Week 2 (Exam 1) Flashcards
(147 cards)
1
Q
What gene mutation is responsible for intracellular lipid accumulation found in Abetalipoproteinemia?
A
MTP
2
Q
What is the agent of choice in treating Trichinella?
A
Albendazole with steroids
3
Q
What is the agent of choice for treating adult tapeworm?
A
Praziquantel
4
Q
What TNF-a Inhibitor is IgG1k chimeric antibody?
A
Infliximab
5
Q
What are the indications for Secukinumab and Ustekinumab?
A
Moderate to Severe UC and CD
6
Q
A patient shows thumb-printing on abdominal X-ray. Where do you expect this finding to occur?
A
Splenic flexure: this is ischemic colitis
7
Q
What histological findings are associated with Salmonella?
A
Enlarged Peyer Patches in the Terminal Ilium Typhoid Nodules (of MO) on the liver, marrow, LN
8
Q
Triad of Diarrhea, Wheight loss, and Arthralgia. What is the morphologic hallmark of this disease?
A
Dense accumulation of distended and foamy macrophages in the small intestinal LP. This is Whipple Disease (also causes cardiac issues and CNS)
9
Q
What is a mucinous tumor of the appendix most likely to cause?
A
Pseudomyxoma Peritonei
10
Q
What class of drug is Ciprofloxacin?
A
Fluoroquinolone
11
Q
What happens to salmonella in the ABSENCE of commensal bacteroides?
A
Salmonella Flagellin binds TLR5, transcribes NF-kB
12
Q
What happens to salmonella in the PRESENCE of commensal bacteroides?
A
PPAR in induced, and pro inflammatory NF-kB is attenuated
13
Q
What is Natalizumab?
A
a-4 intern inhibitor used to treat Crohn’s
14
Q
What is the only indication for using Alvimopan?
A
Speeding up GI recovery after a bowel resection surgery with primary anastomosis (prevents post-op ileus)
15
Q
What are the 5-ASA drugs?
A
sulfaSALAzine meSALAmine (not converted to 5-ASA) olSALAzine balSALAzide (used to treat ulcerative colitis)
16
Q
Where does Yersinia preferentially affect?
A
Ilium, Appendix, Right Colon
17
Q
Which Benzimidazole is only used cutaneously?
A
Thiabendazole
18
Q
What Osmotic Agent Laxative is also used in severe liver disease patients (hyperammonemia)?
A
Lactulose (change in pH traps ammonia in GI)
19
Q
What is Vedolizumab?
A
a-4 Integrin Inhibitor used to treat UC and Crohn’s
20
Q
What is the maintenance dosing of Adalimumab?
A
SQ every 2 weeks
21
Q
How does Magnesium and Phosphate work as a laxative?
A
They are hyperosmolar and retain water in the GI tract
saline agents
22
Q
What is the major risk associated with taking Alvimopan?
A
MI (can’t take more than 15 doses)
23
Q
What are the three functions of Glycerin?
A
Irritant
Osmotic
Lubricant
24
Q
What 4 things can you suggest as Bulk-Forming / Hydrophilic Colloidal Agents?
A
Fiber / Bran
Spyllium (Metamucil)
Carboxy-/MethylCellulose
Calcium Polycarbophil
25
What is the agent of choice for Ascaris Lumbricoides / Roundworm?
Albendazole
26
What infection puts you at a higher risk for colon cancer?
Strep Bovis aka Strep Gallolyticus
27
What laxative would you suspect in a patient with dark or reddish urine?
Senna
28
Why do we block IL-12 and 23?
It prevents T cell differentiation by binding P40-subunit
| Inhibits pro-inflammatory IFN-y, TNF-a, IL-17, etc
29
What kind of cancers occur above and below the pectinate line?
Above: Adenocarcinoma
Below: Squmous Cell Carcinoma
30
What is the MOA of pre-colonoscopy bowel prep?
GI stimulant / irritant
| This is Sodium Picosulfate (with magnesium oxide / anyhdrous citric acid converted to magnesium citrate)
31
What is the dosing of Tofacitinib?
PO BID
32
What is the composition of mesalamine?
single 5-ASA
33
How does Cystic Fibrosis present?
```
Chronic lung disease
Male Infertility
Exocrine Fibrosis and atrophy, Squamous Metaplasia
Avitaminosis A
Meconium Ileus
```
34
All colorectal cancers should undergo testing to look for what kind of mutations?
