Colon Polyps/Cancer, Peds GI

Question 1

inflammatory polyp

Answer 1

benign

Question 2

hamartoma

Answer 2

benign

Question 3

adenoma

Answer 3

neoplastic

Question 4

hyperplastic polyp

Answer 4

benign, non-neoplastic

Question 5

sessile serrated adenoma/polyp

Answer 5

neoplastic

Question 6

traditional serrated adenoma

Answer 6

neoplastic

Question 7

hamartomatous polyp examples

Answer 7

juvenile polyps (AD, mostly rectum)

peutz-jeghers syndrome (AD, colon/SI/Stomach)

Question 8

oral and lip pigmentation

Answer 8

peutz-jeghers syndrome

Question 9

more villous component –> greater

Answer 9

cancer risk

Question 10

serrated polyps, which locations are usually non-neoplastic?

Answer 10

rectum and colon

usu hyperplastic

Question 11

serrated polyps, which locations are usually neoplastic?

Answer 11

proximal to sigmoid, especially R colon (cecum, as colon, transverse colon)

(usu sessile serrated)

Question 12

HNPCC

Answer 12

aka Lynch syndrome

AD
small #polyps, early age
mut in DNA repair genes –> microsat instability

Question 13

Amsterdam II criteria

Answer 13

HNPCC

3+ relatives w/ HNPCC cancer
2+ generations w/ cancer
1+ cancers dx <50

Question 14

familial adenomatous polyposis sundrome (FAP)

Answer 14

AD
APC mut
100% progression to CA by age 30

Question 15

attenuated FAP syndrome

Answer 15

~30 polyps, most proximal

50% lifetime risk for CA

Question 16

Gardener syndrome

Answer 16

FAP w/ osteomas, epidermal cysts, fibromatosis (desmoid tumors)

Question 17

FAP tx

Answer 17

prophylactic colectomy

Question 18

chromosomal instability
(adenoma-carcinoma sequence)

location

histo type

Answer 18

L colon, rectum, sigmoid, descending

• tubular adenomas, tubulovillous, villous
• sessile or pedunculated,

Question 19

microsatellite instability

location

histo type

Answer 19

R colon

-sessile serrated

Question 20

adenoma-carcinoma sequence

MOA

Answer 20

chromosomal instability

• somatic mut occur w/ aging
• APC, Kras, p53

Question 21

MLH1 inactivation

Answer 21

microsat instability

Question 22

Which type of colorectal tumors benefit from anti-GFR therapy?

Answer 22

tumors with wild-type K-ras

Question 23

Which carcinoids metastasize

Answer 23

ileal and colonic tumors

Question 24

Which carcinoids rarely metastasize?

Answer 24

appendiceal and rectal

Question 25

which lymphoma is associated with malabsorption?

Answer 25

T-cell lymphoma

Question 26

most common lymphoma

Answer 26

MALT, t(11;18)

Question 27

primary melanoma mar arise in the

Answer 27

anal canal

Question 28

appendiceal tumors

Answer 28

- mucocele - mucinous cystadenoma - mucinous cystadenocarcinoma

Question 29

melanosis coli

Answer 29

lipofucsin-laden macrophages in lamina propria laxative overuse

Question 30

endometriosis

Answer 30

endometrial glands and stroma in muscularis

Question 31

guaiac test

Answer 31

for peroxidase activity of heme (NOT specific for human blood)

Question 32

FIT

Answer 32

Abs specific for human Hb, albumin, or other blood components

Question 33

start colorectal cancer screening at which age

Answer 33

45 y/o - if 1st degree relative <60, 10 yrs younger than age at first dx, q5yr - " >60, begin at 40, q10yr

Question 34

pancolotis colonoscopy recommendation

Answer 34

annual

Question 35

risk reduction of CRC

Answer 35

aspirin celecoxib (FAP) post-menopause estrogen+progesterone stop cigarettes

Question 36

hypertrophic pyloric stenosis

Answer 36

- first born males - increased vascularity - leads to hypochloremic alkalosis, hypokalemia - tx: pyloromyotomy

Question 37

olive felt on physical

Answer 37

thick pylorus in hypertrophic pyloric stenosis

Question 38

intussusception

Answer 38

- most comm ileocecal - child most idipathic - adult usu have leadpoint classic tx: therapeutic enema

Question 39

Hirschprung's always involves

Answer 39

rectum and extends proximally

Question 40

Hirschprung's

Answer 40

affects both Meissener's and Auerbach's myenteric plexuses -colon can't relax (no effect of NO etc) - dilaTed proximal portion - narrow distal portion

Question 41

Hirschprung's tx

Answer 41

surgical, remove affected portions, primary reanastamosis v temporary ostomy

Question 42

meckle's diverticulum

Answer 42

- THE most common congenital abnormality of the GI tract - outpouching via incomplete obliteration of vitelline duct commenting midgut to yolk sac. - TRUE diverticulum

Question 43

omphalocele

Answer 43

failure of lateral walls to migrate | covered by petitoneum

Question 44

hastroschisis

Answer 44

extrusion of abd contents | no sac

Question 45

necrotizing enterocolitis

Answer 45

- premature, low birth-weight - first 2weeks, onset of enteral feeding - abd distension, vital changes - pneumotosis intestinalis - primarily colonic necrosis - perforation risk tx: bowel rest, abx, surgery