EXAM #3: REVIEW Flashcards Preview

Gastrointestinal System > EXAM #3: REVIEW > Flashcards

Flashcards in EXAM #3: REVIEW Deck (62):
1

List 7x risk factors for colon cancer.

1) Family history
2) IBD
3) Smoking
4) Alcohol
5) Obesity
6) Inactivity
7) Poor diet

2

What is the inheritance pattern of the APC mutation seen in FAP?

Autosomal dominant

3

Name the three scenarios that will give a patient a positive family history for colon cancer.

1) Colon ca in 1st degree relative under 60 y/o
2) 2+ first degree relatives with colon ca at ANY age
3) 2nd degree relative under 50 y/o with colon ca

4

What is the biopsy protocol for a patient with IBD undergoing colonoscopy?

Collect 4x random samples every 10cm of bowel for a total of 30+ samples

5

What are the surveillance recommendations following resection of a colon or rectal cancer?

1) H/P + CEA Q3-6 months
2) CT Q1 year for 5x years

6

List seven diseases that are associated with pancreatic cancer.

1) FAP
2) Peutz-Jegher's Syndrome
3) Von Hippel-Lindau
4) MEN1
5) HNPCC
6) BRCA
7) FAMMM

7

List five signs/ symptoms typically seen in the presentation of pancreatic cancer.

1) Abdominal pain
2) Weight loss
3) Jaundice
4) Steatorrhea
5) Pruritus

8

What should you be concerned about in an elderly, non-obese patient that develops glucose intolerance?

Pancreatic cancer

9

How is pancreatic cancer diagnosed i.e. what studies are needed for the diagnosis?

1) Spiral CT with IV contrast
2) Biopsy

10

What are the characteristics of resectable pancreatic cancer?

1) No extrapancreatic disease
2) No tumor extension into:
- Celiac axis
- SMA

11

What is a non-opiate approach to pain management in pancreatic cancer?

Celiac plexus neurolysis

12

What are the three hallmarks of a cystic neoplasm?

1) Bloating
2) Obstructive jaundice
3) Weight loss

13

What are the most common types of cystic neoplasms?

- Mucinous cystadenomas
- Cystadenocarcinoma

14

Where are mucinous cystadenomas or cystadenocarcinomas located?

Body or tail of the pancreas

15

What is an intraductal papillary mucinous neoplasm referred to as?

Pancreatic precursor tumor

16

What studies should be ordered to work up a cystic neoplasm?

1) Abdominal CT
2) EUS
3) Biopsy

17

What confirms the diagnosis of an insulinoma with a 72 hour fast?

Elevated c-peptide and insulin

18

What lab is diagnostic for a Gastrinoma?

Elevated serum gastrin

19

List the four benign liver lesions. Which is the most common?

1) Hemangioma*
2) Focal Nodular Hyperplasia
3) Adenoma
4) Simple cyst

20

Where is HCC common geographically?

Worldwide except US and Europe

*This is b/c of endemic viral hepatitis*

21

What is the tumor marker for HCC?

Alpha-fetoprotein

22

List four surgical methods for treating HCC.

1) Wedge resection
2) Lobectomy
3) Trisegmentectomy
4) Liver transplant

23

What are the three major obstacles to liver surgery?

1) Dual blood supply
2) Liver reserve
3) Coagulopathy

24

List four characteristics of a good surgical candidate for HCC resection.

1) Class A Child Pugh Score
2) Solitary tumor
3) No vascular invasion
4) Tumor less than 3 cm

25

What drug is specifically used for HCC chemotherapy?

Sorafenib

*Note that this drug block angiogensis and targets HCC surface proteins*

26

List three risk factors for cholangiocarcinoma.

1) Primary Sclerosing Cholangitis
2) Liver flukes
3) Choledochal cyst

27

How does cholangiocarcinoma typically present?

1) Constitutional sx. of cancer
2) Painless jaundice
3) Biliary Tract Obstruction

28

How is cholangiocarcinoma diagnosed?

1) ERCP
2) CT or MRI with cholangiography
3) US

29

What surgery is used to treat perihilar cholangiocarcinoma i.e. the most common type of cholangiocarcioma?

Roux-en-Y Hepaticojejunostomy

30

What patient is most likely to get gallbladder cancer?

Elderly Chilean female from an urban area

31

List four risks associated with phototherapy to treat neonatal jaudice.

