it was eradicated should be treated with what? - answertrial empiric PPI
increased visceral afferent sensitivity, gastric delayed emptying or impaired
accommodation to food or psychosocial stressors = symptoms of ________________
________________ - answer functional dyspepsia
Description of patient with functional dyspepsia - answeryounger pt. that reports a
variety of abd and extra-gi complaints show signs of anxiety or dyspepsia, or have a hx
of use of psychotropic medications
Lifestyle changes to treat functional dyspepsia - answerreduce or d/c ETOH & caffeine
consume small, low fat meals
keep food diary
1/3 patients with dyspepsia get relief from this? - answerplacebo
pharmacologic agent for non-h. pylori dyspepsia - answerpantoprazole 40 mg qd
metoclopramide 5-10 mg TID no more than 3 mo. (black box warning, tardive
dyskinesia)
What is described as a vague intensely disagreeable sensation of sickness or
queasiness and is distinguished from anorexia - answernausea
What is described as often following nausea, as does retching. Distinguished from
regurgitation, rumination - answervomiting
What is an effortless reflux of liquid food or stomach contents - answerregurgitation
What is the chewing or swallowing of food thats regurgitated voluntarily after meals. -
answerrumination
,When might vomiting require hospitalization? - answersevere acute vomiting- unable to
eat, loosing gastric fluids leading to dehydration risk for hypokalemia and metabolic
acidosis - very important to note in very young or old pt.
Treatment for mild self-limiting nausea - answergeneral measures- clear liquids, broth,
teas soups.
What could persistent hiccups signify. - answerunderlying illness, refer to either neuro or
GI
Causes of benign hiccuping - answergastric distention- drinking carbonated drinks, air
swallowing, over eating, sudden changes in temps, heightened state of emotion
Remedies that may help with benign self-limiting hiccups - answerinterrupting the
respiratory cycle- valsalva maneuver, gasping, rebreathing into bag, sneezing
Medication that can treat hiccuping - answerphenothiazine - used to treat psych
disorders
infrequent stools, fewer than 3 in 1 week, hard stools, excessive straining or sense of
incomplete evacuation describes what condition - answerconstipation
First step in evaluating constipation? - answeris to determine what is meant by
constipation meaning asking the patient what their normal bowel habits are vs what is
occurring now
What condition is important to rule out due to new onset constipation - answerColonic
lesions that obstruct fecal passage (neoplasms and strictures)
Which patient should alert you to look further into constipation to rule out colonic lesions
- answernew onset constipation in pt. older than 50 yo, pt w/alarm symptoms or signs -
hematochezia, weight loss, anemia, + fecal occult blood test (FOBT) or fecal
immunochemical test (FIT) and in pt w/a family hx of colon ca or inflammatory bowel
disease. refer
How can you distinguish primary constipation from secondary - answerwith physical
exam- digital rectal exam, assessing pelvic floor motion during simulated defecation -
the ability to expect the finger
additional tests that must be performed- CBC, electrolytes, glucose, TSH colonoscopy
Once an emergency issue of constipation has been ruled out, how can constipation be
managed. - answerestablishing a regular bowel regimen
adequate fluids and fiber intake
prescribe fiber supplements
regular exercise
med reconciliation- d/c meds that can cause constipation
, Probiotics- low efficacy- pts think it helps
use of laxatives- only given intermittently and only if they do not respond to dietary
measure
Side effects of fiber supplements - answerabd distension
flatulence
hesitate in prescribing for pt with opioid constipation and IBS
Which medication given for constipation was traditionally used for colonic lavage prior to
colonoscopy and does not cause flatulence. Onset of bowel evacuation is usually within
24 hrs after use. - answerpolyethylene glycol
When does belching often occur - answerafter meals, comes from swallowing air, gum
chewing, smoking, ingestion of carbonated beverages
What is supra-gastric belching or true air swallowing that is behavioral disorder seen in
pt with anxiety or psych disorders and what step should you take with these pt. -
answerchronic excessive belching.
Refer to behavioral/speech therapist
Causes of flatulence - answerswallowed air and bacterial fermentation of undigested
carbohydrate
How can patients with complaints of flatulence be treated - answer*provide them with a
list of foods containing FODMAPS and refer to dietician
*activated charcoal
*avoid gum chewing and carbonated beverages
****assess for lactose intolerance by 2 week trial of lactose -free diet or by a hydrogen
breath test
an increase stool frequency of more than 3 bowel movements / day is what? -
answerdiarrhea
Questions to ask patient if they complain of diarrhea - answerMust ask them their
normal bowel pattern and nature of current symptoms
What determines treatment of diarrhea - answeris this an acute non-inflammatory
diarrhea or acute inflammatory diarrhea
Which type of diarrhea is described as fever and bloody diarrhea (dysentery) -
answeracute inflammatory diarrhea - caused by invasive or toxin producing bacteria
(c.diff, shiga-toxin-producing e.coli_
Non-inflammatory diarrhea is described as? - answerwatery, non-bloody- caused by
virus (giardia) or noninvasive bacteria (e.coli, staph aureus)
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