Acute Care GI/GU/Neuro Practice Questions

what other medications are used in combo with ABX for the tx of H. pylori?

PPI, bismuth.. how many times/day dare these medications dosed?

What are the 2 prescription combo packs you can write for the tx of H. pylori?

Prevpac, Pylera

When evaluating a patient with acute HA, all of the following observations would indicate the absence of a more serious underlying condition except: a. onset of HA with exertion, coughing, or sneezing b. hx of previous identical HA c. supple neck d. normal neurological examination results

a. onset of HA with exertion, coughing, or sneezing

Which of the following statements about ergotamines is false? a. they are effective for tension-type HAs b. they act as 5-HT1A and 5-HT1D receptor agonists c. they have a potential vasoconstrictor effect d. they should be avoided in the presence of CAD

a. they are effective for tension-type HAs

Patients with stress incontinence often report urine loss: a. with lifting b. at night c. associated with a strong sensation of needing to void d. as dribbling after voiding

a. with lifting

ABX used to treat H. pylori

Amoxicillin, Clindamycin, tetracycline, metronidazole, clarithromycin

A 44-year-old woman presents with pyelonephritis. The report of her urinalysis is least likely to include: a. WBC casts b. positive nitrites c. 3+ protein d. rare RBCs

c. 3+ protein

You are examining a 65-year-old man who has a hx of acute coronary artery syndrome and migraine. Which of the following agents represents the best choice of acute HA (abortive) therapy for this patients? a. verapamil b. ergotamine c. APAP d. sumatriptan

c. APAP

The preferred method to identify the location of small renal stones is: a. x-ray b. abdominal US c. CT scan d. radionuclide scan

c. CT scan

A 37-year-old woman complains of migraine HAs that typically occur after eating in restaurants. Potential triggers that can influence the onset and severity of migraine symptoms include all of the following except: a. cheese pizza b. pickled or fermented foods c. freshly baked yeast products d. baked whitefish

d. baked whitefish

In children and the elderly, which of the following conditions can contribute to bladder instability and increase the risk of UTI? a. constipation b. upper respiratory tract infection c. chronic diarrhea d. efficient bladder emptying

A. constipation

Hemorrhagic cystitis is characterized by: a. irritative voiding symptoms b. persistent microscopic hematuria c. the presence of HTN d. elevated creatinine and BUN levels

A. irritative voiding symptoms

Which of the following is most likely to be part of the clinical presentation of an otherwise healthy 27-year-old woman with uncomplicated lower UTI? a. urinary frequency b. fever c. suprapubic tenderness d. lower GI upset

A. urinary frequency

Common secondary HA causes include all of the following except: a. brain tumor b. intracranial bleeding c. intracranial inflammation d. cluster HA

d. cluster HA

Evidence supports the use of all of the following vitamins and supplements for migraine prevention except: a. butterbur b. riboflavin c. feverfew d. gingko biloba

d. gingko biloba

With fluoroquinolone use, length of antimicrobial therapy during uncomplicated pyelonephritis is typically: a. 5 days b. 1 week c. 2 weeks d. 3 weeks

B. 1 week

Assessing vision and visual fields involves testing cranial nerve (CN): a. I b. II c. III d. IV

B. II

You perform an extraocular movement test on a middle-aged patient. He is unable to move his eyes upward and inward. This indicates a possibility of paralysis of CN: a. II b. III c. V d. VI

B. III

The notation of alkaline urine in a patient with a UTI may point to infection caused by: a. Klebsiella species b. P. mirabilis c. E. coli d. S. saprophyticus

B. P. mirabilis

A 36-year-old febrile woman with no health problems presents with dysuria and frequency of urination. Her urinalysis findings include results positive for nitrites and leukocyte esterase. You evaluate these results and consider that she likely has: a. purulent vulvovaginitis b. a gram-negative UTI c. cystitis caused by Staphylococcus saprophyticus d. urethral syndrome

B. a gram-negative UTI

Risk factors for UTI in women include: a. postvoid wiping back to front b. low perivaginal lactobacilli colonization c. hot tub use d. wearing snug-fitting pantyhose

B. low perivaginal lactobacilli colonization

The most likely causative organism in community-acquired UTI in women during the reproductive years is: a. Klebsiella species b. Proteus mirabilis c. Escherichia coli d. Staphylococcus saprophyticus

C. Eschericia coli

Which of the following is the most accurate information in caring fora 40-year-old man with cystitis? a. this is a common condition in men of this age b. A gram-positive organism is the likely causative pathogen. c. A urological evaluation should be considered. d. Pyuria is rarely found.

