SEC B RECALLS

Question 1

reviewed:

Corkscrew esophagus- feature of ?

Answer 1

Diffuse esophageal spasm

gastric lapus 2019 page 7
Diagnosis:
– Barium swallow
 Corkscrew, Rosary Beads, Pseudiverticula or Curling

Question 2

reviewed: Durg for induction and maintenance of remission in ibd? - prednisone (eto ata?) - azathioprine - fasting - mesalamine

Answer 2

prednisone (eto ata?) -

page 6 ibd

Glucocorticoids

• Induction of remission - best for induction of remission and not for maintenance. Because you only give this during the flare of inflammation. If prolonged use, may lead to cushing’s and many other side effects
• After you achieved the anti inflammatory state you can start tapering
• for moderate to severe UC and CD
  prednisone: 40-60mg/d budesonide

Question 3

reviewed: Most common location ng diverticulitis (ndi ko sure exact question)

Answer 3

Ans. left side 3x

page 3 diverticulosis

Question 4

REVIEWED: Chronic diarrhea with same mechanism, EXCEPT: A. Celiac dse B. Lactase deficiency C. Ulcerative colitis D. Whipple’s dse

Answer 4

C. Ulcerative colitis
inflammatory diarrhea SIYA

PAGE 8 LOWER GIT

Question 5

reviewed: Most common cause of gstric stress related -

Answer 5

px with mechanical ventilator
Most common presentation
o GI bleeding
 usually occur 48-72 h after acute injury
– Risk factor for bleeding
o Patient on mechanical ventilator
o Underlying coagulopathy

page 15 lapus 2019

Question 6

reviewed: Most common type of Gastric Ca

Answer 6

– Adenocarcinoma 85%
Malignant types:
o Adenocarcinoma - 85%
page 2 lapus 2019

Question 7

reviewed: Thin membrane that constricts the esophageal lumen located at the squamocolumnar junction, always associated with hiatal hernia
a. esophageal a ring
b. esophageal b ring
c. esophageal web
d. zenkers diverticulum

Answer 7

b. esophageal b ring
schatzki ring
page 9 lapus 2019

A Ring (muscular)
– Symmetrical band of hypertrophied muscle that constricts the tubular esophageal lumen
– Located roughly 2 cm proximal to the squamocolumnar junction
– consist of three layers: mucosa, submucosa, and muscularis propria
– Rare
– Covered by squamous cell epithelium
– Dysphagia to solid and liquid
– Bougienage/dilatation or botulinium toxin injection
B Ring - Schatzki Ring
– Common
– Thin membrane that constricts the esophageal lumen located at the squamocolumnar junction
– Consist of squamous epithelium on its upper surface and columnar epithelium on its lower surface (demarcates the squamocolumnar junction)
– Always associated with Hiatal hernia
– Composed of mucosa and submucosa
– Mostly asymptomatic
– Intermittent dysphagia
– Diagnosed by esophagogram or endoscopy
– No treatment required if asymptomatic
– Bougienage/balloon dilatation

Question 8

reviewed: Lymph node palpable at the Left anterior axilla-

Answer 8

irish node
page 3 lapus 2019
Lymphatics:
o Virchow’s node (supraclavicular)
o Irish’s node (left axilla)
o Krukenberg’s tumor (ovary)
o “Sister Mary Joseph node” (periumbilical region)
o Blumer’s shelf (peritoneal cul-de-sac)

Question 9

reviewed: Hepatic encephalopathy due to excess

Answer 9

Ammonia

page 15 payawal

Question 10

revieweD: most important Symptom of rectal dse-

Lower abdominal quadrants  relieved by
passage of stool or flatus
 Rectal Pain – deep in the pelvis
 Anal Canal Pain – localized in the perineum
 Thrombosed hemorrhoids
 Anal fissures
 Tenesmus – 
painful straining at stool with a
sensation of incomplete emptying after
defication

Answer 10

tenesmus
important symptom of rectal
disease. E.g proctitis

page 23

Question 11

reviewed: Patient with iron deficiency anemia -

Answer 11

duodenal resection
page 1 lapus
in proximal SI you are dealing with your duodenum and jejunum.
- What are absorbed are your iron, calcium, water soluble vitamins, some aa and fats.

Question 12

REVIEWED: Raceacadopril - answer:

Answer 12

decrease water secretion.

