EXAM #3: REVIEW

Question 1

List 7x risk factors for colon cancer.

Answer 1

1) Family history
2) IBD
3) Smoking
4) Alcohol
5) Obesity
6) Inactivity
7) Poor diet

Question 2

What is the inheritance pattern of the APC mutation seen in FAP?

Answer 2

Autosomal dominant

Question 3

Name the three scenarios that will give a patient a positive family history for colon cancer.

Answer 3

1) Colon ca in 1st degree relative under 60 y/o
2) 2+ first degree relatives with colon ca at ANY age
3) 2nd degree relative under 50 y/o with colon ca

Question 4

What is the biopsy protocol for a patient with IBD undergoing colonoscopy?

Answer 4

Collect 4x random samples every 10cm of bowel for a total of 30+ samples

Question 5

What are the surveillance recommendations following resection of a colon or rectal cancer?

Answer 5

1) H/P + CEA Q3-6 months

2) CT Q1 year for 5x years

Question 6

List seven diseases that are associated with pancreatic cancer.

Answer 6

1) FAP
2) Peutz-Jegher’s Syndrome
3) Von Hippel-Lindau
4) MEN1
5) HNPCC
6) BRCA
7) FAMMM

Question 7

List five signs/ symptoms typically seen in the presentation of pancreatic cancer.

Answer 7

1) Abdominal pain
2) Weight loss
3) Jaundice
4) Steatorrhea
5) Pruritus

Question 8

What should you be concerned about in an elderly, non-obese patient that develops glucose intolerance?

Answer 8

Pancreatic cancer

Question 9

How is pancreatic cancer diagnosed i.e. what studies are needed for the diagnosis?

Answer 9

1) Spiral CT with IV contrast

2) Biopsy

Question 10

What are the characteristics of resectable pancreatic cancer?

Answer 10

1) No extrapancreatic disease
2) No tumor extension into:
- Celiac axis
- SMA

Question 11

What is a non-opiate approach to pain management in pancreatic cancer?

Answer 11

Celiac plexus neurolysis

Question 12

What are the three hallmarks of a cystic neoplasm?

Answer 12

1) Bloating
2) Obstructive jaundice
3) Weight loss

Question 13

What are the most common types of cystic neoplasms?

Answer 13

• Mucinous cystadenomas

- Cystadenocarcinoma

Question 14

Where are mucinous cystadenomas or cystadenocarcinomas located?

Answer 14

Body or tail of the pancreas

Question 15

What is an intraductal papillary mucinous neoplasm referred to as?

Answer 15

Pancreatic precursor tumor

Question 16

What studies should be ordered to work up a cystic neoplasm?

Answer 16

1) Abdominal CT
2) EUS
3) Biopsy

Question 17

What confirms the diagnosis of an insulinoma with a 72 hour fast?

Answer 17

Elevated c-peptide and insulin

Question 18

What lab is diagnostic for a Gastrinoma?

Answer 18

Elevated serum gastrin

Question 19

List the four benign liver lesions. Which is the most common?

Answer 19

1) Hemangioma*
2) Focal Nodular Hyperplasia
3) Adenoma
4) Simple cyst

Question 20

Where is HCC common geographically?

Answer 20

Worldwide except US and Europe

This is b/c of endemic viral hepatitis

Question 21

What is the tumor marker for HCC?

Answer 21

Alpha-fetoprotein

Question 22

List four surgical methods for treating HCC.

Answer 22

1) Wedge resection
2) Lobectomy
3) Trisegmentectomy
4) Liver transplant

Question 23

What are the three major obstacles to liver surgery?

Answer 23

1) Dual blood supply
2) Liver reserve
3) Coagulopathy

Question 24

List four characteristics of a good surgical candidate for HCC resection.

Answer 24

1) Class A Child Pugh Score
2) Solitary tumor
3) No vascular invasion
4) Tumor less than 3 cm

Question 25

What drug is specifically used for HCC chemotherapy?

Answer 25

Sorafenib *Note that this drug block angiogensis and targets HCC surface proteins*

Question 26

List three risk factors for cholangiocarcinoma.

Answer 26

1) Primary Sclerosing Cholangitis 2) Liver flukes 3) Choledochal cyst

Question 27

How does cholangiocarcinoma typically present?

Answer 27

1) Constitutional sx. of cancer 2) Painless jaundice 3) Biliary Tract Obstruction

Question 28

How is cholangiocarcinoma diagnosed?

Answer 28

1) ERCP 2) CT or MRI with cholangiography 3) US

Question 29

What surgery is used to treat perihilar cholangiocarcinoma i.e. the most common type of cholangiocarcioma?

Answer 29

Roux-en-Y Hepaticojejunostomy

Question 30

What patient is most likely to get gallbladder cancer?

Answer 30

Elderly Chilean female from an urban area

Question 31

List four risks associated with phototherapy to treat neonatal jaudice.

