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GI Flashcards

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1
Q

Patient has a history of Clindamycin and Ceftriaxone. Presents with diarrhea, fever, leukocytosis, and abdominal distention. Diagnosis?

A

Pseudomembranous Colitis from C. difficile

-Antibiotic disrupts balance of normal flora and C. difficile reproduces. Toxin B causes apoptosis.

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2
Q

Patient has history of heavy drinking. Presents with vomiting, epigastric pain that radiates to the back, hypotension, tachycardia, fever. Labs show elevated Lipase. Diagnosis?

A

Acute Pancreatitis

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3
Q

APACHE II uses?

A

determine patient mortality risk for hospital admission

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4
Q

Preterm neonate has lethargy and extensive jaundice with a bilirubin >25 mg/dL.

  1. Why is he lethargic?
  2. Why does he have difficulty metabolizing bilirubin?
A
  1. unconjugated bilirubin induced neuro dysfxn that can progress to kernicterus
  2. Increased Br from increased RBC breakdown.

Decreased conjugation due to immature liver increases insolubility.

Decreased Albumin binding allowing more to cross the BBB.

Increased enterohepatic circulation of Br due to delay in feeding that limits intestinal flow and normal flora colonization which break it down into urobilinogen.

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5
Q

40 year-old obese female with more than one child presents with steady RUQ pain, N/V, low fever, with Murphy sign.

  1. Diagnosis?
  2. What is Murphy Sign?
  3. Labs?
  4. Treatment?
  5. Secretion of what protein causes increased pain?
A
  1. Acute Cholecystitis
    - blockage in Cystic duct causes inflammation of gall bladder and wall thickening
    - confirm with ultrasound
  2. Inspiratory arrest on palpation
  3. elevated WBC due to inflammation

normal ALP, AST, ALT

  1. Cholecystectomy
  2. CCK causes GB to contract while stone is stuck in duct

Fat, Female, Forty, Fertile
-estrogen increases risk

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6
Q

Elevated Alkaline Phosphatase. Ddx?

A
  1. Acute Cholangitis
  2. Choledocholithiasis

-bile flow is obstructed

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7
Q

RUQ pain, high fever, jaundice with elevated conjugated bilirubin and alkaline phosphatase?

A

Choledocholithiasis blocks duct and causes ascending Gram negative enteric infection called Acute Cholangitis.

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8
Q

Young man with intense abdominal pain and bloody diarrhea. Colonoscopy shows inflammation from Rectum to Splenic Flexure.

  1. Diagnosis?
  2. Medication?
  3. ADR?
A
  1. Ulcerative Colitis
  2. Azathioprine, used for long term control of IBD, is an antimetabolite that is converted to 6-mercaptopurine and inhibits purine synthesis
  3. Decreased WBC and increased susceptibility to infection.
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9
Q

Middle aged smoking female with epigastric pain that wakes her at night and improves with meals. She has recently gained weight. She has a history of osteoarthritis.

  1. Diagnosis?
  2. Why?
  3. Biopsy shows what?
A
  1. Duodenal Ulcer
  2. Chronic NSAIDS for arthritis inhibits prostaglandins that protect gastric mucosa
    - Bicarbonate improves symptoms at meals and leads to weight gain
    - smoking increases risk of peptic ulcer disease
    - Gastric ulcers pain worsen at meals
  3. Hypertrophy of Brunner’s glands that neutralize acid
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10
Q

Young girl with fever, headache, bloody diarrhea. Her sick dog’s stool shows a spiral shaped organism.

  1. Diagnosis?
  2. Complications?
A
  1. Campylobacter jejuni
  2. Guillain Barre
    - ascending muscle weakness and loss of sensation
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11
Q

Migratory polyarthritis and carditis?

A

Rheumatic fever from Strep pyogenes

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12
Q

Acute renal failure, thrombocytopenia, and hemolytic uremia?

A

E. coli

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13
Q
  1. Acute onset of fever, new murmur, erythema on palms, and splinter hemorrhages?
  2. Subacute onset?
A
  1. Endocarditis from Staph Aureus

2. Strep Viridans

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14
Q

Bilateral hemorrhage into adrenal glands and petechial rash?

A

Neisseria meningitides

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15
Q

Patient with history of IVDA and HIV with white plaques lining tongue and throat that can be scraped off.

  1. Diagnosis?
  2. If cannot be scraped off?
A
  1. Candida Albicans
    - germ tube positive fungus with hyphae
  2. Oral leukoplakia from Epstein Barr
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16
Q

Patient has decreased libido and erectile dysfxn. Liver biopsy shows micro nodular cirrhosis. Family history of hyperpigmentation, Type 1 Diabetes, and liver disease.

  1. Diagnosis?
  2. Pathophys?
A
  1. Primary Hemochromatosis
    - Triad: cirrhosis, diabetes, bronze skin
    - gonadal dysfxn and cardiac issues
  2. Mutated HFE gene causing excess iron absorption
    - iron deposits in liver (nodules), pancreas (diabetes), and skin
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17
Q

Patient has worsening depression, abnormal gait and speech, asterixis, palpable spleen and liver, dark annular deposits around cornea, and jaundice. ALT, AST, and unconjugated bilirubin are high.

  1. Diagnosis?
  2. Pathophys?
  3. Findings?
  4. Treatment?
A
  1. Wilson Disease
  2. lack of copper transport (ceruloplasmin) and excretion into bile leads to accumulation in liver, cornea, basal ganglia
  3. Kayser Fleischer rings round corneas and decreased serum ceruloplasmin
  4. Copper chelators (penicillamine, trientine)
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18
Q

Middle aged woman with 6 month history of abdominal pain and loose greasy stools, muscle weakness, bone pain, dermatitis. CBC shows microcytic anemia. Transglutaminase antibodies to IgA and fecal sudan stain is positive.

  1. Diagnosis?
  2. Pathophys?
  3. Findings?
  4. Treatment?
A
  1. Celiac
  2. Autoimmunity to Gliadin in Duodenum causes fat malabsorption and Vit D deficiency
3. Anti-transglutaminase
Anti-endomysial
Anti-deaminated gliadin
IgA deficiency
Villi Atrophy
  1. Gluten free diet
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19
Q

Old man with arthralgia, diarrhea, steatorrhea, abdominal pain, weight loss, hyper pigmented skin lesions, neuro and cardiac symptoms. Biopsy shows PAS+ foamy macrophages in lamina propria. No tranglutaminase antibodies.

  1. Diagnosis?
A
  1. Whipple disease due to infection with Tropheryma whipplei (gram + intracellular)
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20
Q

Young pregnant woman from Thailand with N/V, watery diarrhea, abdominal pain, icteric sclera, jaundice, no edema, no bacteria or parasites, and increased ALT, AST. She dies 2 weeks later.

  1. Diagnosis?
  2. Pathophys?
  3. Findings?
A
  1. Acute Hepatitis E is associated with fulminant hepatitis is pregnant women.
    - HBV infection would be earlier in life and not associated with pregnancy
  2. Prodromal phase causes N/V, fever, myalgia. Icteric phase causes jaundice, dark urine, pale stool, pruritus.
  3. Massive hepatocyte necrosis
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21
Q

Middle aged caucasian female with jaundice, pale stool, RUQ pain, increased conjugated bilirubin, decreased urobilinogen, and significantly increased ALP.

  1. Diagnosis?
  2. Pathophys?
A
  1. Gallstone causing obstructive jaundice
  2. Stone in common bile duct decreases bilirubin in the GI tract so it is not digested by bacteria causing pale stool and dark urine.
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22
Q

Hyperbilirubin and jaundice only with stress.

Diagnosis?

A

Gilbert Syndrome

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23
Q

Direct hyperbilirubinemia and no elevation in ALP.

Diagnosis?

A

Hemolytic anemia

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24
Q

Jaundice, RUQ pain, indirect hyperbilirubinemia and severely elevated ALT, AST.

Diagnosis?

