Final Exam -- Randomized Cards Part 1 Flashcards
1
Q
What are the treatment options for hepatocellular carcinoma?
A
Liver resection or transplantation, tumor ablation by radiofrequency, transarterial chemoembolization.
2
Q
Charcot triad is a group of symptoms of acute cholangitis. Name the features of this triad.
A
Pain, fever/chills, and jaundice.
3
Q
What types of pharmaceutical agents can be used to try and treat achalasia?
A
Sublingual nitroglycerin, calcium channel blockers, phosphodiesterase inhibitors, and anticholinergics.
4
Q
In 75% of patients with Gardner’s Syndrome, there are multiple, bilateral familiar CHRPEs (sometimes called pigmented ocular fundus lesions of FAP, or POFLs)
A
Free card.
5
Q
Treatment for acute HBV is supportive. In chronic, treat with antivirals.
A
Free card.
6
Q
Diagnosis for IBD is based on endoscopy and imaging (CT with contrast*, MRI)
A
Free card.
7
Q
What are the symptoms of steatosis?
A
Usually asymptomatic
8
Q
10-35% of heavy drinkers have ___________.
A
Alcoholic hepatitis (aka alcoholic steatohepatitis), inflammation of a fatty liver
9
Q
Stress gastritis is caused by a decreased defense mechanism to gastric acid, which can be caused by a reduction in blood flow, mucus, and bicarbonate secretion.
A
Free card.
10
Q
What is the treatment for Barret’s esophagus that does NOT involve high-grade dysplasia?
A
Proton pump inhibitors and/or laproscopic fundoplication; may also need to have a biopsy done with some frequency depending on the level of metaplasia/dysplasia.
11
Q
What enzyme is released by both the mouth and the pancreas and is used for the digestion of carbohydrates?
A
Amylase.
12
Q
How long does it take for inhaled cocaine vapor to reach the brain? How long is its effect?
A
Reaches brain instantaneously, lasts 5-10 minutes
13
Q
What is the typical transmission of Hepatitis B?
A
Percutaneous, sexual, or perinatal.
14
Q
Which GI condition leads to atrophy of esophageal smooth muscle and loss of LES tone?
A
Scleroderma esophagus.
15
Q
Treatment for stress gastritis involves keeping the stomach pH greater than 5.0, and 80% of patients stop bleeding with supportive care. An indication for surgery would be if bleeding recurs or persists and requires more than how many units of blood?
A
Six.
16
Q
There are neurologic, iatrogenic, structural, muscular, infectious, and metabolic causes of oropharyngeal dysphagia. What structural causes are possible?
A
Neoplasia, Zenker’s diverticulum, cricopharyngeal bar
17
Q
______________ consists of non-peristaltic esophageal contractions and impaired relaxation of the LES.
A
Achalasia
18
Q
Some predisposing factor for GERD include hiatal hernia, certain foods and medications, direct mucosal damage, and certain lifestyle habits. What are a few things that can damage the mucosa?
A
Aspirin, iron salts, TCAs, quinidine, potassium chloride tablets
19
Q
What are the symptoms of alcoholic hepatitis (alcoholic steatohepatitis)?
A
Jaundice, fever, anorexia, ascites (causing abdominal distention), muscle wasting, abdominal pain
20
Q
True or false: in most cases, acute pancreatitis is mild and does not require therapy.
A
True.
21
Q
Briefly describe ambulatory pH monitoring.
A
An acid-sensitive catheter is placed in the esophagus for a prolonged period of time to measure the pattern of pH changes. Diet and exercise are unrestricted, and the patient should have stopped acid-suppressing medications 3-14 days prior to the study.
22
Q
Crohn’s Disease is pharmaceutically treated with what kinds of drugs?
A
Corticosteroids and Mesalazine
23
Q
True or false: in HCV, chronic cases are more common than acute.
A
True.
24
Q
True or false: most patients with Crohn’s disease are well controlled with medicine and never end up needing surgery.
A
False; most CD patients require surgery at least once in their lifetime.
25
Gallstones are diagnosed with transabdominal ultrasonography and can be treated with cholecystectomy (surgical removal of gall bladder), bile acid pill, or extracorporeal shock wave lithotripsy. What are some indications for cholecystectomy?
Large stones (more than 2.5 cm), hemolytic anemia, or organ transplant in an immune compromised patient.
26
What are the symptoms of Zollinger-Ellison Syndrome?
Abdominal pain (from the ulcer), heartburn, diarrhea.
27
Is there a vaccine for Hepatitis D?
No, but the Hepatitis B vaccine helps protect against HDV
28
What are the risk factors for gallstones?
Pregnancy, diabetes, obesity, sickle cell disease, and cirrhosis.
29
What are the signs and symptoms of acute pancreatitis?
Acute, severe epigastric pain often radiating to the back, N&V, tenderness on palpation, obstructive jaundice, fever, tachypnea, hypoxemia, hypotension, panniculitis.
30
What sign might be seen on a chest x-ray of a patient with achalasia?
"Bird beak"
31
Stress gastritis is characterized by superficial erosions in the stomach that occur after what types of events?
Physical trauma, shock, sepsis*, or respiratory failure.
32
What are the causes of esophageal dysphagia?
Abnormality of peristalsis and/or deglutitive inhibition or abnormality of LES (achalasia, scleroderma, chronic GERD).
