GI p. 367-371

Question 1

Pt older than —- who consuming mostly hot dogs and cold-cuts are at high risk of what type of ca?

Answer 1

50 years

Colorectal ca

Question 2

“Apple core” lesion are seen at part of the colon?

Answer 2

Seen in sigmoid colon.

Question 3

T or F? CEA tumor marker is good for monitoring recurrence and useful for screening.

Answer 3

F. not for screaning

Question 4

Colorectal ca rarely, presents with which bug?

Answer 4

Streptococcus bovis bacteremia.

Question 5

Which part of the colon is prone to iron def anemia in colorectal ca?

Answer 5

Ascending

Question 6

Hematochezia is associated with which 2 paths?

Answer 6

Descending colon in clolorectal ca

hemorrhoids

Question 7

order from most common to least common sites of colon ca?

Answer 7

Rectosigmoid > ascending > descending.

Question 8

Xeroderma pigmentosum, colorectal cancer and Serrated have what kind of molecular pathology in common?

Answer 8

Microsatellite instability

Question 9

What needs to happen for Adenoma turning into Carcinoma?

Answer 9

Loss of tumor suppressor gene(s) (p53, DCC)

Question 10

T or F? Genetic/ metabolic disorders can cause cirrhosis.

Answer 10

T

Question 11

Name 3 paths with KRAS mutation?

Answer 11

Colorectal ca
Adenocarcinoma
Adenomatous polyps

Question 12

Failure to regulate and destroyed β-catenin is by which protein will cause —- ca?

Answer 12

(APC) protein, encoded by the APC tumour-suppressing gen.

Sporadic colorectal ca

Question 13

Fetor hepaticus refers to what in cirrhosis pts?

Answer 13

breath smells musty

Question 14

Alkaline phosphatase (ALP) is elevated in which 4 kinds of disorders?

Answer 14

Cholestatic and obstructive hepatobiliary disease,
HCC, 
infiltrative disorders
bone disease (pagets)
Semino (placental APL)

Question 15

Cirrhosis pts should refrain from operating machinery do to what?

Answer 15

coarse hand tremor (asterixis = Liver “flap”)

Question 16

Which cells play a big role in cirrhosis of the live?

How do they cause fibrosis?

Answer 16

stellate cells disrupts normal architecture of liver by causing diffuse bridging fibrosis and nodular regeneration.

Question 17

T or F? Reye syndrome causes macrovascular fatty change in liver.

Answer 17

F. microvesicular fatty change

Question 18

What causes melena and what causes Hematemesis in cirrhosis?

Answer 18

peptic ulcer - melena

Esophageal varices - Hematemesis

Question 19

intracytoplasmic eosinophilic inclusions of damaged keratin filaments in the hepatocytes describes what?

Answer 19

Mallory bodies (twisted rope appearance)

Question 20

Amylase is elevated in what 2 dz?

Answer 20

Acute pancreatitis, mumps

Question 21

Hepatic steatosis Macrovesicular or Microvascular fatty change?

Answer 21

Macrovesicular fatty change

Question 22

fatty infiltration of hepatocytes Žcausing cellular “ballooning” and eventual necrosis is seen in what path?

Answer 22

Non-alcoholic fatty liver disease

Question 23

Parents tend to treat their kids with aspirin for which viral infections?

Answer 23

VZV and influenza B

causing Reye syndrome

Question 24

incr NH3 production and absorption is due to?

Answer 24

dietary protein,
GI bleed,
constipation,
infection

Question 25

In which disorder/s is ALP elevated where γ-glutamyl transpeptidase (GGT) is not?

Answer 25

in bone disease

Question 26

insulin resistance and a finding of ALT > AST can cause what hepatic path?

Answer 26

Non-alcoholic fatty liver disease

Question 27

rifaximin is for Tx of what condition?

Answer 27

Hepatic encephalopathy

Question 28

What is the most specific Dx for Acute pancreatitis?

Answer 28

lipase

Question 29

Name 2 carcinogens that can cause HCC?

Answer 29

aflatoxin, ethanol

Question 30

---- decr β-oxidation by reversible inhibition of mitochondrial enzymes causing ----

Answer 30

aspirin metabolites causing Reyes synd

Question 31

Sclerosis around what zone happens in Cirrhosis?

