Form Incorrect Topics

Question 1

Where can you see a pseudodiverticulum occur?
Which layers are affected?

Answer 1

Only the mucosa and submucosa out pouch.
Occurs especially where vasa recta perforate muscular external.

Question 2

What is diverticulosis?

Answer 2

Many false diverticula of the colon, commonly sigmoid.

Question 3

What patient population would you see diverticulosis?

Answer 3

50% of ppl over 60 years

Question 4

How is diverticulosis caused?

Answer 4

Increased intraluminal pressure and focal weakness in colonic wall.

Question 5

What is diverticulosis associated with?

Answer 5

Obesity, diets low in fiber, high in total fat/ red meat.

Question 6

What are the complications associated with diverticulosis?

Answer 6

• Painless hematochezia
• Diverticulitis

Question 7

How does diverticulitis present?

Answer 7

Classically causing LLQ pain, fever, leukocytosis

Question 8

What are the complications to diverticulitis?

Answer 8

Abscess, fistula, (colovesical fistula -> pneumaturia (stool and air in the urine), obstruction (inflammatory stenosis), perforation that can lead to peritonitis. Hematochezia is rare.
Treat with surgery and antibiotics.

Question 9

What is the defect in Lynch Syndrome (Hereditary nonpolyposis colorectal cancer HNPCC)?
What phase would you expect this to occur?

Answer 9

Mismatch repair. Normally occurs in the S phase of the cell cycle.

Question 10

What are some risk factors to colorectal cancer?

Answer 10

• Adenomatous and serrated polyps
• Familial cancer syndromes
• IBD
• Tobacco use
• diet of processed meat with low fiber

Question 11

Where is the colon is colorectal cancer typically seen?

Answer 11

Rectosigmoid > ascending > descending of the large bowel

Question 12

What symptoms is associated with cecal/ascending CRC?

Answer 12

occult bleeding
* in the ascending you can also see exophytic mass, iron deficiency anemia, and weight loss

Question 13

What symptoms are seen on the rectosigmoid region in CRC?

Answer 13

Hematochezia and obstruction (narrow lumen decreases stool caliber resulting in very thin-width stools, pencil thin)

Question 14

What symptoms are associated with CRC located in the descending colon?

Answer 14

Infiltrating mass, partial obstruction, colicky pain, hematochezia (bright red stool indicating a lower GI bleed)

Question 15

What organism is associated with bacteremia/endocarditis in the setting of CRC?

Answer 15

Strep Bovis/gallolyticus (gram positive cocci in pairs with short chains, gamma hemolytic)

Question 16

What can you see on barium swallow in a patient with CRC?

Answer 16

“Apple core” lesion on X-ray

Question 17

What tumor marker is a reliable sign of CRC recurrence?

Answer 17

CEA tumor marker, should not be used for screening

Question 18

What is the sequence of mutations in CRC?

Answer 18

Question 19

How does Bevacizumab help treat CRC?

Answer 19

Targets VEGF to inhibit blood vessel formation

Question 20

What genes need a 2 hit for the lack of expression leading to CRC?

Answer 20

APC
DCC
SMAD4 (DPC4)
- all are tumor suppressors

Question 21

What’s the Dx?

Answer 21

Zenker Diverticulum

Question 22

Diverticulum in the pharynx, what’s the dx?

Answer 22

Zenker diverticulum, this is a pharyngeal esophageal false diverticulum

Question 23

What is the treatment for von Willebrand Disease?

Answer 23

Desmopressin, ADH analog, promotes the release of vWF and Factor 8 from endothelial cells.
- other uses include Central DI, sleep enuresis, hemophilia A

Question 24

What do the blood tests look like in von Willebrand disease?

Answer 24

• PC normal
• BT increased
• PT normal
• PTT normal/increased

Question 25

What is the function of vWF?

Answer 25

Carry and protect factor 8

Question 26

What is the inheritance pattern of von Willebrand Disease?

Answer 26

AD

Question 27

How does von Willebrand disease present?

Answer 27

Epistaxis or Menorrhagia *remember platelets and factor 8 are not interacting causing a defect in platelet plug formation and platelet adhesion.

Question 28

Platelet disorder with GpIB deficiency, what is the dx?

Answer 28

Bernard-Soulier syndrome (defect in platelet adhesion to von Willebrand factor)

Question 29

Inherited bleeding disorder, whats the dx?

Answer 29

von Willebrand disease most commonly

Question 30

What intestinal disorder is associated with von Willebrand disease?