33
Jaundice is the discoloration of skin, conjunctiva, and mucous membranes resulting from elevated plasma bilirubin. What is a normal bilirubin serum level? How much of an increase is typical in jaundice?
Normal levels are less than 1-1.5 mg/dL.Jaundice levels are around 3-4 mg/dL.
34
What two conditions make up inflammatory bowel disease?
Crohn's disease and ulcerative colitis.
35
True or false: achalasia is mostly idiopathic, though 2-5% of cases are familial with autosomal dominant mode of inheritance.
False; most cases are indeed idiopathic; but in the 2-5%, the mode of inheritance is autosomal recessive.
36
Reynold's pentad is a group of symptoms of acute cholangitis. Name the features of this pentad.
Charcot triad (pain, fever/chills, jaundice) plus altered mental status and hypotension.
37
Though most patients with HBV are asymptomatic, what symptoms are possible?
Flu-like symptoms, jaundice, and liver failure (these last two are rare)
38
_________________ is a treatment for achalasia that involves cutting the muscles of the LES.
Heller myotomy
39
True or false: there is no specific treatment for scleroderma esophagus, besides getting the patient on pronton pump inhibitors to help with the GERD.
True. You can also use endoscopy to monitor for esophageal cancer.
40
What techniques are used to diagnose cholecystitis?
Ultrasound, CT.
41
Comparing the upper esophageal sphincter (UES) and the lower esophaegeal sphincter (LES), which is under voluntary control and which is not under voluntary control?
UES is under voluntary control; LES is not under voluntary control.
42
True or false: acute Hepatitis E has a 20% mortality for middle-aged males
False; it has a 20% mortality in pregnant women.
43
Some predisposing factor for GERD include hiatal hernia, certain foods and medications, direct mucosal damage, and certain lifestyle habits. What lifestyle habits can predispose to GERD?
Weight gain, obesity, smoking, and eating prior to reclining.
44
Is there a vaccine for Hepatitis C?
Yes, but not available in the US
45
Ambulatory pH monitoring, barium swllow, esophageal manometry, and endoscopy are all tests that can be used to evaluate GERD. Which test is the most diagnostic test, with a sensitivity and specificity of 92%?
Ambulatory pH monitoring.
46
True or false: most cases of acute HBV are self-limiting.
True.
47
The 5 year survival rate for a person with a gastrinoma drops severely if there has been metastasis to the liver.
Free card.
48
What are the risk factors for pancreatic cancer?
Hereditary chronic pancreatitis, hereditary breast cancer, smoking, diabetes, pancreatic cysts, high BMI, low physical activity.
49
Chronic pancreatitis is progressive inflammation of the pancreas that leads to ______________ (reversible/irreversible) structural damage.
Irreversible
50
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do surface mucus cells secrete?
Mucus and bicarbonate
51
Diverticula is an acquired herniation of the small weak areas of the colon's muscular wall. It is a common occurrence with age except in patients with what kind of diet?
Vegetarian
52
What are the screening recommendations for colorectal cancer?
Begin at age 50 and do either a sigmoidoscopy every 3-5 years or a colonoscopy every 10 years.
53
The biliary system is a collection of vessels that direct the secretions from the liver, gallbladder, and pancreas into which part of the small intestine?
Duodenum.
54
____________ is characterized by the presence of fibrosis and regenerative nodules in the liver.
Cirrhosis
55
What is the typical transmission of Hepatitis C?
Percutaneous (especially drug use)
56
Is there a vaccine for Hepatitis A?
Yes
57
What medications can be given to treat GERD?
Antacids, H2 blocking agents, and proton pump inhibitors.
58
Is there a vaccine for Hepatitis B?
Yes
59
In which form of hepatitis are pregnant women more likely to get fulminant hepatic failure, which a higher rate of mortality?
HEV
60
1/3 of patients with IBD have manifestations in the eyes, skin, or joints. What eye manifestations are there?
Episcleritis and anterior uveitis
61
Comparing sigmoidoscopy and colonoscopy, which does not require that the patient be sedated?
Sigmoidoscopy
62
What is the term for pain on swallowing?
Odynophagia
63
What are the potential complications of choledocholithiasis?
Gallstone pancreatitis and acute cholangitis.
64
Acute cholangitis is a bacterial infection caused by an obstruction of the biliary tree, elevation of intraluminal pressure, and infection of bile. It is most commonly caused by a gallstone.
Free card.
65
Does Hepatitis A have a chronic form?
No.
66
There is an 11% chance of developing IBS following what type of sickness?
Stomach flu
67
How would you treat a patient with Wilson Disease?
Detoxity with chelation, and prevent accumulation of copper by avoiding shellfish, liver, mushrooms, nuts, and chocolates. You can also have the patient take zinc to decrease copper absorption in the intestines.
68
What is the name for a gastrin-secreting non-beta islet cell tumor? What effect does it have on gastric acid?
Gastrinoma, aka Zollinger-Ellison Syndrome. It causes increased gastric acid secretion that leads to ulceration in the stomach and small intestine.
69
What is the major cause of chronic pancreatitis? What are some other causes?
Alcohol abuse is the main cause. Ductal obstruction, tropical location, systemic diseases, autoimmune diseases are some other causes.
70
What test quantifies the amount of liver fibrosis?
