Three medical Qs regarding gastrointestinal diseases; MDs pls help!?I had GI exam today. Checking the key afterwards, I was astounded by some of the professors' answers. Could someone pls explain these for me?
1. After infection with H.pylori, which part of the stomach is gastritis first induced in?
a. Corpus
b. Antrum and duodenum
* I chose "b" but the key was "a". Shall I object? The key may be wrong.
2. 65-y male comes to ER for rectorrhagia. feeling dyspnea and pressure on chest. BP 90/60. HR 115. Hb 14 mg/dl (normal). Coffee-ground drainage of NG tube. which of the following infusions would be recommended?
a. Packed RBC
b. Whole Blood
c. Plasma
d. Dextrose Saline
* I chose "d" but the key was "b". Why?
3. All of the following are states are clinical predictors of acute pancreatitis, except:
a. Age b. Obesity c. Gallstone as a cause d. Short time interval to symptom onset
* The key was "d". Why?
Posted by ►Noble◄
Sorry I am not an MD yet, but I think I can help.
1. One is a fairly leading question, and I can see how could have chose B. But the question is talking about a gastritis not an ulcer. B would be the correct answer for ulcer... gastritis however is most common in corpus. (also can't have a gastritis in the duodenum)
2. The word rectorrhagia is misleading here, it gives the impression there is rectal bleeding, but really it means blood in stool). The low BP, high HR indicates a "pre-shock" scenario. Coffee-ground drainage in the question is referring to is blood after enzymatic attack. The Hb is borderline low... which isn't impossible in an acute hemorrhage. Pt is going into hemorrhagic shock from an upper GI bleed. Replacing lost blood by giving whole blood (B) would be the best treatment. Giving dextrose w/ saline might momentarily fix the hemorrhagic shock, but to no avail. Since the we wouldn't have replaced the lost clotting factor or the RBC it will not save the patient, plus the increase in BP as a result of the saline would only increase the hemorrhage. Rectorrhagia here would be dark brown to black after passage through GI tract. (another tough question)
3. I don't think any of them are the right answer. I really don't know why your Prof picked D. Let me know when you find out.
You must be in med school (if you're not I have nothing but sympathy for your class). These are not easy question. I can see how I would have made similar mistakes if I was short on time. I am taking Step 1 in 3 days, so if find any info that is contrary to my explanation please let me know. It would be a tremendous help.
Posted by Manjit
your professor really doesnt like you does he? question 3 is just very ambigious...
Posted by Stephen
1.gastritis by Definition can't affect the duodenum.
2. packed cells would be my choice whole blood isn't often used. The patient needs volume expansion and re cells so I that's why whole blood was chosen. In practice packed cells + volume expander would be used but that choice isn't there.
3. Its d cause all the others are (process of elimination)
That's the main drawback of multiple Choice, the best answer might not be listed
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