PAGE 6 LOWER GIT
o Enkephalins  endogenous opioid peptides which are synthesized in the intestinal cells and the effect of which is the reverse of the cholera toxin
o It DECREASES cAMP  closes the Cl gates  reduce water secretion
Racecadotril (acetorphan) is an oral enkephalinase inhibitor for use in the treatment of acute diarrhoea. By preventing the degradation of endogenous enkephalins, racecadotril reduces hypersecretion of water and electrolytes into the intestinal lumen

Question 13

REVIEWED: Mesenteric angiography-

Answer 13

gi bleeding detection
LOWER GIT
 Detect vascular abnormalities of the GIT
 Bleeding
 Ischemia
 Detects bleeding: 0.5 ml/min.
 Injection of contrast through the femoral artery

Question 14

REVIEWED: Murphy’s sign-

Answer 14

cholecystitis
PAYAWAL PAGE 17
+ Murphy’s sign
- Hallmark of acute cholecystitis

Question 15

REVIEWED: Non epithelial ( mesenchymal) tumor that arises from the GI pacemaker cells A. Gastro leiomyosarcoma B. GI stromal tumor C. MALT lymphoma D. Adenocarcinoma

Answer 15

B. GI stromal tumor

PAGE 4

Non-epithelial (mesenchymal) tumors that arise from the
gastrointestinal pacemaker cells called the interstitial cells of
Cajal (ICC)

Question 16

REVIEWED: Sinusoidal cause of PORTAL HYPERTENSION except: A. Cirrhosis B. Cystic liver disease C. Schistosomiasis D.Metastatic Malignant Tumor

Answer 16

C. Schistosomiasis

Question 17

REVIEWED: Varioliform gastritis -

Answer 17

lymphocytic gastritis

PAGE 15

LYMPHOCYTIC GASTRITIS
– is characterized histologically by intense infiltration of the surface epithelium with lymphocytes
– infiltrative process
o primarily in the body of the stomach
o consists of mature T cells and plasmacytes.
– A subgroup of patients have thickened folds noted on endoscopy.
– These folds are often capped by small nodules that contain a central depression or erosion; this form of the disease is called varioliform gastritis.

Question 18

REVIEWED: Diffuse type of gastric adenocarcnom-

Answer 18

linitis plastic

PAGE 2

Question 19

REVIEWED: Most common site of hematogenous spread of gastric ca-

Answer 19

liver

PAGE 3LAPUS 2019

Question 20

REVIEWED: Primary cancer site that metastize in stomach-

Answer 20

breast
PAGE 4
Metastatic disease to the stomach can occur with primary tumors of:
– Breast - most common

Question 21

reviewed: Ulcer related to head trauma-

Answer 21

cushing’s ulcer

Curling’s ulcer
– severe burn

page 15 lapus 2019

Question 22

REVIEWED: Bristol stool grade, very liquid, no solids: A. 1 B. 3 C. 5 D. 7

Answer 22

D. 7

Type 1: Separate hard lumps, like nuts (hard to pass)
Type 2: Sausage-shaped, but lumpy
Type 3: Like a sausage but with cracks on its surface
Type 4: Like a sausage or snake, smooth and soft
Type 5: Soft blobs with clear cut edges (easy to pass)
Type 6: Fluffy pieces with ragged edges, a mushy stool
Type 7: Watery, no solid pieces, entirely liquid

Question 23

REVIEWED: Cause fulminant hepatitis to a pregnant woman. A.HAV B.HBV C.HCV D.HDV E.HEV***

Answer 23

E.HEV***

PAYAWAL

Question 24

reviewed: Within 3 cm of pylorus, commonly accompaniedd by DU

Answer 24

Ans.: Normal or inc acid production

PYLORIC GLAND
– G cells
o secretes Gastrin secretion is driven by nutrients (amino acids and amines) that directly stimulates the G cell to release Gastrin
o distention of stomach also leads to gastrin release and acid production

Question 25

reviewed: Small intestine absorption-

Answer 25

due to vili that wound increase the surface area for absorption length of small bowel o SI is around 4 m in adults. The lining of the SI, the mucosa is thrown into folds grossly what we called your plicae. they are further thrown into smaller folds, your villi. The microvilli are the finger-like projection in its villi. They would further increase the surface area for absorption

Question 26

reviewed: CIRRHOSIS IS MANIFESTED BY THE FOLLOWING FINDINGS EXCEPT.

