SRMD and PUD By Alaina Darby

SRMD

Which of the following are the defensive factors that are typically compromised to cause SRMD? Mucosal barrier and mucosal blood flow Mucosal barrier and bicarb production GI motility and mucosal blood flow GI motility and bicarb production a

Curling’s ulcer would be described by which of the following? Localization to the duodenum CNS injury Thermal injury Increased histamine production c

Which of the following is an area where curling’s and cushing’s ulcer may both be found? Esophagus Colon Small intestine Stomach d

RH is a 55 yo wm who has been hospitalized RH is a 55 yo wm who has been hospitalized. Which of the following factors leading to SRMD usually cannot addressed medically? Acid back diffusion Decreased mucosal blood flow Decreased GI motility Decreased bicarb b

RH is a 55 yo wm who has been hospitalized RH is a 55 yo wm who has been hospitalized. What would be most indicative of SRMD? Decreasing hemoglobin Stool guaiac Decreased BP Increased HR b

RH is a 55 yo wm who has been hospitalized RH is a 55 yo wm who has been hospitalized. Which of the following would indicate a bleed in the upper portion of the GI tract? Hematochezia Melena Hematemesis Stool guaiac c

RH is a 55 yo wm who has been hospitalized RH is a 55 yo wm who has been hospitalized. Which of the following is least often assessed/performed? Clinical symptoms Macroscopic blood Endoscopy Microscopic blood c

RH is a 55 yo wm who has been hospitalized. He has tarry stools RH is a 55 yo wm who has been hospitalized. He has tarry stools. His Hgb and BP have decreased and HR have increased since admit. Which of the following would be true concerning SRMD? Clinically significant based on HR and BP Clinically significant based on tarry stools and Hgb Clinically significant based on tarry stools and BP Not clinically significant d Admit Current HR 75 94 BP 140/95 128/70 Hgb 13 10.6

RH is a 55 yo wm who has been hospitalized. He has tarry stools RH is a 55 yo wm who has been hospitalized. He has tarry stools. His Hgb and BP have decreased and HR have increased since before. Which of the following would be true concerning SRMD? Clinically significant based on HR and BP Clinically significant based on tarry stools and Hgb Clinically significant based on tarry stools and BP Not clinically significant c Admit Current HR 75 90 BP 140/95 115/65 Hgb 13 10.2

Which of the following alone would not be considered a higher risk for SRMD? GCS 8 GI bleed 8 months ago INR 1.8 ICU stay for 8 days d

Which of the following can be given to reduce mortality? Antacids H2RAs PPIs Sucralafate d

JR is a 44 yo wm with multiple traumatic injuries from his MVA JR is a 44 yo wm with multiple traumatic injuries from his MVA. He has a perforated bowel, a broken femur, 6 broken ribs, and significant bruising. SCr has risen to 1.9 (1 at baseline). Which of the following would be most indicated for SRMD prophylaxis? Antacids H2RAs PPIs Sucralafate Prophylaxis not required c

RO is a 25 yo wf who has been admitted for asthma RO is a 25 yo wf who has been admitted for asthma. She has had an asthma exacerbation and has been on hydrocortisone 100mg q6h since her admission 4 days ago. What form of prophylaxis should she receive? Antacids PPIs Sucralafate Prophylaxis not required d

RO is a 25 yo wf who has been admitted for asthma RO is a 25 yo wf who has been admitted for asthma. She has had an asthma exacerbation and has been on hydrocortisone 100mg q6h since her admission 5 days ago. yesterday she developed a pneumonia infection which requires her to be mechanically ventilated. What form of prophylaxis should she receive? Antacids PPIs Sucralafate Prophylaxis not required d

RO is a 25 yo wf who has been admitted for asthma RO is a 25 yo wf who has been admitted for asthma. She has had an asthma exacerbation and has been on hydrocortisone 100mg q6h since her admission 6 days ago. she developed a pneumonia infection which has required her to be mechanically ventilated for 48 hours. What form of prophylaxis should she receive? Antacids PPIs Sucralafate Prophylaxis not required b

RO is a 25 yo wf who has been admitted for asthma RO is a 25 yo wf who has been admitted for asthma. She has had an asthma exacerbation and has been on hydrocortisone 100mg q6h since her admission 6 days ago. she developed a pneumonia infection which has required her to be mechanically ventilated for 48 hours. What form of prophylaxis should she receive? Antacids PPIs Sucralafate Prophylaxis not required b

FJ is a 89 yo wf admitted after a fall FJ is a 89 yo wf admitted after a fall. She has fractured her hip and has been hospitalized in the ICU for 5 days due to surgical complications. She takes warfarin for AF and her inr is therapeutic at 2.3. when would she be indicated for prophylaxis? 1 day 2 days 3 days Indicated now b

