CMN 568 Elaborate Exam Study
Questions with Detailed Answers
1. GERD - Definition - ANSWER Heartburn is the typical symptom, usually
occurs 30-60 min after meals and with reclining. Pain may be relieved by
antacids. Most have no structural defects
2. GERD - Symptoms - ANSWER Burning chest pain and regurgitation are
common.
Non-GI symptoms - asthma, chronic cough, laryngitis, sore throat or non-
cardiac chest pain and sleep disturbances.
"Alarm" symptoms - age >55 (new onset), anemia, melena or hemotemesis,
dysphagia, significant weight loss or difficult/painful swallowing.
3. GERD - diagnostics - ANSWER Patients <55 without alarm symptoms may
be treated empirically without further testing.
Patients with alarm symptoms or poor response to empiric therapy should be
referred for upper GI endoscopy.
4. GERD- Treatment Mild intermittent symptoms - ANSWER Lifestyle
modification (smaller meals, eliminate spicy/acidic foods), eliminate foods
that increase reflux (fatty, ETOH, peppermint, chocolate), Elevate head of
bed, do not lay down for 3 hours after meals.
Weight loss if appropriate.
PRN antacids or H2 receptor blockers, Famotadine, rantitidine, cimetidine
5. GERD - Treatment Empiric therapy troublesome symptoms - ANSWER
PPI QD for 4-8 weeks, preferred over H2 blockers for acute and chronic
GERD
,PPI should be taken 30 minutes before breakfast **
10-20% will need BID PPI
If no response refer for upper GI endoscopy
Patients with good symptom control on empiric therapy should be continued on
PPI for 8-12 weeks
6. PUD - Definition - ANSWER Peptic ulcer disease
Two major causes:
NSAIDS (ASA, ibuprofen, naproxen, melixicam)
H Pylori infection
7. PUD - Symptoms - ANSWER Dyspepsia, described as gnawing, hunger-
like, burning pain in epigastric area. Pain may awaken patient. Symptoms
wax and wane. May have relief with food intake or antacids and return of
pain 2-4 hours later. Up to 60% NSAID induced PUD have no symptoms.
8. PUD - Signs - ANSWER Physical exam may be normal or slight epigastric
tenderness. May have Guiac + stools.
Labs are usually normal, Anemia possible if bleeding has occurred.
9. PUD - Diagnostic studies - ANSWER Upper endoscopy with biopsy if
gastric ulcers are present
H Pylori testing: urea breath testing or fecal antigen if prior history of PUD or if
ulcer diagnosed on barium upper GI. Biopsy and rapid urea test & histology of
endoscopy is performed.
10.PUD - Treatment - ANSWER Acid antisecretory agents: PPI have replaced
most H2 blockers
,Antibiotics to eradicate H. pylori
11.Colic - ANSWER Colicky infant defined as one who is healthy and well fed
but cries for more than 3 hrs/day, for more than 3 days/wk, and more than 3
weeks.
Characterized by severe and paroxsymal crying that occurs mainly in the late
afternoon
Infants knees are drawn up and fists are clenched.
A behavioral sign that begins in the firsts few weeks of life and peaks at age 2-3
months. In 30-40% of cases it continues into the 4th and 5th month.
Management consists of parental education, medications have not been proven
to ameliorate colic.
12.Intussusception - ANSWER Most common cause of intestinal obstruction in
the first 2 years of life
Presents as a thriving infant aged 3-12 months with paroxsymal, colicky pain,
draws up knees and screams. Pt is acutely ill
Vomiting and diarrhea occur soon afterward in 90% of cases and bloody BMs
with mucus appear within the next 12 hours (Current jelly stools). Prostration
and fever supervene.
Abdomen is tender and becomes distended. A sausage shaped mass may be
palpated in the upper mid abdomen.
Barium or air enema (done by radiologist) is diagnostic and therapeutic.
Prognosis relates to the duration before treatment - the longer intussesception
persists the more likely complications i.e. ischemia.
13.Hernias - Types - ANSWER Umbilical - affects full-term, AA children
more often, most close spontaneously within 1st year of life and majority
close by the 5th year. Large defects and those persisting after age 4 are
, repaired surgically. In adults-need repair due to high risk of incarceration
and strangulation.
Inguinal - account for 75% of abdominal hernias. in children these are
congenital, but can be acquired from obesity, chronic cough, ascites, chronic
constipation with straining, and lifting heavy objects.
14.Hernias - Management - ANSWER Do not try to reduce strangulated
hernias because reduction can cause gangrenous bowel to enter the
peritoneal cavity. Refer immediately.
If hernia is reducible you can refer for elective repair.
ALARM MARKERS for referral are acute onset of colicky abd pain, N&V, and
edema and discoloration at the site.
15.Malrotation - ANSWER Consider this diagnosis when a healthy infant
suddenly refuses to eat, vomits bile, and becomes inconsolable, and develops
abdominal distension. This usually occurs during the first 3 weeks of life.
Diagnosis: UGI shows the malrotation and it can be further confirmed with a
barium enema.
Treatment is surgical.
16.Pyloric stenosis - definition - ANSWER Cause if unknown, white males
predominate.
Signs and symptoms: Vomiting begins 2-4 week sof age and rapidly becomes
projectile after every feeding. It starts at birth in 10% of infants and onset may
be delayed in premature infants.
Vomitus may be blood streaked
Infant appears hungry, eats frequently, and eventually has constipation,
dehydration, weight loss, and is fretful.
After feeding, upper abdomen may be distended.