Answer 26

ANS ALT/AST LESS THAN 1 RATIO ``` CIRRHOSIS Laboratory: - Liver insufficiency  Decrease albumin (<3.8 g/dL)  Prolonged PTT (INR >1.3)  Increased bilirubin (>1.5mg/dL) - Portal hypertension  Low platelet count (<175 x 1,000/uL) AST/ALT ratio >1 ```

Question 27

drug that could cause fulminant hepatic failure | a. acetaminophen b. etanol c. isoniazid d. troglitazone

Answer 27

a. acetaminophen PAGE 10 Paracetamol  No. 1 cause of drug induced liver disease

Question 28

Patients with CV risk and needs NSAIDS Cox 2 specific is a CVS risk

Answer 28

use traditional, non-specific NSAIDS + proton pump inhibitor (ranitidine) PAGE 27LAPUS 2019

Question 29

Something na nasa UC lng - granuloma - backwash ileitis (eto ata?) - stricture - fistula

Answer 29

backwash ileitis IBD TRANS CHRONS STRICTURE FISTULA GRANULOMA

Question 30

Treatment for H. pylori infection A. H2 + Amox + metronida B. C. Omep + Amox + clarithro D. CHOP

Answer 30

C. Omep + Amox + clarithro

Question 31

Polyp with buccal pigmentation - peutz jeghers - juvenile polyposis - lynch syndrome

Answer 31

peutz jeghers - LOWER GIT 14

Question 32

Bile acid reabsorption/recirculation

Answer 32

– ileum

Question 33

Esophageal atresia with distal TEF

Answer 33

``` - most common congenital anomalies PAGE 5 LAPUS 1. Congenital anomalies – Esophageal Atresia and Tracheoesophageal fistula – Dysphagia Lusoria – Heterotrophic Gastric – Webs (or Inflammatory) – Stenosis – Duplications ```

Question 34

RESERVED: True about bile acid EXCEPT: A. Primary bile acids, cholic acid and chenodeoxycolic acid are synthesized from cholesterol in the liver, conjugated with glycine B. Bile salt recirculation, active Transport mechanism of conjugated ...... C. Detergent like molecule that in aqueous solution D. Secondary bile acid, deoxycholate and lithocolate are bacterial metabolites of primary bile acid

Answer 34

Primary bile acids are those synthesized by the liver. Secondary bile acids result from bacterial actions in the colon. In humans, taurocholic acid and glycocholic acid (derivatives of cholic acid) and taurochenodeoxycholic acid and glycochenodeoxycholic acid (derivatives of chenodeoxycholic acid) are the major bile salts in bile and are roughly equal in concentration. The conjugated salts of their 7-alpha-dehydroxylated derivatives, deoxycholic acid and lithocholic acid, are also found, with derivatives of cholic, chenodeoxycholic and deoxycholic acids accounting for over 90% of human biliary bile acids. About 95% of bile acids are reabsorbed by active transport in the ileum and recycled back to the liver for further secretion into the biliary system and gallbladder. This enterohepatic circulation of bile acids allows a low rate of synthesis but with large amounts being secreted into the intestine

Question 35

``` REVIEWED: Diffuse type of gastric adenocarcinoma a. frequent ulcers b antrum predominant c. assoc with linitis plastica d. has a good prognosis.. ```

Answer 35

c. assoc with linitis plastica PAGE 2 ``` LAPUS 2019 Diffuse type of gastric adenocarcinoma o younger patient o hereditary factor o poorer prognosis ``` ``` Intestinal Type – cohesive neoplastic cells that form glandular tubular structures – frequently ulcerative – ANTRUM good prognosis ``` page 2 lapus 2019

Question 36

Which is true about Hepatitis D except: A. Defective dna virus B. Need hepadna (hepa b) virus C. Co infection with anti hbc IgM of hbv D. Superinfection with anti hbc IgG of hbv The possibility of hepatitis delta superinfection (IgM anti-HBc negative but HBsAg positive),

Answer 36

no answer yet PAGE 9 PAYAWAL Results for anti-HDV immunoglobulin M (IgM) are positive initially and then are positive for anti-HDV immunoglobulin G (IgG); the finding of antigen A antibody to HDV is almost exclusively associated with chronic HDV infection Results for anti-HB core IgM are positive, except with superinfection, in which anti-HB core IgM is absent