Transient elastography
71
_____________ is a surgical treatment for GERD that involves wrapping the stomach around the lower esophagus to strengthen the LES. In how many patients does this surgery lead to symptom resolution?
Laproscopic fundoplication; symptom resolution in more than 90%.
72
What are the causes of peptic ulcer disease?
H. Pylori, NSAIDs, or aspirin
73
What are the symptoms of cirrhosis?
Weight loss, weakness, jaundice, upper GI bleed, spider angioa, gynecomastia, ascites, splenomegaly, palmar erythema, digital clubbing, asterixis, hepatic encephalopathy, absent/irregular menstruation, erectile dysfunction, infertility in men, hepatomegaly.
74
Briefly outline the pharmacologic therapy for a peptic ulcer.
Withdraw from NSAIDs and aspirin if possible; if not, add a proton pump inhibitor or misoprostol. Also eradicate H. Pylori with triple therapy (PPI and 2 different antibiotics for 7-14 days).
75
In Barret's esophagus, ____________ (squamous/columnar) epithelium is replaced by __________ (squamous/columnar) epithelium.
Squamous epithelium is replaced by columnar epithelium.
76
Patients with cirrhosis are 40 times more likely to develop that other condition?
Hepatocellular carcinoma.
77
How is HDV diagnosed?
Detection of IgM HBV antibody; detection of HDV RNA by RT-PCR
78
Which type of dysphagia arises from the esophagus or LES?
Esophageal dysphagia.
79
What is the treatment for chronic pancreatitis?
Pain management, lifestyle changes (smaller meals, low-fat meals, no alcohol or tobacco), pancreatic lithotripsy, surgery.
80
Diagnosis for a diverticula is based on what?
Clinical history and CT or ultrasound
81
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do endocrine cells secrete?
Depends on the type. G cells secrete gastrin; D cells secrete somatostatin
82
___________ is when gallstones are lodged in the common bile duct and can be imaged with intraoperative cholangiography.
Choledocholithiasis.
83
What tests can be run to help diagnose HCV?
HCV antibody test, HCV RNA assay, and other liver tests.
84
In acute pancreatitis, pancreatic enzymes are inappropriately released, damaging pancreatic tissue. What are some causes of this condition?
Toxi exposure (such as with alcohol) and pancreatic duct obstruction (such as from biliary tract disease) are the two main causes.
85
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do parietal cells secrete?
Hydrochloric acid and intrinsic factor
86
What percentage of Hepatitis C cases are chronic?
85%
87
True or false: the symptoms of Barret's esophagus are the same as GERD.
True.
88
Bacteria makes up 30% of the dry weight of fecal matter and helps synthesize which vitamins?
Vitamins B and K
89
90-100% of heavy drinkers have hepative steatosis, which is accumulation of ________ in the liver.
Fat.
90
True or false: lab tests are very useful for diagnosis of hepatocellular carcinoma.
False; they are non-specific. Ultrasound is used on screenings.
91
List the treatment options for acute pancreatitis.
Pain control, IV fluids, ICU (if severe), pancreatic debridement (if necrosis), and treatment of the underlying cause.
92
True or false: Barret's esophagus is a cancerous condition.
False; it is a precancerous condition. 1/200 Barret's esophagus patients develop cancer per year.
93
Comparing Crohn's Disease and Ulcerative Colitis, which features remitting inflammation that is discontinuous?
Crohn's Disease
94
Though 50% of patients with primary sclerosing cholangitis are asymptomatic, symptoms can include what?
Fatigue, pruritis, jaundice, hepatomegaly, splenomegaly.
95
Wilson disease can present with liver, brain, and ocular symptoms. Name the liver symptoms.
Hepatitis, liver failure, cirrhosis
96
Manometry is used to evaluate esophageal dysphagia. What does it measure?
Measures the strength, duration, and sequential nature of esophageal contraction.
97
True or false: about 2/3 of IBS patients experience decreased pain sensitivity in gut stimulation.
False; 2/3 have increased pain sensitivity in gut stimulation
98
1/3 of patients with IBD have manifestations in the eyes, skin, or joints. What joint manifestations are there?
Ankylosing spondylitis and peripheral arthritis
99
Primary sclerosing cholangitis is associated with what bowel condition?
Inflammatory Bowel Disease
100
Comparing sigmoidoscopy and colonoscopy, which evaluates the entire colon?
Colonoscopy
101
There are neurologic, iatrogenic, structural, muscular, infectious, and metabolic causes of oropharyngeal dysphagia. What iatrogenic causes are possible?
Surgery, radiation
102
IBS has between 50% and 70% comorbidity with psychiatric disorders, chronic pelvic pain, temporomandibular joint disorder, and chronic fatigue sydrome, and 20-50% with fibromyalgia.
Free card.
103
True or false: in Hepatitis B, the incidence of chronic infections increases with age.
False; it decreases with age (from 90% neonatal to less than 1% in adults)
104
Comparing Crohn's Disease and Ulcerative Colitis, which does not include the ileum?
Ulcerative Colitis
105
What are some antiviral therapies specific to HCV?
Ribavirin, pegylated interferons, sofosbuvir, simeprevir, telaprevir, boceprevir.
106
True or false: Hepatitis A is typically self-limited
True.
107
What is the function of bile?
