Exam 3 Flashcards
(167 cards)
1
Q
What are the four genes implicated in the pathogenesis of colon cancer? In order?
A
APC
K-Ras
DCC
p53
2
Q
Cancers caused by Lynch Syndrome?
A
colorectal
endometrial
ovarian
3
Q
What enzyme does stool Guiac measure?
A
peroxidase
4
Q
How often should a colonoscopy be done?
A
10 years
5
Q
How often should a flexible sigmoidoscopy be done? With?
A
5 years
FOBT every 3 years
6
Q
How often should a high sensitivity FOBT be performed?
A
every year
7
Q
When should a patient with Crohns or UC have a coloscopy be done? Repeat how often?
A
8-10 years from their diagnosis
every 1-2 years
8
Q
When should a colonoscopy for Lynch Syndrome be performed?
A
20-25 years
9
Q
When should a colonoscopy for FAP Syndrome begin?
A
10-12 years
10
Q
Which nodes would rectal cancer spread to?
A
inguinal
11
Q
How many nodes should be examined for staging?
A
15
12
Q
How long should the margins be during resection?
A
5 cm both sides
13
Q
What does Tis mean?
A
intra-epithelial
14
Q
What does T1 mean?
A
muscularis mucosa in to submucosa
15
Q
What does T2 mean?
A
invades muscularis propria
16
Q
What does T3 mean?
A
invades pericolorectal tissues
17
Q
What does T4a mean?
A
penetrates peritoneum
18
Q
What does T4b mean?
A
invades adjacent organs
19
Q
What is the most common mutated oncogene in panceatic cancer?
A
Kras
20
Q
What are the two chemicals associated with pancreatic cancer?
A
β-naphthyline
benzidine
21
Q
How do tumors of the pancreatic head present?
A
jaundice and weight loss
22
Q
How do pancreatic tumors of the body and tail present?
A
pain
23
Q
What is the diagnostic modality of choice for pancreatic cancer?
A
Spiral CT with contrast
24
Q
What type of pancreatic tumors are found with ERCP?
A
small tumors
25
What is the marker for pancreatic cancer?
CA 19-9
26
Will a pancreatic cancer in the head or the tail present earlier? What type of pancreatic cancer presents in the head?
head
adenocarcinoma
27
Where does pancreatic cancer metastisize?
liver and peritoneum
28
Though modest, what drug has been shown to prolong life in pancreatic cancer?
Gemcitabine
29
What drug works better than gemcitabine for pancreatic cancer?
folfirinox
30
What is the newest drug for pancreatic cancer?
abraxane
31
Which JAK2 inhibitor has shown modest increases in survival time during pancreatic cancer?
Ruloxinib
32
Mucinous cystadenomas effect which population the most? What part of the pancreas?
women
body and tail
33
Intraductal papillary mucinous neoplasms effect which population the most? What part of the pancreas?
men
34
What is the most common endocrine pancreatic tumor? What is confirmatory?
elevated C-peptide
35
What is diagnostic for ZE Syndrome?
gastrin above 200 pg/mL after secretin administraton
36
What are the two treatments of ZES?
resection and PPIs
37
What is the risk factor for hepatic adenomas?
Oral contraceptives
38
What is the definition for focal nodular hyperplasia?
nodular hyperplastic parenchyma with central scar
39
Name three sources of aflatoxins
peanuts, wheat or soybeans
40
What are optimal characteristics for liver cancer resection?
solitary tumors w/o vascular invasion
41
Are the majority of HCC fed by arterial supply or portal system?
arterial
42
Liver flukes can cause what type of cancer?
cholangiocarcinoma
43
95% of cholangiocarcinoma are what type of cancer?
adenocarcinoma
44
What would be two signs of cholangiocarcinoma?
painless jaundice
palpable gallbladder
45
What is the tumor marker for cholangiocarcinoma?
CA 19-9
46
Does chemo help with biliary tract tumors?
no
47
According to Metts, what are the two definitions of Hyperbilirubinemia?
conjugated greater than 2 mg/dL
CONJUGATED bilirubin greater than 20% total
48
According to Metts, jaundice arises above what concentration?
5 mg/dL
49
What gender has a higher risk of hyperbilirubinemia?
male
50
What birthing procedure is associated with hyperbilirubinemia?
forceps
51
Which maternal blood type is associated with hyperbilirubinemia?
Type O
52
Which Rh status is associated with hyperbilirubinemia?
RH negative
53
Which race is associated with hyperbilirubinemia?
asians
54
Premature or full-term is assocuiated hyperbilirubinemia?
premature
55
According to Metts, jaundice occurs in what days of fetal life?
