EXAM #1: REVIEW Flashcards
(128 cards)
1
Q
What is the staining method that is used to diagnose Barrett’s Esophagus?
A
Alcain Blue, which stains mucous secreting goblet cells blue
2
Q
What third of the esophagus is more likely to harbor a squamous cell carcinoma?
A
Middle 1/3
3
Q
At what vertebral level is the esophageal hiatus located?
A
T10
4
Q
What lymph nodes are most likely to be affected by metastasis from the inferior esophagus?
A
Celiac trunk
5
Q
What two surgical procedures can be done for refractory PUD?
A
1) Surgical excision of the pylorus
2) Selective vagotomy
6
Q
Outline the borders of the Gastrinoma Triangle.
A
1) Junction of the cystic duct and common hepatic duct
2) Junction of the neck and body of the pancreas
3) Junction between 2nd and 3rd part of the duodenum
7
Q
What gross change of the stomach is seen in Zollinger-Ellison Syndrome?
A
Prominent rugae due to increased parietal cell mass
8
Q
List the four histologic features of Gluten Enteropathy.
A
1) Disarrayed enterocytes
2) Villous atrophy
3) Crypt hyperplasia
4) Inflammation of the lamina propria
9
Q
What two structures may be damaged if their perforation of a posterior duodenal ulcer?
A
1) Pancreas
2) Gastroduodenal a.
10
Q
What is the result of an anterior duodenal ulcer perforation?
A
Air accumulation between the diaphragm and anterior wall of the liver
11
Q
What is the eponym of the watershed area of the colon that is most prone to ischemia?
A
“Critical Point of Griffiths”
12
Q
What are the three mechanisms that cause esophageal stenosis?
A
1) Sequestration of respiratory tissue elements
2) Myenteric plexus damage that causes hypertrophy
3) Mucosal diaphragm
13
Q
What vascular anomaly can cause esophageal stenosis?
A
Lusorian a.
- 4th brach on the left side of the aortic arch
- Retroesophageal course to become the RIGHT subclavian a.
14
Q
What nerve supplies the rectum inferior to the pectinate line?
A
Inferior rectal n.
15
Q
What is amylopectin?
A
Plant starch with alpha-1,4 glycosidic bonds and alpha-1,6 branches
16
Q
What are the specific oligosaccharides that are the end products of pancreatic alpha-amylase?
A
1) Maltose
2) Maltotriose
3) Alpha-limit dextrins
17
Q
What prevents pancreatic lipase from being denatured by bile acids?
A
Colipase
18
Q
What are the four physical mechanisms that prevent infection of the GI tract?
A
1) Acidity of the stomach
2) Peristalsis
3) Detergent action of bile
4) Mucus secretion
19
Q
List the four major locations of GALT.
A
1) Peyer’s patches
2) Appendix
3) Lymphoid aggregates in the large intestine
4) Lamina propria
20
Q
What are the two important functions that IgA plays in immunity?
A
1) Opzonization
2) Anti-parasite immunity–facilitates eosinophil degranulation
21
Q
What two malignancies are patients with Celiac Disease at risk for?
A
1) GI Lymphoma
2) GI Carcinoma
22
Q
What drug can be used to treat Crohn’s Disease?
A
Infliximab, an anti-TNF-a monoclonal antibody
23
Q
When do the symptoms of Botulism start?
A
12-36 hours post ingestion
24
Q
What are the essential identifying characteristics of C. botulinum?
A
Gram positive bacillus (rod) that is:
- Anaerobic
- Spore-forming
25
Do the major characteristics of C. diff differ from C. botulinum?
No
26
Aside from supportive therapy and stopping the offending agent, how is C. diff colitis treated?
Oral metronidazole or vanomycin
****Note that metronidazole is preferred*****
27
What kind of diarrhea is associated with Shigellosis?
Bloody
28
What are the identifying characteristics of Shigella dysenteraie?
Gram negative bacillus that is:
| - Non-lactose fermenting
29
What are the 3x characteristics that distinguish Shigella from Salmonella?
1) Non-glucose fermenting
2) No H2S production
3) Non-motile
I.e. Salmonella ferments glucose (not lactose), produces H2S, and is motile
30
What is the preferred treatment for Shigellosis?
