MISSED GI

Question 1

Biopsy of Acute Pancreatitis would show

Answer 1

adipose cell destruction and calcium deposits.

• release of lipase leads to fat necrosis and calcium salts. Shows chalky white lesions.

Question 2

GET SMASHED is for what

Answer 2

Acute pancreatitis causes

Gallstones
Ethanol (alcohol) MC
Trauma

Steroids
Mumps
Autoimmune
Scorpion sting
Hypercalcemia, hypertriglyceridemia
ERCP
Drugs –> sulfa, azathioprine, valproic acid

Question 3

Autodigestion of pancreas by prematurely activated enzymes (trypsin)

Answer 3

Acute pancreatitis

Question 4

Progressive fibrosis loss of exocrine and endocrine function

Answer 4

Chronic Pancreatitis

Question 5

Sudden epigastric pain radiating to the back, nausea, vomiting, Amylase lipase increased.

Answer 5

Acute pancreatitis

Question 6

Recurrent epigastric pain, worse after meals, weight loss, amylase/lipase normal to increased, steatorrhea, diabetes.

Answer 6

Chronic Pancreatitis

Question 7

Cullen sign (umbilical ecchymosis), grey turner sign (flank ecchymosis), sentinel loop (xray) shows what DX?

Answer 7

Acute pancreatitis

Question 8

Squamous cell cancer of esophagus effects

Answer 8

Upper

Question 9

Adenocarcinoma of esophagus effects

Answer 9

Lower esophagus

Question 10

Pain worse with food indicates what ulcer

Answer 10

Gastric –> due to NSAIDs. H pylori

Question 11

Pain improves with food what ulcer?

Answer 11

Duodenal

Question 12

Increased BUN:Cr, hematemesis, melena

Answer 12

Upper GI

Question 13

outpouchings, painless rectal bleeding

Answer 13

Diverticulosis

Question 14

In acute diverticulitis, what do you not do?

Answer 14

Perform colonoscopy.. will present with LLQ pain, fever, leukocytosis; may perforate

Question 15

Fecal-oral transmission, high mortality in pregnancy? Hepatitis

Answer 15

E

Question 16

HBsAg indicates

Answer 16

Active Infection - acute or chronic

Question 17

Anti-HBs =

Answer 17

immunity - vaccine or recovery from infection

Question 18

Anti-HBc IgM =

Answer 18

acute infection within 6 months

Question 19

Anti-HBc IgG =

Answer 19

past/chronic infection

Question 20

Lynch syndrome MOA

Answer 20

DNA mismatch repair defect

Question 21

HBeAg

Answer 21

High infectivity (active viral replication)

Question 22

Anti-Hbe

Answer 22

Low infectivity, resolving infection

Question 23

HBV DNA

Answer 23

quantifies viral load (monitor therapy)

Question 24

For hep C, what serology would you see for active infection?

Answer 24

HCV RNA

Question 25

For Hep D, what is needed for coinfection?

Answer 25

HBsAg but superinfection ins worse than coinfection

Question 26

RUQ Pain, Jaundice, fever, hypotension + altered mental status --> sepsis. Increase in WBC's, Increase in ALP, increase bilirubin. DX?

Answer 26

Ascending Cholangitis -- infection due to common bile duct obstruciton Charcots triad: fever, jaundice, RUQ pain. Reynolds Pentad: charcots triad + hypotension, Altered mental status --> sepsis Tx: ERCP for drainage, IV antibiotics (ceftriaxone + metronidazole)

Question 27

Jaundice, RUQ pain, dark urine, increase ALP, GGT, billirubin.

Answer 27

Choledocholithiasis - stone in common bile duct. Risk of ascending cholangitis. Tx: ERCP to remove stone

Question 28

RUQ pain + positive murphy's sign. Fever, leukocytosis, nausea/vomiting, pain radiates to right scapula (Kehr sign), pain after fatty meal. US: thickened wall, pericholecystic fluid.

