lOMoARcPSD|3013804
NR 511 Midterm Exam Study Guide posted
Differential Diagnosis & Primary Care Practicum (Chamberlain
University)
, lOMoARcPSD|3013804
NR511 Midterm Study Guide Worksheet
Disease Risk Subjective Finding Objective Findings Diagnostics Treatment
GI DISORDERS
Appendicitis Risk: age 10-30; men Subjective: acute Objective: looks ill; Tests: CBC - mild to 1st line: IV antibiotics, correcting
twice as likely as onset of mild to diffuse tenderness with moderate leukocytosis; fluid and electrolyte imbalances,
women; diet low in severe colicky, palpation of abdomen – urinalysis – microscopic bedrest, NPO, NG tube if indicated
fiber, high in fat and epigastric, or tenderness over RLQ hematuria or pyuria; x-
high in refined periumbilical pain; ray – fecalith, gas-filled 2nd line: surgery
sugars and other nausea/vomiting; appendix, small bowel
carbs fever ileus, deviation in
bowel gas pattern, or
loss of right iliopsoas
shadow;
US – to visualize
inflamed appendix
Celiac disease Risk: family history, Subjective: most are Objective: exam may be Tests: serological testing 1st line: strict gluten-free diet
Down’s syndrome, asymptomatic; may normal; signs of for anti-tTG IgA
HLA-DQ2 or HLA-DQ8, complain of diarrhea, malabsorption such as antibodies; total IgA; 2nd line: immunomodulating
Turner’s syndrome, or weight loss, muscle wasting, pallor nutritional deficiencies – agents
other genetic based dyspepsia, and (anemia), reduced hemoglobin, iron, folate,
autoimmune disease flatulence subcutaneous fat, ataxia, vitamin B12, calcium,
such as Type 1 DM and and peripheral and vitamin D
thyroiditis neuropathy (Vitamin B12
deficiency)
Cholelithiasis - gallstones Risk: > 25 y/o; most Subjective: symptoms Objective: if pain is severe Tests: gold standard is 1st line for asymptomatic patients:
prevalent in American vary, generalized GI patient may have abdominal ultrasound avoid foods high in fat
Indian women; complaints to involuntary guarding over
intractable pain; the RUQ; positive During acute phase – 2nd line:
Cholesterol stones: indigestion, nausea, Murphy’s sign w/ mild WBC elevation Treatment of choice for acute
female, obesity, and vomiting – palpation over the RUQ; to 15,000/mL; serum cholecystitis:
pregnancy, increased especially after a low grade fever; may have transaminases elevated
, lOMoARcPSD|3013804
NR511 Midterm Study Guide Worksheet
age, drug-induced meal high in fat; as diminished bowel sounds 4x normal; aspartate hospitalization for rehydration w/
(oral contraceptives, the inflammation aminotransferase and IV fluids, antibiotics, analgesics, GI
clofibrates), cystic progresses, the pain alanine aminotransferase rest, NG placement for persistent
fibrosis, rapid weight localizes over the can be elevated to 300 emesis; 2nd or 2rd generation
loss, spinal cord injury, RUQ or epigastrum; U/L; alkaline cephalosporin is started
ileal disease with pain may refer to phosphatase is elevated
extensive resection, middle of back, to 2-4x normal levels; Once stable the patient will
DM, sickle cell anemia infrascapular area, or bilirubin as high as 4 undergo surgery for a
R shoulder mg/dL cholecystectomy
Pigmented stones:
hemolytic diseases, If considered a poor surgical risk
increasing age, patients can be treated w/ oral
hyperalimentation, ingestion of ursodeoxycholic
cirrhosis, biliary stasis, (ursodoil) or direct dissoluction
chronic biliary by percutaneous instillation of
infections methyl-tertiary-butyl ether;
lithotriopsy
Six F’s: fat, female,
forty, flatulent, fertile,
and fat-intolerant
Crohn’s disease Risk: genetic Subjective: abd Objective: Tests: colonoscopy - 1st line: nutrition counseling –
predisposition cramping and 1. Inflammation, RLQ reveals ulcers that are avoid caffeine, raw fruits,
tenderness, fever, pain, and either minor erosions or vegetables, seeds, and nuts, and
anorexia, weight loss, tendnerness deep longitudinal foods high in fiber (whole grain
spasm, flatulence and – presenting like fissures, cobblestone bread and cereal); bland diet
RLQ pain or mass; appendicitis appearance that is high in calories and
increase in symptoms 2. Obstruction, fibrosis, protein yet low in fat
during stress or and stenotic changes 1st line medication:
emotional upset or within the bowel oral prednisone