A fluoroquinolone i.e. CIPROFLOXACIN
31
What is the preferred treatment for Shigellosis in children?
TMP-SMX (bactrim)
*****Note that cipro is not used in kids b/c of an increased risk of tendonitis and achilles tendon rupture*****
32
What are the 4x infections that can be caused by Salmonella?
1) Enterocolitis
2) Typhoid fever
3) Osteomyelitis
4) Sepsis
33
What is the most important host defense against Salmonella typhimurium?
Gastric acid
34
Where does Salmonella typhi replicate?
Mononuclear phagocytes i.e. monocytes and macrophages in Peyer's Patches
35
What organ is associated with the carrier state of Salmonella typhi?
Gallbladder
36
What are the symptoms of Typhoid Fever?
1) Flu
2) Fever/ constipation
3) Bacteremia
4) Rose-spots
37
What are the drugs of choice in treating patients with Salmonella enterocolitis?
1) Ceftriaxone
| 2) Ciprofloaxcin
38
List the major identifiable characteristics of E. coli.
Gram negative bacillus (rod) that:
- Facultative anaerobe
- Ferments lactose
39
What strain of E. coli most commonly causes traveler's diarrhea?
ETEC
40
What is the MOA of the ETEC toxin?
Similar MOA to cholera toxin:
- AB toxin
1) B= binds
2) A= activates Gs--> increases cAMP
****Causing a watery diarrhea****
41
What type of diarrhea is seen with EIEC?
Bloody/ mucous
42
What is EPEC most commonly associated with?
Chronic diarrhea in infants
43
What type of diarrhea is associated with EPEC?
Mucous
44
What toxins are associated with EHEC?
Shiga-like Toxins i.e. SLT-1 and SLT-2
45
What is a major complication of EHEC infection?
Hemolytic Uremic Syndrome that is characterized by:
1) Microangiopathic hemolytic anemia
2) Thrombocytopenia
3) Acute kidney injury
****Note that this is the leading cause of renal failure in children worldwide*****
46
What antibiotics are used to treat E. coli infection in children?
Gentamicin
| Polymyxin
47
What antibiotics are used to treat severe Campylobacter jejuni infections?
1) Erythromycin
| 2) Ciprofloaxcin
48
What neurologic disorder can be part of the sequelae of C. jejuni infection?
Gullian Barre Syndrome
49
What are the identifying characteristics of H. pylori?
Gram negative SPIRAL shaped bacteria that is:
- Microaerophilic
- Contain a polar flagella (motile)
50
What should you think when a patient complains of odonphasia?
Infectious esophagitis i.e. esophagitis caused by:
1) C. albicans
2) HSV
3) CMV
51
What five complications are patients with Achalasia at risk for?
1) Obstruction
2) Aspiration
3) Esophagitis
4) Diverticula formation
5) Squamous cell carcinoma (SCC)
52
What is the primary presenting symptom of an esophageal diverticula?
Halatosis
53
What is the most common infectious cause of esophageal varices?
Schistosomiasis--parasite released from freshwater snails that can cause liver damage and portal HTN similar to chronic alcoholism
54
List four symptoms seen with esophagitis.
1) GERD
2) Dysphagia
3) Hematemesis
4) Melena
55
List six risk factors for GERD.
1) Alcohol use
2) Tobacco use
3) Caffeine
4) Fat-rich diet
5) Obesity
6) Hiatal hernia
56
Outline the histologic progression seen in reflux esophagitis.
1) Eosinophilia
2) Basal zone hyperplasia
3) Elongation of lamina propria papillae
4) Ulceration and superficial necrosis
57
What is the buzzword for low-grade dysplasia seen in Barett's Esophagus?
Picket-fence nuclei
58
What esophageal pathology is Scleroderma associated with?
Fibrosis of smooth muscle leading to stricture formation and dysphagia
59
What is the most common benign tumor of the esophagus?
Leiomyoma
60
List six risk factors for Squamous Cell Carcinoma of the esophagus.
1) Alcohol
2) Tobacco
3) Nitrosamines in food (smoked)
4) Chronic esophagitis
5) Achalasia
6) HPV
61
What are the three types of SCC seen in the esophagus?
1) Protruding
2) Flat
3) Ulcerated
62
What are the two lab markers of cholestatic injury?
1) Alkaline phosphatase (ALP)
| 2) Bilirubin
63
What are three causes of APL elevation?
