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Flashcards in EXAM #1: REVIEW Deck (128)
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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
Q
Do the major characteristics of C. diff differ from C. botulinum?
A
No
26
Q
Aside from supportive therapy and stopping the offending agent, how is C. diff colitis treated?
A
Oral metronidazole or vanomycin

****Note that metronidazole is preferred*****
27
Q
What kind of diarrhea is associated with Shigellosis?
A
Bloody
28
Q
What are the identifying characteristics of Shigella dysenteraie?
A
Gram negative bacillus that is:
- Non-lactose fermenting
29
Q
What are the 3x characteristics that distinguish Shigella from Salmonella?
A
1) Non-glucose fermenting
2) No H2S production
3) Non-motile

I.e. Salmonella ferments glucose (not lactose), produces H2S, and is motile
30
Q
What is the preferred treatment for Shigellosis?
A
A fluoroquinolone i.e. CIPROFLOXACIN
31
Q
What is the preferred treatment for Shigellosis in children?
A
TMP-SMX (bactrim)

*****Note that cipro is not used in kids b/c of an increased risk of tendonitis and achilles tendon rupture*****
32
Q
What are the 4x infections that can be caused by Salmonella?
A
1) Enterocolitis
2) Typhoid fever
3) Osteomyelitis
4) Sepsis
33
Q
What is the most important host defense against Salmonella typhimurium?
A
Gastric acid
34
Q
Where does Salmonella typhi replicate?
A
Mononuclear phagocytes i.e. monocytes and macrophages in Peyer's Patches
35
Q
What organ is associated with the carrier state of Salmonella typhi?
A
Gallbladder
36
Q
What are the symptoms of Typhoid Fever?
A
1) Flu
2) Fever/ constipation
3) Bacteremia
4) Rose-spots
37
Q
What are the drugs of choice in treating patients with Salmonella enterocolitis?
A
1) Ceftriaxone
2) Ciprofloaxcin
38
Q
List the major identifiable characteristics of E. coli.
A
Gram negative bacillus (rod) that:
- Facultative anaerobe
- Ferments lactose
39
Q
What strain of E. coli most commonly causes traveler's diarrhea?
A
ETEC
40
Q
What is the MOA of the ETEC toxin?
A
Similar MOA to cholera toxin:
- AB toxin
1) B= binds
2) A= activates Gs--> increases cAMP