A

Acute Viral Hepatitis

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25
Painless jaundice and weight loss. Diagnosis?
Pancreatic adenocarcinoma
26
Man from China with fatigue, weight loss, ab pain, palpable RUQ mass, and CT showing liver mass. Months later a mass in found in the lungs. 1. Diagnosis? 2. Pathophys?
1. HCC | 2. Chronic HBV (Asia) and alcohol are strong risk factors for HCC. Spread hematogenously to lungs, LN, bone, adrenals.
27
Young woman with dyspnea on exertion, fatigue, hair loss, spoon shaped fingernails, pale mucus membranes, and history of menstrual bleeding. Labs shows low MCV, ferritin, Hgb, and RBC. 1. Diagnosis? 2. Pathophys?
1. Microcytic anemia from iron deficiency | 2. Iron is absorbed in Duodenum. Deficiency in absorption could be caused by resection or Crohn's.
28
Site of folate absorption?
Jejunum
29
Site of Fat soluble vitamin and Vitamin B12 absorption?
Ileum
30
Site of iron absorption?
Duodenum
31
Side effect of chronic opiate use? Mechanism?
Constipation due to Mu receptors in intestines that slow peristalsis. Increased water absorption and hard stool. Increased tone of ampulla of vater decreases biliary excretions.
32
Senna glycoside mechanism?
stimulates peristalsis through enteric nerve stimulation
33
Young boy with slow growth, unsteadiness, inability to use utensils, and hypotonia. 1. Diagnosis? 2. Pathophys
1. Acetyl coa carboxylase deficiency 2. causes decreased fatty acid synthesis. Decreased malonyl coa (rate limiting) leads to increased beta oxidation which further decreases the amount of fatty acids.
34
Child has fever and new onset right lower quadrant pain that is more tender on rebound. Labs show increased WBC. 1. Diagnosis? 2. Pathophys?
1. Acute appendicitis - Diverticulitis can mimic this but is more often on left side 2. viral infection causes lymphoid hyperplasia
35
Antral ulcers?
H. pylori
36
Body of the stomach ulcers?
Chronic NSAIDS
37
Young woman with recurrent epigastric pain that worsens after eating. Endoscopy shows patches of gastritis in antrum and positive urease test. Biopsy shows extra nodal B cells. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. MALToma 2. Chronic H. pylori causes increased risk of malignancy. 3. Triple Therapy to eradicate H. pylori - PPI - Amoxicillin (metronidazole) if pen allergy - Clarithromycin
38
Autoantibodies against intrinsic factor?
pernicious anemia due to Vit B12 deficiency
39
Painful mucosal lacerations at GE junction?
Mallory weiss syndrome
40
Boy with diarrhea, increased flatulence, foul stools that float, fatigue, dermatitis similar to HSV. Labs show low MCV. Jejunal biopsy shows villi blunting and lymphocytes. 1. Diagnosis?
1. Celiac - antiendomysial Ab - transglutaminase Ab
41
Painful nodules on shins?
IBS
42
Ascending weakness?
GBS
43
Infant has meconium ileum and positive chloride sweat test. 1. Diagnosis? 2. What other embryonic structure is affected?
1. Cystic Fibrosis 2. defective Wolffian (mesonephric) ducts leads to defective vas deferens and kidney problems child will also have chronic upper respiratory infections
44
Man with history of alcohol abuse, altered mental status has jaundice, spider nevi on face, distended veins around umbilicus. He vomits blood and has hypotension and tachycardia. 1. Diagnosis? 2. Source of bleeding?
1. Alcoholic cirrhosis and portal HTN | 2. Portal vein increased pressure backs up into left gastric veins and ruptured esophageal varices
45
Woman with chronic diarrhea, steatorrhea, low MCV, and dermatitis of papules and vesicles. 1. Diagnosis?
Celiac | -IgA transglutaminase Ab
46
Man with HIV who recently travelled has steatorrhea, diarrhea, weight loss. Stool shows trophoblasts and cysts. Diagnosis?
Giardia lamblia
47
Man with refractory abdominal pain that radiates to the back and chronic steatorrhea. CT shows calcification of pancreas. Diagnosis?
Chronic pancreatitis
48
Patient has hypotension, followed by acidosis, and left sided abdominal pain. Diagnosis?
Ischemic bowel at splenic flexure at junction of SMA and IMA
49
Patient has loose stools, intermittent abdominal pain, and occasional joint pain. His father had the same symptoms. 1. Diagnosis? 2. Endoscopy findings? 3. Treatment?
1. Crohn 2. linear ulcers, cobblestone mucosa, erythema 3. Sulfasalazine, Abx, glucocorticoids - if severe, use anti-TNF Ab (infliximab)
50
Patient has loose, bulky, foul stools that float, is sexually active with men. Stool shows cysts and positive fecal antigen. 1. Diagnosis? 2. Pathophys?
1. Giardia lamblia | 2. ingested cysts turn into trophozoites that infect duodenum and jejunum causing malabsorption.
51
Patient has bloody stool and positive PCR for entamoeba histolytic. Diagnosis?
Amebiasis
52
Non bloody diarrhea and high fever. Diagnosis?
Salmonella typhoidal
53
Patient has black stools and abdominal pain relieved by eating. He has a history of smoking. 1. Diagnosis? 2. Pathophys?
1. Duodenal ulcers - black stool from bleeding ulcer 2. Smoking exacerbates chronic H. pylori
54
Middled aged woman that is IVDA has jaundice and RUQ pain. Labs show increased ALT > AST, and Total bilirubin. 1. Diagnosis? 2. Pathophys?
1. Acute viral hepatitis 2. IVDA associated with HBV and HCV (more common). Acute infection causes immune response but no formation of antibodies yet. Most will progress to chronic hepatitis.
55
AST > ALT 2:1. Diagnosis?
Alcoholic hepatitis
56
Peyer's patches and IgA?
collection of lymph in the submucosa of the ileum, B cells are stimulated here and travel to the lamina propria and differentiate into IgA plasma cells in mesenteric LN.
57
Patient has hepatomegaly and jaundice, decreased facial expressions, impaired gait (parkinsonism), change in personality, and darkening of the cornea. 1. Diagnosis? 2. Treatment?
1. Wilson Disease - copper accumulation in liver, basal ganglia, eyes, kidneys - detect low levels of ceruloplasmin 2. Penicillamine to chelate the copper or Trientine if too many ADR
58
Why not use deferoxamine to treat wilson disease?
iron chelator, does not bind copper
59
Positive Anti-HBsAg and negative anti-HB core Ag?
previously immunized, not active infection
60
Patient has a history of pneumonia that was treated with erythromycin. Currently presents with jaundice, abdominal pain, mildly elevated AST, ALT, ALP and a fungal skin infection being treated with Itraconazole. 1. Diagnosis? 2. Pathophys?
1. Acute cholestatic hepatitis from macrolide toxicity | 2. Itraconazole inhibits Cyt P-450, increasing levels of macrolide toxicity
61
Nurse with a needle stick injury 40 years prior presents with jaundice, skin turgor, ascites, caput medusae and she dies. Mild elevation of ALT, AST. Elevated alpha fetoprotein. 1. Diagnosis?
1. Chronic hepatitis C infection with transformation to HCC
62
Elevated 5-HIAA?
primary metabolite of serotonin elevated in carcinoid syndrome
63
CA 19-9?
pancreatic carcinoma
64
Elevated HCG?
- pregnancy - choriocarcinoma - testicular germ cell tumor
65
CA 125?
ovarian cancer
66
Newborn has poor appetite, constipation, non tender ab distention, and narrow rectosigmoid with dilation proximal to narrowing. Child exhibits squirt sign on rectal exam. 1. Diagnosis? 2. Pathophys?
1. Hirschsprung disease (congenital megacolon) associated with Down Syndrome 2. absence of ganglion cells in meissners and myenteric plexi in distal bowel, lack of parasympathetics
67
Meconium ileum without rectosigmoid narrowing?
cystic fibrosis
68
Patient lacks ability to breakdown most macromolecules. Complex proteins and lipids found in stool. Diagnosis?
lacks Enterokinase in duodenum, cannot activate Tryspin to activate other enzymes
69
Patient has bloody diarrhea, RUQ pain, liver abscesses on CT, leukocytosis, guaiac positive stool, and travel history. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Entamoeba histolytica 2. cysts ingested turn into trophozoites in SI that can colonize the colon causing flask shaped ulcers. They seed the liver via Portal vein and cause abscesses. 3. Metronidazole (symptomatic) and paromycine/iodoquinol (asymptomatic)
70
Pelvic inflammatory disease with violin string adhesions on the peritoneum to the liver?
- Chlamydia trachomatis | - Neisseria gon.
71
Patient with pharyngitis with gray white pseudomembrane, cervical adenopathy, irregular cardiac rhythm, and low grade fever. 1. Diagnosis? 2. Pathophys?
1. Corynebacterium diphtheria - gram + rod 2. Exotoxin inhibits protein synthesis ADP ribosylation of EF2
72
Vitamin A absorption route to the liver?
1. Enter lacteals 2. Thoracic duct 3. Left subclavian vein 4. Ito cells - avoids 1st pass
73
Water soluble vitamins absorption to the liver?
1. Intestinal absorption 2. Enters Portal vein 3. 1st pass Metabolism
74
Patient history of smoking, multiple MI and CVA. ECG shows A-Fib. Presents with acute severe diffuse abdominal pain. Labs show anion gap, metabolic acidosis, elevated lactate. Arteriogram shows poor perfusion to jejunum. 1. Diagnosis?
1. Acute mesenteric ischemia from arterial thrombus due to A-Fib that embolized to SMA blood work is suggestive of ischemia
75
Patient has history of HTN and abdominal pain after eating with chronic weight loss. Diagnosis?
chronic mesenteric ischemia due to atherosclerosis
76
Newborn has jaundice, lethargy, and elevated unconjugated bilirubin. Dies at 1 year. 1. Diagnosis? 2. Pathophys?
1. Crigler Najjar type 1 2. absent UDP-glucuronyltransferase causes lack of conjugation. Unconjugated bilirubin crosses BBB and causes kernicterus.
77
Infant is unable to swallow, coughs, chokes, and vomits with feeding. NG tube cannot be passed to stomach. 1. Diagnosis? 2. Findings in utero?
1. Esophageal atresia with tracheoesophageal fistula | 2. polyhydramnios b/c cannot swallow amniotic fluid
78
Infant with abdominal distention and bilious vomit in 1st day of life. Diagnosis?
Duodenal Atresia with double bubble sign
79
small amount of amniotic fluid in the prenatal period?
renal agenesis
80
Intracranial calcifications in infant?
congenital toxoplasmosis
81
Patient returned from south america with flu like symptoms, joint pain, fever with bradycardia (Faget's sign). Labs shows elevated liver enzymes (AST>ALT)and leukopenia. 1. Diagnosis? 2. Findings?
1. yellow fever by flavivirus (ssRNA) from Haemogogus mosquitoes 2. AST due to damaged skeletal muscle and liver, councilman bodies (eosinophilic degeneration and condensed chromatin). Zone 2 of liver is affected.
82
Lymphopenia and thrombocytopenia with elevated liver enzymes and arthritis?
chikungunya (togavirus)
83
Patient with sudden onset abdominal pain, jaundice, altered mental status, and block of hepatic vein. Followed by ascites and hepatomegaly. 1. Diagnosis? 2. Pathophys?
1. Budd chiari 2. polycythemia vera, essential thrombocytosis, OCPs, HCC, RCC causes thrombosis of hepatic veins leading to congestive liver
84
Patient presents with lethargy, confusion, jaundice, edema, coarse tremor of hands, prolonged PT and low albumin. Previously diagnosed with HCV. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Hepatic encephalopathy 2. Buildup of ammonia due to lack of liver function to convert it to urea 3. Lactulose is converted into acid by colonic bacteria. This acid binds with NH3 to form NH4+ and prevents it from crossing membranes. - Abx is 2nd line drug to kill bacteria
85
Patient has chronic burning chest pain which worsens after meals and while lying supine. ECG is normal. Patient still complains of symptoms after 3 months of omeprazole. 1. Diagnosis? 2. Biopsy?
1. GERD | 2. Barrett's esophagus or Metaplasia of squamous to intestinal columnar epithelium with goblet cells
86
Infant presents with meconium ileus and abdominal distention. He has prominent epicanthal folds, flat face, and downward slant eyes. Holosytolic murmur heard at left sternal border. 1. Diagnosis? 2. Pathophys?
1. Hirschsprung disease with Down Syndrome 2. Failure of neural crest cells migration into bowel causing absence of ganglion cells in rectosigmoid - congenital megacolon
87
Middle age man with acute epigastric pain, elevated triglycerides and CT showing pancreatic edema. 1. Diagnosis? 2. Treatment?
1. Acute pancreatitis due to hyperTG 2. Gemfibrozil increases lipoprotein lipase to enhance TG clearance - large decrease TG - small increase HDL - small decrease LDL
88
Female presents with RUQ pain, slight hepatomegaly, no jaundice or RUQ tenderness. AST and ALT slightly elevated. Normal bilirubin and alpha fetoprotein. Ultrasound shows well circumscribed hypo echoic lesion on liver. She is taking several meds. 1. Diagnosis? 2. Treatment?
1. Hepatic adenoma due to use of OCPs and anabolic steroids | 2. Discontinue OCPs
89
Patient has decreased libido and erectile dysfxn. Liver biopsy shows micro nodular cirrhosis. Paternal grandmother had history of hyperpigmentation, type 1 diabetes, and liver disease. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Hereditary hemochromatosis 2. HFE gene mutation causing excess iron absorption and elevated transferrin. Iron deposits in liver, skin increasing melanin, and pancreatic beta cells destruction 3. phlebotomy and deferoxamine (iron chelation)
90
Increased Collagen synthesis around central veins in liver? Diagnosis?
alcoholic liver disease
91
Drug that inhibits intestinal absorption of glucose and galactose, but fructose is unaffected. Mechanism?
Inhibits Na/K ATPase which maintains Na within the cell. SGLT-1 symporter cannot use Na gradient to import sugar. Fructose uses GLUT-5 and is unaffected.
92
Woman diagnosed with diabetic gastroparesis is given a medication that causes hand tremor, unsteadiness, difficulty controlling movements, and trunk stiffness. What was the med?
Metoclopramide - D2 antagonist that is pro kinetic. Increased motility by blocking dopamine. - ADR of parkinsonlike effects and antiemetic due to CNS block of dopamine
93
Patient has fatigue, weakness, dyspnea, peripheral neuropathy, history of MS, and high MCV. 1. Diagnosis? 2. Pathophys?
1. Pernicious anemia due to Vit B12 deficiency | 2. Autoimmune destruction of parietal cells causes decreased intrinsic factor and lack of B12 absorption.
94
Patient with acute onset abdominal pain, confusion, diffuse ab tenderness, ascites, decreased bowel sounds. Paracentesis reveals bacteria resistant to Gentamicin. 1. Diagnosis? 2. Resistance to gentamicin?
1. Acute bacterial peritonitis as a complication of ascites 2. Gentamicin is bactericidal that irreversibly inhibits 30s ribosomal subunit. Resistance by transferase enzymes the inactivate the drug by modification (phosphorylation) - ineffective against anaerobes b/c need O2
95
Young female with headache, nuchal rigidity, and gram negative diplococci on thayer martin agar from nasopharyngeal swab. 1. Diagnosis? 2. How does it colonize nasopharyngeal?
1. Neisseria meningitidis | 2. proteases cleave IgA into Fab and Fc fragments to adhere
96
Patient has elevated direct bilirubin and jaundice after viral illness. 1. Diagnosis? 2. Pathophys? 3. Differential?
1. Dubin johnson 2. Defective liver excretion of bilirubin. Liver turns black from heme carried by the same carrier. 3. Rotor syndrome can have the same manifestation except the liver is not black.
97
Patient has elevated indirect bilirubin and jaundice after stress or virus. 1. Diagnosis? 2. Pathophys?
1. Gilbert Syndrome | 2. Mild decrease in UDP-glucoronyltransferase
98
Cause of nutmeg liver?
Right CHF backs up fluid and causes secondary Portal HTN
99
Differential of macrovesicular steatosis?
- obesity - metabolic syndrome - diabetes - alcohol
100
Differential of microvesicular steatosis?
- Reye syndrome | - pregnancy
101
Patient returned from Africa with aching back, high fever, and black vomit. He reports many mosquito bites and yellow sclerae. 1. Diagnosis? 2. Pathophys?
1. yellow fever by flavivirus from Aedes mosquitoes | 2. Councilman bodies which are eosinophilic globules from hepatocyte apoptosis in zone 2
102
Mallory bodies?
alcoholic hepatitis
103
Negri bodies?
rabies virus in infected neurons
104
Weibel salade bodies?
normal component of vascular endothelium that store vWF and P-selectin
105
Patient has chronic progressive symptoms of fatigue, jaundice. She has ascites and elevated liver enzymes, direct bilirubin, and ALP. She has history of joint pain and multiple sexual partners. 1. Diagnosis? 2. Treatment?
1. Chronic hepatitis B infection 2. Tenofovir disoproxil fumarate - nucleotide reverse transcriptase inhibitor - ADR: renal insufficiency in HIV+ and decreased bone density in children
106
Treatment for CMV?
Gancyclovir
107
Treatment for primary biliary cirrhosis?
ursodeoxycholic acid
108
Patient has hoarseness, dysphagia, weight loss. He has 20 year history of smoking and heavy alcohol use. CT shows asymmetry and enhancing soft tissue of neck. 1. Diagnosis?
1. Laryngeal squamous cell CA
109
Loss of auerbach nerve plexus in esophagus. Diagnosis?
Achalasia | -manometry is gold standard to diagnose
110
Dysphagia, iron deficiency anemia, and esophageal webs. Diagnosis?
plummer vinson
111
Patient with recurrent right lower quadrant pain, diarrhea sometimes bloody, fever, arthralgia and weight loss. 1. Diagnosis? 2. Histology?
1. Crohn | 2. Transmural inflammation involving any part of GI tract
112
Blunting of villi?
celiac
113
Histology of ulcerative colitis?
submucosal inflammation limited to the colon as opposed to transmural inflammation of Crohn's in any part of the GI
114
Periodic acid schiff stain positive macrophages in intestinal lamina propria?
Whipple Disease - malabsorption due to Tropheryma whipplei - old man with arthralgia and cardiac, neuro symptoms with diarrhea, steatorrhea, weight loss
115
Patient with burning epigastric pain relieved by food. 1. Diagnosis? 2. Causes? 3. . Complications?
1. Dudoenal ulcer 2. H. pylori 3. perforation of bowel and erosion of Gastroduodenal Artery
116