Detoxification, cellular recycling, breakdown and absorption of fat soluble vitamins.
108
Where does copper deposition occur in Wilson disease?
Liver, brain, and cornea
109
Cholelithiasis is another name for gallstones. 20% of gallstones are made of what?
Calcium bilirubinate
110
Comparing Crohn's Disease and Ulcerative Colitis, which features remitting inflammation that is continuous?
Ulcerative Colitis
111
What are the medical risk factors for gastric cancer?
H. Pylori infection, prior gastric surgery, adenomatous polyps, and gastric atrophy and gastritis
112
What are the symptoms of oropharyngeal dysphagia?
Inability to form a bolus, difficulty initiating a swallow, coughing/choking, aspiration/regurgitations, food sticking at the level of throat. Liquids are more problematic.
113
Testing for serum bilirubin (both conjugated and unconjugated) is one way to test for liver function. Which, conjugated or unconjugated, is not found in the serum of healthy patients?
Conjugated
114
True or false: bilirubin in the urine may be an indicator of liver damage or disease.
True.
115
What are the symptoms of gastric cancer?
Poor appetite, weight loss, abdominal pain, sense of fullness after small meals, heartburn, nausea, vomiting, swelling or fluid buildup in abdomen, anemia.
116
Inability to digest complex foods, such as can occur with chronic pancreatitis, occurs when what percentage of pancreatic function is lost?
More than 90%
117
In what percent of neurologic manifestations of Wilson Disease will the patient also have a Kayser-Fleisher Ring?
98%
118
What percentage of gastrinomas are malignant?
60-95%
119
What does the typical patient with Barret's syndrome look like, in terms of gender, race, and age?
Middle-aged Caucasian male
120
What are the symptoms of celiac disease?
Diarrhea, weight loss, fatigue, flatulence, anorexia, abdominal discomfort, and greasy, foul-smelling, voluminous pale stools. The patient may be asymptomatic, however.
121
The primary anti-reflux barrier for the esophagus is the LES. What two main patterns of dysfunction can cause GERD?
Hypotensive LES; transient LES relaxation (can be predisposed by hiatal hernia)
122
1/3 of patients with IBD have manifestations in the eyes, skin, or joints. What skin manifestations are there?
Erythema nodosum, pyoderma gangrenosum, psoriasis, dermatitis, erthematous rash, uticaria
123
How long does it take for inhaled cocaine to reach the brain? How long is its effect?
Reaches brain in 3-5 minutes, lasts 60-90 minutes
124
Workup for Zollinger-Ellison Syndrome involves endoscopy (for diagnosis of the ulcer), imaging to locate the gastrinoma, and testing of serum gastrin level. What level of serum gastrin is indicative of a gastrinoma?
More than 1000 pg/mL
125
What is the 5-year survival rate for hepatocellular carcinoma in the US?
10-12%
126
True or false: in an acute Hepatitis B infection, newborns are typically subclinical.
True.
127
Comparing Crohn's Disease and Ulcerative Colitis, in which is GI bleeding more prominent?
Ulcerative Colitis
128
What test detects and quantifies the level of hepatic steatosis?
MRI
129
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do mucus neck cells secrete?
Mucus
130
True or false: the upper 2/3 of the esophagus has skeletal muscle while the lower 1/3 has smooth muscle.
False; the upper 1/3 of the esophagus has skeletal muscle while the lower 2/3 has smooth muscle.
131
True or false: some patients with IBS have en exaggerated colon motility response to meal ingestion.
True.
132
Oropharyngeal dysphagia causes difficulty in initiating a swallow, and ___________ (solids/liquids) are more problematic.
Liquids.
133
A patient has ALS and is exhibiting difficulty swallowing. What type of dysphagia are they most likely to have, oropharyngeal or esophageal?
Oropharyngeal.
134
Achalasia consists of non-peristaltic esophageal contractions and __________ (increased/impaired) relaxation of the LES.
Impaired.
135
What are the prodromal symptoms of HAV?
Fatigue, nausea, upper quadrant pain, anorexia, fever
136
Cholelithiasis is another name for gallstones. 80% of gallstones are made of what?
Cholesterol
137
How would you treat a patient with HEV?
Supportive care, since HEV is self-limiting.
138
Injected cocaine can cause what kind of retinopathy?
Talc.
139
Gardner's Syndrome is a subtype of familial adenomatous polyposis (FAP) that eventually leads to colorectal cancer if left untreated. Gardner's Syndrome can be cause by what sort of inheritance patterns in which mutated genes?
Autosomal dominant in APC gene (90%) or autosomal recessive in MYH gene (8%)
140
How is HBV diagnosed?
By detecting HBV antigens or IgM and IgG HBV antibodies.
141
Why does jaundice cause pale stools and dark urine?
Bilirubin is normally responsible for the dark color of feces. If there is an obstruction that keeps the bilirubin from getting into the bile, it will spill over into the serum and be filtered by the kidneys. Low bilirubin in the bile leads to pale stools, high bilirubin in the serum leads to dark urine.
142
Hiatal hernia predisposes a patient to develop which esophageal disorder? GERD, achalasia, or inability to form a bolus?
GERD.
143
True or false: Barret's esophagus that invovles high-grade dysplasia has an 80% risk of cancer development.
False; it's a 30% risk of cancer development.