after meals consisting causing obstruction
of fatty, spicy foods, associated w/ 2nd line: mesalamine (Asacol) and
severe
colic, abdominal
, lOMoARcPSD|3013804
NR511 Midterm Study Guide Worksheet
or milk; stools are distension, sulfasalazine (Azulfidine)
soft or semi-liquid; constipation and
blood in stools; vomiting
steatorrhea; periods 3. Diffuse jejunoileitis
of acute exacerbation involving the
alternating with jejunum and ileum
complete remission and characterized by
both inflammation
and obstruction
4. Abdominal fistulas
and abscesses
causing fever,
generalized wasting,
and
abdominal masses
Diverticulitis Risk: low-fiber and Subjective: LLQ pain; Objective: tenderness in Tests: abdominal x-rays – 1st line: high fiber diet or daily
high fat diet; chronic pain may be worse the LLQ; firm-fixed mass reveal free air, ileus, or fiber supplementation with
constipation and after eating, pain is may be identified in the obstruction; a barium psyllium Mild symptoms: rest
straining; irregular sometimes relived area of the diverticula; enema – outlines the clear liquid diet
bowel contractions; with BM or passing hypoactive bowel sounds lumen of the bowel
weakness of bowel flatus; alternating initially, but hyperactive if clearly defining 2nd line: hospitalization for IV
muscle brought on bowel patterns an obstructive process diverticula antibiotics and hydration,
by aging between constipation has developed analgesia, bowel rest, and possible
and diarrhea NG tube
GERD Risk: overweight, BMI Subjective: mild to Objective: exam in Tests: 1st line for mild symptoms:
over 25; increases w/ severe heartburn, normal; possible stool Diagnosis is made by lifestyle modifications – weight
age then decreases regurgitation, water positive for occult blood history alone loss, elevating HOB to 6-8 inches,
after the age of 69; brash, dysphagia, due to microhemorrhages avoid eating meals 2-3 hours
ingestion of sour taste in the in the irritated If unclear diagnosis: EGD before bedtime, avoid certain
foods/pharmacological mouth in the esophageal epithelium foods such as chocolate, alcohol,
agents that lower the morning, belching, caffeine,
acidic or spicy foods; smoking
NR 511 Midterm Exam Study Guide posted
Differential Diagnosis & Primary Care Practicum (Chamberlain
University)
, lOMoARcPSD|3013804
NR511 Midterm Study Guide Worksheet
Disease Risk Subjective Finding Objective Findings Diagnostics Treatment
GI DISORDERS
Appendicitis Risk: age 10-30; men Subjective: acute Objective: looks ill; Tests: CBC - mild to 1st line: IV antibiotics, correcting
twice as likely as onset of mild to diffuse tenderness with moderate leukocytosis; fluid and electrolyte imbalances,
women; diet low in severe colicky, palpation of abdomen – urinalysis – microscopic bedrest, NPO, NG tube if indicated
fiber, high in fat and epigastric, or tenderness over RLQ hematuria or pyuria; x-
high in refined periumbilical pain; ray – fecalith, gas-filled 2nd line: surgery
sugars and other nausea/vomiting; appendix, small bowel
carbs fever ileus, deviation in
bowel gas pattern, or
loss of right iliopsoas
shadow;
US – to visualize
inflamed appendix
Celiac disease Risk: family history, Subjective: most are Objective: exam may be Tests: serological testing 1st line: strict gluten-free diet
Down’s syndrome, asymptomatic; may normal; signs of for anti-tTG IgA
HLA-DQ2 or HLA-DQ8, complain of diarrhea, malabsorption such as antibodies; total IgA; 2nd line: immunomodulating
Turner’s syndrome, or weight loss, muscle wasting, pallor nutritional deficiencies – agents
other genetic based dyspepsia, and (anemia), reduced hemoglobin, iron, folate,
autoimmune disease flatulence subcutaneous fat, ataxia, vitamin B12, calcium,
such as Type 1 DM and and peripheral and vitamin D
thyroiditis neuropathy (Vitamin B12
deficiency)
Cholelithiasis - gallstones Risk: > 25 y/o; most Subjective: symptoms Objective: if pain is severe Tests: gold standard is 1st line for asymptomatic patients:
prevalent in American vary, generalized GI patient may have abdominal ultrasound avoid foods high in fat
Indian women; complaints to involuntary guarding over
intractable pain; the RUQ; positive During acute phase – 2nd line:
Cholesterol stones: indigestion, nausea, Murphy’s sign w/ mild WBC elevation Treatment of choice for acute
