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A 40-year-old woman presents with a history of chronic constipation, bloating, and abdominal pain. She notes that the pain is relieved with defecation. She denies any weight loss, blood in her stools, or nocturnal symptoms. Physical examination and routine blood tests are normal. What is the most likely diagnosis?
- A. Inflammatory bowel disease
- B. Irritable bowel syndrome
- C. Celiac disease
- D. Lactose intolerance
Correct Answer: B
Rationale: The correct answer is B: Irritable bowel syndrome (IBS). The key clues in the question are chronic constipation, bloating, abdominal pain relieved with defecation, and absence of alarming symptoms. These symptoms align with the Rome IV criteria for IBS. Inflammatory bowel disease (A) typically presents with more severe symptoms, including weight loss and blood in stools. Celiac disease (C) is associated with malabsorption symptoms and autoimmune features, not typically seen in this case. Lactose intolerance (D) presents with symptoms after consuming dairy, which is not mentioned in the patient's history. Therefore, based on the clinical presentation and exclusion of other conditions, the most likely diagnosis is IBS.
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The nurse is caring for a client with a history of deep vein thrombosis (DVT) who is receiving warfarin (Coumadin). Which laboratory value should the nurse monitor closely?
- A. Platelet count.
- B. Prothrombin time (PT).
- C. Hemoglobin level.
- D. White blood cell count.
Correct Answer: B
Rationale: The correct answer is B: Prothrombin time (PT). Warfarin affects the clotting process by inhibiting vitamin K-dependent clotting factors. Monitoring PT helps assess the effectiveness of warfarin therapy and prevent complications like bleeding. Platelet count (A) is important but not directly affected by warfarin. Hemoglobin level (C) and white blood cell count (D) are not typically affected by warfarin therapy.
A 56-year-old woman with rheumatoid arthritis has severe joint pain and swelling in her hands. She has a history of peptic ulcer disease five years ago but presently has no GI symptoms. You elect to start her on an NSAID. Which of the following is correct?
- A. Proton-pump inhibitors and H2-blockers are equally effective in prophylaxis against NSAID-related GI toxicity.
- B. Misoprostol is superior to an H2-blocker in prophylaxis against NSAID-related GI toxicity.
- C. Sucralfate is not the drug of choice for prophylaxis in this patient.
- D. H. pylori infection can alter the risk for an NSAID-induced ulcer.
Correct Answer: B
Rationale: Step 1: Misoprostol is a prostaglandin analog that helps protect the gastric mucosa by increasing mucus production. This mechanism of action makes it effective in preventing NSAID-related GI toxicity.
Step 2: H2-blockers (Choice A) and PPIs are not as effective as misoprostol in preventing NSAID-related GI toxicity.
Step 3: Sucralfate (Choice C) is not as effective as misoprostol in preventing NSAID-related GI toxicity due to its different mechanism of action.
Step 4: H. pylori infection (Choice D) can increase the risk of NSAID-induced ulcers but is not directly related to the prophylactic treatment with misoprostol.
What is the most likely diagnosis in a 30-year-old woman with right upper quadrant pain, fever, and jaundice, along with elevated white blood cell count and bilirubin levels?
- A. Acute hepatitis
- B. Acute cholecystitis
- C. Acute cholangitis
- D. Pancreatic cancer
Correct Answer: C
Rationale: The correct answer is C: Acute cholangitis. In a 30-year-old woman with right upper quadrant pain, fever, jaundice, elevated white blood cell count, and bilirubin levels, acute cholangitis is the most likely diagnosis. This condition is characterized by inflammation of the bile ducts, often due to obstruction, leading to symptoms such as pain, fever, and jaundice. The combination of right upper quadrant pain, fever, jaundice, and elevated white blood cell count and bilirubin levels suggests an infection in the biliary system, which is typical of acute cholangitis. Acute hepatitis (choice A) typically presents with elevated liver enzymes but may not have the same degree of biliary obstruction symptoms. Acute cholecystitis (choice B) usually presents with gallbladder inflammation and may not cause jaundice. Pancreatic cancer (choice D) typically presents with different symptoms and is less common in a
An 82-year-old woman with no past medical history presents to your clinic complaining of arthritic symptoms. She is not taking any medications but needs something for her arthritis. You want to start her on a nonsteroidal anti-inflammatory drug (NSAID) but are concerned about her age and the risk of peptic ulcers. As she has to pay for her medications out-of-pocket and requests the most cost-effective option, what is the most appropriate treatment plan?
- A. Prescribe an inexpensive NSAID alone
- B. Prescribe an inexpensive NSAID and misoprostol
- C. Prescribe celecoxib
- D. Prescribe an inexpensive NSAID and sucralfate
Correct Answer: A
Rationale: The correct answer is A: Prescribe an inexpensive NSAID alone. This option is the most appropriate because it balances the need for cost-effectiveness with the concern for peptic ulcers in an elderly patient. Starting with a simple NSAID reduces the risk of adverse effects and minimizes the financial burden on the patient. Option B adds misoprostol, which may help protect the stomach but increases the cost. Option C, prescribing celecoxib, is more expensive and carries a higher cardiovascular risk. Option D, adding sucralfate, does not have strong evidence for preventing NSAID-induced ulcers and adds unnecessary cost. Therefore, option A is the most suitable choice for this scenario.
A 55-year-old man presents with jaundice, pruritus, and dark urine. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. What is the most likely diagnosis?
- A. Primary biliary cirrhosis
- B. Primary sclerosing cholangitis
- C. Gallstones
- D. Pancreatic cancer
Correct Answer: A
Rationale: The most likely diagnosis is Primary biliary cirrhosis (PBC). PBC typically presents with jaundice, pruritus, and dark urine due to impaired bile flow. Elevated bilirubin and alkaline phosphatase levels are common in PBC. Imaging findings of dilated intrahepatic bile ducts and a normal common bile duct support the diagnosis of PBC. Primary sclerosing cholangitis (Choice B) would show strictures and beading of bile ducts on imaging. Gallstones (Choice C) would typically present with a common bile duct obstruction. Pancreatic cancer (Choice D) may present with similar symptoms but is less likely given the specific imaging findings in this case.