FJ is a 89 yo wf admitted after a fall FJ is a 89 yo wf admitted after a fall. She has fractured her hip and has been hospitalized in the ICU for 5 days due to surgical complications. She takes warfarin for AF and her inr is therapeutic at 2.3. What would you want to monitor in this patient if she is to begin H2RA therapy? Mental status Hepatic function INR Drug interactions a

FJ is a 89 yo wf admitted after a fall FJ is a 89 yo wf admitted after a fall. She has fractured her hip and has been hospitalized in the ICU for 5 days due to surgical complications. She takes warfarin for AF and her inr is therapeutic at 2.3. When should the H2RA be discontinued? When gastric pH is >3.5 When gastric pH is >4.5 Upon transfer to the floor Upon hospital discharge c

FJ is a 89 yo wf admitted after a fall. She has fractured her hip FJ is a 89 yo wf admitted after a fall. She has fractured her hip. She takes warfarin for AF and her inr is therapeutic at 2.3. On day 6 she develops SrmD. What should you do first? Continue H2RA Start somatstatin Start PPI Endoscopy d

FJ is a 89 yo wf admitted after a fall. She has fractured her hip FJ is a 89 yo wf admitted after a fall. She has fractured her hip. She takes warfarin for AF and her inr is therapeutic at 2.3. What pharmacological treatment would be preferred? Continue H2RA Start somatstatin Start PPI Start sucralafate Combination of 2 of the above c

FJ is a 89 yo wf admitted after a fall. She has fractured her hip FJ is a 89 yo wf admitted after a fall. She has fractured her hip. She takes warfarin for AF and her inr is therapeutic at 2.3. Which of the following would be preferred for treatment? Esomeprazole 60 mg x1 then 8 mg/hr Esomeprazole 80 mg x1 then 8 mg/hr Lansoprazole 60 mg x1 then 8 mg/hr Lansoprazole 80 mg x1 then 8 mg/hr b

FJ is a 89 yo wf admitted after a fall. She has fractured her hip FJ is a 89 yo wf admitted after a fall. She has fractured her hip. She takes warfarin for AF and her inr is therapeutic at 2.3. What would be the least relevant concern in this patient when taking a PPI? Renal function Bone mineralization Vit B12 deficiency C. diff infection a

PUD

Which of the following is not a common form of PUD? H. pylori positive NSAID induced Neoplastic origin Stress ulcers c

Which of the following is most likely to lead to a stress-type ulcer? Radiation Chemotherapy Smoking Vascular insufficiency d

Which of the following cells is the target for sucralafate? Parietal cells Chief cells Foveolar/mucus neck cells G cells b… pepsinogen!

Which of the following cells is instrumental in protecting the GI tract? Parietal cells Chief cells Foveolar/mucus neck cells G cells c

Which of the following cells overproduces in ZEs? Parietal cells Chief cells Foveolar/mucus neck cells G cells a

Which of the following cells is the target of most pharmacotherapy for PUD? Parietal cells Chief cells Foveolar/mucus neck cells G cells a

G cells Parietal cells Chief cells Gastrin Histamine Gastric acid Eterchro-maffin like cells Gastric acid Parietal cells Pepsin (from pepsinogen) Chief cells

Which of the following might increase histamine production in someone already dealing with allergies? PPIs H2RAs Sucralafate Misoprostol a

JR is pregnant. Which of the following would be safest in this patient? PPIs H2RAs Sucralafate Misoprostol c

Which of the following Would only be indicated for PUD prophylaxis of NSAID associated PUD? PPIs H2RAs Sucralafate Misoprostol d

JR is a 78 yo wm who has GERD symptoms JR is a 78 yo wm who has GERD symptoms. What of the following tests will most likely be done to evaluate for h. pylori? Endoscopy with biopsies Urea breath test Fecal antigen Antibody detection d

JR is a 78 yo wm who has h. pylori associated PUD per testing JR is a 78 yo wm who has h. pylori associated PUD per testing. What is the preferred treatment? PPI x 10 days PPI + clarithromycin + amoxicillin x 10 days PPI + bismuth subsalicylate + metronidazole + tetracycline x 10 days PPI + clarithromycin + amoxicillin + metronidazole x 10 days b

JR is a 78 yo wm who has h. pylori associated PUD per testing JR is a 78 yo wm who has h. pylori associated PUD per testing. What is the preferred treatment if he fails first line therapy? PPI x 10 days PPI + clarithromycin + amoxicillin x 10 days PPI + bismuth subsalicylate + metronidazole + tetracycline x 10 days PPI + clarithromycin + amoxicillin + metronidazole x 10 days d

JR is a 78 yo wm who has h. pylori associated PUD per testing JR is a 78 yo wm who has h. pylori associated PUD per testing. What should you tell him to expect when he starts his PPI/antibiotic therapy? Immediate relief of GERD symptoms Increased incidence of GERD symptoms Increased likelihood of fracture if he falls Possible neurological effects due to B12 deficiency b