Patient with history of chronic NSAID use, gnawing abdominal pain, and duodenal ulcers. Symptoms do not improve with omeprazole. 1. Diagnosis? 2. Pathophys? 3. Diagnostics?
1. Zollinger ellison syndrome 2. Gastrinoma secretes Gastrin (G cells) that stimulates hyper secretion of acid from parietal cells 3. High serum Gastrin level Secretin Test: normally inhibits Gastrin but it stays elevated
117
Patient has early satiety, discomfort after eating, and bloating. History of Type 2 diabetes. 1. Diagnosis? 2. Treatment? 3. ADR?
1. Gastroparesis from impaired neural control 2. Metoclopramide - D2 antagonist, antiemetic that increases gastric motility 3. parkinson like syndrome, tardive dyskinesia
118
Patient has bloody diarrhea and ab pain. Colonoscopy shows inflammation in colon. 1. Diagnosis? 2. Treatment? 3. ADR?
1. Ulcerative colitis 2. Azathioprine - antimetabolite converted to mercaptopurine in immunosuppressive that inhibits purine synthesis 3. Decreased WBC and susceptibility to infection
119
60 year old obese white male who smokes and drinks heavily with a history of chronic GERD has soft tissue tenderness at T3-T6 on right and dysphagia. 1. Diagnosis? 2. Complications? 3. Pathophys?
1. Barrett's esophagus with columnar metaplasia 2. Esophageal adenocarcinoma risk 3. Chronic acid reflux into esophagus causes change in cell type from squamous to columnar
120
50 year old female with low MCV and dysphagia complains of solid food getting stuck in her throat sometimes. She had concave spoon shaped nails. 1. Diagnosis? 2. Complications?
1. Plummer vinson syndrome - triad of iron deficiency anemia, dysphagia, and esophageal webs usually affects women in 5th decade 2. Esophageal carcinoma
121
Young female with history of major depression presents with confusion, emesis, diarrhea, hyperreflexia, myoclonus, fever, high BP and HR. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Serotonin syndrome - hyperreflexia differentiates it from other drug overdoses 2. SSRI increase serotonin levels 3. Sedation with benzos Cyproheptadine (serotonin antagonist)
122
Young female with foul smelling diarrhea for 8 months, paravertebral hypertonicity T5-T9, and a pruritic papulovesicular rash on her elbows. 1. Diagnosis? 2. Biopsy? 3. Treatment?
1. Celiac 2. Blunted villi with lymphocytes 3. Gluten free diet
123
Middle age male who is a heavy drinker is vomiting blood. 1. Diagnosis? 2. Liver biopsy?
1. Alcoholic cirrhosis with esophageal varices | 2. uniform small nodules with fibrosis
124
Patient with burning epigastric pain has been taking NSAIDS for 6 months. He notices dark stool. He has felt fatigued lately. 1. Diagnosis? 2. Peripheral blood smear?
1. Peptic ulcer disease due to NSAIDs. Ulcers ruptured causing anemia and dark stool. 2. Microcytic and hypo chromic RBC with central pallor and pencil cells
125
Microcytic, hypo chromic RBC with coarse basophilic stippling?
1. Beta thalassemia | 2. Lead poison
126
Oval macrocytic RBC?
Pernicious anemia from Vit B12 deficiency
127
Male with flank pain that radiates to his groin. Urine shows magnesium ammonium phosphate. 1. Diagnosis? 2. Pathophys?
1. Struvite stones | 2. UTI from urease+ gram negative rods that split urea into ammonium such as Proteus and Klebsiella
128
Male with history of alcohol abuse has peripheral edema, abdomen dull to percussion, low BP, and dilation of periumbilical vessels. No JVD. Paravertebral hypertonicity at T6-T9. He also has jaundice and spider angiomas on his nose. 1. Diagnosis? 2. Cause of Edema? 3. T6-T9?
1. Alcoholic cirrhosis 2. decreased plasma colloid oncotic pressure due to decreased liver synthesis of albumin 3. segments represent foregut pathology such as liver
129
Pregnant female is having painless bleeding from rectum. 1. Diagnosis? 2. Pathophys?
1. Internal hemorrhoids above pectinate line | 2. superior rectal veins become dilated due to increased pressure from pregnancy or cirrhosis
130
Boy ate a whole bottle of iron supplements. Treatment?
iron chelator such as deferoxamine
131
Old man has LRQ pain, fever, rebound tenderness. Tender nodule on tip of right T12 rib anteriorly and posteriorly on transverse process of right T11. Diagnosis?
Acute appendicitis from fecalith | -children due to lymphoid hyperplasia
132
What are all the signs of appendicitis?
1. Obturator sign- right hip flexed 90 degrees and rotated internally causes pain 2. Rebound tenderness 3. Rovsing sign- pain in RLQ with palpation of LLQ 4. Psoas sign- patient lies on left side and doctor passively extends right hip causing RLQ pain 5. McBurney's- tenderness 2 inches medial to ASIS
133
Boy with recent flank pain, lethargy, and multiple bruises not from trauma. 2 weeks prior, he had bloody diarrhea and vomit after eating hamburgers and potato salad at picnic. Urinalysis shows proteinuria and hematuria. Platelet counts are low. 1. Diagnosis? 2. Pathophys? 3. clinical features?
1. Hemolytic uremic syndrome after hemorrhagic colitis from enterohemorrhagic E. coli shiga toxin 2. Toxin inhibits protein synthesis by cleaving 60s ribosomal subunit leading to apoptosis and bloody colitis. Toxin enters blood causing thrombosis of glomerulus and renal necrosis. 3. thrombocytopenia, hemolytic anemia, and acute renal failure
134
Young male has vague abdominal pain, fatigue, and jaundice, especially after long runs. Labs shows elevated unconjugated bilirubin. 1. Diagnosis? 2. Pathophys?
1. Gilbert disease | 2. mild UGT deficiency causes lack of conjugation usually only presenting symptoms with stress
135
Patient has constant LLQ pain, fever, and elevated WBC. Tender nodule on proximal IT band on left thigh. 1. Diagnosis? 2. Pathophys? 3. Nodule? 4. Complications?
1. Diverticulitis (left sided appendicitis) in sigmoid 2. inflammation of out pouches usually in sigmoid colon due to low fiber diet, constipation, obesity 3. chapman point on anterior thigh corresponding to colon. The more proximal colon = more distal thigh 4. Abscesses, obstruction, fistula, perforation
136
GI viscerosomatic reflexes?
Esophagus T2-T8 Foregut T5-T9 Midgut T10-T11 Hindgut T12-L2 Appendix T12
137
One week after camping, HIV+ male has explosive watery diarrhea, nausea, and foul flatulence. Stool shows oval cysts. 1. Diagnosis? 2. Treatment?
1. Giardia lamblia - protozoa spread fecal-oral from drinking contaminated water or being at daycare 2. Metronidazole - dont take with alcohol
138
Patient with history of smoking and alcohol presents with constant epigastric pain, fatigue, jaundice, and weight loss. Nontender mass is palpated. 1. Diagnosis? 2. PE findings? 3. Risk factors?
1. Pancreatic adenocarcinoma - head of pancreas causes obstruction of bile duct in embryonic ventral pancreatic bud 2. Courvoisier- painless mass (GB) Trousseau- migratory thrombophlebitis (palpable cordlike veins) Elevated 19-9 3. Smoking doubles the risk
139
Patient with Ulcerative colitis, pruritis, hepatomegaly, and no palpable mass. Diagnosis?
Primary sclerosis cholangitis
140
Middle aged woman with unexplained pruritis, fatigue, jaundice, xanthelasma, and osteoporosis. Hypertonicity T6-T9. Elevated ALP and +antimitochondrial Ab. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Primary Biliary cirrhosis 2. autoimmune destruction of intrahepatic bile ducts, portal inflammation, scarring 3. Ursodiol
141
Patient with RUQ pain that radiates to the shoulder, leukocytosis, fever, and inspiratory arrest with deep palpation (Murphy's). No jaundice. 1. Diagnosis? 2. Pathophys?
1. Acute Cholecystitis | 2. block of cystic duct, not CBD
142
Patient has epigastric pain, dark stools, hyperemia of gastric mucosa and linear ulcerations. History of osteoarthritis and gout. 1. Diagnosis? 2. Pathophys?
1. Acute Gastritis from NSAIDS 2. NSAIDS inhibit COX which decreases prostaglandins and decreases the protective mucous barrier in the gastric mucosa - SSRI and Nicotine also associated with this
143
Patient with high BP and spontaneous episodes of swelling in arms, face, genitals that resolve. Father had similar symptoms. 1. Diagnosis? 2. Pathophys? 3. What medication should be avoided?
1. Hereditary angioedema 2. deficient C1 esterase inhibitor - inhibits C1 complement - inactivates kallikrein which decreases bradykinin - deficiency leads to increase in bradykinin. C3a, C5a leading to dilation 3. Lisinopril (ACEi) - increases bradykinin
144
Patient was camping and returned with watery diarrhea. 1. Diagnosis? 2. Pathophys?
1. Giardia lamblia | 2. trophozoites colonize the small bowel resulting in inflammation and villous atrophy reducing absorption
145
Middle aged white man with unintentional weight loss, migratory joint pain, and diarrhea. 1. Diagnosis? 2. Pathophys? 3. Histo?
1. Whipple Disease 2. Infection by Tropheryma whipplei (Gram + non acid fast bacilli) distort the villi 3. foamy macrophages with periodic acid schiff+ granules crowd lamina propria of intestines
146
Elderly patient with constipation, painless rectal bleeding, and LLQ pain. Labs shows leukocytosis and low MCV. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Acute Diverticulitis from Diverticulosis 2. False diverticula in mucosa/sub of sigmoid colon become inflamed and infected 3. Ciprofloxaxin and Metronidazole and then colonoscopy (6 weeks later) to rule out cancer
147
Patient with gnawing epigastric pain exacerbated by meals and unintentional weight loss. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Gastric ulcer in antrum 2. H. pylori - gram negative flagellated curved bacteria causing punched out solitary lesions that are sharply demarcated with chronic inflammatory cells 3. Triple therapy - PPI - Clarithromycin - Amoxicillin or Metronidazole
148
Preterm neonate with lethargy and extensive jaundice. 1. Diagnosis? 2. Pathophys?
1. Bilirubin induce neuro dysfunction that can progress to kernicterus 2. unconjugated Br is insoluble and crosses BBB
149
Why do neonates struggle to metabolize bilirubin?
1. increased RBC breakdown increases Br production 2. Decreased Br clearance and conjugation (immature liver) 3. Increased enterohepatic circulation
150
Treatment for acetaminophen overdose?
N-acetylcysteine
151
Patient has painless sores on face, neck, and arms after serving as a 1st responder to a bioterrorism attack. 1. Diagnosis? 2. Pathophys? 3. What else acts similarly?
1. Bacillus Anthracis 2. edema factor increases intracellular cAMP - lethal factor increases TNF and IL-1 3. Vibrio cholera (cholera toxin) - enterotoxigenic E coli heat labile toxin)
152
Patient presents with constipation after abusing heroin all week. Why does the patient have abdominal discomfort?
opioids stimulate mew receptors in the GI tract causing decreased bowel motility
153
Patient returned from Mexico with bloody diarrhea, fever, RUQ pain that radiates to the shoulder, and a large hypo echoic mass in the liver. Increased ALP. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Amebic abscess from Entamoeba histolytica (protozoa) 2. cysts in water ingested and turn into trophozoites that ingest RBC 3. Metronidazole
154
Patient bathed in the Amazon river and presents with abdominal pain, ascites, and hepatosplenomegaly. Mildly elevated ALP and GGT with eosinophilia. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Parasitic blood fluke disease from Schistiomiasis manosoni 2. Parasite penetrates the skin and settles in portal vein causing liver fibrosis and granulomas. Leads to cirrhosis and portal HTN. 3. Praziquantel
155
Patient with history of Crohn disease has flank pain radiating to groin. He reports steatorrhea. 1. Diagnosis? 2. Pathophys?
1. Nephrolithiasis 2. Crohn disease causes damage to terminal ileum causing decreased bile acid absorption which impaired lipid absorption. Calcium in the lumen binds with excess fat which increases free oxalate. Oxalate is absorbed and filtered through kidneys where it binds with calcium there forming calcium oxalate crystals.
156
Patient with bilious vomit and diffusely tender abdomen. 1. Diagnosis? 2. Pathophys?
1. Small bowel obstruction 2. leading cause of obstruction is adhesion formation that form during the healing process after abdominal surgery. - possible hernia or cancer
157
Patient has rectal bleeding, crampy abdominal pain, worsening bloody mixed diarrhea, fever, arthralgia, and erythema nodosa on shins. 1. Diagnosis? 2. Treatment? 3. ADR?
1. Ulcerative Colitis 2. Mesalamine or Sulfasalazine - anti-inflammatory suppositories 3. sulfonamide toxicity and reversible oligospermia
158
Newborn with green brown vomit, hypotonia, a palmar crease, and scaphoid abdomen (anterior wall sunken and hollow). 1. Diagnosis? 2. Pathophys? 3. X-ray?
1. Duodenal atresia associated with Down syndrome 2. failure to reanalyze at 8-10 weeks 3. Double bubble sign
159
What do labs show in alcoholic hepatitis?
- moderate increased liver enzymes AST:ALT in 2:1 ratio - hyperbilirubin - moderate increased ALP and GGT - decreased albumin - decreased Vit K dependent clotting factors (2, 7, 9, 10) causing increased PT and INR
160
Patient with pruritus, jaundice, and elevated conjugated bilirubin, ALP, AST, ALT. 1. Diagnosis? 2. Differentials?
1. Cholestasis due to intrahepatic or extra hepatic biliary obstruction 2. gallstones - cholangiocarcinoma - cancer - liver flukes - primary sclerosis cholangitis - primary biliary colangitis
161
HIV positive woman with jaundice and upper abdominal pain. PE shows positive fluid wave (ascites), splenomegaly, low grade fever, and nodular shrunken liver. 1. Diagnosis? 2. What blood count should be low? why?
1. Cirrhosis due to Hepatitis most likely HCV, also HBV possible 2. low platelet count. Portal HTN causes splenomegaly from increased pressure and it sequesters more platelets and breaks them down
162
HLA-B27 disease?
- Psoriasis - Ankylosing spondylitis - IBD (ulcerative colitis) - Reiter syndrome
163
Patient weight loss, reduced appetite, and palpable LN above left clavicle. 1. Diagnosis? 2. Histo findings?
1. Gastric Adenocarcinoma - increased smoked foods 2. signet ring cells from LN biopsy - if found in ovary= krukenberg tumor B/L
164
Young man with muscle pain, twitching, weakness, burning epigastric pain, and decreased libido. Calcium, PTH, and Gastrin are high. 1. Diagnosis? 2. Treatment? 3. ADR?
1. MEN-1 - parathyroid adenoma causing muscle weakness and twitch - pancreatic gastronoma (ZE) causing burning epigastric pain - pituitary adenoma causing hypogonadism 2. Omeprazole (PPI) 3. decreased magnesium
165
Boy with non bilious vomiting, diarrhea, and dehydration after a recent outbreak at day-care. He is vaccinated. 1. Diagnosis?
1. Gastroenteritis from Norovirus +ssRNA nacke icosahedral 2. Polio has same genetic makeup
166
Old woman has painless hard mass in RUQ. Xray shows GB with opaque calcified rims. 1. Diagnosis? 2. Pathophys?
1. Porcelain GB secondary to Chronic Cholecystitis | 2. prolonged inflammation causes dystrophic calcification due to deposition of calcium salts
167
Patient has N/V, diabetic retinopathy, and early satiety. 1. Diagnosis? 2. Treatment? 3. ADR?
1. Diabetic gastroparesis 2. Metoclopramide - muscarinic agonist that increases LES tone, gastric emptying, and decreases pyloric sphincter tone - dopamine antagonist to decrease N/V 3. parkinsonism, dystonia, akathisia, tardive dyskinesia
168
Use of carcinoemryonic antigen level (CEA)?
monitor effectiveness of treatment
169
Patient has lower abdominal cramping, fever, and nonbloody diarrhea several days after being treated for cellulitis with Clindamycin. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. pseudomembranous colitis from Clostridium difficile 2. broad spectrum antibiotics shifts balance of normal flora allowing c. difficile to grow 3. Oral vancomycin - inhibits cell wall peptidoglycan by binding D-ala D-ala
170
Pregnant woman has jaundice, fever, ab pain, and severely elevated ALT>AST after traveling to India. 1. Diagnosis? 2. Treatment?
1. HEV causing Fulminant hepatitis - ssRNA linear hepevirus virus 2. supportive care b/c it is self limiting but causes mortality in 20% pregnant women
171
Man with UC progresses to colon cancer. What features will his colon have?
chronic inflammation leads to dysplasia and multifocal lesions
172
Child with fever, tachycardia, abdominal distention, absent bowel sounds, and double bubble sign after taking Loperamide. 1. Diagnosis? 2. Pathophys?
1. Toxic megacolon | 2. Loperamide is an opiate antidiarrheal that is contraindicated in children <2 years old
173
Patient with chronic peptic ulcer disease is on medication that causes impotence and decreased libido. 1. Medication? 2. Mechanism? 3. Other medication with less ADR?
1. Cimetidine 2. H2 blocker that decreases HCl release from parietal cells 3. Ranitidine works by same mechanism but doesn't have antiandrogenic effects
174
Man from China has weight loss, RUQ pain, early satiety, and a palpable RUQ mass. Alpha fetoprotein and liver enzymes are elevated. His father died of liver cancer. 1. Diagnosis? 2. Pathophys?
1. HCC from chronic HBV | 2. HBV integrates into host genome. Chronic cirrhosis leads to malignant conversion (usually seen in HCV)
175
Old man has fatigue, distended abdomen with pitting leg edema. Labs shows elevated AST:ALT in a 2:1 ratio. 1. Diagnosis? 2. Cause of edema? 3. Liver biopsy?
1. Alcoholic hepatitis 2. decreased albumin production decreases capillary oncotic pressure leading to fluid loss into ISF 3. Mallory bodies with eosinophilic inclusion bodies
176
Infliximab 1. MOA? 2. Use? 3. ADR?
1. binds and blocks TNF-alpha 2. use for Crohn's when steroid therapy has failed 3. Upper RTI and reactivation of latent TB
177
Cells implicated in the pathologic process of cirrhosis?
persistent activation of stellate cells transforms them into myofibroblasts increasing collagen deposition
178
Patient has history of liver cirrhosis and HCV. What is the best medication for pre-op sedation?
