Step Up- GI

Question 1

This is the most common site of distant spread of colorectal cancer

Answer 1

Liver through the portal circulation

Question 2

Risk of CRC in a patient with familial adenomatous polyposis?

Answer 2

100% by 3rd or 4th decade

Question 3

Polyps + osteomas and dental abnormalities

Possibly with benign soft tissue tumors

Answer 3

Gardner syndrome

Question 4

This test is an important screen in a patient with gardner syndrome

Answer 4

colonoscopy– nearly 100% develop CRC by age 40

Question 5

Turcot syndome

Answer 5

Polyps + medulloblastoma or gliblastoma multiforme

Question 6

patient with pigemented spots around lips and multiple GI hamartomas

Answer 6

Peutz-Jeghers syndrome

Question 7

Most common cause of large bowel obstruction in adults?

Answer 7

CRC

Question 8

Abx that are most commonly associated with pseudomembranous colitis

Answer 8

Clindamycin

Ampicillin

Cephalosporins

Question 9

Tx for C. diff colitis?

Answer 9

Mtronidazole or oral vancomycin

Metronidazole can not be used in children and pregnant patients

Question 10

Deficiency of this in wilson disease

Answer 10

ceruloplasmin

Question 11

Medical tx for wilson disease

Answer 11

d-penicillamine

Zinc- prevents uptake

Question 12

Potential effects of hemochromatosis

Answer 12

Cirrhosis

Cardiomyopathy

Diabetes

Artritis (2nd and 3rd mcp, hips and knees)

Hypogonadism

Hypothyriodism

Hyperpigmentation of skin

Question 13

Lab findings in hemochromatosis

Answer 13

Decreased TIBC

Increased Transferrin saturation

Increased Iron

Elevated Ferritin

Question 14

This tumor can develop in females on OCP…

Answer 14

Hepatocellular adenoma

Question 15

treatment for hepatocellular adenoma

Answer 15

Stop offending agent like OCP

If it does not regress, resect it

Question 16

Most common benign liver tumor

Answer 16

Cavernous hemangioma

Question 17

27 year old female with RUQ pain, started OCPs a few months ago. Fullness in the RUQ, what test?

Answer 17

RUQ ultrasound or CT

Likely hepatocellular adenoma

Stop OCP and watch in case of rupture

Question 18

Two kinds of hepatocellular carcinoma…

Which is associated with Hepatitis infection

Answer 18

nonfibrolamellar– most common and associated with HepB and C

Fibrolamellar– not associated. more treatable

Question 19

These chemicals are associated with HCC

Answer 19

Aflatoxin

PVC

Thorotrast

Question 20

These are diseases that increase risk for HCC

Answer 20

Cirrhosis

AAT deficiency

Hemochromatosis and wilson disease

schostosomiasis

hepatic adenoma

cigarette smoking

glycogen storage diseases

Question 21

This tumor marker is commonly elevated in HCC

Answer 21

AFP

Question 22

How is the histology of NASH different from alcoholic fatty liver?

Answer 22

It ISNT!

Histologically they are the same. Differentiated based on Hx (obesity, dm, HLD but NO ALCOHOL)

Question 23

Gilbert disease cause

Answer 23

decreased activity of UDP-glucuronyl transferase

increased unconjugated bili

Question 24

Cause of hydatid liver cysts

Answer 24

Echinococcus granulosis and multilocularis

Question 25

This portion of the liver is the most commonly affected by hydatid liver cysts

Answer 25

Right lobe

Question 26

Complication associated with hydatid cyst? This medication is given with surgery

Answer 26

Rupture leading to anaphylaxis Mebendazole given with surgery

Question 27

Causes and treatment of pyogenic liver abscess

Answer 27

Causes: E. coli, klebsiella, proteus, enterococcus, anaerobes IV Abx and drainage

Question 28

Cause of amebic liver abscess

Answer 28

Entamoeba histolytica Fecal-oral Gay dudes...

Question 29

Tx of entomoeba histolytica

Answer 29

metronidazole

Question 30

Causes of budd chiari syndrome

Answer 30

hypercoagluable states myeloproliferative disorders pregnancy chronic inflammatory disease infection cancer trauma

Question 31

Dark urine is an indication of this subset of hyperbilirubinemia. Why?