1) Stretch or inflammation of the biliary tree
2) Bone disease
3) 3rd trimester pregnancy
64
What is LKM?
Anti-Liver/Kidney miroscomal antibody
65
What lab and what antibody are associated with Primary Biliary Cirrhosis?
- Elevated ALP
| - ANA
66
What are the red flags for Primary Sclerosing Cholangitis on lab evaluation?
1) Elevated ALP
2) Beads on a string bile duct
3) Onion skin bile duct
67
What antibodies are associated with autoimmune hepatitis?
ANA
| ASMA
68
List six causes of acute gastritis.
1) NSAIDs
2) Alcohol
3) Chemotherapy
4) Severe burn (Curling)
5) Increased ICP (Cushing)
6) Shock (Stress)
69
Histologically, how will mild acute gastritis appear?
- Hyperemia (increased blood)
- Edema
- Neutrophils above the basement membrane
70
Histologically, how will severe acute gastritis appear?
- Erosion of entire mucosal thickness
| - Hemorrhage
71
Histologically, what will chronic gastritis lead to?
- Mucosal atrophy
| - Intestinal metaplasia
72
What characteristic of H. pylori facilitates binding to the gastric mucosas?
Adhesins
73
What is the most common site of H.pylori infection in the stoamch?
Antrum
74
What are the two types of gastric carcinoma?
1) Intestinal-type
| 2) Diffuse-type
75
What are the characteristics of an intestinal-type gastric carcinoma?
- Large
- Irregular
- Heaped-up margins
76
Where are intestinal-type gastric carcinomas typically found?
Lesser curvature of the stomach in the anturm
77
List four risk factors for gastric carcinoma.
1) H. pylori
2) Autoimmune gastritis
3) Nitrosamines
4) Blood Type A
78
What are the symptoms of gastric carcinoma?
- Abdominal pain
- Early satiety
- Anemia
- Weight loss
79
What cell-type undergoes neoplastic proliferation in a GIST?
Mesenchymal "Cells of Cajal"
80
What are the histologic markers for a GIST?
- CD117
| - c-KIT
81
What is the typical clinical presentation of Crohn's Disease?
- Intermittent non-bloody diarrhea
- RLQ pain
- Fever
82
List the major complications associated with Crohn's Disease.
1) Malabsorption
2) Calcium oxalate nephorlithiasis
3) Fistula formation
4) Carcinoma
83
What is the typical clinical presentation in Ulcerative Colitis?
- Bloody diarrhea
| - LLQ pain
84
What are the major complications associated with Ulcerative Colitis?
1) Toxic megacolon
2) Perforation
3) Carcinoma
85
What are the two classic morphologic features of Ulcerative Colitis?
1) Loss of haustra
| 2) Pseudopolyps
86
How is the inflammation in Ulcerative Colitis described?
Crypt abscess formation
87
What is the typical complication of chronic bowel ischemia?
Stricture leading to obstruction
88
Where are most diverticula located?
Sigmoid colon
89
List five potential complications of diverticular disease.
1) Inflammation and diverticulitis
2) Perforation
3) Abscess formation
4) Rupture (of the abscess)
5) Fistula tract formation
90
What is the classic presentation of diverticulitis?
- Cramping abdominal pain
- LLQ pain
- Sensation of being unable to empty rectum
91
List the symptoms of an intestinal obstruction.
- Abdominal pain
- Abdominal distension
- Vomiting
- Constipation
- Inability to pass gas
92
What is the mnemonic to remember the difference between indirect and direct inguinal hernias?
MDs don't LIe
- Medial to inferior epigastric= direct
- Lateral to inferior epigastric= indirect
93
What type of inguinal hernia will result in bowel in the scrotum?
Indirect
94
What are the two most common causes of intussception in kids?
1) Secondary Lymphoid Hyperplasia
| 2) Rotavirus
95
Name two secondary causes of bowel obstruction.
1) Foreign body e.g. "drug mule"
| 2) Carcinoma
96
What are the three most common malabsorptive disorders in the US?
1) Celiac spure
2) Chronic pancreatitis
3) Crohn's Disease
97
What is the cause of Whipple Disease?
Tropheryma whipplei
98
What is the hallmark of Whipple Disease?
