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FNP Family Nurse Practitioner Exam Prep

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A 41-year-old obese male schedules a clinic appointment complaining of chest pain. The patient describes the pain as burning and located at the epigastric or mid-sternal level. The patient reports the pain frequently awakens him at night and is relieved by eating, especially milk products.

On exam, the patient appears well. Vital signs show blood pressure of 120/75, pulse 75, temperature 98.6, respiratory rate 20, and oxygen saturation of 99% on room air. The abdominal exam is significant only for some mild epigastric tenderness to palpation.

EKG and chest x-ray are unremarkable.

What is the next best diagnostic step?

  1. Transthoracic echocardiography (TTE)
  2. Chest and abdominal CT with contrast
  3. Upper gastrointestinal endoscopy
  4. Upper gastrointestinal series with small bowel follow through
  5. Angiography
Explanation

Answer: C - This patient presents with classic symptoms of peptic ulcer disease, a burning epigastric non-radiating pain that is worse at night and relieved by meals. In patients with symptoms of peptic ulcer disease, the gold standard for diagnosis is upper GI endoscopy to visualize the ulcer directly.

Endoscopy is more sensitive and specific than upper gastrointestinal barium studies. TTE and CT of the chest and abdomen with contrast are of little value in diagnosing peptic ulcer disease. Angiography would be appropriate in an upper GI bleed or mesenteric ischemia.

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