Lorazepam -does not utilize phase 1 hydroxylation by liver p-450. It enters phase 2 directly to an inactive metabolite. It does not have a prolonged sedative effect. An ineffective p-450 due to liver disease would prolong sedation in Diazepam.
179
Patient with dysphagia to solids, fever, night sweats, weight loss, nontender LN, and chronic cough. Biopsy shows large cells with bilobed nucleus with eosinophilic inclusions. 1. Diagnosis? 2. Cell biomarkers?
1. Hodgkin's lymphoma - Reed sternberg cells 2. CD15+ and CD30+
180
Key feature in aspirin toxicity?
Tinnitus
181
Why does aspirin cause bronchospasm?
Blocks COX which shifts back toward LPO which increases LTC4
182
Young patient with tumors found in proximal colon and family history of colon cancer. 1. Diagnosis? 2. Pathophys?
1. HNPCC or Lynch syndrome | 2. autosomal dominant disorder of DNA mismatch repair
183
Colonic polyps with high malignant potential?
Villous
184
Patient has weight loss, proptosis, fever, diaphoresis, altered mental status, tachycardia, and Afib. Diagnosis?
Thyroid storm | -Graves disease doesn't present with altered mental status
185
Patient with history of cirrhosis and alcohol abuse presents with change in personality. 1. Diagnosis? 2. Treatment?
1. Hepatic encephalopathy | 2. Lactulose is broken down by gut bacteria to lactic acid that converts NH3 to NH4+
186
Most reliable lab test to predict mortality in acute pancreatitis?
Elevated BUN
187
Patient with progressively worsening abdominal pain and distention, constipation. Xray shows U-shaped sigmoid colon. 1. Diagnosis?
1. Sigmoid volvulus
188
Infant born with ventral defect of inferior abdominal wall, bladder, and epispadias. 1. Diagnosis?
1. Bladder exystrophy from ruptured cloacal membrane
189
Patient with diarrhea, weight loss, and edema. Endoscopy shows cerebriform rugae in stomach and very few parietal cells. 1. Diagnosis? 2. Pathophys?
1. Menetrier Disease | 2. Hypertrophy of gastric glands causes loss of parietal cells and protein loss
190
What is the demarcation between upper and lower GI bleeds?
Ligament of Treitz that inserts into 3rd/4th portion of Duodenum. -upper bleed causes dark stools
191
Patient has low blood glucose. Symptoms relieved when given glucose and labs show elevated serum C-peptide. 1. Diagnosis? 2. Pathophys?
1. Insulinoma in Beta cells 2. excessive insulin produced lowering blood glucose with direct effect on nervous system. C-peptide is a marker of insulin production.
192
Extraintestinal manifestations of IBD?
- anterior uveitis - pyoderma gangrenous - primary sclerosis cholangitis - toxic megacolon - erythema nodosa on shins - apthous ulcers
193
Patient with alcoholic cirrhosis and painless bright red stool. 1. Diagnosis?
Portal HTN causing internal hemorrhoids (superior rectal vein)
194
Patient with flank pain radiating to groin. Nothing on Xray. Blood pH is 5.4. Diagnosis?
Uric acid kidney stone | -radiolucent
195
Patient has a history of UTIs. She has severe right abdominal pain.. Her urine pH is 7.9. Diagnosis?
magnesium ammonium phosphate stone (Struvite) | -need ammonia production and basic urine
196
Young patient with recurrent nephrolithiasis. Diagnosis?
Cystinuria
197
Patient presents with migratory arthralgias, weight loss, steatorrhea, and abdominal pain. PAS+ macrophages. 1. Diagnosis? 2. Pathophys?
1. Whipple Disease | 2. Tropheryma whipplei infection (Gram+ bacilli PAS+)
198
Patient blacked out after drinking a lot of alcohol. What metabolic consequences are you worried about?
Breakdown of acetaldehyde increases NADH: 1. Increased conversion of pyruvate to lactate causing lactic acidosis 2. Increased conversion of OAA to Malate causing decreased GNG and hypoglycemia, diverting to ketoacids 3. Acetyl CoA diverted to ketoacids because increased NADH decreases TCA cycle 4. Acetyl CoA diverted to fatty acids leading hepatosteatosis
199
Patient presents with severe abdominal cramping after meals, steatorrhea, and vesicular rash on knees and elbows. Tissue transglutaminase antibody is positive. 1. Diagnosis? 2. What else is associated?
1. Celiac | 2. Hashimoto thyroiditis or other autoimmune diseases
200
Patient presents with burning epigastric pain that is worse after eating. What Osteopathic technique would you use?
Suboccipital release to normalize parasympathetic stimulation of parietal cells. Nerves bind M3 receptors and activate phospholipase C leading to IP3 and DG to increase calcium and stimulate H/K ATPase to secrete acid.
201
Patient presents with bloody diarrhea with WBC in stool and fever. Bacteria is grown on MacConkey agar and ferments sorbitol. Diagnosis?
Enteroinvasive E coli -Shigella similar presentation
202
Patient with bloody diarrhea. Bacteria does not ferment sorbitol. Diagnosis?
Enterohemorrhagic E coli
203
Child with nonbloody diarrhea and no fever. Diagnosis?
Enteropathogenic E coli
204
Patient with nonbloody diarrhea and severe dehydration. Diagnosis?
Enterotoxigenic E coli | -travelers diarrhea
205
Male on a cruise ship presents with vomiting, watery diarrhea, and low grade fever. Hypertonicity at T10-L2 and Suboccipital. 1. Diagnosis? 2. Pathophys? 3. Osteopathic?
1. Norovirus - naked ssRNA calicivirus most common cause of gastroenteritis outbreaks 2. Blunts intestinal villi causing malabsorption and slows GI motility causing vomiting. 3. T10-L2 = SI, Colon Suboccipital= increased parasympathetic
206
Child presents in ER with confusion, lethargy, and vomiting. Exam shows hepatomegaly, elevated AST, ALT, and Ammonia. Parents say he had a viral illness. 1. Diagnosis? 2. Histology?
1. Reye Syndrome from Aspirin toxicity 2. Liver- fatty change Brain- noninflammatory cerebral edema
207
Portal Triad?
Portal Vein Proper Hepatic Artery Common Bile Duct
208
Man presents with foul smelling watery diarrhea after returning from camping trip where he drank from the stream. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Giardia Lamblia (protozoa) 2. Cysts in stream water from beavers get in GI and become motile trophozoites in stool 3. Metronidazole
209
Patient presents with flushing that begins suddenly and lasts 30 minutes, purple vascular lesions on face, watery diarrhea, bronchospasm, and a new holosystolic murmur on the left sternal border. Symptoms have worsened over the past few months. Urine shows increased 5-HIAA levels. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Carcinoid Syndrome 2. Metastatic neuroendocrine tumor that secretes Serotonin. symptoms do not appear until the tumor has reached the liver. - Plaque like deposits on Tricuspid valve causes regurgitation. 3. Octreotide - serotonin antagonist
210
1. Why does serotonin syndrome lead to Niacin deficiency? | 2. Symptoms?
1. Deficiency in Tryptophan which is the precursor to Serotonin and Niacin. Due to overproduction of Serotonin. 2. Pellagra - Diarrhea - Dementia - Dermatitis
211
Child presents with fatigue, vomiting, diaphoresis after being introduced fruit into their diet. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Hereditary Fructose intolerance 2. Aldolase B deficiency causing accumulation of F1P and hypoglycemia 3. Remove sucrose, fructose, and sorbitol from diet
212
African american with rash on cheeks that spare the nasolabial folds, arthralgias, and fatigue. Labs show renal failure and thrombocytopenia. 1. Diagnosis? 2. Tests?
1. SLE 2. ANA Anti-dsDNA (more severe and renal) Anti-Smith
213
Patient presents with weight gain, bradycardia, and slow reflexes. Labs show elevated TSH. 1. Diagnosis? 2. Tests?
1. Hashimoto Thyroiditis causing Hypothyroidism 2. Anti-microsomal Ab Anti-TPO Ab
214
Patient presents with difficulty swallowing, skin tightness in hands, and fingers turn blue when cold. 1. Diagnosis? 2. Tests?
1. CREST | 2. Anti-centromere
215
Patient has progressive dysphagia to solids and liquids and finds undigested food on pillow at night. Barium swallow shows dilated esophagus and distal tapering. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Achalasia 2. Incomplete relaxation of LES due to loss of ganglion cells in myenteric plexus that normally produce NO to relax sphincter. Caused by chagas (trypanosoma) 3. Treat with nitrates, beta blockers, botulinum, ca channel blockers - decrease calcium availability for actin and myosin leading to SM relaxation
216
Male with purulent urethral discharge and painful urination. Biopsy shows Gram- diplococci with neutrophils. 1. Diagnosis? 2. Treatment?
1. Neisseria gonorrhoeae | 2. Ceftriaxone (+dual therapy for chlamydia)
217
Female presents with strong vaginal odor. She douches regularly. Microscopic exam shows numerous epithelial cells with stippled appearance. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Gardnerella Vaginalis 2. douching disrupts normal flora leading to bacterial overgrowth 3. Metronidazole
218
Man presents with non painful ulcer on glans of penis after intercourse with prostitute. Microscopy shows spirochetes. 1. Diagnosis?
1. Syphilis from Treponema pallidum | 2. Penicillin G
219
Female with purulent frothy, malodorous discharge and pruritus and dysuria. 1. Diagnosis? 2. Treatment?
1. Trichomonas vaginalis | 2. Metronidazole
220
Patient with purulent discharge, dysuria, and lymphadenopathy. 1. Diagnosis? 2. Treatment?
1. Chlamydia trachomatis | 2. Azithromycin (+dual therapy for neisseria)
221
Patient with abdominal pain, foul diarrhea, weight loss, joint pain, and skin hyperpigmentation. His wife reports that he has been forgetful. Gram + bacteria are found. PAS+ stain. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Whipple Disease 2. Tropheryma whipplei (Gram+ bacilli) infects causing macrophages to infiltrate the lamina propria of the SI. They phagocytose them. Foamy macrophages compress lacteals in villi of SI which prevents chylomicrons from entering lymphatic system, inhibiting fat absorption. 3. Doxycycline or Macrolides
222
What is the only exception to informed consent?
life threatening emergencies
223
Young girl presents with abdominal pain, fever, RUQ tenderness, and hives on her extremities and trunk. She takes her dog to the park everyday. Immunoassay shows TES-Ag and IgE. 1. Diagnosis? 2. Pathophys?
1. Toxocariasis 2. Soil in parks contain Toxocara canis eggs that are deposited in dog feces. Ingested through oral contamination. The larvae penetrate the intestinal wall and migrate through vessels to muscle, liver, lungs, eyes, brain. Eosinophils respond.
224
What proteins are decreased in cirrhosis?
- Albumin - Acute phase reactants (CRP) - Clotting factors except factor 8
225
6 Month old previously healthy with vomiting, bloody "currant jelly" stools, and intermittent abdominal pain. The infant is fussy and draws up legs, but a mass is palpated in the RLQ. Ultrasound shows bullseye looking bowel. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Intussesception 2. Most common intestinal obstruction in infants between 6-36 months. Occurs at ileocecal junction where a section of bowel folds in on itself. 3. Contrast enema or surgery
226
Pregnant woman has mild RUQ discomfort, increasing abdominal girth, moderately enlarged liver, no murphy sign, and no jaundice. No history of alcohol. Liver enzymes are normal. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Budd Chiari 2. Thrombi occlude hepatic vein causing centrilobular congestion and ascites. Pregnancy increases fibrinogen, thrombin, and decreases protein S which causes a hyper coagulable state to prevents postpartum hemorrhage. 3. Thrombolysis and Anticoagulation TIPS or Transplant
227
Patient visited Uganda and returns with fever, malaise, and headache. He is now experiencing bloody diarrhea, epistaxis, icteric sclera, and abdominal pain. BP is low and HR is high. High WBC, low Hgb and platelets. 1. Diagnosis? 2. Next step?
1. Ebola Virus | 2. Place patient in isolation and notify CDC
228
9 month old child is the in the 5th percentile for weight. At 6 months, she was 50th percentile and was being breastfed. She has been eating a regular diet but has had loose, watery, and nonbloody stools. CBC shows low Hgb and low MCV. 1. What test should you run next? 2. Diagnosis? 3. Treatment?
1. Antitissue transglutaminase IgA 2. Celiac 3. Gluten free diet
229
Endoscopy results of Celiac?
flattened villi
230
Genetic predispositions for Celiac?
HLA DQ2 HLA DQ8
231
Cause of osteoporosis in Celiac?
Decreased absorption of Fat soluble Vit D which decreases absorption of calcium. PTH increases to increase serum calcium and breaks down bone.
232
AIDS patient presents with profuse watery diarrhea causing weight loss, dehydration, and abdominal pain. 1. Diagnosis? 2. Treatment?
1. Cryptosporidium parvum - protozoan parasite in contaminated water 2. Nitazoxanide - broad spectrum anti parasitic and antiviral
233
AIDS patient with meningitis?
Cryptococcus neoformans
234
AIDS patient with pneumonia?
Pneumocystis jirovecci
235
AIDS patient with meninogoencephalitis with ring enhanced brain lesions on MRI?
Toxoplasma gondii
236
HBsAg+ Anti-HBc IgM+ HBeAg+
Acute HBV
237
HBsAg- | Anti-HBc IgM+
Window period
238
Anti-HBs IgG+ Anti-HBc IgG+ Anti-HBe IgG+
Cleared HBV and immune
239
Anti-HBs IgG+ | Anti-HBc IgG-
Vaccinated and immune
240
HBsAg+ HBeAg+ Anti-HBc IgG+
Chronic HBV high risk
241
HBsAg+ Anti-HBc IgG+ Anti-HBe IgG+
Chronic HBV low risk
242
Child had scoliosis surgery. 10 days after surgery, she has severe nausea, sharp abdominal pain and bilious vomiting. Pain is exacerbated when lying supine and relieved when in lateral decubitus. Chapman's points 8-10th ICS. 1. Diagnosis? 2. Pathophys? 3. What embryo structure is affected?
1. SMA Syndrome 2. Duodenum is trapped and compressed between Aorta and SMA. Duodenum is normally buffered by fat and lymph, but when spine is lengthened, this shifts everything. Knees to chest, prone, and lateral decubitus positions elevate the root of SMA to relieve pain. 3. Vitelline arteries (Celiac, SMA, IMA) carry blood to yolk sac
243
Patient recently returned from trip to Africa. She explains that she often walked barefoot like the locals. She presents with petechial hemorrhages in her feet, pruritus and edema. She complains of a mild cough, wheezing, diarrhea, and abdominal pain. 1. Diagnosis? 2. Pathophys?
1. Strongyloides stercoralis 2. Roundworm found in soil contaminated with human feces. Penetration of skin allows larvae to enter feet. It migrates to respiratory tract and then GI. Immunocompromised patients get hyper infection where eggs in GI hatch and worms migrate to various organs.
244
Patient presents with 6 month history of alternating constipation and diarrhea that is received after defecation. No blood in stool and colonoscopy is negative. 1. Diagnosis 2. Osteopathic technique?
1. Irritable bowel syndrome 2. Midline pressure on SMA ganglion and release helps decrease sympathetic tone to T10-T11 (Distal duodenum to mid transverse colon). Contraindicated if aortic aneurysm or surgery.
245
3 day old newborn has not passed any stool since birth. He cries continually. Xray shows dilated bowel loops and decreased air in rectum. 1. Diagnosis? 2. Pathophys? 3. Genetic associations?
1. Hirschsprung Disease 2. Absent ganglion cells to Auerbachs and Meissners plexus in one segment of colon, usually sigmoid or rectum. This is due to failure of neural crest cells to migrate. Segment lacks peristalsis. 3. Down Syndrome
246
Male with epigastric pain that is relieved by eating. 1. Diagnosis? 2. Pathophys?
1. Duodenal ulcer 2. H. pylori (Gram- curved bacilli) produces Urease that allows it to inhabit the stomach by cleaving urea into ammonia and CO2. Ammonia neutralizes the stomach cid and raises pH. VacA, CagA, and other proteins damage tissue and attract Neutrophils that contribute to peptic ulcer formation.
247
Patient with burning epigastric pain that worsens after eating spicy meals and lying supine. 1. Diagnosis? 2. Tissue texture changes?
1. GERD | 2. Viscerosomatic reflexes causes tissue texture changes T5-T8.
248
Patient returns from mission trip to Haiti with vomiting, acute onset watery diarrhea, and painful leg cramps. Haiti had been destroyed by an earthquake and everyone is staying in a makeshift place. Patient is alert. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Vibrio cholerae 2. Cholera toxin causes ADP ribosylation of Gsa subunit which activates adenylate cyclase and cAMP. Chloride is released into gut lumen and decreased Na reabsorption. Electrolyte imbalance causes water loss and rice water stools. 3. Oral fluid and electrolyte replacement - use IVF if altered mental status, hypovolemic shock, cannot tolerate oral, or weak pulses
249
Patient has received two hepatitis vaccines. What other hepatitis virus is he immune to?
HDV - Only HAV and HBV vaccines exist - HDV is a delta virus that requires HBsAg to create envelope to infect (coinfection or superinfection)
250
Patient is an IVDA. What chronic hepatitis is he at risk for?
HCV - Flavivirus transmitted via blood through needles - 60-80% become chronic HCV and 20% progress to cirrhosis and HCC
251
Patient is not an IVDA and is not sexually active. Returns from trip to Mexico with N/V, diarrhea, RUQ pain, and jaundice. 1. Diagnosis? 2. Pathophys?
1. HAV | 2. picornavirus from contaminated water or food. No chronic carrier state. Symptoms 2-6 weeks after exposure.
252
Enveloped circular dsDNA virus?
HBV
253
Transmission of HBV?
Sex Needles Vertical transmission
254
Male with dull RUQ pain radiating to back, severe weight loss, fatigue, and jaundice. He has smoked for 48 years. Left supraclavicular LN is palpable. Superficial thrombophlebitis in left arm that was in his right arm. 1. Diagnosis? 2. Three signs? 3. Biomarkers?
1. Pancreatic Adenocarcinoma 2. Courvisier's: tumor in head of pancreas blocks CBD causing enlarged GB that is painless Trousseau's: Migratory thrombophlebitis of superficial veins Virchow's node: Left supraclavicular LN 3. CEA and CA 19-9
255