****Causing a watery diarrhea****
41
Q
What type of diarrhea is seen with EIEC?
A
Bloody/ mucous
42
Q
What is EPEC most commonly associated with?
A
Chronic diarrhea in infants
43
Q
What type of diarrhea is associated with EPEC?
A
Mucous
44
Q
What toxins are associated with EHEC?
A
Shiga-like Toxins i.e. SLT-1 and SLT-2
45
Q
What is a major complication of EHEC infection?
A
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
Q
What antibiotics are used to treat E. coli infection in children?
A
Gentamicin
Polymyxin
47
Q
What antibiotics are used to treat severe Campylobacter jejuni infections?
A
1) Erythromycin
2) Ciprofloaxcin
48
Q
What neurologic disorder can be part of the sequelae of C. jejuni infection?
A
Gullian Barre Syndrome
49
Q
What are the identifying characteristics of H. pylori?
A
Gram negative SPIRAL shaped bacteria that is:
- Microaerophilic
- Contain a polar flagella (motile)
50
Q
What should you think when a patient complains of odonphasia?
A
Infectious esophagitis i.e. esophagitis caused by:
1) C. albicans
2) HSV
3) CMV
51
Q
What five complications are patients with Achalasia at risk for?
A
1) Obstruction
2) Aspiration
3) Esophagitis
4) Diverticula formation
5) Squamous cell carcinoma (SCC)
52
Q
What is the primary presenting symptom of an esophageal diverticula?
A
Halatosis
53
Q
What is the most common infectious cause of esophageal varices?
A
Schistosomiasis--parasite released from freshwater snails that can cause liver damage and portal HTN similar to chronic alcoholism
54
Q
List four symptoms seen with esophagitis.
A
1) GERD
2) Dysphagia
3) Hematemesis
4) Melena
55
Q
List six risk factors for GERD.
A
1) Alcohol use
2) Tobacco use
3) Caffeine
4) Fat-rich diet
5) Obesity
6) Hiatal hernia
56
Q
Outline the histologic progression seen in reflux esophagitis.
A
1) Eosinophilia
2) Basal zone hyperplasia
3) Elongation of lamina propria papillae
4) Ulceration and superficial necrosis
57
Q
What is the buzzword for low-grade dysplasia seen in Barett's Esophagus?
A
Picket-fence nuclei
58
Q
What esophageal pathology is Scleroderma associated with?
A
Fibrosis of smooth muscle leading to stricture formation and dysphagia
59
Q
What is the most common benign tumor of the esophagus?
A
Leiomyoma
60
Q
List six risk factors for Squamous Cell Carcinoma of the esophagus.
A
1) Alcohol
2) Tobacco
3) Nitrosamines in food (smoked)
4) Chronic esophagitis
5) Achalasia
6) HPV
61
Q
What are the three types of SCC seen in the esophagus?
A
1) Protruding
2) Flat
3) Ulcerated
62
Q
What are the two lab markers of cholestatic injury?
A
1) Alkaline phosphatase (ALP)
2) Bilirubin
63
Q
What are three causes of APL elevation?
A
1) Stretch or inflammation of the biliary tree
2) Bone disease
3) 3rd trimester pregnancy
64
Q
What is LKM?
A
Anti-Liver/Kidney miroscomal antibody
65
Q
What lab and what antibody are associated with Primary Biliary Cirrhosis?
A
- Elevated ALP
- ANA
66
Q
What are the red flags for Primary Sclerosing Cholangitis on lab evaluation?
A
1) Elevated ALP
2) Beads on a string bile duct
3) Onion skin bile duct
67
Q
What antibodies are associated with autoimmune hepatitis?
A
ANA
ASMA
68
Q
List six causes of acute gastritis.
A
1) NSAIDs
2) Alcohol
3) Chemotherapy
4) Severe burn (Curling)
5) Increased ICP (Cushing)
6) Shock (Stress)
69
Q
Histologically, how will mild acute gastritis appear?
A
- Hyperemia (increased blood)
- Edema
- Neutrophils above the basement membrane
70
Q
Histologically, how will severe acute gastritis appear?
A
- Erosion of entire mucosal thickness
- Hemorrhage
71
Q
Histologically, what will chronic gastritis lead to?
A
- Mucosal atrophy
- Intestinal metaplasia
72
Q
What characteristic of H. pylori facilitates binding to the gastric mucosas?
A
Adhesins
73
Q
What is the most common site of H.pylori infection in the stoamch?
A
Antrum
74
Q
What are the two types of gastric carcinoma?
A
1) Intestinal-type
2) Diffuse-type
75
Q
What are the characteristics of an intestinal-type gastric carcinoma?
A
- Large
- Irregular
- Heaped-up margins
76
Q
Where are intestinal-type gastric carcinomas typically found?
A
Lesser curvature of the stomach in the anturm
77
Q
List four risk factors for gastric carcinoma.
A
1) H. pylori
2) Autoimmune gastritis
3) Nitrosamines
4) Blood Type A
78
Q
What are the symptoms of gastric carcinoma?
A
- Abdominal pain
- Early satiety
- Anemia
- Weight loss
79
Q
What cell-type undergoes neoplastic proliferation in a GIST?
A
Mesenchymal "Cells of Cajal"
80
Q
What are the histologic markers for a GIST?
A
- CD117
- c-KIT
81
Q
What is the typical clinical presentation of Crohn's Disease?
A
- Intermittent non-bloody diarrhea
- RLQ pain
- Fever
82
Q
List the major complications associated with Crohn's Disease.
A
1) Malabsorption
2) Calcium oxalate nephorlithiasis
3) Fistula formation
4) Carcinoma
83
Q
What is the typical clinical presentation in Ulcerative Colitis?
A
- Bloody diarrhea
- LLQ pain
84
Q
What are the major complications associated with Ulcerative Colitis?
A
1) Toxic megacolon
2) Perforation
3) Carcinoma
85
Q
What are the two classic morphologic features of Ulcerative Colitis?
A
1) Loss of haustra
2) Pseudopolyps
86
Q
How is the inflammation in Ulcerative Colitis described?
A
Crypt abscess formation
87
Q
What is the typical complication of chronic bowel ischemia?