144
What are the atypical symptoms of GERD?
Hoarseness, chronic laryngitis and sore throat, globus sensation, otitis media, dental erosion, non-cardiac chest pain, aspiration pneumonia, and asthma
145
What are some of the risk factors for IBS?
Anxiety depression, personality disorders, history of childhood sexual abuse, and domestic abuse in women.
146
How is gastic cancer diagnosed?
Endoscopy with biopsy. Endoscopic ultrasonography can be used to see the extent of the cancer.
147
5-15% of heavy drinkers have __________.
Cirrhosis
148
What are the symptoms of jaundice, besides the yellowing of skin, conjunctiva, and mucous membranes?
Pale stools*, dark urine*, itching, ever, chills, abdominal pain, and weight loss.
149
True or false: the symptoms of HEV are similar to those of HAV but are less severe.
False; the symptoms of HEV are much more severe than those of HAV.
150
What are the symptoms of colorectal cancer?
Constipation, small-caliber stool, fecal impaction or obstructive symptoms, pain/bloating, acute or chronic GI bleed, bowel obsturction.
151
The National Dysphagia Diet consists of three levels, numbered 1-3, depending on the severity of the swallowing difficulty. Which level refers to a mild difficulty, in which the patient can still eat most foods but needs them cut into small, bite-sized pieces first?
Level 3
152
Testing for peptic ulcer disease can be done with an antibody test (for H. Pylori antibodies), urea breath test, stool antigen test, and endoscopy. Which of these tests is used to confirm eradication of H. Pylori after 6 weeks of therapy?
Stool antigen test.
153
True or false: histologic confirmation is needed for diagnosis of pancreatic cancer.
True.
154
Acute cholangitis is concerning due to the potential for sepsis. What are the treatment options for this condition?
Hospital admission, antibiotics, establish biliary drainage, and cholecystectomy.
155
Irritable bowel syndrome (IBS) is characterized by abdominal pain or discomfort linked with bowel function and persists at least 6 months. What relieves the pain or discomfort?
Defecation
156
What is the gold standard for diagnosis of celiac disease?
Mucosal intestinal biopsy* and response to dietary withdrawal of gluten*.
157
What are the treatment options for Barret's esophagus that DOES involve high-grade dysplasia?
Endoscopic mucosal resection (EMR)*, photodynamic therapy (PDT)*, radiofrequency ablation, focal thermal ablation, and cryoablation.
158
True or false: the only treatment for pancreatic cancer is surgery, but the prognosis is low.
True. The 5-year survival is only 25-30%, and only 15-20% of patients are good candidates for surgery anyway.
159
What percentage of patients with Zollinger-Ellison Syndrome have Multiple Endocrine Neoplasia type 1?
20-25%
160
What is the only drug approved to treat HDV?
Interferon alfa (IFNa)
161
What are the major roles of the large intestine?
Water absorption and electrolyte exchange.
162
What is the typical transmission of Hepatitis D?
Percutaneous, intrafamily
163
What are the treatment options for choledocholithiasis?
Lithotripsy, cholecystectomy, biliary stenting, ERCP.
164
Choledocholithiasis can be diagnosed with transabdominal ultrasound, CT, magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), or endoscopic ultrasonography. Which of these imaging techniques includes the ability to perform surgical procedures as treatment for choledocholithiasis?
ERCP
165
Cirrhosis results from chronic liver disease, most commonly ___________ and ____________.
Alcoholic liver disease and hepatitis B/C (also from fatty liver)
166
What sorts of lifestyle changes can a patient with GERD make to ease the symptoms?
Weight loss, elevate bed slightly, avoid reclining within 2-3 hours of eating, eat small meals, stop smoking, and avoid foods and drinks that trigger the GERD.
167
One of the esophageal conditions discussed in class has a higher prevalence in men. Which condition is it?
Barret's esophagus
168
What are the screening recommendations for patients with a first degree relative with Gardner's Syndrome??
Sigmoidoscopy every 1-2 years beginning at age 12; genetic counseling after age 10-12
169
How would you diagnose primary sclerosing cholangitis?
ERCP, magnetic resonance cholangiography (MRC), percutaneous cholangiogram, possibly liver biopsy.
170
Ambulatory pH monitoring, barium swllow, esophageal manometry, and endoscopy are all tests that can be used to evaluate GERD. Which test is used for the detection of complications from GERD?
Endoscopy
171
What are the symptoms of acute HCV?
Fatigue, myalgias, right upper quadrant pain, N&V, poor appetite. (Remember that most acute HCV is asymptomatic, though.)
172
What are the signs and symptoms of chronic pancreatitis?
Epigastric abdominal pain, jaundice, and inability to digest complex foods.
173
Testing for peptic ulcer disease can be done with an antibody test (for H. Pylori antibodies), urea breath test, stool antigen test, and endoscopy. Which of these tests does not differentiate an active vs past infection of H. Pylori?
Antibody test.
174
What sort of lab tests could you run on a patient with scleroderma?
ANA, anti-scl-70, anticentromere antibodies
175
What are some of the roles of the liver?
Glucose homeostasis, fat/protein/hormone/bilirubin/drug metabolism, bile formation, plasma protein production, clotting factor production, blood detoxification.