female, obesity, and vomiting – palpation over the RUQ; to 15,000/mL; serum cholecystitis:
pregnancy, increased especially after a low grade fever; may have transaminases elevated
, lOMoARcPSD|3013804
NR511 Midterm Study Guide Worksheet
age, drug-induced meal high in fat; as diminished bowel sounds 4x normal; aspartate hospitalization for rehydration w/
(oral contraceptives, the inflammation aminotransferase and IV fluids, antibiotics, analgesics, GI
clofibrates), cystic progresses, the pain alanine aminotransferase rest, NG placement for persistent
fibrosis, rapid weight localizes over the can be elevated to 300 emesis; 2nd or 2rd generation
loss, spinal cord injury, RUQ or epigastrum; U/L; alkaline cephalosporin is started
ileal disease with pain may refer to phosphatase is elevated
extensive resection, middle of back, to 2-4x normal levels; Once stable the patient will
DM, sickle cell anemia infrascapular area, or bilirubin as high as 4 undergo surgery for a
R shoulder mg/dL cholecystectomy
Pigmented stones:
hemolytic diseases, If considered a poor surgical risk
increasing age, patients can be treated w/ oral
hyperalimentation, ingestion of ursodeoxycholic
cirrhosis, biliary stasis, (ursodoil) or direct dissoluction
chronic biliary by percutaneous instillation of
infections methyl-tertiary-butyl ether;
lithotriopsy
Six F’s: fat, female,
forty, flatulent, fertile,
and fat-intolerant
Crohn’s disease Risk: genetic Subjective: abd Objective: Tests: colonoscopy - 1st line: nutrition counseling –
predisposition cramping and 1. Inflammation, RLQ reveals ulcers that are avoid caffeine, raw fruits,
tenderness, fever, pain, and either minor erosions or vegetables, seeds, and nuts, and
anorexia, weight loss, tendnerness deep longitudinal foods high in fiber (whole grain
spasm, flatulence and – presenting like fissures, cobblestone bread and cereal); bland diet
RLQ pain or mass; appendicitis appearance that is high in calories and
increase in symptoms 2. Obstruction, fibrosis, protein yet low in fat
during stress or and stenotic changes 1st line medication:
emotional upset or within the bowel oral prednisone
after meals consisting causing obstruction
of fatty, spicy foods, associated w/ 2nd line: mesalamine (Asacol) and
severe
colic, abdominal
, lOMoARcPSD|3013804
NR511 Midterm Study Guide Worksheet
or milk; stools are distension, sulfasalazine (Azulfidine)
soft or semi-liquid; constipation and
blood in stools; vomiting
steatorrhea; periods 3. Diffuse jejunoileitis
of acute exacerbation involving the
alternating with jejunum and ileum
complete remission and characterized by
both inflammation
and obstruction
4. Abdominal fistulas
and abscesses
causing fever,
generalized wasting,
and
abdominal masses
Diverticulitis Risk: low-fiber and Subjective: LLQ pain; Objective: tenderness in Tests: abdominal x-rays – 1st line: high fiber diet or daily
high fat diet; chronic pain may be worse the LLQ; firm-fixed mass reveal free air, ileus, or fiber supplementation with
constipation and after eating, pain is may be identified in the obstruction; a barium psyllium Mild symptoms: rest
straining; irregular sometimes relived area of the diverticula; enema – outlines the clear liquid diet
bowel contractions; with BM or passing hypoactive bowel sounds lumen of the bowel
weakness of bowel flatus; alternating initially, but hyperactive if clearly defining 2nd line: hospitalization for IV
muscle brought on bowel patterns an obstructive process diverticula antibiotics and hydration,
by aging between constipation has developed analgesia, bowel rest, and possible
and diarrhea NG tube
GERD Risk: overweight, BMI Subjective: mild to Objective: exam in Tests: 1st line for mild symptoms:
over 25; increases w/ severe heartburn, normal; possible stool Diagnosis is made by lifestyle modifications – weight
age then decreases regurgitation, water positive for occult blood history alone loss, elevating HOB to 6-8 inches,
after the age of 69; brash, dysphagia, due to microhemorrhages avoid eating meals 2-3 hours
ingestion of sour taste in the in the irritated If unclear diagnosis: EGD before bedtime, avoid certain
foods/pharmacological mouth in the esophageal epithelium foods such as chocolate, alcohol,
agents that lower the morning, belching, caffeine,
acidic or spicy foods; smoking
