Nokea
A 36-year-old woman complains of reflux symptoms and intermittent diarrhea. The diagnosis of gastrinoma is suspected so a fasting serum gastrin is obtained and found to be 280 pg/mL (normal <115 pg/mL). An abdominal CT is negative. What would you do now?
- A. Refer her for an exploratory laparotomy
- B. Measure serum gastrin in response to secretin infusion
- C. Treat her for H. pylori
- D. Obtain a dedicated small bowel series
Correct Answer: B
Rationale: The correct answer is B: Measure serum gastrin in response to secretin infusion. This step is necessary to confirm the diagnosis of gastrinoma. Secretin stimulation test is used to differentiate between Zollinger-Ellison syndrome (gastrinoma) and other causes of hypergastrinemia. If serum gastrin levels remain elevated after secretin infusion, it supports the diagnosis of gastrinoma.
Choice A: Refer her for an exploratory laparotomy - This is an invasive procedure and should not be the first step in the investigation of gastrinoma.
Choice C: Treat her for H. pylori - This is not indicated in the management of suspected gastrinoma. H. pylori infection is not a likely cause of the symptoms described.
Choice D: Obtain a dedicated small bowel series - This test is not typically used in the initial evaluation of gastrinoma. The secretin stimulation test is the preferred method for confirming the diagnosis.
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A 35-year-old man presents with fatigue, weight loss, and hyperpigmentation of the skin. Laboratory tests reveal hyponatremia, hyperkalemia, and low cortisol levels. What is the most likely diagnosis?
- A. Cushing's syndrome
- B. Addison's disease
- C. Hypothyroidism
- D. Pheochromocytoma
Correct Answer: B
Rationale: The most likely diagnosis is Addison's disease (Choice B) because the symptoms match adrenal insufficiency. The low cortisol levels indicate adrenal cortex dysfunction, leading to fatigue and weight loss. Hyponatremia and hyperkalemia result from mineralocorticoid deficiency. Hyperpigmentation occurs due to elevated ACTH levels stimulating melanin production in Addison's. Cushing's syndrome (Choice A) presents with high cortisol levels, opposite to the low levels seen here. Hypothyroidism (Choice C) does not typically cause hyponatremia or hyperkalemia. Pheochromocytoma (Choice D) manifests with hypertension and catecholamine excess, not seen in this case.
When teaching a client postoperative breathing techniques with an incentive spirometer (IS), what should the nurse encourage the client to do to maintain sustained maximal inspiration?
- A. Exhale forcefully into the tubing for 3 to 5 seconds.
- B. Inspire deeply and slowly over 3 to 5 seconds.
- C. Breathe into the spirometer using normal breath volumes.
- D. Perform IS breathing exercises every 6 hours.
Correct Answer: B
Rationale: The correct answer is B: Inspire deeply and slowly over 3 to 5 seconds. This technique is recommended for using an incentive spirometer (IS) to maintain sustained maximal inspiration. Slow, deep inhalation helps fully expand the lungs and improve lung function postoperatively.
A: Exhaling forcefully into the tubing is incorrect because the purpose of using an IS is to promote deep inhalation, not forceful exhalation.
C: Breathing into the spirometer using normal breath volumes is incorrect as it does not promote maximal inspiration and may not fully expand the lungs.
D: Performing IS breathing exercises every 6 hours is incorrect as regular, consistent practice throughout the day is recommended for optimal lung recovery.
The patient described in the preceding question has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?
- A. She is at low risk for reinfection with H. pylori
- B. A positive serum IgG indicates that eradication of H. pylori was successful
- C. The urease breath test is an ideal test to document failure of eradication
- D. Dyspepsia typically worsens with H. pylori eradication
Correct Answer: C
Rationale: The correct answer is C because the urease breath test is the ideal test to document failure of H. pylori eradication. This test directly measures the presence of the H. pylori bacterium in the stomach by detecting the enzyme urease produced by the bacterium. If the patient still has symptoms after treatment, a positive urease breath test would indicate that the bacterium is still present, leading to treatment failure.
Choice A is incorrect because a positive antibody test does not indicate low risk for reinfection. Choice B is incorrect because a positive serum IgG may persist even after successful eradication. Choice D is incorrect because dyspepsia can improve after successful H. pylori eradication rather than worsen.
The patient described in the preceding questions has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?
- A. She is at high risk for reinfection with H. pylori.
- B. A positive serum IgG indicates that eradication of H. pylori was unsuccessful.
- C. The urease breath test is an ideal test to document failure of eradication.
- D. Dyspepsia usually improves with H. pylori eradication.
Correct Answer: C
Rationale: Step 1: The patient has a positive H. pylori antibody blood test, indicating exposure to the bacteria.
Step 2: Compliance with medical regimen suggests treatment for H. pylori infection.
Step 3: Persistence of symptoms after treatment indicates possible treatment failure.
Step 4: The urease breath test is ideal for detecting treatment failure as it directly measures the presence of H. pylori.
Step 5: Therefore, choice C is correct as it identifies the appropriate test for confirming eradication failure.
Summary:
- Choice A is incorrect as reinfection risk is not the immediate concern.
- Choice B is incorrect as a positive serum IgG doesn't definitively indicate eradication failure.
- Choice D is incorrect as not all dyspepsia cases improve with H. pylori eradication.
Which regimen is most effective for treating H. pylori infection?
- A. Metronidazole, bismuth subsalicylate, amoxicillin for 14 days
- B. Clarithromycin and omeprazole for 14 days
- C. Metronidazole, lansoprazole, and clarithromycin for 14 days
- D. Metronidazole, clarithromycin, and omeprazole for 7 days
Correct Answer: C
Rationale: The correct answer is C - Metronidazole, lansoprazole, and clarithromycin for 14 days. This regimen includes a proton pump inhibitor (lansoprazole) to reduce stomach acid, clarithromycin to kill the bacteria, and metronidazole as an alternative antibiotic. This combination therapy is recommended by guidelines as it targets H. pylori effectively, reducing the risk of resistance.
Choice A is incorrect as bismuth subsalicylate is not included in the recommended regimen. Choice B is incorrect because omeprazole is not the preferred proton pump inhibitor, and using clarithromycin alone can lead to resistance. Choice D is incorrect as the duration of treatment is insufficient for eradication. Overall, choice C is the most effective option based on current guidelines and best practices for treating H. pylori infection.