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Flashcards in GI Tests/Imaging (Pass NPLEX) Deck (36)
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1

If ALP is elevated out of proportion to AST and ALT, what condition should you consider?

Cholestasis or a bone disorder marked with an increase in osteoclastic activity

Note: cholestasis typically presents with elevated ALP & GGT much higher than ALT and AST. AST and ALT may be slightly elevated though.

ALP can also be fractioned into the various isotypes to determine whether the ALP is from a bone condition (AP2)

2

In gram staining what colour are gram negative bacteria? What colour are gram positive bacteria?

Gram Negative = Pink

Gram Positive = Blue (because the cell wall retains the blue dye)

3

What is the gold standard method for diagnosis of Crohn's Disease?

Ileum biopsy

4

Fistulas are best seen with what form of radiographic imaging? What IBD condition is a likely cause of the fistula?

Barium enema is best used to identify a fistula

Crohn's disease is a common cause of fistulae

5

What lab tests will be abnormal in pancreatitis?

1.) Elevated Amylase & Lipase
2.) Glucose may be elevated in severe cases
3.) GGT is likely to be elevated if related to alcoholism
4.) TG are usually elevated

6

What does a sentinel loop in plain film imaging typically designate?

Local ileus (obstruction) from nearby inflammation. It is the dilation of a segment of the large or small intestine

7

How do you investigate for vibrio cholera?

Darkfield microscopy

8

Describe what each of the following tests indicate:
1.) HBsAg
2.) HBcAg
3.) HBeAg

1.) HBsAg (Hep B surface antigen)
i.) indicates the presence of hepatitis B virus.
ii.) To differentiate chronic and acute hepatitis B = IgM Anti-HBc (Acute) & IgG Anti-HBc (Chronic)

2.) HBcAg (Hepatitis B core antigen)
i.) it is an indicator of active viral replication in the hepatocyte
ii.) Requires hepatic biopsy, it cannot be identified through serological investigation.

3.) HBeAg (Hepatitis B extracellular antigen)
i.) The test is an indicator of active viral replication found in the blood.
ii.) it is the equivalent to HBcAg but found extracellularly (in the serum).

9

What evaluation test is used to identify Hepatitis C?

Biopsy

10

What is the gold standard diagnostic test for H.pylori?

Culture from biopsy obtained during endoscopy of the stomach

11

Gull Wing Organisms (like a bird in flight) found on gram staining is associated with what cause of bacterial diarrhea?

Campylobacter jejuni

12

What are mallory bodies?

Mallory bodies are inclusion bodies bound in the liver's cells' cytosol

Present in alcholic hepatitis, wilson's dx, cirrhosis, hepatocarcinoma

13

In plain film imaging, how can a clinician differentiate a gastric ulcer from malignancy?

Non-malignant ulcerations have hampton's line. Hampton's line is the radiolucent (dark) line (typically 1mm) along the rim of the gastric ulcer

14

How do you diagnose Zenker's Diverticulum?

Zenker's Diverticulum is typically diagnosed using a barium swallow on plain film, however an upper GI endoscope may also reveal the diverticulum.

15

What percent of abdominal aneurysms are calcified, and therefore visible on plain film imaging?

50%

a diameter > 3.5cm is problematic

16

Gastrointestinal String Sign is a medical term for a radiographic finding that represents:

Severe narrowing of the intestinal lumen.

It is commonly seen in crohn's disease, colon cancer, and hypertrophic pyloric stenosis

17

Increased ALP and GGT are suggestive of what condition?

Cholestasis

18

What is hampton's line?

it is a radiolucent (dark) line along the rim of a peptic ulceration

it is not present in a carcinomatous ulcer and is therefore a typical differentiation between the two aforementioned pathologies

19

If you have isolated elevation of ALP, what should you rule out and how?

Bone disease should be ruled out by fractioning ALP into the various isozymes. (AP2 is a byproduct of osteoblastic activity).

Note: if cholestasis is the cause of elevated ALP then GGT will also be elevated

20

A bulge in the wall of the esophagus (that is non-mobile) on plain film imagining is most likely to be:

Zenker's diverticulum

21

What condition presents with a stacked coin appearance on plain film imaging of the abdomen?

Generalized ileus

22

A rise in serum O and H agglutinin titers 3-4 weeks post-infection suggests what microorganism?

Salmonellosis

23

What liver enzyme is more specific to liver damage: AST or ALT?

ALT

24

What lab marker is indicative of an active Hepatitis A viral infection?

IgM HAV

25

A lead pipe colon displayed on plain film imaging is likely related to what condition?

Ulcerative Colitis.

A lead pipe colon is present with the loss of haustra

26

What would diverticulosis look like with a barium enema?

Multiple small white masses

27

What are Schistocytes and in what conditions would you find them?

Schistocytes are fragmented RBCs found on microscopy

When the endothelial layer of small vessels becomes damaged fibrin deposits and platelets aggregate. Then as RBCs travel through the damaged blood vessels they are fragmented (into schistocytes) resulting in intravascular hemolysis. This is known as MAHA (microangiopathic hemolytic anemia).

MAHA and the corresponding schistocytes occur in the following conditions:

1.) Disseminated Intravascular Coagulation (DIC)
2.) Hemolytic Uremic Syndrome (caused by Shiga-like toxin from EHEC)
3.) Aortic Stenosis (most common cause of schistocytes)
4.) Artificial Heart Valves

28

The prognosis for Hepatitis B is worse if HBsAg, HBeAg, HBcAg persist for greater than how long?

3 months

29

Kidney Stones vs. Gall Stones: Which are more radiopaque on imaging?

Kidney stones are very radiopaque because of a high calcium content. Gall stones are typically radiolucent (more black)

30

What would the AST:ALT ratio look like in viral hepatitis or fatty liver?

<1:1

ALT will be higher than AST.

Note: in alcoholic hepatitis AST is significantly higher than ALT