Answer 31

Direct It is the only form that can be excreted in the urine

Question 32

Intrahepatic causes of + urine bilirubin (conjugated)

Answer 32

Hepatocelluar disease Dubin-johnson, rotor syndrome Drug induced PBC PSC

Question 33

Extrahepatic causes of + urine bilirubin

Answer 33

gallstones pancreatic cancer (head) cholangiocarcinoma periampullary tumor biliary atrisia

Question 34

Causes of unconjugated hyperbilirubinemia

Answer 34

Gilbert Crigler-Najjar Haundice of the newborn diffuse liver disease like cirrhosis

Question 35

Mild elevations of AST and ALT (low hundreds) think about...

Answer 35

Chronic viral hepatitis or acute viral hepatitis

Question 36

Moderately elevated ALT and AST (high hundreds to thousands) think about...

Answer 36

acute viral hepatitis

Question 37

Severly elevated AST and ALT (\>10,000) think about...

Answer 37

Extensive necrosis - Shock liver (ischemia) - Acetominophen tox - Severe viral hepaitis

Question 38

Mnemonic for causes of LFT elevation...

Answer 38

**A**utoimmuno hepatitis Hep **B** Hep C **D**rugs or toxins **E**thanol **F**atty Liver **G**rowths **H**emodynamic compromise (CHF) **I**ron and others (Wilson, and AAT deficiency)

Question 39

Alk Phos is elevated but GGT is not. What should be suspected?

Answer 39

Pregnancy or bone disease

Question 40

Most common cause for acute cholangitis

Answer 40

Choledocolithiasis

Question 41

RUQ, jaundice and fever

Answer 41

Charcots triad The pentad include AMS and septic shock-- rapidly fatal

Question 42

Cancer associated with primary sclerosin cholangitis

Answer 42

Cholangiocarcinoma

Question 43

Primary sclerosing cholangitis is associated with this GI disorder

Answer 43

ulcerative colitis

Question 44

Clinical features of primary sclerosing cholangitis

Answer 44

Puritis fever weight loss obstructive jaundice

Question 45

ERCP findings in PSC

Answer 45

Beads on a string of biliary tree

Question 46

Biliary tree disease associated with +AMA

Answer 46

primary biliary cirrhosis-- middle aged women

Question 47

Treatment for primary biliary cirrhosis`

Answer 47

Cholestyramine-- tx of puritis Calcium, bisphosphonates and Vit D-- osteoporosis Ursodeoxycholic acid-- **slows disease progression**

Question 48

This is the most common cause of pancreatitis in children

Answer 48

Blunt abdominal trauma

Question 49

Which is more specific for pancreatitis? Lipase or amylase?

Answer 49

Lipase

Question 50

Cause of hypocalcemia in pancreatitis

Answer 50

Saponification Calcium is chelated in the digesting fat

Question 51

Ranson criteria

Answer 51

GA LAW **G**lucose \>200 **L**DH \>350 **A**ST \>250 **W**BC \>16000

Question 52

Circumferential ring in the lower esophagus ALWAYS accompanied by a sliding hiatal hernia

Answer 52

Shatzki ring (distal esophageal web)

Question 53

Plummer-vinson syndrome

Answer 53

upper esophageal webs accompanied by iron deficiency anemia, koilonychia and atrophic oral mucosa

Question 54

What is the underlying cause of zenker and epiphrenic diverticula

Answer 54

motility disorder increasing esophageal pressure

Question 55

This divertuculum is located near the tracheal bifurcation

Answer 55

traction diverticula

Question 56

Most common cause of PUD

Answer 56

H. pylori

Question 57

H. pylori more commonly causes ulcers in the area...do they have high malignancy potential?

Answer 57

duodenal NO the high potential for malignancy exists in the stomach

Question 58

Which blood type is associated with gastric ulcers? Duodenal ulcers?

Answer 58

Type **A**= g**A**stric ulcers Type **O**= du**O**denal ulcers

Question 59

Most sensitive test for H. pylori? Most convenient?

Answer 59

Most sensitive is biopsy with microscopy Most convenient is urease breath test-- also asseses effective therapy

Question 60

Pain better with food

Answer 60

Duodenal ulcer

Question 61

Pain worse with food

Answer 61

Gastric ulcer

Question 62

Diabetic with bloating and constipation

Answer 62

Gastroparesis from autonomic neuropathy