Answer 31

zone III

Question 32

“hobnail” appearance refers to what path? is it Micro or Macronodular?

Answer 32

Micronodular due to irregularly shrunken liver in Cirrhosis.

Question 33

decr NH3 removal is due to?

Answer 33

due to renal failure diuretics bypassed hepatic blood flow post-TIPS (btw portal-hepatic vein)

Question 34

HCC may lead to which syndrome?

Answer 34

Budd-Chiari syndrome (hepatic vein)

Question 35

Biopsy in which liver path is contraindicated because of risk of hemorrhage?

Answer 35

Cavernous hemangioma (soft blue compressive mass)

Question 36

Accumulation of ---- hyperbilirubinemia in ---- part of brain causes kernicterus.

Answer 36

unconjugated | basal ganglia

Question 37

Diagnostic lab for HCC?

Answer 37

incr α-fetoprotein

Question 38

Name path with incr α-fetoprotein?

Answer 38

- Neural tube defects (annencephay) - abdominal wall defects, - Hepatocellular carcinoma - hepatoblastoma - yolk sac (endodermal sinus) tumor - mixed germ cell tumor

Question 39

Pts in the business of furniture and automobile upholstery are at risk of liver tumor?

Answer 39

Angiosarcoma (PCAM-1, CD31) due to vinyl chloride

Question 40

Pts in poultry, swine production and farmers are at risk of liver tumor?

Answer 40

Angiosarcoma due to Arsenic

Question 41

Budd-Chiari syndrome causes inc or no JVD?

Answer 41

Absence of JVD

Question 42

Misfolded gene product protein aggregates in hepatocellular ER Žcausing cirrhosis with PAS ⊕ globules describes what path?

Answer 42

α1-antitrypsin deficiency

Question 43

Bilirubin levels that cause jaundice?

Answer 43

> 2.5 mg/dL

Question 44

Mixed (direct and indirect) hyperbilirubinemia is seen in what 2 paths?

Answer 44

Hepatitis | cirrhosis

Question 45

A young female on OCP and an athlete can have which benign liver tumor in common?

Answer 45

Hepatic adenoma

Question 46

"nutmeg liver" is seen in what 2 paths?

Answer 46

Right heart failure | Budd-Chiari syndrome

Question 47

T or F? Unconjugated hyperbilirubinemia is seen in 1° sclerosing cholangitis and 1° biliary cirrhosis.

Answer 47

F. Conjugated (direct) hyperbilirubinemia

Question 48

Elastase is regulates by what?

Answer 48

α1-antitrypsin

Question 49

Most common overall cause of liver tumor?

Answer 49

Metastasis from GI malignancies, breast and lung cancer.

Question 50

Budd-Chiari syndrome is associated with what 4 pths?

Answer 50

hypercoagulable states (factor 5, protein c/s def, antithrobin def. prothrombin) polycythemia vera postpartum state HCC

Question 51

Pt with pancreatic ca complains of what physical apparent findings?

Answer 51

Jaundice with puritis

Question 52

Hereditary harmless jaundice is due to?

Answer 52

Gilbert syndrome, benign congenital unconjugated hyperbilirubinemia

Question 53

Pt's liver has turned dark. what pathophys is the cause?

Answer 53

Excretion defect of Conjugated (direct) hyperbilirubinemia in Dubin-Johnson syndrome (EP metabolites in lysosomes cause the blackness)

Question 54

The Tx of plasmapheresis and phototherapy is needed in what path that has incr unconj. hyperbil.?

Answer 54

Crigler-Najjar | TTP

Question 55

Thorotrast as a dye causes what path?

Answer 55

Angiosarcoma of liver

Question 56

Plasmaphorasis is used for?

Answer 56

Crigler-Najjar TTP Gullian Barre

Question 57

KRAS is a

Answer 57

GTPase

Question 58

Microsatellite instability (MSI)

Answer 58

is the condition of genetic hypermutability that results from impaired DNA mismatch repair (MMR).

Question 59

What prophylaxis of colorectal ca?

Answer 59

Aspirin