176
The National Dysphagia Diet consists of three levels, numbered 1-3, depending on the severity of the swallowing difficulty. Which level refers to a mild to moderate difficulty, in which the patient's foods must have a consistency similar to minced meat?
Level 2
177
Celiac disease is a chronic autoimmune disease characterized by malabsorption and diarrhea precipitated by ingestion of food products containing gluten. CD is more common in people with what other conditions?
Type I diabetes and thyroid disorder.
178
Which of the stomach/intestine conditions discussed in class has a higher prevalence in men?
Gastric cancer, Zollinger-Ellison Syndrome, colorectal cancer, and peptic ulcer disease (though just barely)
179
Comparing Crohn's Disease and Ulcerative Colitis, which tends to include the ileum?
Crohn's Disease
180
What would a chest X-ray show on a patient with esophageal dysphagia?
Widened esophagus, and bird beak sign toward the end of the esophagus.
181
Treatment for a gastrinoma involves surgical removal and then medication for long term therapy. What medications can be used?
Proton pump inhibitor and somatostatin analog
182
What are the symptoms of HAV?
Dark urine, pale stools, jaundice, pruritis
183
What are the symptoms of scleroderma?
Dysphagia, dry mouth, calcific skin deposits, tight skin, severe GERD, and chest pain.
184
Peptic ulcer disease is a mucosal defect in the stomach or small intestine. What symptoms arer associated with this condition? What symptoms would be cause for alarm?
Typical symptoms: epigastric pain with gnawing, dull, or "hunger like" sensation Alarm symptoms: possibly indicate a bleed and include melena (black, tarry stool), hematemesis (vomiting blood), guaiac-positive stool (blood in stool but not visible), anemia.
185
Comparing Crohn's Disease and Ulcerative Colitis, which features lower left abdominal pain?
Ulcerative Colitis
186
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do chief cells secrete?
Pepsinogen
187
What surgery is used to treat ulcerative colitis?
Colectomy with ileal pouch-anal anastomosis
188
True or false: there is no provent treatment to slow the progression of primary sclerosing cholangitis, though you can do IV fluids and antibiotics for sepsis, and balloon dilation for short term relief. Liver transplant can be used if cirrhosis develops.
True.
189
What are the risk factors for Barret's esophagus?
High BMI, male, age, tobacco smoking, heavy alcohol use, poor diet with low fruits and vegetables, and poor compliance with proton pump inhibitors.
190
______________________ is chronic inflammation, fibrosis, and stricturing of the biliary tree inside and/or outside of the liver.
Primary sclerosing cholangitis.
191
Some predisposing factor for GERD include hiatal hernia, certain foods and medications, direct mucosal damage, and certain lifestyle habits. Which medications tend to predispose to GERD?
Diazepam, estrogens, progesterone, anticholinergics, and TCAs (tricyclic antidepressants?)
192
What is the typical transmission of Hepatitis A?
Fecal-oral
193
What is the term for inability to swallow?
Aphagia
194
True or false: 50% of patients with chronic pancreatitis die within 5 years.
False; 50% die within 10 years.
195
Is there a vaccine for Hepatitis C?
No
196
The National Dysphagia Diet consists of three levels, numbered 1-3, depending on the severity of the swallowing difficulty. Which level refers to a moderate to severe difficulty, in which the patient's foods must have a pudding/puree-like consistency?
Level 1
197
Wilson disease can present with liver, brain, and ocular symptoms. Name the eye symptoms.
Kayser-Fleisher Ring, sunflower cataract
198
True or false: acute Hepatitis C is usually subclinical
True.
199
Which upper GI order is the most common in the Western World, consisting of 75% of esophageal diseases?
Gastroesophageal reflux disease (GERD)
200
Workup for Zollinger-Ellison Syndrome involves endoscopy (for diagnosis of the ulcer), imaging to locate the gastrinoma, and testing of serum gastrin level. What is considered a normal serum gastrin level?
Less than 100 pg/mL
201
Manometry on a patient with scleroderma esophagus would show ___________ (hypotensive/hypertensive) LES and ____________ (poor/strong) peristaltic contraction.
Hypotensive; poor
202
Some predisposing factor for GERD include hiatal hernia, certain foods and medications, direct mucosal damage, and certain lifestyle habits. Which foods tend to predispose to GERD?
Caffeine, chocolate, peppermint, alcohol, and tomato-based products.
203
What is the name of the disease caused by a defect in the ATP7B gene? Is this an autosomal dominant or recessive condition? Transport of what substance is decreased in this condition.
Wilson Disease; autosomal recessive. Copper transport is decreased.
204
In how many patients with scleroderma is the esophagus involved?
75-85%
205
What is the name of the protein produced in the liver that transports unconjugated bilirubin to the liver? Is a test for this protein a good indicator of acute damage? Why or why not?
Albumin. Testing for serum albumin may give an idea of the level of liver function; however, it has a half life of 15-20 days, so it is not a good indicator for acute damage or disease.
206
Which of the stomach/intestine conditions discussed in class has a higher prevalence in women?
Celiac disease and irritable bowel syndrome
207
What imaging is used to screen individuals who are at high risk for pancreatic cancer?
CT, MRI, EUS
208
True or false: HDV requires co-infection with HBV for replication.
True.
209
How long does it take for injected cocaine (dissolved in water) to reach the brain? How long is its effect?