Pancreatic pain vs GB pain?
Pancreatic: radiates to the back GB: radiates to shoulder
256
CA 15-3?
Breast cancer
257
HER2/neu?
Breast or gastric cancer
258
AFP?
HCC or yolk sac tumor
259
hCG beta?
Choriocarcinoma
260
S100?
Melanoma
261
PSA?
Prostate cancer
262
Elevated calcitonin?
Medullary thyroid cancer
263
CEA?
colorectal or pancreatic cancer
264
Patient who visited southeast Asia presents with intermittent RUQ pain and jaundice. Eggs are found in his stool sample. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Chlonorchis sirensis 2. Trematode is a liver fluke that infects liver, GB, and biliary tree. Chronic inflammation can lead to cholangiosarcoma. 3. Praziquantel in an antihelminth that increases cell membrane permeability leading to disintegration of the parasite.
265
Patient presents with fatigue, pain in RLQ, pale conjunctiva, weight loss, and positive fecal occult blood test. Hct is 30%. 1. Diagnosis? 2. Pathophys? 3. Chapman's point?
1. Ascending Colon cancer 2. Right sided colon tumors are associated with anemia b/c they bleed. Left sided associated with obstruction. 3. Right lateral thigh more proximal
266
Patient has LLQ pain, bloody stools, weight loss, and blurry vision. Colonoscopy shows abnormal inflamed mucosa with shallow ulcers until the midline of the ascending colon. The rest is normal. 1. Diagnosis?
1. Ulcerative Colitis | 2. Starts with crypt abscesses which are groups of Neutrophils with colonic crypts
267
Features of Crohns?
- Any part of GI tract - Transmural inflammation - Cobblestone mucosa with longitudinal fissures - noncaseating granulomas - creeping fat - fistulas
268
UC features?
- Colon inflammation only beginning at rectum - Confined to mucosa - Pseudopolyps (surviving non ulcerated mucosa between ulcers)
269
Child with RLQ pain, fever, vomiting, and rebound tenderness on right side. The pain started periumbilical and then migrated to RLQ. 1. Diagnosis? 2. Chapmans points?
1. Acute Appendicitis 2. Posterior Transverse process of T11 Anterior tip of 12th rib
270
Bethanechol 1. MoA? 2. Uses? 3. ADR?
1. Muscarinic agonist that increases parasympathetic activity and peristalsis 2. Post op Ileus and to treat urinary retention 3. Diarrhea, Urinary incontinence
271
Male with sudden onset retrosternal chest pain. He consumed a large quantity of alcohol and vomited repeatedly with no hematemesis. Muscle spasms at T2-T8. CXR shows pneumomediastinum. BP 100/60. HR 110 and Fever. 1. Diagnosis? 2. Additional findings? 3. Treatment?
1. Boerhaave Syndrome (Esophageal rupture) 2. Hamman Crunch: crackling sound heard with each heartbeat associated with pneumomediastinum Subcutaneous Emphysema: air from ruptured esophagus travels to soft tissue and skin makes a crackling sound when pushed 3. IVF, Broad Abx, PPI, and surgery
272
Bowel sounds heard in chest?
Diaphragmatic hernia | -hiatal is most common
273
Holosystolic murmur loudest at apex and radiates to axilla?
Mitral regurgitation
274
Holosystolic loudest at left sternal border and is enhanced by inspiration?
Tricuspid regurgitation
275
Holosystolic harsh at left lower sternal border and enhanced by handgrip?
VSD
276
Patient with fever, LLQ pain without rebounding or guarding, and maroon colored stools. 1. Diagnosis? 2. Pathophys? 3. Tissue texture changes?
1. Diverticulitis 2. Inflammation and micro perforation of sigmoid colon 3. Viscerosomatic at T12-L2
277
T1-T5 VS?
Head, neck, heart
278
T2-T6 VS?
Lungs
279
T5-T9 VS?
Stomach to Distal Esophagus proximal to ligament of Treitz
280
T10-T11 VS?
Distal Esophagus to Proximal 2/3 transverse colon, kidneys, and ureters
281
T12-L2 VS?
Distal 1/3 transverse colon, sigmoid, and rectum
282
Patient with chest pain, dysphagia, odynophagia, and weight loss. Upper GI series shows dilatation of esophagus with narrowing of the distal portion. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Achalasia 2. Failure of LES to relax due to loss of myenteric plexus function in the muscularis externa. Auerbachs plexus is responsible for motility of GI tract by inhibition of the sphincter. Caused by malignancies of Chagas (Trypanosoma cruzi) ``` 3. Modify diet Nitrates Anticholinergics Ca channel blockers Botulinum Surgery ```
283
Young patient is jaundice but feels healthy. CBC shows elevated conjugated bilirubin and urinary coproporyphrin I. Liver enzymes and histology are normal. 1. Diagnosis? 2. Pathophys?
1. Rotor Syndrome | 2. decreased transport of bilirubin into bile canaliculi
284
Young patient with mild icterus, mild abdominal pain and weakness. Total bilirubin is elevated with 50% conjugated. Urinary coproporphyrin is normal. Liver appears black. 1. Diagnosis? 2. Pathophys?
1. Dubin Johnson | 2. Decreased transport of Br into bile canaliculi
285
40 year old female with severe RUQ pain that radiates to the shoulder exacerbated by heavy meals and deep breathing. 1. Diagnosis? 2. Chapmans point? 3. VS reflex?
1. Cholelithiasis 2. Right 6th ICS at midclavicular line 3. T6= GB (T5-T9)
286
Chapmans 5th right ICS midclavicular line?
Liver
287
Chapmans 5th left ICS midclavicular line?
acidity of stomach
288
Chapmans 6th left ICS midclavicular line?
stomach peristalsis
289
Chapmans 6th right ICS midclavicular line?
gallbladder
290
Chapmans 7th right ICS midclavicular line?
pancreas
291
Chapmans 7th left ICS midclavicular line?
spleen
292
Patient who recently visited west africa has fever, chills, severe sore throat, low BP, facial swelling, pulmonary edema, and lost hearing. Microscopy shows sand like virus. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Lassa Fever (Viral hemorrhagic) from aerosolized rodent urine and feces 2. Arenaviridae steal ribosomes from host during viral assembly and budding showing "grain of sand" appearance. Circular ssRNA 2 segments. 3. Ribaviron and Isolation
293
Patient with suprapubic pain that begins as dull pain and escalates. She has fever, chills, fatigue, weakness, N/V, and flank pain. Urinalysis shows pyuria and WBC casts. 1. Diagnosis? 2. Pathophys?
1. Acute Pyelonephritis 2. E coli, Enterbacteriaceae (Proteus, Klebsiella), or Staph saprophyticus ascends urinary tract and abundance of Neutrophils is seen
294
Alcoholic with cirrhosis is throwing up blood. 1. Diagnosis? 2. Areas blood anastomoses?
1. Esophageal varices due to Portal HTN 2. Left Gastric Vein and Azygous vein (Varices) Paraumbilical and Epigastric veins (Caput medusae) Superior Rectal and Inferior Rectal veins (Hemmorhoids)
295
Patient with watery diarrhea, muscle aches, chills, weakness, and tachycardia after eating large meals. History of gastric bypass surgery. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Dumping Syndrome 2. Insufficient functioning of pyloric sphincter after surgery causing decreased transit time through GI and hyperosmolar contents draw fluid into the lumen. Loss of potassium causes muscle aches. 3. Eat smaller meals
296
Best treatment for GERD? MoA?
PPI (Omeprazole) | -inhibits H/K ATPase on parietal cells which decreases acid secretion
297
Patient with history of UC has LLQ pain and bloody diarrhea. Where would you find tissue texture changes?
T12-L2 (Distal colon)
298
40 year old male with history of UC presents with fatigue, jaundice, pruritus, and hepatomegaly. Labs show elevated ALP. ERCP shows beading pattern of intrahepatic and extra hepatic ducts. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Primary Sclerosing Cholangitis 2. Obliterative fibrosis of bile ducts due to inflammatory bowel disease 3. Liver transplant if severe Can lead to Cholangiocarcinoma
299
50 Year old female with pruritus, xanthomas, hepatomegaly, jaundice, and a history of CREST syndrome (anti-centromere). During exam, her hands turned white and cyanotic. Labs shows elevated ALP and Br. US and MRCP are normal. Anti-mitochondrial Ab+. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Primary Biliary Cholangitis 2. cholestatic autoimmune lymphocytic infiltration and granulomas that destroy small interlobular ducts in portal triads 3. Ursodiol Can lead to cirrhosis Liver transplant if cirrhotic
300
Extraintestinal manifestations of IBD?
Erythema Nodosum -raised tender subcutaneous nodules over anterior Tibia Anterior Uveitis -ocular pain and redness from inflamed iris capillaries Apthous Ulcers Pyoderma Gangrenosum -red papule from trauma become necrotic
301
Major complication of UC?
Colorectal cancer especially with pan colitis Toxic Megacolon -fulminant colitis when inflammation extends beyond mucosa to muscle layers of colon
302
Patient has new onset DM, cholelithiasis, steatorrhea, and hypochlorhydria. Gastrin levels are low. 1. Diagnosis? 2. Result?
1. Somatostatinoma (Delta cell tumor) 2. Pepsin decrease causes loss of protein breakdown. Gastritis develops. Pancreatic insufficiency due inhibition of Trypsin
303
Patient with history of B-thalassemia presents with fatigue and skin hyperpigmentation. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Secondary Hemochromatosis 2. Multiple blood transfusions leads to chronic iron overload that deposit in multiple tissues including Kupffer cells in liver. Could lead to dilated cardiomyopathy and gonadal failure. 3. Iron chelators and Phlebotomy
304
Boy with history of painless bright red stools, N/V, and inability to pass gas. Abdomen is distended with absent bowel sounds. Radiographic tracer (normal in gastric mucosa) shows contrast uptake above bladder close to the ileocecal junction. 1. Diagnosis? 2. Pathophys?
1. Meckel Diverticulum with intestinal obstruction (SMA) | 2. Failure of vitelline duct to obliterate causing true diverticulum
305
Child had a sleepover with friends and came home with a rash. The mother administered an OTC medication to relieve the pain. Within hours that child vomited and lost consciousness. Labs shows elevated ALT and AST. 1. Diagnosis? 2. Pathophys? 3. Who should get this med?
1. Reye Syndrome 2. Children who had Influenza or Varicella are administered Aspirin (salicylate) which irreversibly inhibits COX causing toxic metabolite formation in the mitochondria leading to brain swelling and fulminant liver failure. 3. Only give to children with Kawasaki
306
Rate limiting step of Glycolysis? What regulates it?
1. F6P to F1,6BP by PFK 2. Inhibited by ATP and Citrate Activated by AMP and F2,6BP
307
Child is struggling to gain weight. She has had frequent watery stools. Biopsy shows blunting of villi and lymphocytes. 1. Diagnosis? 2. Pathophys? 3. Test performed next? 4. Other manifestations?
1. Celiac 2. Autoimmune response to gliadin causes blunting of villi and malabsorption. 3. Test for Anti-tissue transglutaminase Ab 4. Erythromatous vesicular rash and osteoporosis
308
Patient picked mushrooms while hiking and ate them in her salad. Later she presents with colicky abdominal pain, N/V, diarrhea, hypotension, and tachycardia. 1. Diagnosis? 2. Pathophys?
1. Amanita phalloides (death cap mushroom) 2. alpha amanitin toxin inhibits RNA pol II and III causing decreased mRNA leading to inhibited transcription and translation.
309
Teenage girl with history of depression presents with vomiting, abdominal pain, and hepatomegaly. Labs shows elevated ALT, AST, Br, and prolonged PT. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Acetaminophen overdose 2. It is metabolized by liver enzymes until they become saturated where it is then metabolized by Cyt P-450 in zone 3. This increases toxic metabolites acetoquinone leading to recruitment of Kupffer cells and increase in cytokines causing centrilobular necrosis 3. N-acetylcysteine
310
Construction worker presents with diffuse abdominal pain, constipation, fatigue, difficulty concentrating, dark painless gingival lesions, and wrist drop. Labs show low Hgb, low Hct and MCV. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Lead Toxicity 2. lead inhibits aminolevulinic acid dehydratase and ferrochetolase which inhibits incorporation of iron into heme 3. Dimercaprol and EDTA are lead chelators
311
Opioid overdose treatment?
Naloxone
312
Heparin overdose treatment?
Protamine sulfate
313
Patient from India has diarrhea with blood and mucous, weight loss, abdominal pain, and elevated WBC for weeks. Positive fecal Ag test. No eosinophilia. 1. Diagnosis? 2. Pathophys?
1. Amoebic colitis from Entamoeba histolytica 2. Poor sanitation transmission be fecal oral. It affects the intestines and invades the portal vein of the liver causing hepatic abscesses.
314
Patient is undergoing high dose chemo (Cisplatin). 1. What are they prescribed to help with the N/V? 2. ADR? 3. What antibiotic has the same ADR?
1. Odansetron (serotonin antagonist) 2. Serotonin syndrome Odansetron blocks serotonin receptors which increases circulating serotonin causing tachycardia, HTN, dilated pupils, hyperthermia, clones, and hyperreflexia. 3. Linezolid for Gram+ bacteria that are resistant to other drugs
315
Woman with a history of RA is at risk of PUD due to chronic NSAID use. She mentions that she is trying to get pregnant. 1. What do you not prescribe? 2. MoA? 3. Why not?
1. Misoprostol 2. PG1 analog that acts on prostaglandins receptors on parietal cells to increase mucus and bicarbonate and decrease acid. 3. It is used to to induce abortions because it causing the uterus to contract. It also inhibits uterine implantation of the blastocyst and can cause birth defects.
316
Patient presents with several episodes of profuse vomiting. 1. Electrolyte abnormalities? 2. Body response?
1. Primary Metabolic Alkalosis due to loss of HCl from stomach leading to high bicarbonate and pH. 2. Decreased ventilation to increase pCO2 to lower the pH. Patient should show reduced O2sat.
317
Child presents with fever, sore throat, and tonsillar exudates. 1. Diagnosis? 2. Treatment and MoA?
1. Strep pharyngitis | 2. Penicillin (beta lactam) block cross linking of peptidoglycan and prevent cell wall synthesis
318
Adolescent with recent onset behavioral issues, gait instability, dark urine, and palpable liver. Eye exam shows deposits around the ring of the eye. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Wilson Disease 2. failed excretion of copper into bile (low ceruloplasmin) causes copper buildup in liver (cirrhosis), corneas (kayser fleischer rings), brain (behavior, gait) 3. Penicillamine (copper chelator)
319
Therapy for HBV?
Entecavir= adenosine analog that inhibits reverse transcription blocking hepatitis replication IFN-alpha= block viral replication and inhibits HBV replication for chronic HBV
320
Therapy for HCV?
Ribavirin IFN-alpha
321
Female with choledocholithiasis presents with fever and RUQ pain. 1. Diagnosis? 2. Treatment?
1. Ascending cholangitis | 2. IVF and antibiotics
322
Toddler had recent diarrheal illness and now presents with episodic abdominal pain and blood in diaper. US shows bullseye in SI. 1. Diagnosis? 2. Pathophys?
1. Intussusception after GI infection 2. Infection causes hyperplasia of Peyer patches (M cells responsible to present Ag to B cells) which then serve as lead point for intussusception
323
What vitamin does Stellate cells store?
Vit A
324
Patient with history of Crohn's presents with RUQ pain, low grade fever, and N/V. Labs shows leukocytosis. US shows thickening of GB wall and obstruction by stone. 1. Diagnosis? 2. Pathophys?
1. Acute Cholecystitis (stone blocking cystic duct) 2. Crohns causes transmural skip lesions which affects the terminal Ileum and impairs bile acid reabsorption. Lack of bile acid and increased cholesterol leads to the formation of a cholesterol stone. Increased lipid binding calcium in the lumen increases the reabsorption of free oxalate leading to kidney stones.
325
Neonate has distended abdomen and is breastfeeding normally. He has bilious emesis and has not passed meconium in his 1st 2 days. Upon digital rectal exam, stool squirts out.
1. Hirschsprung 2. failure of neuroblasts (ganglion cells) to migrate to the intestine during development. Colon is constricted causing buildup of stool proximally (dilated loops of bowel-distention) and no air in rectum.
326
Neonate with jaundice, pale stool, dark urine, and enlarged mass in RUQ. Labs show elevated direct Br, GGT, and normal liver enzymes. 1. Diagnosis? 2. Pathophys?
1. Biliary Atresia 2. fibro obliteration of extra hepatic bile ducts resulting in cholestasis which could lead to biliary cirrhosis Most common cause of pediatric liver transplant
327
Patient was recently treated for UTI now presents with acute onset diarrhea, abdominal cramps, and fever. Flexible proctoscopy shows pseudomembranes (yellow white plaques) in the rectal mucosa. 1. Diagnosis? 2. Pathophys? 3. Prevention?
1. Clostridium difficile 2. spore forming toxin producing Gram+ anaerobic bacteria is associated with antibiotic associated colitis. Abx kill normal flora allowing C. difficile to colonize. 3. Private room and wear gloves and gowns
328
Patient presents with bloating, flatulence, foul smelling diarrhea, and light colored stools. Stool analysis shows teardrop shaped trophozoites. 1. Diagnosis? 2. Pathophys? 3. Treatment? 4. MoA?
1. Giardia lamblia 2. fecal oral transmission by cysts in contaminated water 3. Metronidazole or Tinidazole, Nitazoxanide 4. activated by metabolic enzymes of anaerobic microbes to toxic intermediates that damage DNA
329
Patient presents with insidious, slowly progressing fatigue. History of smoking and poor diet as truck driver for years. Labs shows mild anemia. Colonoscopy reveals an exophytic polyp, ulceration, and bleeding. 1. Diagnosis? 2. Pathophys? 3. Cancer mechanism?
1. Colonic Adenocarcinoma 2. Large villous adenomatous polyp has the highest malignant potential b/c of larger surface area 3. Loss of APC leads to increased KRAS causing tumor proliferation and loss of p53 tumor suppressor
330
Left sided vs right sided colorectal carcinoma?
1. Right - bleed more - anemia and fatigue 2. Left - abdominal discomfort - bowel obstruction