Answer 31

1) Retinal degeneration 2) Increased fluid loss 3) Bronze Baby Syndrome 4) Congenital Erythropoietic Porphyria

Question 32

What are the four different types of gallstones?

Answer 32

1) Cholesterol-mixed 2) Pigmented 3) Sludge 4) Single large

Question 33

What are the signs and symptoms of a simple gallstones?

Answer 33

- RUQ pain - Exacerbated with eating - Murphy's sign

Question 34

How do you initially manage cholecystitis in the ED?

Answer 34

1) NPO 2) Hydration 3) Ketorlac

Question 35

Name four criteria that would warrant admission to the hospital with cholecystitis.

Answer 35

- Impacted stone - Sepsis - Unrelenting pain - Uncertain diagnosis

Question 36

What are three medical therapies for gallstones?

Answer 36

1) Ursodiol 2) ESWL shock waves 3) Contact dissolution

Question 37

What are the quasi medical therapies for gallstones?

Answer 37

1) ERCP | 2) Transcutaneous drain

Question 38

What is Charcot's triad of cholangitis?

Answer 38

1) Fever 2) RUQ pain 3) Jaundice

Question 39

What are the three infectious etiologies of pancreatitis?

Answer 39

1) Mumps 2) Coxsackievirus 3) Mycoplasma pneumonia

Question 40

List seven complications of acute pancreatitis.

Answer 40

1) Shock 2) ARDS 3) Acute renal failure 4) DIC 5) Pancreatic abscess 6) Pancreatic pseudocyst 7) Duodenal obstruction

Question 41

How would you describe the microscopic appearance of chronic pancreatitis?

Answer 41

1) Acinar drop out 2) Inflammatory infiltrate 3) Fibrosis 4) Protein/ductal plugs

Question 42

What are the important clinical features of Von Hippel Lindau disease?

Answer 42

- Mutation of chromosome 3 - Renal cell carcinoma and pheochromocytoma are common - CYSTS in the PANCREAS, liver, and kidneys - Angiomas in the retina, cerebellum, and brainstem

Question 43

List the three major types of cystic neoplasia involving the pancreas.

Answer 43

1) Microcystic serous cystadenoma 2) Mucinous cystic tumor 3) Solid pseudopapillary tumor

Question 44

What are the major complications of cholecystitis?

Answer 44

1) Bacterial superinfection 2) Perforation/abscess formation 3) Fistula formation

Question 45

Name three functional disorders of the GI system.

Answer 45

1) Gastroparesis 2) IBS 3) Non-ulcer dyspepsia

Question 46

Name four organic disorders of the GI system.

Answer 46

1) Hepatitis 2) Pancreatitis 3) Cholecystitis 4) IBD

Question 47

What two things make constant bloating a red flag?

Answer 47

1) Ovarian cancer | 2) Ascites

Question 48

How do you repair a TE fistula?

Answer 48

Right thoracotomy and extrapleural repair

Question 49

What does the VACTERL associated with TE fistuala stand for?

Answer 49

``` Vertebral Anorectal Cardiovascular Tracheal Esophageal Renal Limb ``` Any patient with a TE fistual needs to be assessed for issues with these associated structures.

Question 50

What anomalies are associated with omphalocele?

Answer 50

1) Heart 2) Urinary tract 3) Beckwith-Wiedeman

Question 51

What is the classical sign for duodenal atresia with imaging?

Answer 51

Double bubble sign

Question 52

What is the US finding that is indicative of intussusception? What should you do if you see this?

Answer 52

"Target sign" -->Barium enema

Question 53

How does biliary atresia present?

Answer 53

Persistent direct hyperbilirubinemia

Question 54

List 4x signs/sx. of pediatric cholestasis.

Answer 54

1) Jaundice 2) Dark urine 3) Pruritus 4) RUQ pain

Question 55

What does acholic stool suggest in an child?

Answer 55

Obstructive jaundice

Question 56

Outline the sequence required to diagnose pediatric biliary atresia.

Answer 56

1) Elevated direct bilirubin 2) US 3) Biopsy 4) Laparotomy 5) Intraoperative cholangiography

Question 57

How are choledochal cysts treated?

Answer 57

Roux-en Y cholechocojejunostomy

Question 58

What five anomalies are associated with Alagille Syndrome?

Answer 58

1) Facial changes 2) Peripheral pulmonic stenosis 3) Butterfly vertebrae 4) Posterior embryotoxon 5) Growth retardation

Question 59

What are the major criteria for Hy's Law?

Answer 59

1) 3x normal transaminases 2) 2x normal bilirubin 3) No alternative explanation for elevation

Question 60

What is the definition of acute DILI?

Answer 60

Onset of sx. within 3 months of starting drug

Question 61

Name three extrahepatic manifestation of DILI.

Answer 61

- Rash - Fever - Eosinophilia

Question 62

What are the three methods of indirect hernia repair with a "tissue repair?"

Answer 62

1) Bassini= 1 level 2) Shouldice= 4 level 3) McVay= Cooper's ligament