C. a urological evaluation should be considered.

A 40 year-old man presents with a 5 week history of recurrent HAs that awaken him during the nights. The pain is severe, lasts about 1 hour, and is located behind his L eye. Additional symptoms include lacrimation and nasal discharge. His PE is WNL. His clinical presentation is most consistent with: a. migraine without aura b. migraine with aura c. cluster HA d. increased ICP

C. cluster HA

laboratory evaluation for epigastric pain

CBC, CMP, H. pylori

A 45-year-old man who presents with a sudden, abrupt HA. Upon questioning, he appears somewhat confused with decreased alertness to his surroundings. Pt should get a:

CT scan

Which urine culture result is needed to confirm a UTI in an asymptomatic woman who has not had recent use of a urinary catheter? a. 10 ^2 cfu/mL or more b. 10^3 cfu/mL or more c. 10^4 cfu/mL or more d. 10^5 cfu/mL or more

D. 10^5 cfu/mL or more

Which of the following is not a gram negative organism? a. E. coli b. K. pneumoniae c. P. mirabilis D. S. saprophyticus

D. S. saprophyticus

Compared with UTI in lower woman, uncomplicated UTI in an elderly woman is more likely to be associated with each of the following s/s except: a. new-onset urinary incontinence b. delirium c. weakness d. hematuria

D. hematuria

You see a 34-year-old woman with an uncomplicated UTI. She is otherwise healthy but reports having a sulfa allergy. Appropriate therapy would include: a. TMP-SMX b. amoxicillin c. azithromycin d. nitrofurantoin

D. nitrofurantoin

All of the following can negatively impact perivaginal lactobacilli colonization except: a. recent microbial use b. exposure to the spermicide nonoxynol-9 c. estrogen deficiency d. postcoital voiding

D. postcoital voiding

A 48-year-old women a hx of breast CA who presents with 3-month hx of progressively severe HA, and bulging optic disk. Pt should get:

a MRI scan

Indicators that a HA can be the presenting symptom of a serious illness and may require neuroimaging include all of the following except: a. HAs that occur periodically in clusters b. increasing frequency and severity of HAs c. HA causing confusion, dizziness, and/or lack of coordination d. HA causing awakening from sleep

a. HAs that occur periodically in clusters

The MOA of triptans is as: a. a SSRI b. a dopamine antagonist c. a vasoconstrictor d. an inhibitor of leukotriene synthesis

a. a SSRI

Among the following beta blockers, which is the least effective in preventing migraine HAs? a. acebutolol b. metoprolol c. atenolol d. propranolol

a. acebutolol

Prophylatic tx for migraine HA includes the use of: a. amitriptylline b. ergot derivative c. naproxen sodium d. clonidine

a. amitriptylline

In counseling a patient who experiences migraines, you recommend all of the following lifestyle changes to minimize the risk of triggering a HA except: a. avoiding eating within 1-2 hours of AM awakening b. limiting exposure to cigarette smoking c. avoiding trigger physical activities d. implementing strategies to reduce stress

a. avoiding eating within 1-2 hours of AM awakening

Risk factors for cluster Has include all of the following except: a. being older than 65 years of age b. heavy EtOH use c. heavy tobacco use d. male gender

a. being older than 65 years of age

A 64-year-old woman presents with urge incontience and has not been able to tolerate treatment with anticholinergic agents. You recommend the use of which of the following: (more than one answer) a. botulinum toxin injections b. fesoterodine fumarate (Toviaz) c. mirabegron (Myrbetriq) d. finasteride (Proscar)

a. botulinum toxin injections and c. mirabegron (Myrbetriq)

The most common renal stones are composed of: a. calcium b. uric acid c. sodium d. iron

a. caclcium

Factors that contribute to urge incontinence include: a. detrusor overactivity b. pelvic floor weakness c. urethral stricture d. UTI

a. detrusor overactivity

Common adverse effects of musculotropic relaxants (eg. fesoterodine) uses in the tx of urinary incontinence include: a. dry mouth and constipation b. nausea c. HA d. syncope

a. dry mouth and constipation

A first line prophylatic tx option for the prevention of tension-type HA is: a. nortriptyline b. verapamil c. carbamazepine d. valproate

a. nortriptyline

The most effective strategy for preventing renal stones is: a. daily exercise b. adequate hydration c. limiting coffee consumption d. smoking cessation