Question 37

REVIEWED: In whom should we suspect cirrhosis except Low albumin Prolonged prothrombin time Increased bilirubin AST:ALT ratio less than 1

Answer 37

``` AST:ALT ratio less than 1 PAYAWAL PAGE 15 CIRRHOSIS Laboratory: - Liver insufficiency  Decrease albumin (<3.8 g/dL)  Prolonged PTT (INR >1.3)  Increased bilirubin (>1.5mg/dL) - Portal hypertension  Low platelet count (<175 x 1,000/uL) AST/ALT ratio >1 ```

Question 38

Which of the following will cause Portal Hypertension? A. Sinusoidal distortion B. Splanchnic vasoconstriction C. Increase resistance to Portal flow D. Increase Portal venous inflow

Answer 38

-C. Increase resistance to Portal flow D. Increase Portal venous inflow

Question 39

REVIEWED: component of MELD score except a. albumin b. INR/PT c. creatinine d. Bilirubin

Answer 39

a. albumin MELD uses the patient's values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR) to predict survival. It is calculated according to the following formul

Question 40

``` Virulence factor ng H. pylori A. Lipopolysaccharide B. Flagella C. cag-PAI D. Urease ```

Answer 40

-C. cag-PAI GASTRO 2019 LAPUS PAGE 22

Question 41

``` FODMAPS diet - di ko maalala choices high FODMAPS reduces bloatedness B. FODMAPS are fermentable C. High FODMAPS induces constipation D. High FODMAPS treat diarrhea ```

Answer 41

B. FODMAPS are fermentable C-High FODMAPS induces constipation

Question 42

malabsorption syndrome accompanied with steatorrhea except celiac sprue

Answer 42

-INTESTINAL LYMPHOMA  The patient will experience steatorrhea (primary manifestation)  Lymphomatous infiltrate in the lymphatic which may involved the intestinal mucosa  CLINICAL FEATURES 1. malabsorption syndrome resembling celiac sprue but within complete response to gluten free diet

Question 43

REVIEWED: Diverticula A. Absence in rectum due to three layer chuchu B. Found at left colon C. Bleeding is due to infection D. Common in women of reproductive age

Answer 43

ANSWERIS A -A. Absence in rectum due to three layer chuchu Rare in Rectum due to differences in muscle layer ``` B. Found at left colon - WRONG RIGHT C. Bleeding is due to infection - WRONG RISK FACTORS  Hypertension  Atherosclerosis  NSAID use ``` D. Common in women of reproductive age WRONG More often in men

Question 44

``` Risk factor for developing Gastric Ca A. B. Smoking C. H. pylori D. ```

Answer 44

-Established risk factors: advanced age, history of ulcer, concomitant use of glucocorticoids, high-dose NSAIDs, multiple NSAIDs, concomitant use of anticoagulants, serious or multisystem disease Possible risk factors: concomitant infection with H. pylori, cigarette smoking, alcohol consumption

Question 45

Manifestation of cirrhosis except: -bridging necrosis -Decreased collagen meshwork - regenerative nodule - activation of hepatic stellate cells

Answer 45

-Decreased collagen meshwork

Question 46

risk factors for pseudomembranous enterocolitis a. advanced age b. IBD c. rifampicin d. use of foley catheter

Answer 46

- a. advanced age b. IBD c. rifampicin ``` Surgery – most common !!!  Colon, gastric or pelvic Older age  Increased co-morbidities  Patients undergoing cytotoxic chemotherapy o Methotrexate – most common  HIV infxn  IBD ```

Question 47

Risk factor for colonic adenocarcinoma A. Family hx B. Smoking c. Chronic constipation

Answer 47

A. FAMILY HISTORY -Nitrate containing o dried, smoked, salted foods, pickled vegetables o nitrates are converted to carcinogenic nitrites by bacteria through the ingestion of partially decayed foods – H. pylori bacteria o adenocarcinoma o lymphoma – Menetrier’s disease o extreme hypertrophy of gastric folds – Atrophic gastritis and Pernicious anemia – Blood type A – Genetics: high incidence of occult gastric cancers in the young

Question 48

Diver After activty had severe abdominal pain rises from a rapid pace A.Acute mesenteric embolous B. Acute mesenteric throbus C. Chronic mesenteric insufficiency D. Venous mesenteric thrombus

Answer 48

D. Venous mesenteric thrombus