DNA mismatch repair genes (MLH1/2, MSH6/2)
| This is for Lynch Syndrome / HNPCC
35
What are the indications of Golimumab?
Moderate to severe CD
36
What are the potential side effects of Alostetron?
Black Box for Ischemic Colitis
37
What are the indications for Vedolizumab?
Moderate to Severe CD and UC
38
What is the major side effects of Natalizumab, and what are its 3 main risk factors?
Progressive Multifocal Leukoencephalopathy:
| Treatment longer than 2 years, prior immunosuppression, anti-JC virus Abs
39
What does commensal bacteria use to suppress pathobionts?
Treg Cells
| IL-10
40
IBD is characterized by bacterial components crossing the epithelial barrier through weakened tight junctions. Which specific aberrant responses are mainly associated with which disease?
Disruption of Barrier is mainly UC
Dysfunction of Microbe Sensing is mainly CD
Both have changes in immunoregulation
41
How do you diagnose Microvillus Inclusion Disease?
CD10 Immunohistochemistry
42
What is the bacterial composition found in IBD compared to normal?
Normal: Mostly Bateroidetes, some Fimicutes
CD: Mostly Firmicutes, some Actinobacteria
UC: Evenly Firmicutes, Proteobacteria, and Bacteroidetes
43
How does Loperamide work?
Treats diarrhea by opioid-like action
| No analgesia or dependence
44
A patient has IBS-D (diarrhea-predominant subtype IBS). What does the recommended drug target?
Mu and Kappa agonist, Delta antagonist (less secretions)
| This is Eluxadoline
45
What is the dosing for Ustekinumab?
SQ every 8 weeks
46
What TNF-a inhibitor is a recombinant Fab fragment?
Certolizumab
47
What is the major contraindication in treating Shigella after it is diagnosed via Stool culture?
Antidiarrheals: Prolongs symptoms. Give Abx instead
48
What are the Antihelmintics?
```
Benzimidazoles (Al-/Me-/Thia-bendazole)
Ivermectin
Nitazoxanide
Praxiquantel
Pyrantel Pamoate
```
49
How do you treat and prevent HNPCC?
Subtotal Colectomy with Ileorectal Anastomosis
| Prohylactic Hyeterectomy and Oophorectomy for women at age 40 or once they're done having kids
50
What TNF-a Inhibitor is IgG1k monoclonal antibody?
Golimumab
51
What is the structure of Ustekinumab?
Fully Human IgG1k mab
52
What are the positive lab findings in IBD?
Crohn's is ASCA+
| UC is pANCA+
53
What gene causes a deficiency in brush-border assembly?
MYO5B (this is microvillus inclusion disease)
54
What should be avoided when treating moderate to severe UC with JAK inhibitors?
Biologics or immunosuppressants
55
What are the indications of Infliximab?
Moderate to severe CD
| Severe UC
56
How do you treat Shigella?
Ciprofloxacin
57
How would you distinguish left sided vs right sided colon cancers?
Left: Rectal bleeding, ab/back pain, altered bowel habits
Right: Anemia, Bloody stool, weight loss, others
58
What is the maintenance dosing of Golimubab?
SQ every 4 weeks
59
What are the indication s for Linaclotide?
IBS-C
| Chronic Idiopathic Constipation (CIC)
60
What are the side effects of giving Eluxadilone for diarrhea?
Pancreatitis (especially w/o a gallbladder)
| Getting high
61
What is the MOA of Linaclotide?
Guanylate Cyclase C Agonist
Activates CFTR ion channel
Stimulates Cl-/HCO3- secretion
62
What is the agent of choice in treating larval tapeworm Echinococcus Granulosus?
Albendazole and Praziquantel at the same time
63
What is the maintenance dosing of Infliximab?
IV every 8 weeks
64
How do you get Sterile Peritonitis?
Leakage of bile or pancreatic enzymes
65
What TNF-a Inhibitor is a recombinant IgG1 monoclonal antibody?
Adalimumab
66
What is the structure of Natalizumab?
Recombinant IgG4k monoclonal ab
| a4b1 (VCAM-1) and a4b7 (MAdCAM-1)
67
What does CARD15 recognize, and what is the result?
MDP (muramyl dipeptide): Peptidoglycan in bacteria
| Triggers NF-kB
68
What is the agent of choice for Giardia?