2-5 days
56
According to metts, what percentage of infants experience jaundice?
50-60%
57
What is the exclusion criteria for physiological jaundice?
jaundice in the first 24 hours
58
What infant blood type is associated with neonatal jaundice when the mother is Type O?
Type A
59
What type of immunoglobulin is the anti-Rh?
IgG
60
When does breastmilk jaundice occur? Peak?
7-15 days
10-30 mg/dL
61
Which type of Criggler-Najjer is responsive to phenobarbital?
Type Two
62
What procedure is used if phototherapy does not bring don bilirubin levels?
Exchange transfusion
63
What valve does a gall stone ileus often impede?
ileocecal
64
What contrast is used during a HIDA scan?
technitium
65
What are the drugs that cause Pancreatitis?
Didanosine
Corticosteroids
Alcohol
Valproate
Azathioprine
Diuretics
66
What should one suspect if amylase stays high?
Pseudocyst
67
Which goes back down faster, amylase or lipase?
amylase
68
What kidney pathology could acute pancreatitis cause? Why?
acute tubular necrosis
hypoperfusion due to shcok
69
Why is a pancreatic pseudocyst not a true cyst?
no real epithelial lining
70
What is the hallmark of chronic pancreatitis?
fibrosis
71
What two genes are involved in Chronic Pancreatitis?
PRSS1 and SPINK1
72
What does PRSS1 encode? What does SPINK1 encode?
trypsin
trypsin inhibitor
73
What does alcohol do to pancreatic secretions? What is the result?
increased protein and decreased bicarb
ductal occlusion
74
Chronic Pancreatitis is characterized by what triad?
Steatorrhea
diabetes
calcifications
75
What three locations will HVL Disease produce a cyst?
pancreas, kidney and liver
76
What three locations will HVL Disease produce an angioma?
retina
cerebellum
brainstem
77
What is contained in a pancreatic pseudocyst?
pancreatic secretions
78
What causes the formation of a pancreatic pseudocyst?
acute pancreatitis
79
What are the two tissues linings of a pancreatic pseudocust?
fibrin and granulation tissue
80
What population is a serous cystadenoma most often seen?
elderly women
81
Mucinous cystic tumor is seen in what patient population?
young
82
Intraductal Papillary Mucinous Neoplasma occur the most in what population? Where in the pancreas?
older men
head
83
Is pancreatic cancer more common in men or women?
men
84
What race has the highest liklihood of developing pancreatic cancer?
african americans
85
What are the two serum markers for pancreatic adenocrcinoma?
CEA and CA 19-9
86
What is the strongest risk factor for the development of pancreatic cancer? What gene?
smoking
k-ras
87
According to Carnevale, where are the three locations a pancreatic carcinoma may metastisize?
lung
liver
peritoneum
88
What type of cancer is most often found in gallbladder cancer?
Adenocarcinoma
89
Prognosis of gallbladder cancer?
poor
90
Chronic diarrhea has to last longer than?
14 days
91
What is Kehr's Sign?
pain at the shoulder due to diaphgragm pressure
92
What is the biggest risk to life during gastroschisis?
heat loss
93
What is the product of heme oxygenase?
biliverdin
94
What is the product of Biliverdin Reductase?
unconjugated bilirubin
95
According to Philson, what is the most common cause of cholestasis in kids?
biliary atresia
96
What procedure is used to 'fix' biliary atresia?
Kasai procedure
97
What disease would have a palpable gall bladder in the RUQ of an infant?
Choledochal cyst
98
What is Alagille Syndrome? Inheritance pattern?
congenitally deformed intrahepatic bile ducts
autosomal dominant
99
What would be a very common presenting symptom of a patient with Alagille Syndrome?
Xanthomas
100
What is the most common cardiac symptom during Alagille Syndrome?
pulmonic stenosis
101
What would be obvious on an Xray during Alagille Syndrome?
butterfly vertebrae
102
What substrate cant be transported into the bile during PFIC Type 1?
aminophospholipids
103
What substrate cant be transported into the bile during PFIC Type 2?
bile salts
104
What substrate cant be transported into the bile during PFIC Type 3?
phosphatidylcholine
105
What part of bile metabolism is missing during Cretinism?
conjugation
106
What three hormones promote bile formation?
cortisol
growth hormone
thyroid
107
What is the cure for stopping Galactosemia?
stopping lactose
108
What type of medication most often produces cholestasis?
TPN
109
What type of fats dont need transporters to be absorbed?
Medium chain fatty acids
110
What vaccines does a kid with cholestasis especially need?
HBC and HCV
111
What drug can stimulate bile flow?