331
Patient with history of colon cancer presents with slurred speech, facial droop, and painful red lesions on hands. 1. Diagnosis? 2. Pathophys?
1. Strep Gallolyticus (Bovis) 2. Group D strep found in GI enters bloodstream due to disruption of colonic mucosa by cancer causing IE on aortic valve. Vegetations break off and form septic emboli to brain. Pulmonary problems if vegetations on right heart.
332
RLQ colon chapmans point?
right proximal femur
333
Patient hospitalized takes clindamycin for 3 days and develops foul smelling diarrhea, fever, and ab pain. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. C. difficile 2. Broad spectrum Abx eradicate normal flora, allowing C. diff spores to colonize. Toxin A causes diarrhea. Pseudomembranous colitis develops which is fibrin plaques growing over lower GI. 2. Oral Vancomycin or Metronidazole
334
Chapmans points on left proximal lateral thigh over IT band?
T12-L2 | -left colon
335
Patient with history of heavy drinking and pancreatic pseudocysts presents with elevated AST double the ALT. 1. Diagnosis? 2. Pathophys?
1. Alcoholic Hepatitis 2. Ethanol depletes glutathione and increases cytokines from Kupffer cells. Hepatocytes with masses of altered cytokeratin intermediate filaments (Mallory bodies)
336
Patient has increased flareups of crohns. Mesalamine, Prednisone, and Mercaptopurine no longer control it. 1. What is prescribed next? 2. ADR?
1. Anti-TNF alpha receptor antagonists - Infliximab - Adalimumab - Etanercept 2. blocks phagocytosis and activation of macrophages leading to Histoplasmosis and other infections
337
Order of drugs for IBD?
1. 5-aminosalicylic acids (Mesalamine) 2. Corticosteroids for acute flares - Prednisone - Budesonide 3. Immunosuppressives - Azathioprine, Mercaptopurine, Methotrexate (Crohns/UC) - Cyclosporine (UC) 4. Anti TNF alpha receptor antagonists - Adalimumab 5. Anti-integrein therapy - Natalizumab
338
Patient with history of IBD is traveling to Mexico and would like prophylaxis for Travelers diarrhea. 1. Prescription?
1. Ciprofloxacin Azithromycin Rifaximin -normally you don't give prophylaxis Abx for traveling unless patient with IBD, cardiac, renal disease, or immunocompromised.
339
40 year old obese female has episodic cramping abdominal pain in RUQ after fatty meal that resolves. No inspiratory arrest. 1. Diagnosis? 2. Pathophys?
1. Cholelithiasis 2. Bile becomes supersaturated with cholesterol forming Gallstone in the GB that intermittently blocks neck of cystic duct causing biliary colic.
340
Patient with history of DM presents with N/V, early satiety, and bloating. 1. Diagnosis? 2. Pathophys? 3. Treatment? 4. MoA?
1. Diabetic Gastroparesis 2. Damage to Vagus Nerve from prolonged high blood glucose, delays gastric emptying. 3. Erythromycin (Macrolide) 4. Blocks 50s ribosomal subunit with ADR of increased GI motility
341
Person from the southwest presents with fever, hemoptysis, painful LN, and black fingertips. 1. Diagnosis? 2. Pathophys?
1. Yersinia Pestis (Gram- bacillus on rodents) | 2. Incubation of 1-6 days, highly virulent pneumonia and meningitis
342
Patient presents with abdominal pain, blood in stool, multiple impacted teeth, and hypertrophy of retinal pigment epithelium. Father died of Colon cancer.
1. Gardner Syndrome | 2. Mutation in APC gene on 5q21, which is same gene as FAP
343
Chapman point on greater tubercle of humerus?
Retina pathology
344
Female patient with severe RUQ pain especially after fatty foods. Pain persisted and now she has fever and night sweats, low BP, and tachycardia. Labs show elevated liver enzymes, Br, and ALP. CBD is dilated. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Ascending Cholangitis from Choledocholithiasis 2. E. coli and Klebsiella ascend from Duodenum 3. IVF and Abx ERCP to remove stone
345
Patient with history of squamous cell lung cancer presents with right flank pain that radiates to groin. Dipstick shows hematuria. Stone is radiopaque. 1. Diagnosis? 2. Pathophys?
1. Calcium Oxalate kidney stone (most common) | 2. Lung cancer leads to hypercalcemia through PTH related protein
346
Appendix chapmans points?
Anterior tip of 12th right rib Posterior T11 TP
347
Chapmans point for sigmoid colon?
proximal left lateral thigh
348
Chapmans point for pyelonephritis?
1 inch superior and 1 inch lateral to umbilicus
349
Chapmans point for bladder?
periumbilical
350
Abrupt onset of cramps and colicky abdominal pain, N/V, abdominal distention, and high pitched bowel sounds. History of abdominal surgery. Xray shows stacked air fluid levels. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Small bowel obstruction 2. Adhesions form after surgery, SM contracts against area of resistance that prevents forward motion 3. NPO with IVF and NG tube to suction
351
Peritoneal signs?
diffuse tender abdomen with guarding and rigidity
352
Window period after acute HBV?
- disappearance of HBsAg and appearance of HBsAb - antibodies are less than HBsAg when first being produced so they are not detected in serum - there is a period where all are bound and none is detected - HbcAb IgM is the first sign of immune response
353
Patient with acute N/V, severe epigastric pain radiating to back, and severely elevated amylase and lipase. History of HTN and taking Hydrochlorothiazide. 1. Diagnosis? 2. Pathophys?
1. Acute Pancreatitis 2. Thiazide inhibits NaCl reabsorption at DCT which decreases calcium excretion leading to hypercalcemia. Calcium can deposit in pancreatic duct leading to activation of Trypsinogen to Trypsin.
354
Patient with depression attempted suicide with pills presents with scleral icterus with golden hue, prolonged INR, normal ECG, severe abdominal pain, and vomiting. 1. Diagnosis? 2. Treatment and MoA?
1. Acetaminophen overdose - normal ECG rules out TCA 2. N-acetylcysteine (NAC) increases synthesis of Glutathione which forms a conjugate with toxic metabolites
355
Patient with family history of colon cancer, endometrial cancer and flat polyps in cecum. 1. Diagnosis? 2. Pathophys?
1. HNPCC (Lynch) - endometrial cancer unlikely in other genetic colon cancers 2. mutation of DNA mismatch repair genes
356
Patient with intermittent episodes of abdominal pain, nonbloody diarrhea, fatigue, weight loss, and apthous ulcers. PE shows fever and +fecal occult blood test. 1. Diagnosis? 2. Pathophys?
1. Crohn's 2. Transmural inflammation and cobblestone mucosa with skip lesions, creeping fat, noncaseating granulomas (Th1), and bowel wall thickening (string sign)
357
Patient with history of constipation, crampy pain, tenderness in LLQ, diarrhea, weight loss, low fever, and blood in stool. 1. Diagnosis? 2. Pathophys?
1. Diverticulitis 2. herniation of sigmoid colonic mucosa and submucosa through attenuated muscularis propria, at sites weakened by vasa recta, creating a false diverticulum that becomes inflamed
358
Patient presents with severe N/V after chemotherapy. 1. Treatment? 2. MoA? 3. ADR?
1. Odansetron 2. strong anti-emetic by blocking serotonin 5-HT3 receptors 3. Serotonin syndrome
359
1 year old previously healthy child presents with vomiting, frank bloody stool, and episodes of crying. Asymptomatic between episodes. Xray shows distended loop of bowel. 1. Diagnosis? 2. Pathophys?
1. Intussesception 2. Proximal bowel telescopes distal bowel causing lymph obstruction, swelling, decreased perfusion, intermittent colicky pain.
360
Patient has difficulty sleeping due to perianal itching. Cellophane tape test shows pinworms. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Enterobius vermicularis 2. spread fecal oral or by contact with eggs on bed sheets 3. Mebendazole
361
Patient has worsening flushing, nausea, diarrhea, and abdominal pain with wheezing and holosystolic murmur on left sternal border. Urinary 5-HIAA is elevated. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Carcinoid syndrome 2. carcinoids arise in SI, secrete serotonin, and metastasize to liver. Serotonin causes bronchospasm and tricuspid valve degeneration. 3. Octreotide (somatostatin analog)
362
Patient with chronic GERD now presents with epigastric pain, dysphagia, and weight loss. 1. Diagnosis? 2. Treatment?
1. Esophageal Adenocarcinoma distal 1/3 - cytokeratin will stain+ 2. Esophagectomy, but could damage left gastric artery
363
Asian girl presents with diarrhea, flatulence, acidic stool pH, elevated stool osmotic gap, and a dairy rich diet. 1. Diagnosis? 2. Pathophys?
1. Lactase deficiency 2. lactose is no longer broken down into galactose and glucose which increases lactose absorption which is fermented by intestinal bacteria causing bloating, flatulence, and acidic stool from bacterial products. Water is drawn into lumen increasing stool osmotic gap.
364
Patient with a history of Clozapine presents with B/L pain in cheeks anterior to ears, pain with swallowing, and hyper salivation. 1. Diagnosis? 2. Pathophys?
1. Parotitis from medication 2. higher saliva flow rate decreases contact time with epithelium causing less reabsorption of Na, Cl, less K secretion, and more bicarbonate secretion. Higher concentration of amylase.
365
Easy test for malabsorption?
72 hour fecal fat collection
366
Patient with history of aortic valve replacement presents with RUQ pain with fatty foods and chronic fatigue. Labs show low Hct, elevated indirect Br and reticulocyte. Xray shows nodular radio densities in RUQ. 1. Diagnosis? 2. Pathophys?
1. Biliary Colic 2. RBC shear against aortic valve causing hemolytic anemia which leads to increased immature RBC produced. Macrophages in spleen process damaged RBC into unconjugated Br which overwhelms the liver's ability to conjugate. B/c indirect Br is insoluble, it cystallizes to form pigment stones.
367
Complete iron study in hemochromatosis?
Increased ferritin, transferrin saturation, and serum iron Decreased total iron binding capacity
368
Intoxicated homeless man presents with lethargy, low grade fever, poor dentition, and buccal mucosa with thick yellow exudate. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Actinomycosis israelii 2. anaerobic gram+ bacilli with long branching filaments that causes oral abscesses with yellow sulfur granules 3. IV penicillin 2-6 weeks followed by oral penicillin or amoxicillin 6-12 months
369
Pulmonary infection and brain abscesses in immunocompromised patient?
Nocardia asteroides
370
Cystic fibrosis patient with pneumonia and blue green exudate?
Pseudomonas aeruginosa
371
Young girl who attends daycare presents with abdominal pain, vomiting, diarrhea with mucus and blood, and fever. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Shigella dysenteriae (gram-, oxidase- which does not ferment lactose or produce HS-) - shigella sonnei is more common in US and doesn't produce shiga toxin 2. Shiga toxin binds binds endothelial cells causing inactivation of ADAMTS-13 and hemolytic uremic syndrome. Activation of coagulation cascade leads to formation of micro thrombi causing consumption of platelets leading to thrombocytopenia, an shearing of RBC causing microangiopathic hemolytic anemia. And renal failure. 3. supportive care
372
Patient presents with dysuria, increased urinary frequency, and spiking fevers. And a history of GERD. 1. Diagnosis? 2. Treatment? 3. Potential drug interactions related to GERD?
1. UTI from prostatitis 2. Levofloxacin (fluoroquinolone) 3. Calcium carbonate contains cations that bind levofloxacin and prevent its absorption
373
Patient attends a pork BBQ and presents with diarrhea, ab pain, diffuse myalgias, conjunctival hemorrhage and periorbital edema. Labs show eosinophilia. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Trichinellosis 2. Trichinella spiralis is a nematode found in uncooked pork. Larvae in GI penetrate intestinal mucosa that multiply and seek out striated muscle to encyst. 3. Bendazoles
374
Bloating, diarrhea, cramping, and vomiting after eating reheated rice?
Bacillus cereus
375
Patient with history of HTN and CAD presents with extreme abdominal pain that begins 30 minutes after a meal and lasts for hours. In the ER, patient goes into septic shock and dies. 1. Diagnosis? 2. Pathophys?
1. Acute mesenteric ischemia 2. Arterial embolism from the heart (mural thrombus) occludes a mesenteric artery leading to bowel ischemia and necrosis. The bowel perforated leading to sepsis.
376
HIV+ patient with severe non bloody diarrhea?
Cyptosporidium
377
Macrophages with amastigotes found in blood, BM, or skin?
Leishmania donovani from sandfly
378
RBC with schizonts?
Plasmodia (malaria)
379
Tear shaped trophozoites?
Giardia lamblia
380
Old woman presents with RUQ pain, hyperactive bowel sounds in RLQ, and bilious vomit. CT shows gallstones and air in the biliary tree. 1. Diagnosis? 2. Pathophys?
1. Gallstone ileus 2. large gallstone with chronic inflammation forms a fistula between GB and SI which enters the SI and obstructs the Ileocecal valve
381
Patient presents with diarrhea, hypokalemia, hyperchloremia, and CT showing pancreatic mass. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. VIPoma 2. VIP secreted from pancreatic tumor (tail) causes increased secretion of water and electrolytes and relaxation of intestinal SM and sphincters. Inhibition of gastric acid leads to accumulation of Cl in blood and watery diarrhea. 3. Octreotide (Somatostatin analog)
382
Patient who recently visited Greece presents with fever that rises during the day and decreases at night, moldy body odor, night sweats, weight loss, fatigue, and muscle and joint pain. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Brucellosis or undulant fever 2. Brucella melitensis (intracellular Gram- coccobacillus, acid fast) enters through ingestion of contaminated milk products and spreads in RES 3. Doxycycline
383
Patient presents with weight loss, abdominal pain, nausea, palpable perimubilical node, and left supraclavicular LN. Diagnosis?
Gastric Adenocarcinoma
384
Failure of fusion of maxillary and medial nasal processes?
cleft lip
385
Failure of fusion of lateral palatine processes?
cleft palate
386
1 year old boy presents with sudden onset abdominal pain, vomiting, dark red stool, inconsolable crying, and bringing knees up to chest. 1. Diagnosis? 2. Pathophys?
1. Intussusception 2. Meckel diverticulum is out pouch of SI that results from failure of vitelline duct to close. Becomes lead point for intussusception. Ectopic parietal cells secreting acid cause damage to SI.
387
Patient who vomited has high pH, high bicarbonate and high CO2. 1. Diagnosis? 2. Pathophys?
1. Metabolic alkalosis with respiratory compensation 2. vomiting causes loss of HCl from stomach causing parietal cells to secrete new acid, increasing bicarbonate levels into blood. Hypoventilation increases CO2 in blood to generate carbonic acid and lower pH
388
Patient with a history of AAA has aorta that is increasing in diameter. She needs surgery. 1. Surgery risks?
1. AAA are most common below renal arteries which puts the IMA are risk for damage which could damage the sigmoid colon
389
What NT is decreased in depression?
Serotonin
390
Patient with unexplained weight loss, jaundice, and nontender mass in RUQ.
Pancreatic adenocarcinoma | -head of pancreas derived from ventral pancreatic bud obstructs main duct causing jaundice
391
Man presents with dyspepsia, nausea, and tingling in toes and lips. History of autoimmune thyroiditis. EGD shows chronic inflammation in fundus and body of stomach. Doesnt smoke or take NSAIDS. 1. Diagnosis? 2. Pathophy?
1. Autoimmune gastritis (type A) 2. CD4 T cells are directed against parietal cells reducing intrinsic factor leading to decreased absorption of vitamin B12 causing pernicious anemia (tingling)
392
Patient presents with painful ulcers on skin of ankles. History of unintentional weight loss, fatigue, intermittent ab pain and diarrhea for months, and apthous ulcers. 1. Diagnosis? 2. Other manifestations? 3. Treatment?
1. Crohn's with pyoderma gangrenosum 2. skip lesions with cobblestone mucosa, migratory arthritis, sacroilitis, ankylosing spondylitis, erythema nodosa, uveitis 3. oral corticosteroids
393
Peritoneal inflammation?
lying still with hips flexed
394
Young woman with abdominal pain and diarrhea that increase with stress but is relieved by defecation. 1. Diagnosis? 2. Treatment?
1. IBS 2. Loperamide (opioid agonist) - can also use Diphenoxylate which more potent and Atropine to reduce overdose
395
Newborn with choking, coughing on feeding, failure to pass meconium, distended abdomen, and limb defects. At birth, US showed excess amionitic fluid. 1. Diagnosis? 2. Pathophys?
1. Tracheoesophageal fistula with esophageal atresia 2. Esophagus closed off causes food to fall into trachea causing choking. Aspirate passes from stomach into trachea causing laryngeal spasm and coughing. Air from trachea goes into stomach causing abdominal distention. Amniotic fluid cannot be swallowed during fetal development like normal.
396
Patient has watery diarrhea and pain for 3 days after being at daycare. The patient did not receive all vaccinations. 1. Diagnosis? 2. Ddx?
1. Viral gastroenteritis from Rotavirus - linear dsRNA non enveloped reovirus 2. Norovirus is more common in developed countries because of vaccine to Rotavirus
397
Patient has bloody diarrhea, ab pain, and mild fever after eating undercooked meat. Stool smear shows gram negative rods that do not ferment sorbitol. 1. Diagnosis? 2. Pathophys?
1. Hemolytic uremic syndrome 2. E. coli O157:H7 enterohemorrhagic strain with Shiga toxin causes anemia, thrombocytopenia, and renal failure (elevated creatinine)
398
Petechial rash and adrenal gland hemorrhage?
N. meningitidis
399
Newborn of 2 days has jaundice, scleral icterus, elevated indirect Br, normal CBC and liver enzymes. Phenobarbital doesnt work. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Crigler Najjar Type 1 2. mutation in UGT1A1 gene causes absent UDP-G which leads to lack of Br conjugation. Indirect Br is lipid soluble and crosses BBB causing Br deposition in brain and kernicterus. 3. Phenobarbital reduces Br in Type II but not Type I. Type 1 requires plasmapheresis, phototherapy, and liver transplant.