A
Stricture leading to obstruction
88
Q
Where are most diverticula located?
A
Sigmoid colon
89
Q
List five potential complications of diverticular disease.
A
1) Inflammation and diverticulitis
2) Perforation
3) Abscess formation
4) Rupture (of the abscess)
5) Fistula tract formation
90
Q
What is the classic presentation of diverticulitis?
A
- Cramping abdominal pain
- LLQ pain
- Sensation of being unable to empty rectum
91
Q
List the symptoms of an intestinal obstruction.
A
- Abdominal pain
- Abdominal distension
- Vomiting
- Constipation
- Inability to pass gas
92
Q
What is the mnemonic to remember the difference between indirect and direct inguinal hernias?
A
MDs don't LIe
- Medial to inferior epigastric= direct
- Lateral to inferior epigastric= indirect
93
Q
What type of inguinal hernia will result in bowel in the scrotum?
A
Indirect
94
Q
What are the two most common causes of intussception in kids?
A
1) Secondary Lymphoid Hyperplasia
2) Rotavirus
95
Q
Name two secondary causes of bowel obstruction.
A
1) Foreign body e.g. "drug mule"
2) Carcinoma
96
Q
What are the three most common malabsorptive disorders in the US?
A
1) Celiac spure
2) Chronic pancreatitis
3) Crohn's Disease
97
Q
What is the cause of Whipple Disease?
A
Tropheryma whipplei
98
Q
What is the hallmark of Whipple Disease?
A
Macrophages stuffed with PAS+ granules in multiple organ systems
99
Q
What are the clinical features of Whipple Disease?
A
Fat malabsorption and steatorrhea
- Macrophages block the lacteals
- Chylomicrons cannot be transferred from enterocytes to lymphatics
100
Q
What are the two most common tumors of the small bowel?
A
1) Adenomas
2) Mesenchymal tumors i.e. GISTS
101
Q
What are the two most common malignant tumors of the small bowel?
A
1) Adenocarcinoma
2) Carcinoid
102
Q
What specific location in the small bowel harbors the most adenomas?
A
Ampulla of Vater i.e. the union of the pancreatic duct and common bile duct
103
Q
Where do most hyperplastic polyps occur?
A
Rectosigmoid region
104
Q
What are patients with Peutz-Jegher's Syndrome at risk for?
A
- Intussusception
- Cancer i.e.
1) Colorectal
2) Breast
3) GYN
105
Q
What is the classic presentation of a villous polyp?
A
- Overt rectal bleeding
- Hyponatremia
- Hypokalemia
106
Q
List four risk factors for colorectal carcinoma.
A
1) Increased age
2) Prior colorectal cancer or polyps
3) Ulcerative Colitis or Crohn's Disease
4) Poor diet
107
Q
What is the inheritance pattern of FAP?
A
Autosomal Dominant
108
Q
What is the average age of onset in FAP?
A
25 years old
109
Q
What is the hallmark of Mediterranean Lymphoma?
A
Abnormal IgA heavy chain
110
Q
List the causes of extrinsic neuropathy leading to dysmotility.
A
1) DM
2) Trauma
3) PD
4) Amyloidosis
5) Paraneoplastic Syndrome
111
Q
What causes enteric neuropathy?
A
1) Idiopathic degeneration
2) Inflammatory/infiltrative processes
112
Q
What are the two most common causes of GI dysmotility?
A
Gastroparesis
Pseudo-obstruction
113
Q
List the differential diagnosis for a GI dysmotility disorder.
A
1) Mechanical obstruction
2) Crohn's Disease/ IBD
3) Autonomic neuropathy
4) Functional GI Disorder
5) Eating disorder
114
Q
What labs can you order to rule out organic disorders that may mimic IBS?
A
1) Celiac antibodies
2) TSH
3) CRP/ESR
4) Stool studies
5) Imaging
115
Q
What are the mixed neural and muscle causes of dysmotility?
A
1) Amyloidosis
2) Mitochondrial cytopathies
3) Sclerderma
116
Q
List the four "other" minor diseases associated with IBD.
A
1) Microscopic colitis
2) Diversion colitis
3) Diverticular colitis
4) Pouchitis
117
Q
Outline the four pathogenic mechanisms that lead to the development of IBD.
A
1) Persistent infection
2) Defective mucosal integrity
3) Dysbiosis
4) Dysregulated immune response
118
Q
List the symptoms that are classic for UC.
A
- Bloody diarrhea*
- Rectal discomfort
- Fecal urgency
- Abdominal cramping
119
Q
List the symptoms that are classic for CD.
A
- Abdominal pain
- Diarrhea
- Low grade fever
- Anorexia
120
Q
Which has a higher associated with perianal disease, Ulcerative Colitis or Crohn's Disease?
A
Crohn's Disease
121
Q
What are the drug classes used to treat IBD.?
A
1) Aminosalicylates
2) Corticosteroids
3) Immunomodulators
4) Antibiotics
5) Supportive agents
122
Q
How is remission induced in UC? How it maintained?
A
- Aminosalicylates*
- 6MP/Azathoprine*
- Corticosteroids
- Cyclosporine

*Used for both induction and remission.*
123
Q
What are the adverse effects of Metronidazole?
A
- Nausea
- Metallic taste
- Furry tongue
- Candidiasis
- Peripheral neuropathy
124
Q
What are the indications for topical corticosteroids?
A
- Proctitis
- Left-sided colitis
125
Q
What are the adverse effects associated with 6MP/ Azathioprine?
A
- Hypersensitivity
- Bone marrow suppression
- Opportunistic infection
- Lymphoma risk
126
Q
What are the indications for surgery is Ulcerative Colitis?
A
1) Severe bleeding
2) Perforation
3) Cancer or dysplasia
4) Unresponsive acute disease
127
Q
What surgical procedure is the standard of care for UC?
A
Ileal pouch-anal anastamosis
128
Q
What are the indications for surgery in Crohn's Disease?
A
1) Severe bleeding
2) Perforation
3) Cancer or dysplasia
4) High grade obstruction

(vs. unresponsive acute disease in UC)