Answer 28

Cholecystitis - gallstone obstructs cystic duct --> inflammation of gallbladder. TX: NPO, IV fluids, antibiotics, cholcystectomy within 72 hours

Question 29

Colicky RUQ pain after fatty meals, murphy's sign negative, normal labs, BUZZ: Fat, female usually, fertile, forty

Answer 29

Cholelithiasis (gallstones)

Question 30

CREST SYNDROME ASSOCIATED WITH

Answer 30

PBC. Primary biliary cholangitis

Question 31

pruritis, jaundice, dark urine, light stools, hepatosplenomegaly. Mostly in middle aged women, CREST syndrome here

Answer 31

PBC

Question 32

watery diarrhea, hypokalemia, achlorhydria (without chloride or decreased)

Answer 32

due to Vipoma, vasoactive intestinal polypeptide

Question 33

severe chest pain after undergoing recent upper endoscopy

Answer 33

esophageal perforation should be suspected.. severe chest pain, upper abdominal pain, mediastinal widening on chest imaging

Question 34

tumor marker for liver/biliary/pancreas cancers?

Answer 34

CA 19-9

Question 35

coffee ground emesis is consistent with

Answer 35

mallory weiss tear (linear lacerations at GE junction) and met alkalosis

Question 36

borheave syndrome associated with

Answer 36

subcutaneous emphysema --> air in mediastinum

Question 37

vomitting, what happens to acid base?

Answer 37

met alkalosis increased pH and increased bicarb

Question 38

diarrhea, what do u have with acid base

Answer 38

met acidosis pH decreased and low bicarb NON ANION GAP

Question 39

obese male with 8 week asthma and intermittent squeezing chest pain at night. What patho term is used to describe histo change may have on endoscopy and biopsy of lower esophageal region?

Answer 39

this is GERD (decrease in LES tone) nonkeratitized squamous to simple columnar with goblet cells --> barret's esophagus --> esophageal adenocarcinoma metaplasia --> dysplasia --> carcinoma

Question 40

barrett's esophagus, endometrial hyperplasia, H pylori leads to what?

Answer 40

Adenocarcinoma

Question 41

Achalasia, smoking, alcohol can, actinic keratosis lead to ?

Answer 41

squamous cell carcinoma "chronic irritation"

Question 42

NSAIDS --> effect thromboxane A2 --> less platelet activity and less prostaglandins --> less mucus --> more infections

Question 43

RUQ

Answer 43

liver, gallbladder cholecystitis cholelithiasis - female, fat, forty hepatomegaly referred pain to shoulder

Question 44

Epigastric region houses

Answer 44

pancreas - pancreatitis AAA, dissection

Question 45

LUQ issues

Answer 45

spleen splenic rupture -- trauma, EBV, don't play contact sports

Question 46

flank pain related to

Answer 46

pyelonephritis - fever + cva tenderness, signs of UTI, vesicouretal reflux Kidney stone - afebrile, UA shows some blood

Question 47

peri-umbilical pain

Answer 47

early appendicitis

Question 48

suprapubic pain

Answer 48

cystitis ectopic pregnancy PID torsion

Question 49

neonate with resp failure + air noted in left lower lung field

Answer 49

congenital diaphragmatic hernia - watch for trauma after MVC

Question 50

failure of vitellin duct to obliterate completely

Answer 50

meckels diverticulum Gastric tissue in diverticulum Composed of True diverticulum - mucosa, submucosa, muscular, serosa --> all layers are outpouched.

Question 51

False diverticulum

Answer 51

mucosa, submucosa layers - Zenker's diverticulum (cricopharyngeal dysfunction + halitosis) - Diverticulosis

Question 52

Poop from umbilicus --> persistent vitelline fistula

Answer 52

omphalomesenteric duct is the same thing as vitelline duct

Question 53

Pee from umbilicus

Answer 53

patent urachus allantois becomes urachus

Question 54

full thickness inflammation and non caseating granulomas

Answer 54

chrons disease Macrophages secrete IL12 --> TH1 --> Th1 secrete IL2 and IFN gamma which activates macrophages in turn secrete TNF alpha --> intestinal cell injury

Question 55

Chron's disease associated with what derm condition?

Answer 55

pyoderma granulosa

Question 56

mucosal inflammation and crypts

Answer 56

Ulcerative colitis

Question 57

profuse bloody diarrhea, abdominal pain and blaoting, and shock

Answer 57

Toxic megacolon - complication of Ulcerative colitis

Question 58

cobblestone mucosa, strictures, fistulas, apthous ulcers

Answer 58

chrons

Question 59

PSC, p-ANCA is associated with

Answer 59

ulcerative colitis

Question 60

terminal ileum disease

Answer 60

reabsorb B12 and bile salts are impaired

Question 61

Insulin resistance --> more fatty acid uptake you get

Answer 61

Non alcoholic fatty liver diseae and more free radical injury leading to non alcoholic steatohepatitis