GI, Harrison

Question 1

Lymphadenopathy to peritoneal cul de sac palpable on rectal or vaginal examination in patients with gastric CA

Answer 1

Blumer’s shelf

Question 2

Type of gastric CA: Leather bottle appearance

Answer 2

Diffuse adenoCA

Question 3

Aortic wall diameter indicative of AAA

Answer 3

> 3 cm or > 50% greater than uninvolved proximal vessel

Question 4

Pseudoaneurysm involves what layers of the blood vessel

Answer 4

Intima and media disrupted; dilatation lined by adventitia only and sometimes by perivascular clot

Question 5

Aneurysm that affects the entire circumference resulting in a diffusely dilated lesion

Answer 5

Fusiform

Question 6

Aneurysm that affect only a portion of the circumference resulting in out pouching of vessel wall

Answer 6

Saccular

Question 7

MCC pathologic condition associated with degenerative aortic aneurysms

Answer 7

Atherosclerosis

Question 8

Mycotic aneurysms are caused by

Answer 8

Salmonella, staph, strep, fungi

Question 9

Vasculitis that causes thoracic and abdominal aneurysms

Answer 9

Behcet’s disease

Question 10

T/F AAA is usually asymptomatic

Answer 10

T

Question 11

T/F AAA rupture usually occurs without warning

Answer 11

T

Question 12

Modality useful for screening and for serial documentation of aneurysmal size of AAA

Answer 12

Abdominal ultrasonography

Question 13

Modality of choice for rapid bedside diagnosis in patients presenting with suspected or actual rupture of AAA

Answer 13

Abdominal ultrasonography

Question 14

Accurate, non-invasive test to determine the location and size of AAA

Answer 14

CT with contrast, MRI

Question 15

Indications for surgery of AAA

Answer 15

1) Symptomatic 2) >5.5 cm even if asymptomatic

Question 16

EGD visualises up to what part of the GIT

Answer 16

Second part of duodenum

Question 17

Gold standard for diagnosis of colonic mucosal disease

Answer 17

Colonoscopy

Question 18

Flexible sigmoidoscopy visualises up to what part of the GIT

Answer 18

60 cm from anal verge

Question 19

Structure identified in ERCP which is cannulated and radio contrast material injected under fluoroscopic guidance

Answer 19

Ampula of Vater

Question 20

MCC of ascites

Answer 20

Liver cirrhosis

Question 21

Ascites occurs within ___ years in majority of patients with cirrhosis

Answer 21

10

Question 22

Distinguishes ascites secondary to portal hypertension from other causes

Answer 22

Serum-ascites albumin gradient (SAAG); >1.1 g/dL is from liver cirrhosis, cardiac ascites, portal vein thrombosis, veno-occlusive disease, Budd-Chiari syndrome, fatty liver of pregnancy; less than 1.1 g/dL is from other causes

Question 23

Presence of this substance in ascitic fluid indicates pancreatic ascites/pancreatitis

Answer 23

Amylase

Question 24

Cloudy ascites

Answer 24

Infection

Question 25

Milky ascites

Answer 25

Chylous

Question 26

Bloody ascites

Answer 26

Traumatic paracentesis or malignancy

Question 27

Predominantly lymphocytic ascites

Answer 27

Tuberculous

Question 28

Low-sodium diet consists of ___ mg/d

Answer 28

1,500-2000

Question 29

Diuretic/antimineralocorticoid of choice for ascites

Answer 29

Spironolactone

Question 30

Diuretic that causes gynecomastia

Answer 30

Spironolactone

Question 31

Therapeutic paracentesis is indicated for

Answer 31

1) Large-volume ascites 2) Unresponsive to diuretic therapy 3) Refractory ascites

Question 32

Indicated after large-volume paracentesis to prevent complications of hypotension and renal impairment, if less than 5L

Answer 32

Volume expansion with synthetic plasma substitute or NSS

Question 33

Indicated after large-volume paracentesis to prevent complications of hypotension and renal impairment, if greater than or equal to 5L

Answer 33

Albumin at 8g/L ascites removed

Question 34

T/F Paracentesis for ascites is considered safe even in coagulopathy

Answer 34

T

Question 35

TIPS is inserted between ___ to relieve portal hypertension

Answer 35

Hepatic and portal veins

Question 36

TIPS is indicated for

Answer 36

Refractory ascites when paracentesis is contraindicated or ineffective, or becomes intolerable

Question 37

Shunt obstruction in TIPS occurs in majority of patients after ___

Answer 37

1 year

Question 38

TIPS is contraindicated in

Answer 38

1) >70y/o 2) Preexisting hepatic enceph 3) Preexisting cardiac dysfunction 4) Child-Pugh score >12

Question 39

Represents a significant worsening of prognosis in patients with cirrhosis

Answer 39

Ascites

Question 40

Reflects irreversible chronic injury of the hepatic parechyma

Answer 40

Cirrhosis

Question 41

End-stage liver disease due to excessive and chronic ingestion of alcohol

Answer 41

Laennec's cirrhosis

Question 42

Cirrhosis in which the aetiology is unknown

Answer 42

Cryptogenic

Question 43

Alcoholic cirrhosis is significantly accelerated if concomitant ___ is present

Answer 43

Hepatitis C infection

Question 44

Central event leading to hepatic fibrosis

Answer 44

Activation of hepatic stellate cell