Reaches brain in 15-30 seconds, lasts 20-60 minutes
210
Comparing Crohn's Disease and Ulcerative Colitis, which features lower right abdominal pain?
Crohn's Disease
211
What percentage of patients with Hepatitis D have a Hepatitis B coinfection?
5%
212
One of the esophageal conditions discussed in class has a higher prevalence in women. Which condition is it?
Scleroderma esophagus. (Scleroderma is more common in women, and since the esophagus is involved in 75-85% of patients with scleroderma, I assume scleroderma esophagus is also skewed toward women.)
213
The symptoms of choledocholithiasis are similar to those of cholelithiasis, with the addition of?
Jaundice, dark urine, pale stools, rapid heartbeat and decreased BP.
214
True or false: eradication of H. Pylori decreases ulcer recurrence to less than 10%
True.
215
Test is the definitive diagnosis for cirrhosis?
Liver biopsy
216
What are the symptoms of esophageal dysphagia?
Coughing/choking at night (unrelated to swallowing), symptoms of GERD, associated chest pain and regurgitation, feeling that swallowed bolus is "stuck" on the way down. Dsyphagia occurs with solids and liquids.
217
Comparing Crohn's Disease and Ulcerative Colitis, in which is abdominal pain more prominent?
Crohn's Disease
218
In 12% of patients with reflux documented by pH monitoring, what complication is found?
Barret's esophagus
219
True or false: achalasia is associated with the degeneration of postganglionic inhibitory neurons.
True.
220
True or false: with ulcerative colitis, medical therapy has 70% success rate for remission.
True.
221
True or false: worldwide, gastric cancer is the 2nd most common cancer and the 4th leading cause of cancer death.
False; worldwide, it is the 4th most common cancer and the 2nd leading cause of cancer death.
222
Cholecystitis is inflammation of the gall bladder. True or false: it is more commonly due to tumors.
False; it is most commonly related to gallstones.
223
What is the typical transmission of Hepatitis E?
Fecal-oral
224
_________________ is a way to treat achalasia that involved placing a baloon at the LES to stretch the area.
Pneumatic dilation
225
What sort of imaging can be done for chronic pancreatitis?
X-ray, CT, and endoscopic untrasonography with or without fine needle aspiration.
226
Treatment for cholecystitis includes likely hospitalization, antibiotics and/or pain medication, possible cholecystectomy, and what else?
Fasting (to lessen contractions of the gallbladder.
227
In what percent of hepatic manifestations of Wilson Disease will the patient also have a Kayser-Fleisher Ring?
50%
228
Testing for peptic ulcer disease can be done with an antibody test (for H. Pylori antibodies), urea breath test, stool antigen test, and endoscopy. Which of these tests is used for definitive diagnosis?
Endoscopy
229
What is the treatment for gastric cancer?
Gastrectomy with regional lymphadenectomy, chemotherapy, radiotherapy
230
What ocular finding is a concern with interferon therapy?
Interferon retinopathy (CWS, superficial hemorrhages around ONH and posterior pole; also possible are subconj hemorrhages, BRAO, RD, ONH edema, and vitreous hemorrhages)
231
What laboratory testing can be done for celiac disease?
IgA anti-tissue transglutaminase (anti-tTGA) and HLA-DQ2 allele
232
There are neurologic, iatrogenic, structural, muscular, infectious, and metabolic causes of oropharyngeal dysphagia. What neurologic causes are possible?
Cardiovascular accident, Parkinson's, ALS
233
What are the symptoms of cholecystitis?
Severe pain in upper right abdomen, tenderness over abdomen, N&V, fever.
234
What are the typical symptoms of GERD?
Heartburn, regurgitation, and dysphagia
235
Diagnosis of Wilson Disease is based on clinical manifestations (evidenced by a liver biopsy or the psychiatric symptoms or ocular manifestations) and lab testing. What lab tests could you do?
Serum ceruloplasmin low (less than 200 mg/L; transports copper)Serum copper low (less than 65 mcg/L; deposits in tissues, doesn't stay in blood)24 hour urinary copper excretion (more than 100 mcg).
236
What percentage of patients with Hepatitis D have a Hepatitis B superinfection?
More than 90%
237
Comparing sigmoidoscopy and colonoscopy, which evaluates the descending colon?
Sigmoidoscopy
238
Gallstones are mostly asymptomatic, although biliary colic sometimes happen. What is biliary colic?
Occurs typically after a fatty meal when the gall bladder contracts and a gallstone blocks the cystic duct. This causes an attack of upper right abdominal pain, N&V, and sometimes pain in the right shoulder/back.
239
Which of the pancreatic and biliary system conditions discussed in class are more common in males?
Primary sclerosing cholangitis, chronic pancreatitis, pancreatic cancer (just barely)
240
Colorectal cancer is the second leading cause of cancer mortality among men and women combined. What are the risk factors for colorectal cancer?
Family history of colorectal cancer or polyps, IBD, older age, history of smoking, high fat/low fiber diet, sedentary lifestyle
241
__________ cells have an exocrine function, and their enzymes drain into the duodenum.
Acinar
242
Wilson disease can present with liver, brain, and ocular symptoms. Name the brain symptoms.
Dysarthria, gait abnormalities/ataxia, dystonia, tremor, Parkinsonism, drooling.
