EXAM #1: REVIEW Flashcards Preview

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Flashcards in EXAM #1: REVIEW Deck (128):
1

What is the staining method that is used to diagnose Barrett's Esophagus?

Alcain Blue, which stains mucous secreting goblet cells blue

2

What third of the esophagus is more likely to harbor a squamous cell carcinoma?

Middle 1/3

3

At what vertebral level is the esophageal hiatus located?

T10

4

What lymph nodes are most likely to be affected by metastasis from the inferior esophagus?

Celiac trunk

5

What two surgical procedures can be done for refractory PUD?

1) Surgical excision of the pylorus
2) Selective vagotomy

6

Outline the borders of the Gastrinoma Triangle.

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

What gross change of the stomach is seen in Zollinger-Ellison Syndrome?

Prominent rugae due to increased parietal cell mass

8

List the four histologic features of Gluten Enteropathy.

1) Disarrayed enterocytes
2) Villous atrophy
3) Crypt hyperplasia
4) Inflammation of the lamina propria

9

What two structures may be damaged if their perforation of a posterior duodenal ulcer?

1) Pancreas
2) Gastroduodenal a.

10

What is the result of an anterior duodenal ulcer perforation?

Air accumulation between the diaphragm and anterior wall of the liver

11

What is the eponym of the watershed area of the colon that is most prone to ischemia?

"Critical Point of Griffiths"

12

What are the three mechanisms that cause esophageal stenosis?

1) Sequestration of respiratory tissue elements
2) Myenteric plexus damage that causes hypertrophy
3) Mucosal diaphragm

13

What vascular anomaly can cause esophageal stenosis?

Lusorian a.
- 4th brach on the left side of the aortic arch
- Retroesophageal course to become the RIGHT subclavian a.

14

What nerve supplies the rectum inferior to the pectinate line?

Inferior rectal n.

15

What is amylopectin?

Plant starch with alpha-1,4 glycosidic bonds and alpha-1,6 branches

16

What are the specific oligosaccharides that are the end products of pancreatic alpha-amylase?

1) Maltose
2) Maltotriose
3) Alpha-limit dextrins

17

What prevents pancreatic lipase from being denatured by bile acids?

Colipase

18

What are the four physical mechanisms that prevent infection of the GI tract?

1) Acidity of the stomach
2) Peristalsis
3) Detergent action of bile
4) Mucus secretion

19

List the four major locations of GALT.

1) Peyer's patches
2) Appendix
3) Lymphoid aggregates in the large intestine
4) Lamina propria

20

What are the two important functions that IgA plays in immunity?

1) Opzonization
2) Anti-parasite immunity--facilitates eosinophil degranulation

21

What two malignancies are patients with Celiac Disease at risk for?

1) GI Lymphoma
2) GI Carcinoma

22

What drug can be used to treat Crohn's Disease?

Infliximab, an anti-TNF-a monoclonal antibody

23

When do the symptoms of Botulism start?

12-36 hours post ingestion

24

What are the essential identifying characteristics of C. botulinum?

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)