Prominent gastric peristaltic waves may be seen
Questions with Detailed Answers
1. GERD - Definition - ANSWER Heartburn is the typical symptom, usually
occurs 30-60 min after meals and with reclining. Pain may be relieved by
antacids. Most have no structural defects
2. GERD - Symptoms - ANSWER Burning chest pain and regurgitation are
common.
Non-GI symptoms - asthma, chronic cough, laryngitis, sore throat or non-
cardiac chest pain and sleep disturbances.
"Alarm" symptoms - age >55 (new onset), anemia, melena or hemotemesis,
dysphagia, significant weight loss or difficult/painful swallowing.
3. GERD - diagnostics - ANSWER Patients <55 without alarm symptoms may
be treated empirically without further testing.
Patients with alarm symptoms or poor response to empiric therapy should be
referred for upper GI endoscopy.
4. GERD- Treatment Mild intermittent symptoms - ANSWER Lifestyle
modification (smaller meals, eliminate spicy/acidic foods), eliminate foods
that increase reflux (fatty, ETOH, peppermint, chocolate), Elevate head of
bed, do not lay down for 3 hours after meals.
Weight loss if appropriate.
PRN antacids or H2 receptor blockers, Famotadine, rantitidine, cimetidine
5. GERD - Treatment Empiric therapy troublesome symptoms - ANSWER
PPI QD for 4-8 weeks, preferred over H2 blockers for acute and chronic
GERD
,PPI should be taken 30 minutes before breakfast **
10-20% will need BID PPI
If no response refer for upper GI endoscopy
Patients with good symptom control on empiric therapy should be continued on
PPI for 8-12 weeks
6. PUD - Definition - ANSWER Peptic ulcer disease
Two major causes:
NSAIDS (ASA, ibuprofen, naproxen, melixicam)
H Pylori infection
7. PUD - Symptoms - ANSWER Dyspepsia, described as gnawing, hunger-
like, burning pain in epigastric area. Pain may awaken patient. Symptoms
wax and wane. May have relief with food intake or antacids and return of
pain 2-4 hours later. Up to 60% NSAID induced PUD have no symptoms.
8. PUD - Signs - ANSWER Physical exam may be normal or slight epigastric
tenderness. May have Guiac + stools.
Labs are usually normal, Anemia possible if bleeding has occurred.
9. PUD - Diagnostic studies - ANSWER Upper endoscopy with biopsy if
gastric ulcers are present
H Pylori testing: urea breath testing or fecal antigen if prior history of PUD or if
ulcer diagnosed on barium upper GI. Biopsy and rapid urea test & histology of
endoscopy is performed.
10.PUD - Treatment - ANSWER Acid antisecretory agents: PPI have replaced
most H2 blockers
,Antibiotics to eradicate H. pylori
11.Colic - ANSWER Colicky infant defined as one who is healthy and well fed
but cries for more than 3 hrs/day, for more than 3 days/wk, and more than 3
weeks.
Characterized by severe and paroxsymal crying that occurs mainly in the late
afternoon
Infants knees are drawn up and fists are clenched.
A behavioral sign that begins in the firsts few weeks of life and peaks at age 2-3
months. In 30-40% of cases it continues into the 4th and 5th month.
Management consists of parental education, medications have not been proven
to ameliorate colic.
12.Intussusception - ANSWER Most common cause of intestinal obstruction in
the first 2 years of life
Presents as a thriving infant aged 3-12 months with paroxsymal, colicky pain,
draws up knees and screams. Pt is acutely ill
Vomiting and diarrhea occur soon afterward in 90% of cases and bloody BMs
with mucus appear within the next 12 hours (Current jelly stools). Prostration
and fever supervene.
Abdomen is tender and becomes distended. A sausage shaped mass may be
palpated in the upper mid abdomen.
Barium or air enema (done by radiologist) is diagnostic and therapeutic.
Prognosis relates to the duration before treatment - the longer intussesception
persists the more likely complications i.e. ischemia.
13.Hernias - Types - ANSWER Umbilical - affects full-term, AA children
more often, most close spontaneously within 1st year of life and majority
close by the 5th year. Large defects and those persisting after age 4 are
, repaired surgically. In adults-need repair due to high risk of incarceration
and strangulation.
Inguinal - account for 75% of abdominal hernias. in children these are
congenital, but can be acquired from obesity, chronic cough, ascites, chronic
constipation with straining, and lifting heavy objects.
14.Hernias - Management - ANSWER Do not try to reduce strangulated
hernias because reduction can cause gangrenous bowel to enter the
peritoneal cavity. Refer immediately.
If hernia is reducible you can refer for elective repair.
ALARM MARKERS for referral are acute onset of colicky abd pain, N&V, and
edema and discoloration at the site.
15.Malrotation - ANSWER Consider this diagnosis when a healthy infant
suddenly refuses to eat, vomits bile, and becomes inconsolable, and develops
abdominal distension. This usually occurs during the first 3 weeks of life.
Diagnosis: UGI shows the malrotation and it can be further confirmed with a
barium enema.
Treatment is surgical.
16.Pyloric stenosis - definition - ANSWER Cause if unknown, white males
predominate.
Signs and symptoms: Vomiting begins 2-4 week sof age and rapidly becomes
projectile after every feeding. It starts at birth in 10% of infants and onset may
be delayed in premature infants.
Vomitus may be blood streaked
Infant appears hungry, eats frequently, and eventually has constipation,
dehydration, weight loss, and is fretful.
After feeding, upper abdomen may be distended.
Prominent gastric peristaltic waves may be seen