243
Proteins are digested by what pepsin from the stomach, trypsinogen from the pancreas, and trypsin/chymotrypsin/elastase from the small intestine.
Free card.
244
In terms of diet and eating habits for a person with dysphagia, which of the following recommendations is incorrect? Eat in an uprightposition; eat small bites; eat slowly; don't talk while eating; check inside of cheek for pocketed food after eating; turn head up when swallowing; remain in upright position for 30-45 minutes after eating.
Turning head up when swallowing is incorrect; it is recommended that the patient turn their head down when swallowing.
245
True or false: in an acute Hepatitis A infection, 70% of adults are symptomatic.
True.
246
Which of the liver conditions discussed in class are more common in men?
Hepatocellular carcinoma
247
____________ product hormones like insulin and glucagon, and release them into the blood stream.
Islets of Langerhans
248
Testing for serum bilirubin (both conjugated and unconjugated) is one way to test for liver function. Which, conjugated or unconjugated, is found in small amounts in the serum of healthy patients?
Unconjugated
249
What are the nutritional risk factors for gastric cancer?
Salted meats/fish, high nitrate consumption, smoking, and alcohol.
250
What are some treatment options for IBS?
Dietary modification, fiber supplements, psychotherapy, antidiarrheals, laxatives, suppositories, SSRIs, TCAs
251
Which type of dysphagia arises from the oropharynx, larynx, and/or UES?
Oropharyngeal dysphagia.
252
What surgery is used to treat Crohn's disease?
Resection (typically of the ileus)
253
True or false: in an acute Hepatitis B infection, 70% of adults are clinical, 30% are subclinical.
False; 70% are subclinical, and 30% are clinical.
254
The average stomach can hold how much food/liquid, at maximum?
1.5 gallons
255
True or false: if left untreated, all Gardner's Syndrome patients will develop colon cancer by age 35-40.
True.
256
How is acute pancreatitis diagnosed?
2-3 times elevated serum lipase/amylase, and/or characteristic findings on imaging.
257
What is the name of the study in which you swallow barium and the camera can construct a video of how the swallowed foods move into the stomach?
Videofluoroscopic swallowing study (VFSS) or modified barium swallow
258
In which gender and age range are scleroderma more common?
Women; 30-50 years
259
Fill in the blanks: old hemoglobin is broken down in the ___________, releasing ____________ (unconjugated/conjugated) bilirubin, which is transported by _____________ to the _____________, where it is converted to ________________ (unconjugated/conjugated) bilirubin and exceted into the bile.
Old hemoglobin is broken down in the spleen, releasing unconjugated bilirubin, which is transported by albumin to the liver, where it is converted to conjugated bilirubin and exceted into the bile.
260
_______________ cancer is the 4th leading cause of cancer related deaths among men and women in the US.
Pancreatic
261
What are some potential complications of HBV?
Cirrhosis, hepatocellular carcinoma, hepatic failure, and serum sickness
262
Comparing sigmoidoscopy and colonoscopy, which requires that the patient be sedated?
Colonoscopy
263
Though most (80%) patients with diverticula are asymptomatic, what symptoms are experienced by the other 20%?
Caused by inflammation or infection of the diverticula: acute lower abdominal pain (intermittent or constant), N&V, anorexia, and diarrhea or constipation.
264
HAV is diagnosed from the typical clinical presentation, as well as detection of what?
IgM anti-HAV antibodies
265
What are the signs and symptoms of pancreatic cancer?
Pain*, jaundice, weight loss, dark urine, pale stools, diarrhea, vomiting.
266
True or false: most HAV-infected individuals exerpience full recovery within 2 months.
False; most experience recovery within 6 months.
267
Esophageal dysphagia has issues with solids or liquids?
Both.
268
True or false: the majority of patients infected with H. Pylori develop peptic ulcers.
False; only 10-15% of patients infected with H. Pylori develop peptic ulcers.
269
In which portion of the small intestine does protein digestion and absorption occur?
Jejunum
270
A defect in which gene leads to Wilson Disease? Transport of what substance is decreased in this condition?
ATP7B gene; copper transport is decreased.
271
The liver releases certain proteins when there is acute damage. Which four proteins can you test for, as discussed in class? Which two of these are most commonly done?
Aspartate amino transferase (AST)Alanine Transaminase (ALT)Alkaline Phosphatase (ALP)Gamma-glutamyltranspeptidase (GGT).AST and ALT are the most commonly done.
272
Since primary sclerosing cholangitis can cause cirrhosis, the median survival time of symptomatic patients is 10-18 years after initial diagnosis.
Free card.
273
Which type of hepatitis is the most common cause of chronic liver disease and indications for liver transplantation?
HCV
274
Wheat, barley, and rye are high in content of _______ and ______, which resists digestive processes in patients with celiac disease.
Glutamine and proline*
275
Comparing sigmoidoscopy and colonoscopy, which is more suitable for screenings if combined with fecal occult blood testing (FOBT)?
Sigmoidoscopy
276
If a liver nodule is found on ultrasound, how big would the nodule be in order to evaluate with imaging and possible biopsy, rather than just following the patient?
More than 1 cm
277
Does Hepatitis E have a chronic form?
No.
278
True or false: cirrhosis is mostly irreversible, so all you can do is limit the further damage done, manage the symptoms, and decide whether transplantation is a good fit.
True.