400
Infant has scrotal mass that does not transilluminate when a light is shined. 1. Diagnosis? 2. Pathophys?
1. Indirect inguinal hernia - hydrocele would transilluminate 2. Processus vaginalis failed to close allowing peritoneum to enter deep inguinal ring lateral to inferior epigastric.
401
Patient with acute colicky ab pain, lack of flatus or bowel movements, distention and anorexia. Xray shows omega loop sign. Diagnosis?
Sigmoid volvulus
402
Double bubble sign?
Duodenal Atresia
403
Patient with generalized ab pain with distention, non bloody emesis, constipation, dehydration, and hyperactive bowel sounds. Upright Xray shows air fluid levels. Patient has history of gallstones. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Small bowel obstruction 2. Gallstone lodges in ileocecal valve 3. Surgery
404
Woman with gray foul smelling vaginal discharge receives medication. Later she drinks with friends and presents with N/V, headache, palpitations, and flushing. Diagnosis and pathophys?
Metronidazole for bacterial vaginosis inhibits acetaldehyde dehydrogenase causing a buildup of acetaldehyde. Combined with alcohol produces a disulfiram reaction.
405
IVDA presents with N/V and jaundice. ALT and AST are elevated. HBsAg+, HBc IgM+, and HBeAg+. 1. Diagnosis? 2. Most likely outcome?
1. Acute HBV | 2. Clear the virus
406
Patient who works in grain silo presents with RUQ, unintentional weight loss, right side pleuritic pain, and progressive SOB. PFT shows FEV1/FEV is 65%. Father died of cirrhosis and sister has emphysema. 1. Diagnosis? 2. Pathophys?
1. A1-AT deficiency causing HCC 2. lack of A1-AT causes panacinar emphysema due to lack of elastase inhibition. A1-AT accumulates in liver causing cirrhosis. Aflatoxin 1 from Aspergillus found in stored grains increases risk of HCC. Tumor is causing pleuritic pain.
407
1st step to confirm steatorrhea?
Sudan III stain due to high sensitivity
408
IVDA with odynophagia, decreased appetite, weight loss, submandibular LN, and white plaques lining throat that can be scraped off. 1. Diagnosis?
1. Candida albicans (germ tube+) | - oral leukoplakia by EBV does not scrape off
409
Sensitivity test?
True positives
410
Specificity test?
True negatives
411
Patient with severe dyslipidemia, tendon xanthoma over achilles, and family history of early MI. 1. Diagnosis? 2. Treatment?
1. Familial hypercholesterolemia 2. Statin to inhibit HMG-CoA reductase to reduce cholesterol synthesis - reduce dietary transfat and saturated fat
412
Chi square test?
investigate relationship between two variables | -PPI with C. diff vs no PP with C. diff
413
Patient with history of alcoholism presents with RUQ pain radiating to back. 1. Diagnosis? 2. Pathophys?
1. Pancreatitis | 2. Trypsin activated early to damage pancreas
414
Patient presents with painful hematemesis and back pain with history of chronic alcoholism. CXR appears normal. 1. Diagnosis? 2. Pathophys?
1. Mallory Weiss tears - Boerhaave if air seen in mediastinum and subcutaneous emphysema 2. chronic retching causes longitudinal tears at GE junctions
415
Patient with epigastric pain radiating to back, increased amylase, lipase, and WBC. 1. Diagnosis? 2. Other findings?
1. Acute pancreatitis | 2. Pseudocysts with necrotic debris and blood, ecchymosis and edema around umbilicus (cullen sign)
416
Patient presents with LLQ pain, nausea, fever, constipation, tender lump and guarding. Labs shows leukocytosis. CT shows sigmoid fat stranding. 1. Diagnosis? 2. Pathophys?
1. Diverticulitis 2. low fiber or high fat diets cause out pouching of mucosa in weak areas where vessel penetrates wall causes diverticulosis. This leads to low bulk stools and increased pressure and straining which causes microperforations and inflammation.
417
Pregnant patient presents with dizziness when she lies on her back. BP is normal. 1. Diagnosis? 2. Treatment?
1. Compression of IVC in central tendon | 2. lie in lateral recumbent position to improve preload and CO
418
Patient presents with intermittent bloating, ab pain, diarrhea, and flatulence after meals. Increased stool osmotic gap and positive H breath test with normal villi. 1. Diagnosis? 2. Pathophys?
1. Lactase deficiency | 2. increased lactose is broken down by bacteria to increase H and water is drawn into lumen
419
Patient was recently prescribed medication for weight loss presents with ab pain, flatulence, steatorrhea, and frequent bowel movements. 1. Diagnosis? 2. MoA?
1. Orlistat 2. it inhibits gastric and pancreatic lipase which inhibits break down of fat which increases fecal fat excretion and decreased absorption of fat soluble vitamins.
420
Elderly obese male presents with bright red blood in stool but is painless. History of chronic constipation, minimal physical activity, and low fiber diet. 1. Diagnosis? 2. Pathophys?
1. Diverticulosis 2. diverticula form in areas of wall weakness (arteries penetrate) due to increased luminal pressure. Commonly found in sigmoid colon.
421
Patient has a fear of gaining weight, restricts calories, and has a BMI of 15. Exam shows Lanugo hair. 1. Diagnosis? 2. Treatment?
1. Anorexia Nervosa | 2. Cognitive behavior therapy
422
Patient presents with nausea, melena, and epigastric pain that worsens with meals. History of osteoarthritis and alcoholism. 1. Diagnosis? 2. Pathophys? 3. What would labs show?
1. Bleeding gastric ulcer 2. NSAIDS and alcohol increase risk of gastric ulcer. Inhibit prostaglandins and decrease mucous lining. 3. Increased BUN:Creatinine because blood is digested to increase serum urea. Creatinine is normal indicating normal GFR.
423
Vegan presents with fatigue and loss of balance. Blood smear shows hypersegmented neutrophils. CBC shows high MCV, low Hct and Hgb. 1. Diagnosis? 2. Pathophys?
1. Megaloblastic anemia | 2. Vit B12 deficiency due to lack of meat or dairy consumption causes an anemia of RBC production
424
First priority for non english speaking patient who is non compliant?
get an interpreter
425
Schilling test for pernicious anemia?
Radioactive B12 is given PO and non-radioactive B12 is given IM. IM will be absorbed faster and saturate receptors. Radioactive B12 will be excreted in urine. Low urinary levels indicates defective GI absorption or lack of intrinsic factor. Test is repeated with intrinsic factor added. Normal urinary levels would indicate pernicious anemia due to lack of intrinsic factor.
426
Sensation to anterior tongue?
Sensation: Lingual N. (Trigeminal 3rd) Taste: Chorda tympani of Facial N.
427
Sensation to posterior tongue?
Glossopharyngeal N. for sensation and taste
428
How does cirrhosis affect calcium?
Circulating inactive calcium is bound to albumin. Albumin is decreased in cirrhosis. This decreases total serum calcium. This does not effect free ionized active calcium which is regulated by PTH.
429
Old patient presents with weight loss, fatigue, recent change in stool, LLQ and LUQ tenderness and iron deficiency anemia. 1. Diagnosis? 2. Pathophys?
1. Colon cancer 2. APC gene mutation causes accumulation of beta catenin which leads to KRAS mutations and loss of TGF-beta and p53 tumor suppressor mutation.
430
Patient is being treated for HTN due to increased after load on the heart. He presents with new onset heartburn after meals. 1. Diagnosis? 2. Pathophys?
1. ADR from calcium channel blocker Amlodipine | 2. Decreased intracellular calcium relax LES causing regurgitation
431
Histo of tubular vs villous adenomas?
Tubular: normal architecture Villous: elongated leaf like and dysplastic epithelium
432
Iron deficiency anemia iron panel?
Decreased iron Increased TIBC Decreased Ferritin Decreased Transferrin saturation
433
Patient presents with N/V and diarrhea. He is taking a medication for COPD and was recently prescribed a new medication for a foot infection. 1. Diagnosis? 2. Pathophys?
1. Ketoconazole induced toxicity of Theophylline 2. Theophylline is used for COPD which inhibits PDE causing increased cAMP and bronchodilation. It has a narrow therapeutic window. Ketoconazole inhibits Cyt P-450 which metabolizes Theophylline. This led to drug toxicity due to lack of Theophylline breakdown.
434
Hypoperfusion of short gastric artery indicates what?
Damage to splenic artery - travels along superior portion of pancreas - supplies spleen, left gastroepiploic, and short gastric
435
Blood supply to GB?
Common Hepatic -> Proper Hepatic -> Cystic
436
MoA of Acetaminophen?
inhibits prostaglandin production to reduce fever | -does not inhibit inflammation or platelets
437
Hernia lateral to inferior epigastric?
Indirect inguinal
438
Hernia medial to inferior epigastric?
Direct inguinal
439
Woman with bulge in upper thigh next to groin causing N/V. 1. Diagnosis? 2. Pathophys?
1. Femoral hernia 2. bowel herniates inferior to inguinal ligament through femoral ring containing contents of femoral sheath. Most common hernia causing bowel incarceration.
440
Patient with history of asthma presents with GI distress, tinnitus, hyperthermia, and bronchospasm. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Aspirin toxicity 2. Increased leukotriene production. COX is inhibited sending the pathway back toward LPO. 3. Sodium Bicarbonate
441
Patient with gnawing epigastric pain is not improved by calcium carbonate and is worsened by spicy and fatty foods. No history of NSAIDs use.
1. PUD from H. pylori 2. spirochete that neutralizes acid by urease which produces ammonia. Mucinase decreases protective layers in stomach and duodenum. Ulcers are produced in antrum. 3. PPI Amoxicillin Clarithromycin
442
Patient with RUQ pain that radiates to shoulder, fever, and inspiratory arrest on palpation. 1. Diagnosis? 2. Pathophys? 3. Next step?
1. Acute Cholecystitis 2. stone obstructs cystic duct and pain is felt with every GB contraction 3. RUQ ultrasound to localize stone for cholecystectomy
443
Patient presents with SOB on exertion, fatigue, weight loss and low MCV. Mother had endometrial cancer. Grandfather had colon cancer. 1. Diagnosis? 2. Pathophys?
1. HNPCC colon cancer 2. right sided colon cancer usually bleed leading to anemia. Drains to superior mesenteric nodes. HNPCC associated with colon and other cancers.
444
Patient with N/V, fatigue, weight loss, icterus, distended abdomen, hepatomegaly, wasting, elevated lipase and ALP. 1. Diagnosis? 2. Other PE findings?
1. Pancreatic adenocarcinoma 2. CA 19-9 Migratory thrombophlebitis (trousseau) Painless palpable GB and pruritus (Courvoisier) Virchow node
445
6 month old with hypoglycemia, lethargy, tachypnea, tremors, hypothermia, diaphoresis, and emesis after drinking fruit juice. 1. Diagnosis? 2. Pathophys?
1. Hereditary fructose intolerance | 2. Aldolase B deficiency leads to buildup of F1P and decreased available phosphate inhibiting glycogenolysis and GNG
446
Patient with episodic flushing, diarrhea, and SOB.
1. Carcinoid that has metastasized to the liver 2. Carcinoids arising from SI secrete serotonin causing these symptoms but are usually asymptomatic until they metastasize to the liver. Liver normally metabolizes carcinoid products. Tumor in liver secretes directly into portal vein without metabolism.
447
AIDS patient with fever, chest pain, dry cough and CXR showing nonspecific inflammation. Bronchoalveolar lavage shows oval budding yeast. 1. Diagnosis? 2. Pathophys? 3. Treatment? MoA? ADR?
1. Histoplasma capsulatum 2. dimorphic fungus endemic to midwest US infects immunocompromised 3. Ketoconazole inhibits fungal cyt p450 demethylase enzyme but can also inhibit human liver cyt enzymes altering metabolism of other drugs. Must monitor liver function.
448
Obese female with history of recurrent RUQ pain after meals presents with acute epigastric pain radiating to back, fever, low BP, tachycardia, and elevated ALT, AST, and lipase. CT shows fat stranding. Diagnosis?
1. Gallstone pancreatitis
449
Hospital outbreak showing colonic inflammation with exudates and necrosis of mucosal surface. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. C. diff 2. gram+ anaerobe spore forming that produces Toxin A causing diarrhea and Toxin B which is cytotoxic. Pseudomembranes form. 3. Oral vancomycin
450
Patient presents with decreased libido and worsened heartburn. He has been taking a larger dose of medication for GERD. 1. Diagnosis? 2. Pathophys?
1. Cimetidine toxicity 2. H2 blocker inhibits cyt p450 and has anti androgen effects. Increased prolactin leads to gynecomastia, erectile dysfunction, and decreased libido.
451
Newborn with aspiration, coughing, choking, cyanosis, and air in stomach. 1. Diagnosis? 2. Pathophys?
1. Esophageal atresia with tracheoesophageal fistula 2. esophagus doesn't connect to stomach causing aspiration. Fistula from trachea to stomach causing air distention. Laryngeal spasm from aspiration and coughing cause cyanosis.
452
Man with late onset DM, recent cholelithiasis, unintentional weight loss, and steatorrhea. Labs show decreased amylase, lipase, insulin, pepsinogen, and glucagon. CT shows pancreatic mass. 1. Diagnosis? 2. Pathophys?
1. Somatostatinoma | 2. Somatostatin from D cells inhibit all the things in the case. Poor prognosis.
453
Patient with bloody diarrhea, emesis, and ab pain after camping where he consumed undercooked food. 1. Diagnosis? 2. Pathophys? 3. Complications?
1. Campylobacter jejuni 2. Gram- motile rods from unpasteurized milk, untreated water, or undercooked poultry cause bloody diarrhea. 3. GBS: ascending muscle weakness
454
Use of Octreotide?
Somatostatin analog used to decrease pancreatic secretion in chronic pancreatitis
455
Patient with episodes of bloody diarrhea, progressive fatigue, pruritus, leg ulcerations, icteric sclera. Colonoscopy shows hemorrhagic ulcers and multiple areas of granulation tissue in rectum. Direct Br and ALP are high. P-ANCA is positive. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. PSC from UC 2. progressive fibrosis of intra and extra hepatic ducts increasing risk of cholangiocarcinoma 3. liver transplant
456
Patient with family history of colon cancer before age 50 from microsatellite instability. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. HNPCC (Lynch) 2. MMR mutation with high risk of colon, endometrial, ovarian, urinary, SI, stomach, and biliary cancer. 3. colonoscopy to screen
457
Woman with history of PUD and GERD presents with constipation, fatigue, weakness, and depression. She is taking medication for PUD. Labs show increased calcium. 1. Diagnosis? 2. Treatment? 3. Complications?
1. Hypercalcemia (milk alkali syndrome) from Calcium carbonate 2. Discontinue antacid 3. renal complication and urinary/gastric pH disruption
458
Patient presents with N/V, abdominal pain radiating to back or shoulder, and elevated lipase. PE shows muscle twitch after palpation of cheek. 1. Diagnosis? 2. Pathophy?
1. Acute Pancreatitis 2. saponification of calcium or sepsis cause hypocalcemia or Mg and deficiency of PTH and Vit D. Nerves and muscle cells become excitable and twitch.
459
Boy with bloody stool, but other wise healthy. 1. Diagnosis? 2. Pathophys?
1. Meckel diverticulum 2. Persistent vitelline duct leaves out pouch of all three layers with ectopic gastric tissue. Increases risk of intussusception.
460
Immigrant from SE Asia presents with watery diarrhea, chronic cough, mobile pruritic rash on buttock and upper thigh, and eosinophilia. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Strongyloidiasis 2. Strongyloides stercoralis (nematode) larvae enters skin from human feces in soil. It migrates in blood stream to lungs where it ascends and is swallowed in GI. Larvae mature in GI producing eggs that are excreted in stool. Hyperinfection occurs in immunocompromised. Steroids can exacerbate. 3. Ivermectin or Albendazole
461
Infant with painless hematochezia, soft non distended abdomen, and increased uptake of technetium-99 in LUQ. 1. Diagnosis? 2. Pathophys?
1. Meckel Diverticulum 2. Incomplete obliteration of vitelline duct (omphalomesenteric). Ectopic gastric tissue can damage ileum causing hematochezia.
462
Patient with fever, headache, and bloody diarrhea. She has a puppy. Stool culture shows curved spiral organism. 1. Diagnosis? 2. Complications?
1. Campylobacter jejuni (Gram- lactose non fermenting, oxidase+, microaerophilic) -thermophilic -domestic animals or undercooked poultry 2. GBS Reactive arthritis
463
Man taking medication for GERD presents with gynecomastia. 1. Diagnosis? 2. Pathophys?
1. Cimetidine toxicity | 2. H2 antagonist inhibits P450 to slow breakdown of estradiol increasing estrogen/testosterone ratio
464
Patient with painless jaundice, pruritus, and weight loss. Molecular testing shows KRAS+ mutation and CEA marker. 1. Diagnosis? 2. Pathophys?
1. Pancreatic Adenocarcinoma | 2. KRAS mutation linked to tyrosine kinase receptors cause Ras to bind GTP stimulating growth.
465
Patient has burning sensation in throat despite taking medication and elevated Gastrin level. 1. Diagnosis? 2. Pathophys? 3. Complications?
1. GERD taking Omeprazole 2. PPI irreversibly inhibits H/K ATPase decreasing HCl secretion and disrupting feedback loop to inhibit Gastrin. Higher gastric pH inhibits somatostatin release which further increases Gastrin. 3. Atrophic Gastritis - Hypergastrinemia C. difficile -disrupted pH
466
Patient with bloody diarrhea, ab pain, and fever with no other recent illness. Stool shows Gram negative, oxidase negative bacilli that are motile. Macconkey agar is clear. Hektoen agar is green with black centers. 1. Diagnosis? 2. Agar explanation?
1. Salmonella enteritidis 2. Salmonella produces H2S causing black precipitation with thiosulfate agar. Macconkey is clear because it does not ferment lactose. Shigella does not produce H2S and is non-motile
