NR 511 DIFFERENTIAL DIAGNOSIS & PRIMARY CARE
PRACTICUM FINAL EXAM TEST ()
Gastritis -
Answer Patient will present with epigastric pain that is constant. May have associated
nausea, vomiting, diarrhea, fever, hemorrhage; worse with alcohol, nsaids, aspirin; is
rarely worse with food
Salpingitis -
Answer Patient will present with right lower quadrant and or left lower quadrant pain.
Pain will be worse around menstruation and when ascending stairs. There will be
cervical motion and adnexal tenderness
Irritable bowel syndrome (IBS) -
Answer Patient will present with left lower quadrant pain right lower quadrant pain the
pain will be intermittent and recurrent. Will have associated diarrhea, mucus in store;
worse with stress and eating; often relieved by defecation. There will be: tender to
palpation; small bowel follow through to rule out other causes
Inflammatory bowel disease (Crohn's disease, ulcerative colitis) -
Answer Patient will present with pain in the right lower quadrant and left lower
quadrant; may have diarrhea, weight loss, rectal bleeding, tenesmus, fever; worse with
stress. Physical exam will show tenderness in the right lower quadrant left lower
quadrant; order CBC with differential small bowel follow through (crohns) and a
colonoscopy (UC)
Gastroenteritis -
Answer This pain will be diffuse. May have associated nausea, vomiting, diarrhea,
fever, chills; worse with food; relieved with vomiting or defecation. Physical exam will
show hyperactive bowel sounds; stool ova and parasites, stool culture
Diverticulitis -
Answer Patient will present with left lower quadrant intermittent pain. May have
associated constipation, diarrhea, fever. Physical assessment Michelle left lower
quadrant mass, mild tenderness in the left iliac fossa; laparoscopy will diagnose; other
labs are normal
, Cholecystitis/Cholelithiasis -
Answer Patient will present with right upper quadrant pain radiating to the infrascapular
region, also mid at the gastric pain; starts as visceral progressing to parietal. May have
associated nausea, vomiting, jaundice, dark urine, light colored stools, fever, chills;
worse with high fat foods, estrogen containing medication, cholestyramine. Order
ultrasound, CBC with differential, liver function test, amylase
Appendicitis -
Answer Patient will present with epigastrium or Peri umbilical pain later may turn into
right lower quadrant pain. Pain starts as a cute visceral progressing to parietal. May
present with vomiting, fever, constipation; pain is worse with movement and coughing,
relieved by lying still. Physical exam will show right lower quadrant guarding and
rebound tenderness; order CBC with differential, ultrasound, CT
Functional constipation -
Answer Generally results from a diet that is low in fiber, sedentary lifestyle, holding
stool
Disordered motility constipation -
Answer Most often seen an older adults and is caused by slowed transit time
Secondary constipation -
Answer Often is a result of medication such as opioids, anal Jesus, calcium channel
blockers, antidepressants, anti-Parkinson drugs, cough medicine, aluminum antacids
What is the management of simple constipation -
Answer Patient should be instructed to slowly increase the amount of dietary fiber to
25 to 35 g per day at least 12 to 15 g at breakfast. Mild exercise in the morning is often
helpful. Uninterrupted toilet time in the morning is also helpful. Patient needs to be
instructed about adequate hydration and should be encouraged to drink at least 64
ounces of fluid daily
Management of diarrhea -
Answer Increase fluid intake with electrolytes, if afebrile then use loperamide or
Imodium or Pepto-Bismol empirical treatment with antibiotics is not recommended
Heartburn -
PRACTICUM FINAL EXAM TEST ()
Gastritis -
Answer Patient will present with epigastric pain that is constant. May have associated
nausea, vomiting, diarrhea, fever, hemorrhage; worse with alcohol, nsaids, aspirin; is
rarely worse with food
Salpingitis -
Answer Patient will present with right lower quadrant and or left lower quadrant pain.
Pain will be worse around menstruation and when ascending stairs. There will be
cervical motion and adnexal tenderness
Irritable bowel syndrome (IBS) -
Answer Patient will present with left lower quadrant pain right lower quadrant pain the
pain will be intermittent and recurrent. Will have associated diarrhea, mucus in store;
worse with stress and eating; often relieved by defecation. There will be: tender to
palpation; small bowel follow through to rule out other causes
Inflammatory bowel disease (Crohn's disease, ulcerative colitis) -
Answer Patient will present with pain in the right lower quadrant and left lower
quadrant; may have diarrhea, weight loss, rectal bleeding, tenesmus, fever; worse with
stress. Physical exam will show tenderness in the right lower quadrant left lower
quadrant; order CBC with differential small bowel follow through (crohns) and a
colonoscopy (UC)
Gastroenteritis -
Answer This pain will be diffuse. May have associated nausea, vomiting, diarrhea,
fever, chills; worse with food; relieved with vomiting or defecation. Physical exam will
show hyperactive bowel sounds; stool ova and parasites, stool culture
Diverticulitis -
Answer Patient will present with left lower quadrant intermittent pain. May have
associated constipation, diarrhea, fever. Physical assessment Michelle left lower
quadrant mass, mild tenderness in the left iliac fossa; laparoscopy will diagnose; other
labs are normal
, Cholecystitis/Cholelithiasis -
Answer Patient will present with right upper quadrant pain radiating to the infrascapular
region, also mid at the gastric pain; starts as visceral progressing to parietal. May have
associated nausea, vomiting, jaundice, dark urine, light colored stools, fever, chills;
worse with high fat foods, estrogen containing medication, cholestyramine. Order
ultrasound, CBC with differential, liver function test, amylase
Appendicitis -
Answer Patient will present with epigastrium or Peri umbilical pain later may turn into
right lower quadrant pain. Pain starts as a cute visceral progressing to parietal. May
present with vomiting, fever, constipation; pain is worse with movement and coughing,
relieved by lying still. Physical exam will show right lower quadrant guarding and
rebound tenderness; order CBC with differential, ultrasound, CT
Functional constipation -
Answer Generally results from a diet that is low in fiber, sedentary lifestyle, holding
stool
Disordered motility constipation -
Answer Most often seen an older adults and is caused by slowed transit time
Secondary constipation -
Answer Often is a result of medication such as opioids, anal Jesus, calcium channel
blockers, antidepressants, anti-Parkinson drugs, cough medicine, aluminum antacids
What is the management of simple constipation -
Answer Patient should be instructed to slowly increase the amount of dietary fiber to
25 to 35 g per day at least 12 to 15 g at breakfast. Mild exercise in the morning is often
helpful. Uninterrupted toilet time in the morning is also helpful. Patient needs to be
instructed about adequate hydration and should be encouraged to drink at least 64
ounces of fluid daily
Management of diarrhea -
Answer Increase fluid intake with electrolytes, if afebrile then use loperamide or
Imodium or Pepto-Bismol empirical treatment with antibiotics is not recommended
Heartburn -