Macrophages stuffed with PAS+ granules in multiple organ systems
99
What are the clinical features of Whipple Disease?
Fat malabsorption and steatorrhea
- Macrophages block the lacteals
- Chylomicrons cannot be transferred from enterocytes to lymphatics
100
What are the two most common tumors of the small bowel?
1) Adenomas
| 2) Mesenchymal tumors i.e. GISTS
101
What are the two most common malignant tumors of the small bowel?
1) Adenocarcinoma
| 2) Carcinoid
102
What specific location in the small bowel harbors the most adenomas?
Ampulla of Vater i.e. the union of the pancreatic duct and common bile duct
103
Where do most hyperplastic polyps occur?
Rectosigmoid region
104
What are patients with Peutz-Jegher's Syndrome at risk for?
- Intussusception
- Cancer i.e.
1) Colorectal
2) Breast
3) GYN
105
What is the classic presentation of a villous polyp?
- Overt rectal bleeding
- Hyponatremia
- Hypokalemia
106
List four risk factors for colorectal carcinoma.
1) Increased age
2) Prior colorectal cancer or polyps
3) Ulcerative Colitis or Crohn's Disease
4) Poor diet
107
What is the inheritance pattern of FAP?
Autosomal Dominant
108
What is the average age of onset in FAP?
25 years old
109
What is the hallmark of Mediterranean Lymphoma?
Abnormal IgA heavy chain
110
List the causes of extrinsic neuropathy leading to dysmotility.
1) DM
2) Trauma
3) PD
4) Amyloidosis
5) Paraneoplastic Syndrome
111
What causes enteric neuropathy?
1) Idiopathic degeneration
| 2) Inflammatory/infiltrative processes
112
What are the two most common causes of GI dysmotility?
Gastroparesis
| Pseudo-obstruction
113
List the differential diagnosis for a GI dysmotility disorder.
1) Mechanical obstruction
2) Crohn's Disease/ IBD
3) Autonomic neuropathy
4) Functional GI Disorder
5) Eating disorder
114
What labs can you order to rule out organic disorders that may mimic IBS?
1) Celiac antibodies
2) TSH
3) CRP/ESR
4) Stool studies
5) Imaging
115
What are the mixed neural and muscle causes of dysmotility?
1) Amyloidosis
2) Mitochondrial cytopathies
3) Sclerderma
116
List the four "other" minor diseases associated with IBD.
1) Microscopic colitis
2) Diversion colitis
3) Diverticular colitis
4) Pouchitis
117
Outline the four pathogenic mechanisms that lead to the development of IBD.
1) Persistent infection
2) Defective mucosal integrity
3) Dysbiosis
4) Dysregulated immune response
118
List the symptoms that are classic for UC.
- Bloody diarrhea*
- Rectal discomfort
- Fecal urgency
- Abdominal cramping
119
List the symptoms that are classic for CD.
- Abdominal pain
- Diarrhea
- Low grade fever
- Anorexia
120
Which has a higher associated with perianal disease, Ulcerative Colitis or Crohn's Disease?
Crohn's Disease
121
What are the drug classes used to treat IBD.?
1) Aminosalicylates
2) Corticosteroids
3) Immunomodulators
4) Antibiotics
5) Supportive agents
122
How is remission induced in UC? How it maintained?
- Aminosalicylates*
- 6MP/Azathoprine*
- Corticosteroids
- Cyclosporine
*Used for both induction and remission.*
123
What are the adverse effects of Metronidazole?
- Nausea
- Metallic taste
- Furry tongue
- Candidiasis
- Peripheral neuropathy
124
What are the indications for topical corticosteroids?
- Proctitis
| - Left-sided colitis
125
What are the adverse effects associated with 6MP/ Azathioprine?
- Hypersensitivity
- Bone marrow suppression
- Opportunistic infection
- Lymphoma risk
126
What are the indications for surgery is Ulcerative Colitis?
1) Severe bleeding
2) Perforation
3) Cancer or dysplasia
4) Unresponsive acute disease
127
What surgical procedure is the standard of care for UC?
Ileal pouch-anal anastamosis
128
What are the indications for surgery in Crohn's Disease?
1) Severe bleeding
2) Perforation
3) Cancer or dysplasia
4) High grade obstruction
(vs. unresponsive acute disease in UC)