467
Dog owner presents with RUQ pain, N/V and liver cyst on ultrasound. No other signs of liver disease. 1. Diagnosis? 2. Pathophys? 3. Treatment? 4. ADR?
1. Echinococcus granulosus 2. tapeworm transmitted by dog feces cause slow growing cysts that can cause anaphylactic shock. 3. Albendazole - inhibits tubule polymerization - only surgical drainage if over 5cm 4. cytopenia and renal failure
468
Patient has severe rice water diarrhea and dehydration after giving hurricane relief in Haiti. 1. Diagnosis? 2. Pathophys?
1. Vibrio cholera - motile comma shaped non lactose fermenting, oxidase+ 2. toxin ribosylates Gs alpha subunit activating adenylate cyclase increasing cAMP levels overactivating PKA which increases chloride excretion and water efflux.
469
Woman on medication for DM presents with vomiting, flushing, and tachycardia after drinking alcohol.
1. Disulfaram rxn from Chlorpropamide 2. sulfonylurea used to treat DM increases insulin. It inhibits alcohol metabolism leading to accumulation of acetaldehyde.
470
Medications causing disulfiram rxn?
Sulfonylureas Procarbazine Cephalosporins Griseofulvin Metronidazole Sorry Pals, Can't Go Mingle
471
Composition of saliva when flow rate is increased?
Increased Sodium -normally reabsorbed Decreased Potassium -normally secreted Increased Bicarbonate -secretion stimulated by PSNS
472
What exacerbates the pain in cholelithiasis and what other functions does it have?
CCK - contract GB - increases pancreatic enzymes - inhibits gastric emptying
473
Pregnant patient presents with constipation, pain with defection, and a sensitive perianal lump. 1. Diagnosis? 2. Pathophys?
1. External Hemorrhoids 2. pregnancy increases pressure causing prolapse of tissue into anal canal and decreased venous drainage from inferior rectal vein to IVC
474
Infant with bulge in groin, fever, irritability, vomiting, and has not passed bowel in 2 days. 1. Diagnosis? 2. Pathophys?
1. Indirect inguinal hernia 2. processus vaginalis fails to close creating space in deep inguinal ring for bowel to enter lateral to inferior epigastric. Incarceration (inability to reduce) and strangulation (loss of bloody supply) lead to necrosis.
475
Why are Brunners gland hypertrophied in duodenal ulcers?
increased secretin to increase bicarbonate secretion to relieve pain by neutralizing acid
476
Patient who recently traveled presents with watery diarrhea with flecks of mucous and hypokalemia and hypochloremia. 1. Diagnosis? 2. Pathophys?
1. Vibrio cholera | 2. toxin activates Gs to increase cAMP which activates CFTR to secrete chloride
477
Genetic mutation that caused patient's symptoms of nontender GB, palpable left supraclavicular node, and migratory thrombophlebitis?
KRAS | -pancreatic adenocarcinoma
478
Patient with unknown vaccine history presents with recent infection of cough, runny nose, and conjunctivitis followed by a red rash. Her eye is found to have an edematous thickened cornea (keratomalacia). 1. Diagnosis? 2. Pathophys?
1. Measles 2. Measles makes patients Vit A deficient which could lead to eye issues and pneumonia. It is exacerbated if the patient is already deficient in Vit A due to malnourishment of fat soluble vitamins. Their absorption requires micelles and bile salts.
479
Patient with abdominal pain, steatorrhea, weight loss, fatigue, and joint pain. Biopsy shows villous blunting in SI. 1. Diagnosis? 2. Pathophys? 3. Complications?
1. Celiac 2. HLA-DQ2/8 with autoimmune response to gluten (Ab to gliadin) 3. Anemia Autoimmune Thyroid Type 1 Diabetes IgA deficiency
480
Patient with history of diarrhea, apthous ulcers, pain, fatigue, weight loss, and narrowing of ileum with barium enema. 1. Diagnosis? 2. Pathophys? 3. Complications?
1. Crohns 2. chronic inflammation of any part of GI most commonly ileum and colon. Fat malabsorption may increase free calcium binding of fatty acids that are then excreted. Oxalate is absorbed increasing risk of kidney stones. ``` 3. Uveitis Migratory polyarthritis Erythema nodosum Adenocarcinoma Renal stones ```
481
Ranitidine MoA?
H2 receptor block on parietal cells that block the binding of histamine. Gs is inhibited resulting in decreased cAMP and acid
482
Infant with weakness, increased respiratory effort, enlarged liver, and enlarged cardiac silhouette on CXR. The patient dies. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Pompe (type II glycogen storage disease) 2. defect in lysosomal alpha 1,4 glucosidase which causes accumulation of toxic levels of glycogen in muscles, heart, liver, and neurons. 3. Enzyme replacement
483
Patient with history of smoking presents with painless jaundice, enlarged GB, and weight loss. 1. Diagnosis? 2. Br levels in blood and urine?
1. pancreatic ca | 2. growing tumor obstructs CBD causing buildup of conjugated Br. It is water soluble which increases Br in urine.
484
Patient on medication for dyslipidemia presents with RUQ pain after meals. 1. Diagnosis? 2. Pathophys?
1. Gemfibrozil - ADR: gallstones 2. activates PPAR to increase TG clearance. Also inhibits hydroxylase which inhibits bile acid synthesis and reduces solubility of cholesterol leading to gall stones
485
How does Secretin relieve duodenal ulcers?
1. produced by S cells to increase bicarbonate secretion to neutralize acid 2. increases somatostatin to inhibit gastrin 3. increases PG to buildup mucosa
486
Patients presents with benign colonic adenoma. 1. Preventive medication? 2. MoA? 3. What not to use?
1. Aspirin 2. inhibits COX2 irreversibly. Daily Aspirin reduces risk of CRC. COX is increased in CRC causing increased PG and EGF 3. Do not use Celecoxib b/c of increased risk of CVD.
487
Woman with alternating bouts of diarrhea and constipation. No blood in stool. No abnormal biopsy or colonoscopy findings.
IBS
488
Black female with dysphagia to solids and liquids with a history of dilated face capillaries (telangiectasia), Reynauds (arterial spasm in hands), and thickened skin over fingers. 1. Diagnosis? 2. Pathophys?
1. Scleroderma 2. CT disorder that affects GI, lungs, MSK, then heart, vessels, lungs, kidneys. Causes SM atrophy of lower 2/3 of esophagus and incompetent LES.
489
Patient presents after MVA with multiple fractures and contusions. Eye exam shows papilledema. One week later in ICU, blood comes out of his NG tube. 1. Diagnosis? 2. Pathophys?
1. Cushing Ulcer 2. Elevated intracranial pressure from trauma stimulates the Vagus Nerve to increase acid secretion in stomach. Ulcer occurs in fungus and tends to bleed. Increased ICP causes papilledema in eye.
490
Patient with severe LUQ pain, left shoulder pain, and N/V with elevated LDH and WBC. 1. Diagnosis? 2. Pathophys?
1. Splenic infarct | 2. poor blood flow through celiac trunk by embolism usually
491
Healthy woman presents with worsening substernal chest pain over the past month, dysphagia to solids and liquids, and corkscrew esophagus with barium swallow. 1. Diagnosis? 2. Pathophys?
1. Diffuse Esophageal spasms 2. impaired inhibitory innervation to myenteric plexus causes uncoordinated non peristaltic contractions of esophagus blocking passage of food.
492
Patient from China with multiple sex partners presents with worsening N/V and fatigue over the past month. CT shows hepatic mass. 1. Diagnosis? 2. Pathophys? 3. Prevention?
1. HCC from HBV 2. HBV endemic to china that transmitted through sex and blood. 3. HBV vaccine
493
Alcoholic presents with N/V, steatorrhea, and epigastric pain that radiates to the back. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Chronic Pancreatitis 2. decreased fat absorption from pancreatic insufficiency causes Vit ADEK malabsorption. Alcohol is primary risk factor. 3. Low fat diet and enzyme replacement
494
Migration of pain in appendicitis?
T10 (umbilicus) viscerosomatic that migrates to peritoneal diffuse pain in RLQ
495
Liver biopsy shows intracytoplasmic hyaline inclusions derived from cytokeratin filaments?
Mallory bodies in alcoholic hepatitis
496
Patient with worsening bloody diarrhea, cramping, progressive fatigue, scleral icterus, and pruritus. ERCP shows strictures and dilations of bile ducts. 1. Diagnosis? 2. Pathophys?
1. Primary sclerosing cholangitis 2. PSC is associated with UC which this patient has. Inflammation, obliterative fibrosis, and segmental constriction of intrahepatic and extra hepatic bile ducts.
497
2 year old boy with chronic diarrhea, frequent bouts of pneumonia and ear infections. Lavage shows Pneumocystis jirovecci. Labs shows lack of response to step pneumonia and tetanus antigens. Increased IgM and decreased other Ig. 1. Diagnosis? 2. Pathophysiology?
1. Hyper IgM Syndrome 2. defect in CD40L on T helper cells decreases class switching from IgM to IgG and others. Increased susceptibility to opportunistic infections especially pneumocystis, cryptosporidium, and histoplasma
498
2 day old infant with bilious vomit and abdominal distention?
Duodenal atresia
499
3 week old infant with nonbilious projectile vomit after feedings?
Pyloric stenosis
500
Young man with vague chronic abdominal pain, stool positive for occult blood, and low Hgb. Colonoscopy reveals innumerable polyps. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. FAP 2. autosomal dominant mutation in APC 3. Colonectomy
501
Pregnant woman with jaundice, anorexia, fever, abdominal pain, N/V after consuming river water. Labs shows high ALT and AST. She is sent to ICU for 2 weeks. 1. Diagnosis? 2. Pathophys?
1. Fulminant Hepatitis from HEV | 2. nonenveloped ssRNA hepevirus causes high mortality in pregnant women
502
Patient admitted to hospital with pneumonia is administered Levofloxacin for several days. She develops fever and diarrhea. 1. Diagnosis? 2. Pathophys? 3. Diagnostics?
1. C. difficile 2. Fluoroquinolones disrupt normal flora and Exotoxins A and B cause pseudomembranous colitis 3. Toxin assay (ELISA)
503
Boy with intermittent abdominal pain, currant jelly stools, and hyper pigmented spots on lips. Endoscopy shows multiple hamartomatous polyps in SI. 1. Diagnosis? 2. Pathophys?
1. Peutz Jeghers 2. autosomal dominant mutation in STK11 causes hyperpigmented lip macule and polyps with no risk of malignancy but can lead to intussusception.
504
Patient who doesn't drink alcohol presents with liver disease, diabetes, and darkened skin on axilla and back. 1. Diagnosis? 2. Pathophys? 3. Diagnostics? 4. Complications? 5. Treatment?
1. Hemochromatosis 2. autosomal recessive mutation in HFE causes dysregulation of hepcidin and increased iron absorption into gut. Iron is poorly excreted and causes accumulation of iron. 3. Increased ferritin and transferrin saturation but decreased TIBC. Iron deposits stain blue on prussian blue stain. 4. HCC 5. Phlebotomy and Deferoxamine
505
Patient with nausea, bloating, and distention after meal. Elevated HbA1c. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Gastroparesis 2. poorly controlled diabetes delays gastric emptying 3. Metoclopramide (pro kinetic)
506
Most common cause of formation of gallstones?
elevated cholesterol causes supersaturation of bile and crystallization
507
Boy with episodes of abdominal pain, N/V, fever, and palpable abdominal mass. No loose or frequent stools. He plays normal in between episodes. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Intussusception 2. telescoping of bowel into distal bowel causes colicky pain. Linked with Rotavirus, Meckel diverticulum, HS purpura 3. Air enema Surgery if perforated
508
Patient is taking Phenytoin for seizures presents with N/V and malaise after taking medication for a headache. 1. Diagnosis? 2. Pathophys? 3. Other symptoms? 4. Treatment?
1. Acetaminophen toxicity 2. Phenytoin is an inducer of Cyt P450 which increases the toxic metabolites of acetaminophen causing centrilobular necrosis ``` 3. Diaphoresis Pallor Lethargy Elevated ALT and AST RUQ pain Hepatomegaly Jaundice Encephalopathy Hyperammonemia ``` 4. N-acetylcysteine to regenerate glutathione
509
Brazilian immigrant presents with progressive difficulty with swallowing solids and liquids and painless regurgitation of undigested food. 1. Diagnosis? 2. Pathophys? 3. Complications?
1. Achalasia 2. failure of LES to relax due to loss of inhibitory neurons of myenteric plexus. Arises from Chagas disease from infection with Trypanosoma cruzi from reduviid bug (kissing bug). Bird beak appearance on barium swallow and increased manometry. 3. Myocarditis Dilated cardiomyopathy Megacolon
510
1. What stimulates release of Secretin? | 2. Functions?
1. increased acid and fatty acid in duodenum | 2. increases bicarbonate which facilitates functioning of pancreatic enzymes by neutralizing acid
511
Patient with HCV is treated. She is found to be severely depressed after medication. 1. Diagnosis? 2. ADR? 3. Treatment?
1. Peginterferon alpha 2. contraindicated in patients with depression 3. Ledipasvir Sofosbuvir Ribavirin
512
Patient with persistent diarrhea that is now bloody, fever, weight loss after visiting the tropics. CT shows liver abscess. 1. Diagnosis? 2. Pathophys? 3. Diagnostics? 4. Treatment?
1. Entamoeba histolytica 2. organism invades mucosa and submucosa of colon gaining access to portal circulation 3. Trophozoites with phagocytosed RBC 4. Metronidazole Iodoquinol (cyst carriers without symptoms)
513
Patient suffers severe burns. They present with epigastric pain with meals. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Curling Ulcer 2. reduced plasma volume results in mucosal ischemia and necrosis causing ulcers in fundus of stomach 3. PPI or H2 antagonist
514
Young patient presents with jaundice, elevated direct Br, and dark pigmented hepatocytes. 1. Diagnosis? 2. Pathophys?
1. Dubin Johnson 2. ABCC2 mutation causes impaired transport of Br into bile causing accumulation of Br in hepatocytes and increased serum direct Br
515
4 week old infant presents with projectile non bilious vomiting and palpable epigastric mass. Metabolic panel shows low K and chloride and high bicarbonate. 1. Diagnosis? 2. Pathophys? 3. Treatment?
1. Pyloric Stenosis 2. hypertrophy of circular muscle layer around pylorus reduces gastric emptying. Vomiting leads to dehydration and metabolic alkalosis. K, Cl, and acid are vomited causing increased retention of bicarbonate. 3. surgical release (pyloromyotomy)
516
Patient presents with muscle weakness, diarrhea, weight loss, and peripheral neuropathy. Labs shows low Hct, Hgb, and high MCV with hyperhsegmented neutrophils. History of hypothyroidism. 1. Diagnosis? 2. Pathophys?
1. Pernicious Anemia (Megaloblastic) 2. Hashimoto thyroiditis (most common) associated with autoimmune destruction of parietal cells leading to decreased intrinsic factor and deficiency in Vitamin B12. B12 is important for DNA synthesis during RBC production.
517
Patient with history of atherosclerosis presents with severe periumbilical pain, fever, leukocytosis, and occult blood in stool. Pain is out of proportion to PE findings. 1. Diagnosis? 2. Pathophys?
1. Acute ischemic bowel 2. emboli, thrombosis or vasoconstriction causes intestinal hypoperfusion. If too long, irreversible necrosis could occur with leak of enzymes.
518
Immigrant presents with fatigue, N/V, anorexia, and malaise. His wife has had a chronic cough and he is instructed to take a prophylactic medication for 9 months. 1. Diagnosis? 2. Pathophys?
1. Isoniazid ADR 2. TB prophylaxis for 9 months has ADR of hepatitis, P450 inhibition, neuropathy, hemolysis in G6PD, and lupus like syndrome.
519
Patient has watery diarrhea. What is their sodium and water status?
decrease in total body water and greater decrease in sodium
520
Biopsy of pseudomembranous colitis?
- inflammatory exudate with mucinous debris, fibrin, necrotic epithelial cells, and PMN due to toxins A and B of C. diff - diagnose by stool assay for toxin
521
25 year old with hundreds of adenomatous polyps. Father diagnosed with colon cancer at 35 years old. Diagnosis?
FAP due to APC mutation
522
Biopsy of stomach shows multiple spindle shaped cells. Diagnosis?
GI Stromal tumor (GIST) from KIT mutation
523
Patient with melanin spots on lips and multiple hamartomatous polyps.
Peutz jeghers from STK11 mutation
524
Pediatric patient with asymptomatic GI bleed with no fever or abdominal pain.
Meckel Diverticulum (2 feet proximal to ileocecal valve)
525
Patient smoked for years and presents with SOB, productive cough, barrel chest, and breathing through pursed lips. 1. Diagnosis? 2. Pathophys?
1. Emphysema 2. destruction of capillary all interface causes decreased diffusion of O2. Air is trapped due to loss of elasticity. CO2 is retained causing primary respiratory acidosis and buildup of bicarbonate to compensate metabolically.
526
Patient vomits profusely. Electrolytes?
vomit contains H and Cl. Bicarbonate shifts to ECF and pH increases. CO2 is retained to compensate.
527
NSAIDS effect on GFR?
inhibit prostaglandin causing constriction of afferent arteriole with a decrease in GFR and RPF
528
Metoclopramide?
prokinetic that sensitizes GI to Ach used for diabetic gastroparesis
529
Polyp with greatest risk of malignancy?
villous
530
Most common site of metastasis in CRC?
liver
531
CRC tumor marker?
CEA
532
Anti-HBc IgG+, Anti-HBs IgG+, Anti-HBe IgG+?
complete recovery from prior infection
533
Anti-HBc IgM+, HBsAg+, HBeAg+?
Acute HBV
534
Anti-HBc IgG+, HBsAg+, Anti-HBe IgG+?
Chronic carrier of HBV
535
Patient with a history of alcohol abuse presents with distended abdomen, red palms, gynecomastia, jaundice, and altered mental status. 1. Diagnosis? 2. Pathophys?
1. Hepatic Encephalopathy from Cirrhosis 2. decreased ammonia metabolism by Urea cycle in liver causes hyperammonemia. High levels of ammonia lead to depletion of alpha ketoglutarate. Decreased estrogen breakdown causes gynecomastia and palmar erythema.

USMLE (3 decks)

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