1) Retinal degeneration
2) Increased fluid loss
3) Bronze Baby Syndrome
4) Congenital Erythropoietic Porphyria

32

What are the four different types of gallstones?

1) Cholesterol-mixed
2) Pigmented
3) Sludge
4) Single large

33

What are the signs and symptoms of a simple gallstones?

- RUQ pain
- Exacerbated with eating
- Murphy's sign

34

How do you initially manage cholecystitis in the ED?

1) NPO
2) Hydration
3) Ketorlac

35

Name four criteria that would warrant admission to the hospital with cholecystitis.

- Impacted stone
- Sepsis
- Unrelenting pain
- Uncertain diagnosis

36

What are three medical therapies for gallstones?

1) Ursodiol
2) ESWL shock waves
3) Contact dissolution

37

What are the quasi medical therapies for gallstones?

1) ERCP
2) Transcutaneous drain

38

What is Charcot's triad of cholangitis?

1) Fever
2) RUQ pain
3) Jaundice

39

What are the three infectious etiologies of pancreatitis?

1) Mumps
2) Coxsackievirus
3) Mycoplasma pneumonia

40

List seven complications of acute pancreatitis.

1) Shock
2) ARDS
3) Acute renal failure
4) DIC
5) Pancreatic abscess
6) Pancreatic pseudocyst
7) Duodenal obstruction

41

How would you describe the microscopic appearance of chronic pancreatitis?

1) Acinar drop out
2) Inflammatory infiltrate
3) Fibrosis
4) Protein/ductal plugs

42

What are the important clinical features of Von Hippel Lindau disease?

- Mutation of chromosome 3
- Renal cell carcinoma and pheochromocytoma are common
- CYSTS in the PANCREAS, liver, and kidneys
- Angiomas in the retina, cerebellum, and brainstem

43

List the three major types of cystic neoplasia involving the pancreas.

1) Microcystic serous cystadenoma
2) Mucinous cystic tumor
3) Solid pseudopapillary tumor

44

What are the major complications of cholecystitis?

1) Bacterial superinfection
2) Perforation/abscess formation
3) Fistula formation

45

Name three functional disorders of the GI system.

1) Gastroparesis
2) IBS
3) Non-ulcer dyspepsia

46

Name four organic disorders of the GI system.

1) Hepatitis
2) Pancreatitis
3) Cholecystitis
4) IBD

47

What two things make constant bloating a red flag?

1) Ovarian cancer
2) Ascites

48

How do you repair a TE fistula?

Right thoracotomy and extrapleural repair

49

What does the VACTERL associated with TE fistuala stand for?

Vertebral
Anorectal
Cardiovascular
Tracheal
Esophageal
Renal
Limb

Any patient with a TE fistual needs to be assessed for issues with these associated structures.

50

What anomalies are associated with omphalocele?

1) Heart
2) Urinary tract
3) Beckwith-Wiedeman

51

What is the classical sign for duodenal atresia with imaging?

Double bubble sign

52

What is the US finding that is indicative of intussusception? What should you do if you see this?

"Target sign"

-->Barium enema

53

How does biliary atresia present?

Persistent direct hyperbilirubinemia

54

List 4x signs/sx. of pediatric cholestasis.

1) Jaundice
2) Dark urine
3) Pruritus
4) RUQ pain

55

What does acholic stool suggest in an child?

Obstructive jaundice

56

Outline the sequence required to diagnose pediatric biliary atresia.

1) Elevated direct bilirubin
2) US
3) Biopsy
4) Laparotomy
5) Intraoperative cholangiography

57

How are choledochal cysts treated?

Roux-en Y cholechocojejunostomy

58

What five anomalies are associated with Alagille Syndrome?

1) Facial changes
2) Peripheral pulmonic stenosis
3) Butterfly vertebrae
4) Posterior embryotoxon
5) Growth retardation

59

What are the major criteria for Hy's Law?

1) 3x normal transaminases
2) 2x normal bilirubin
3) No alternative explanation for elevation

60

What is the definition of acute DILI?

Onset of sx. within 3 months of starting drug

61

Name three extrahepatic manifestation of DILI.

- Rash
- Fever
- Eosinophilia

62

What are the three methods of indirect hernia repair with a "tissue repair?"

1) Bassini= 1 level
2) Shouldice= 4 level
3) McVay= Cooper's ligament