Passmed GI pathology Questions

Question 1

The areas where diverticulosis most likely develops are:

Answer 1

caecum, ascending colon, transverse colon, and sigmoid.

Question 2

A patient with acute pancreatitis showing symptoms of Upper Abdo pain, fever + vomiting would have which LFT raised?

Answer 2

Amylase - product in pancreas + used to digest carbohydrates. Released into the blood in large quantities in pancreatic disease.

Question 3

When would GGT be raised?

Answer 3

Usually occurs due to alcohol / drugs e.g. pheytoin

Question 4

A patient with Crohn’s disease is likely to develop conditions such as…

Answer 4

Gallstones
Malabsorption
Pyoderma gangrenosum
Amyloidosis

Question 5

What is the role of CCK?

Answer 5

Produced by I cells CCK contracts gallbladder to release bile into the duodenum

Question 6

Blood of gallbladder?

Answer 6

cystic artery (branch of right hepatic artery).

Question 7

Following vessels responsible for the blood supply to a Meckel’s Diverticulum?

Answer 7

Vitelline / omphalomesenteric artery

Question 8

Femoral hernia tend to exit…

Answer 8

Below and lateral to the pubic tubercle. This is very common in females. High risk of strangulation.

Question 9

Blood supply to head of pancreas?

Answer 9

Pancreaticoduodenal artery

Question 10

Blood supply to tail of pancreas?

Answer 10

Splenic artery

Question 11

Genes implicated in adenoma carcinoma sequence in CRC?

Answer 11

c-myc, APC, p53, K-ras

Question 12

What is achalasia?

Answer 12

is a motility disorder + not obstructive due to impaired relaxation of LOSin response to swallowing. present with dysphagia of BOTH liquids + solids.

Question 13

Treatment of achalasia

Answer 13

Intra-sphincteric injection of botulinum toxin.
Heller cardiomyotomy
Ballon dilation
Drug therapy

Question 14

In response to shock the substances that will be produced are…

Answer 14

Catecholamines
ADH
Angiotensin II

Question 15

Common genetic predisposition for CRC

Answer 15

FAP + HNPCC

Question 16

A BUZZWORD for a feature found in Gastric cancer?

Answer 16

Signet ring cell = features of poorly differentiated gastric cancer associated with a increased risk of metastatic disease.

Question 17

What is Gilberts syndrome?

Answer 17

It is an autosomal recessive condition results in unconjugated hyperbilirubinaemia in times of stress (such as fasting/ infection).

Due to deficiency of UDP glucuronosyltransferase.= unable to conjugate.

Question 18

what is pneumobilia?

Answer 18

air in the gallbladder + biliary tree on AXR due to cholecystoenteric fistula.

Question 19

Define Dysplasia?

Answer 19

Develops as a results of prolonged stimulation.

Increased no. of mitosis/abnormal mitosis + cellular differentiation

Considered to be a delay in maturation of cells rather than differentiated cells.

Question 20

Most common oesophageal cancer?

Answer 20

Squamous cell carcinoma = common in patient who had achalasia

Question 21

Why is Prothrombin time used to measure LFT instead of albumin sometimes?

Answer 21

Because prothrombin has a shorter life-time than albumin, making it better measure of acute liver failure.

PT will fall because liver is unable to replace PT.

Albumin concentration will remain unchanged.

Question 22

FAP is associated with which feature

Answer 22

More than 100 adenomatous polyps affecting the colon and rectum. Duodenal and fundic glandular polyps

Genetic composition: ACP (80% sporadic)

Question 23

HNPCC is associated with which feature

Answer 23

Colorectal cancer (likely to be right sided and mucinous) without extensive polyposis. Endometrial cancer, Gastric, renal and CNS.

Genetic composition:MSH2 / MLH1 (mismatch repair gene).

Question 24

Peutz-Jeghers syndrome is associated with which feature

Answer 24

Hamartomatous polyps in GI tract and increased risk of GI malignancy

Genetic composition: LKB1 and STK11

Question 25

For Bowel obstruction treament?

Answer 25

decompression + IV fluid (drip + suck) as long as there is not spesis / perotinitis.

Question 26

Hormones released by carcinod tumour?

Answer 26

Sertonin

Question 27

Causes of Chronic Pancreatitis?

Answer 27

80% due to alcohol but 20% of cases are unknown:
- Genetic: cystic fibrosis, haemochromatosis
- Ductal obstruction: tumours, stones,
structural abnormalities including pancreas
divisum and annular pancreas

Question 28

Gastric gastro-intestinal stromal tumour origin of lesion?

Answer 28

intestinal cells of Cajal

Question 29

hyperpigmented macules on lips is caused by which bengin condition?

Answer 29

Peutz-Jeghers syndrome

Question 30

Features associated with gilberts syndrom?

Answer 30

unconjugated hyperbilirubinaemia (i.e. not in urine)
jaundice may only be seen during an intercurrent illness, exercise or fasting

Question 31

‘red-currant jelly’ + 6-18 months old. Boys are affected twice as often as girls.

Answer 31

Intussusception

Question 32

Rovsing’s sign

Answer 32

sign in appendicitis - RIF pain on palpation of LIF

Question 33

Microcytic anaemia = low MCV

Answer 33

Iron deficiency anaemia

Question 34

Raised MCV = macrocytic anaemia

Answer 34

B12 and folate deficiency.

Question 35

Gastrin

Answer 35

Produced by G cells in antrum

Increases HCL, pepsin + IF secretion.

Inhibited by somatostatin + low ph.

Question 36

Secretin

Answer 36

produced by S cells in upper small bowel.

When acidic chyme is present + fatty acids.

Increases secretion of biocarb-rich fluid from pancreas + hepatic duct cells.

Question 37

VIP

Answer 37

Produced by small intestine + pancreas

Stimulate secretion via pancreas + intestines, inhibits acid + pepsinogen secretion.

Question 38

Somatosatin

Answer 38

produced by D cells in the pancreas + stomach.

Presents of fat, bile, salts in SB.

Decreases acid + pepsin, decreases gastrin, decreases pancreatic enzymes, decreases insulin + glucagon. Stimulates gastric mucous production.