Ursodeoxycholic acid
112
What is a Bassini Repair?
single layer reconstruction of the pelvic floor
113
What is a Shouldice repair?
four layer reconstruction of the pelvic floor
114
What is a McVay repair? Fixes what kind of hernia?
inguinal floor brought to coopers ligament
femoral
115
What is the standard hernia repair?
Lichtenstein repair
116
Where do Spigelian hernias occur? Inferior or superior?
where vessels penetrate the semilunar line
inferior
117
What type of hernia impairs blood flow?
strangulated hernias
118
What is not a hernia?
Diastasis Recti
119
What drugs are the most common cause of Drug Induced Liver Injury? Which one specifically?
antibiotics
Augmentin
120
What are some characteristics of intrinsic drug induced liver disease?
predictable
dose-dependent
121
What three conditions would mean acetominphen is not acceptable to use?
alcohol
starvation
malnutrition
122
What is the time frame for acute drug induced liver injury?
less than 3 months
123
Drug induced hepatitis may mimmic what other disease?
Mononucleosis
124
What three symptoms may manifest during drug induced liver hypersensitivity?
fever
rash
eosinophilia
125
What does one do to a drug is the liver enzymes are >5x the normal level?
stop drug
126
What does one do to a drug is the liver enzymes are 3-5 the normal level?
liver panel every 1 month
127
What does one do to a drug is the liver enzymes are
liver panel every 3 months
128
What age range does FAP begin?
10-12
129
What age range does Lynch Syndrome begin?
20-25
130
Is Lynch of FAP characterized by defects in mismatch repair enzymes?
Lynch
131
Regarding colon cancer, what does N1 mean?
mets found in 1-3 nodes
132
Most pancreatic cancers are what type of cancer?
adenocarcinoma
133
What is a very strong social risk factor for the development of pancreatic cancer?
smoking
134
Fibrolamellar HCC is most often seen in what patient group? Prognosis?
young, females
fairly good
135
Sorafenib is used to treat which cancer? MOA?
HCC
anti-angiogenesis
136
Which GI cancer is increasing in frequency in north america and europe?
cholangiocarcinoma
137
Does brown baby syndrome occur with direct of indirect hyperbilirubinemia?
direct
138
Does rapid weight loss or rapid weight gain increase the risk for cholelithiasis?
rapid weight loss
139
What drug may reverse the liver damage caused by valproate?
L-Carnitine
140
What drug can reverse the hepatic effects of leflunomide?
Cholestyramine
141
According to Benzoni, what is required to detect somatic sensation?
spinal nerves
142
According to Benzoni, if a patient is afraid of moving what does this mean?
peritonitis
143
How much does the bilirubin have to increase in one hour to be exclusion criteria?
greater than 5 mg/dL/24 hours
144
Exclusion criteria in term infant?
> 13 mg/dL
145
Exclusion criteria in preterm infant?
> 15 mg/dL
146
According to Benzoni, do statins promote formation of a gall stone?
no
147
Would biliary atresia present with a direct or indirect hyperbilirubinemia?
direct
148
When does biliary atresia produce jaundice?
3-6 weeks
149
What confirms the Dx of Biliary Atresia?
biopsy
150
According to GI guy, what is a bad combination of diseases for liver injury?
HCV and HIV
151
What is exclusion criteria for jaundice in terms of length in pre-term babies?
longer than 2 weeks
152
What is exclusion criteria for jaundice in terms of length in term babies?
longer than 1 week
153
What do juice and water do to breastmilk jaundice?
worsen
154
What is recommended to aid breastmilk jaundice?
more frequent feedings
155
What antibodies are produced during Rhesus disease?
D-antigen
156
What causes breast milk jaundice?
factor in breast milk that causes increased absorption of bilirubin
157
According to Oshea, what is an alarming sign regarding bloating?
if it is constant
158
What is Rosvings sign?
if LLQ palpation reproduces LRQ pain
159
What is Lloyd's sign?
kidney
160
What is carnetts sign?
when abdominal pain remains or gets worse when flexing abdominal muscles
161
According to Oshea, what is Grey Turners a sign of?
retroperitoneal bleeding
162
According to Philson, what is a red flag for cholestatic jaundice?
jaundice in first 24 hours
163
According to Philson, what is a choledochal cyst a precursor of?
cholangiocarcinoma
164
Hy's law says what percentage of patients will die of DILD?
10%
165
What are the two critria for Hy's Law?
ALT or AST greater than 3x UNL
bilirubin 2x UNL w/o cholestasis
166
According to GI guy, what is the most important risk factor for DILI?
genetic factors
167
According to GI guy, what is the maximum dosage of acetominophen in a day?
4 grams