Answer 30

Angiodysplasia - tortuous dilation oof vessels leading to hematochezia. Most often in the right side of the colon. Acquired vWD > inherited

Question 31

Where is vWF normally released from?

Answer 31

Weibel Palade Body

Question 32

How does somatic symptom disorder present?

Answer 32

Bodily complaints (eg abdominal pain, fatigue) lasting months to years. Associated with excessive persistent thought and anxiety about symptoms. May co-occur with medical illness.

Question 33

How do you treat somatic symptom disorder?

Answer 33

Regular office visits with the same physician in combination with psychotherapy.

Question 34

What is the mechanism behind Hemolytic uremic syndrome?

Answer 34

Shiga/Shiga-like toxins inactivate 60S ribosome by removing adenine from rRNA inhibiting protein synthesis, leading to increase cytokine release

Question 35

Which organisms cause HUS?

Answer 35

Shigella spp and Enterohemorrhagic E coli (EHEC) Shigella invades the host cells EHEC doesn't

Question 36

Which Bacteria increase cAMP?

Answer 36

Cholera, Anthracis, Pertussis, E coli "Increase cAMP with CAPE"

Question 37

What would you see in PBS in the case of HUS?

Answer 37

Schistocytes "helmet cells" fragmented RBCs

Question 38

How can HUS present?

Answer 38

Petechiae, mucosal bleeding, prolonged bleeding time - also seen in Platelet disorders (eg Glanzmann thromasthenia, Bernard Soulier, TTP, ITP, uremic platelet dysfunction

Question 39

How to treat HUS?

Answer 39

Supportive care - intravenous fluids, blood transfusions, dialysis, and medication to manage blood pressure and other issues

Question 40

Describe the Hardy-Weinberg principle:

Answer 40

Question 41

What is the mechanism behind Methemoglobin?

Answer 41

Oxidized Hb secondary to dapsone, local anesthetics, nitrites, and nitrates oxidizes iron (Fe2+ to Fe3+, ferrous to ferric) in hemoglobin, this decreases oxygen binding but increases cyanide affinity leading to tissue hypoxia. *Treat with methylene blue and vitamin C (vitamin C reduces iron)

Question 42

How does methemoglobinemia present?

Answer 42

Cyanosis that does not improve with O2 supplementation and chocolate colored blood

Question 43

What is the Oxygen content of the blood in the case of methemoglobinemia?

Answer 43

Question 44

What local anesthetics can cause methemoglobinemia?

Answer 44

Benzocaine (ester) and prilocaine (amide)

Question 45

Whats the organism?

Answer 45

Schistosoma

Question 46

What can Schistosoma infection cause?

Answer 46

Question 47

What organism is associated with bleeding varicose leading to portal HTN?

Answer 47

Schistosoma Mansoni (look for the egg with a lateral spine) Schistosoma japonica can also cause portal HTN.

Question 48

What organism is associated with squamous cell carcinoma of the bladder (painless hematuria) and pulmonary HTN?

Answer 48

Schistosoma Haematobium (look for the egg with terminal spine) - also look for chronic infection - also look for Middle East geographical clues

Question 49

How are Schistosoma infection transmitted?

Answer 49

Snails are the intermediate host. Cercariae penetrate human skin. Look for contaminated fresh water (eg swimming or bathing)

Question 50

What is the treatment for Schistosoma infections?

Answer 50

Praziquantel - increases Ca2+ permeability and increases vacuolization

Question 51

Duchenne muscular dystrophy, Tay-Sachs disease, and cystic fibrosis are examples of what kind of mutation?

Answer 51

Frameshift mutation, deletion or insertion of any number of nucleotides not divisible by 3

Question 52

What does the mutation in Duchenne muscular dystrophy cause?

Answer 52

Frameshift mutations cause loss of anchoring protein to ECM (dystrophin) leading to myonecrosis

Question 53

What is the mechanism behind LAD type 1?

Answer 53

LFA-1 integrin defect (CD18) leads to impaired phagocyte migration and chemotaxis

Question 54

Late separation of umbilical cord (>30 days), no pus, recurrent skin and mucosal bacterial infections, whats the dx?

Answer 54

LAD

Question 55

Describe Lead poisoning:

Answer 55

Question 56

Describe sideroblastic anemia

Answer 56

Question 57

Describe Acute Intermittent Porphyria:

Answer 57

Affected enzyme; accumulated substrate; presenting symptoms

Question 58

Describe Porphyria cutanea tarda:

Answer 58

Affected enzyme; accumulated substrate; presenting symptoms

Question 59

Draw how heme is made:

Answer 59