b. adequate hydration

The use of neuroleptics such as prochlorperazine (Compazine) and promethazine (Phenergan) in migraine therapy should be limited to less than 3 times per week because of their: a. addictive potential b. extrapyramidal movement risk c. ability to cause rebound HA d. sedative effect

b. extrapyramidal movement risk

A 68-year-old man presents with new onset of HAs. He describes the pain as b/l frontal to occipital and most severe when he arises in the morning and when coughing. He feels much better by midafternoon. The hx is most consistent with Ha caused by: a. vascular compromise b. increased ICP c. brain tumor d. tension-type with atypical geriatric presentation

b. increased ICP

Which of the following oral agents has the most rapid analgesic onset? a. naproxen b. liquid ibuprofen c. diclofenac d. enteric-coated Naproxen

b. liquid Ibuprofen

Medications known to increase the risk of renal stones include all of the following except: a. hydrochlorothiazide b. moxifloxacin c. topiramate d. indinavir

b. moxifloxacin

Factors that contribute to stress incontinence include: a. detrusor overactivity b. pelvic floor weakness c. urethral stricture d. UTI

b. pelvic floor weakness

A 48-year-old woman presents with a monthly 4-day premenstrual migraine HA, poorly responsive to triptans and analgesics, and accompanied by vasomotor symptoms (hot flashes). The clinician considers prescribing all of the following except: a. continuous monophasic combined oral contraceptive b. phasic combined oral contraceptive with a 7-day-per-month withdrawal period. c. low-dose estrogen patch use during the premenstrual week d. triptan prophylaxis

b. phasic combined oral contraceptive with a 7-day-per-month withdrawal period

A 63 year old man presents with abdominal pain, pain during urination, and red urine. Imaging reveals a renal stone in the ureter. An appropriate treatment option would be: a. percutaneous nephrolithotomy b. shock wave lithotripsy c. insertion of a nephrostomy tube d. insertion of a bladder catheter

b. shock wave lithotripsy

In tension-type HA, which of the following is true? a. photophobia is seldom reported b. the pain is typically described as 'pressing' in quality c. the HA is usually unilateral d. physical activity usually makes the discomfort worse

b. the pain is typically described as 'pressing' in quality

Pharmacologic intervention for patients with urge incontinence include: a. tamsulosin (flomax) b. tolterodine (Detrol) c. finasteride (Proscar) d. pseudoephedrine

b. tolterodine (Detrol)

Which form of urinary incontinence is most common in elderly persons? a. stress b. urge c. iatrogenic d. overflow

b. urge

Risk factors for renal stones include all of the following except: a. male gender b. vegetarian diet c. family hx of renal stones d. obesity

b. vegetarian diet

stress incontinence

behavior intervention for this incontinence is to do Kegel exercises in and pelvic floor rehab with biofeedback

urge incontinence

behavior intervention for this incontinence is to establish a voiding schedule and gentle bladder stretching

functional continence

behavior intevention for this incontinence is to have an assistant who is aware of voiding cues and help with toileting activities

Loss of corneal reflex is in part seen in dysfunction of CN: a. III b. IV c. V d. VI

c. V

With appropriately prescribed HA prophylactic therapy, the pt should be informed to expect: a. virtual resolution of HAs b. no fewer but less severe HAs c. approximately 50% reduction in the number of HAs d. that lifelong therapy is advised

c. approximately 50% reduction in the number of HAs

Patients with urge incontinence ofen report urine loss: a. with exercise b. at night c. associated with a strong sensation of needing to void d. as dribbling after voiding

c. associated with a strong sensation of needing to void

An example of a first-line therapeutic agent for the treatment of pyelonephritis is: a. amoxicillin with clauvulanate b. trimethoprin-sulfamethoxazole c. ciprofloxacin d. nitrofurantoin

c. ciprofloxacin

You see a 70-year-old woman in a walk-in center with a chief complaint of increased urinary frequency and dysuria. Urinalysis reveals pyuria and positive nitrites. She mentions she has a 'bit of kidney trouble, not too bad.' Recent evaluation of renal status is unavailable. In considering antimicrobial therapy for this patient, you prescribe: a. nitrofurantoin b. fosfomycin c. ciprofloxacin d. doxycycline

c. ciprofloxacin

You see an 82-year-old woman with early-onset dementia and urge incontinence. Which of the following medications is least likely to contribute to worsening mental status? a. oxybutynin (Ditropan) b. tolterodine (Detrol) c. darifenacin (Enablex) d. solifenacin succinate (Vesicare)

c. darifenacin (Enablex)

Limitations of use of butalbital with APAP and caffeine (Fioricet) include its: a. energizing effect b. GI upset profile c. high rate of rebound HA if used frequently d. excessive cost

c. high rate of rebound HA if used frequently

Systemic corticosteroid therapy would be most appropriate in treating: a. tension-type HA b. migraines occurring on a weekly basis c. intractable or severe migraines and cluster HAs d. migraines occurring during pregnancy

c. intractable or severe migraines and cluster HAs

Antiepileptic drugs uses for preventing migraine HAs include all of the following except: a. divalproex b. valproate c. lamotrigine d. topiramate

c. lamotrigine

Common symptoms of renal stones include all of the following except: a. pink, red, or brown urine b. sharp pain in the back or lower abdomen c. marked febrile response d. pain while urinating

c. marked febrile response

A 22 year old woman presents with a 3-year history of recurrent, unilateral, pulsating HAs with vomiting and photophobia. The HAs, which generally last 3 hours, can be aborted by resting in a dark room. She can usually tell that she is going to get a HA. She explains, "I see 'little' squiggles' before my eyes for about 15 minute. Her PE is unremarkable. This presentation is most consistent with:' a. tension-type HA b. migraine without aura c. migraine with aura d. cluster HA

c. migraine with aura

A 47-year-old woman experiences occassional migraine with aura and reports partial relief with zolmitriptan. You decide to add which of the following to augment the pain control by the triptan? a. lamotrigine b. gabapentin c. naproxen Na d. magnesium

c. naproxen Na

A 45-year-old man experiences rapidly progressing migraine HAs that are accompanied by significant GI upset. Appropriate acute HA (abortive) treatment includes all of the following exept: a. injectable sumatriptan b. dihydroergotamine nasal spray c. oral naproxen Na d. zolmitriptan nasal spray

c. oral naproxen Na

You see a 58 year old man diagnosed with a kidney stone who reports pain primarily during urination. You consider all of the following except: a. improved hydration b. alpha blocker use c. prescribing a diuretic d. analgesia use

c. prescribing a diuretic

Evidence-based factors that prevent or minimize the risk of UTIs include all of the following except: a. male gender b. longer urethra-to-anus length in women c. timed voiding schedule d. zinc-rich prostatic secretions

c. timed voiding schedule

Tx options in cluster HA include the use of: a. NSAIDs b. O2 c. the triptans d. all of the above therapies

d. all of the above therapies

Patients with urethral stricture often report urine loss: a. with exercise b. during the day c. associated with urgency d. as dribbling after voiding

d. as dribbling after voiding

You see a 58 year old woman who is being treated for a renal stone. Analysis of a stone passed in the urine reveals that it is composed of calcium oxalate. In counseling, the patient about preventing future stones, you consider all of the following except: a. reducing sodium in her diet b. limiting consumption of beets, rhubarb, nuts, and chocolate c. encouraging her to get her daily calcium requirements from food d. if calcium supplements are needed, this medication should be taken on an empty stomach

d. if calcium supplements are needed, this medication should be taken on an empty stomach

With migraine, which of the following statements is true? a. migraine with aura is the most common form b. most migraineurs are in ongoing healthcare for the condition c. the condition is equally common in both men and women d. the pain is typically described as pulsating

d. the pain is typically described as pulsating

Struvite stones are typically found in people: a. with type 2 diabetes b. who live in colder climates c. who abuse alcohol d. with a hx of kidney infections

d. with a hx of kidney infections

differential diagnoses for epigastric pain

functional dyspepsia, GERD, PUD, biliary etiology, ischemic bowel, constipation, gastroparesis, medications

Ken, a 46 year old Caucasian male, presents to the clinic with 2-month history of epigastric pain occurring 2-3 hours after a meal. He also wakes at night and needs to take antacids for epigastric pain relief. What else do you want to know? PE exam?

if he has had any nausea or vomiting; antacids would help a little but should prescribe him prilosec to help and since symptoms might come back -PE exam: exam essentially normal, no HTN, mild epigatric pain with exam, nothing alarming

functional dyspepsia

symptoms orriginate in gastro-duodenal region no dz to cause symptoms symptoms include: epigastric discomfort or pain, postprandial fullness, early satiety -any hx of past ulcer dz?