Metronidazole
69
Which IL-12 / 23 inhibitor is used to treat Crohn's?
Ustekinumab
70
What is Polyethylene Glycol used for?
Large doses for Bowel Prep prior to scopes and stuff
| Smaller doses are used as a laxative
71
What is the agent of choice in treating Trichuris Trichiura / Whipworm?
Mebendazole
72
What is the structure of Vedolizumab?
Humanized IgG1 Monoclonal antibody
| a4b7 (MAdCAM-1)
73
What would a mutation the FOXP3 gene cause?
Immune Dysregulation, Polyendocrinopathy, Enteropathy, X-linked. (IPEX)
74
What is the agent of choice in treating Strongyloides Stercoralis / Threadworm?
Ivermectin
75
What mutation is associated with Peutz-Jeghers Syndrome?
Serine Threonine Kinase 11
| AD
76
How do you treat C Diff?
At first? Vanco
| First Recurrence? Fidaxomicin
77
What is the composition of Balsalazide?
Inert carrier + 5-ASA
78
A child has hypertrophy of the retinal pigment, detected at birth. What genes do you suspect to be involved in this disease?
```
APC mutation (90%)
MUTYH mutation (8%)
This is Familial Adenomatous Polyposis
```
79
What is the composition of sulfasalazine?
Sulfapyridine + 5-ASA
80
What are the major stool softeners?
Docusate salts
| Mineral Oil
81
How do the 4 major macronutrients in your diet affect your gut microbiome?
High fat diet: Decreases Everything
High Protein and High Carb: Increases Everything
High Fiber: Increases everything but Proteobacteria
82
What would you expect to find on blood smear of a patient who is completely deficient of Apolipoprotein B?
Acanthocytes
83
What class of drug is Vanco?
Glycopeptide
84
What is the mechanism of action you would use to treat non-infectious diarrhea in HIV/AIDS patients?
Cl- channel blocker (Crofelemer)
85
What is expressed on Treg cells that makes it good at suppression?
CTLA-4 and IL-2R (deprives the IL-2)
86
What is the maintenance dosing for Vedolizumab?
IV every 8 weeks
87
What is the only indication for olsalazine?
Maintenance of remission of UC
88
What causes a granulomatous reaction from release of Keratins?
Ruptured Dermoid Cyst
89
What drug combines with atropine to reduce the likelihood of abuse?
Diphenoxylate
90
What class of drug are Fidaxomicin and Azithromycin?
Macrolide
91
What is the role of Helminths in IBD?
Prevalence is inversely related
92
What is the composition of olsaalazine?
2 molecules of 5-ASA
93
What are the possible side effects of Crofelemer?
Abdominal Distension
Elevated Liver Enzymes
Repiratory and Urinary Infections
94
What is the MOA of Lubiprostone?
PGE-1 Derivative: Activates GI Cl-Channels (ClC-2)
| Increases Intestinal Fluid Secretions
95
What other conditions is Tofacitinib used for?
Psoriatic and Rheumatoid Arthritis
96
How do 5-ASA (-sala-) agents work?
Inhibit prostaglandins and leukotrienes via COX and LIPOX pathways
Reduces PMN and Macrophage Chemotaxis, NF-kB
97
What are the two disorders that can be characterized as IBD?
UC and Crohn's
98
How do you get Acute Hemorrhagic Pancreatitis?
Leakage of pancreatic enzymes
| Fat Necrosis
99
What are. the agents of choice for Entamoeba Histolytica?
Metronidazole followed by Paromomycin
100
What are the radiological identifiers of IBD?
Crohn's has a String Sign and Cobblestoning
| UC has "lead pipe colon"
101
Alostetron is obviously a Serotonin blocker. What is it used for?
Really bad IBS-D that isn't responsive to other therapies (women)
102
What are the indications for Natalizumab?
Moderate to severe CD
| do not take with immunosuppressants like TNF-a agents
103
What are the side effects of Diphenoxylate?
Anticholinergic
104
How do you treat Salmonella?
Ciprofloxacin
105
What part of the GI tract is more likely to be spared in Crohn's Disease?
Rectum
106
What is the agent of choice for Cryptosporidium?
Nitazoxanide
107
What is the only indication for Balsalazide?
Active Disease (UC)
108
What is the agent of choice for treating Cyclospora Cayetanesis?
TMP-SMX
| Ciprofloxacin for sulfa-allergies
109
What mutation is associated with hamartomatous polyps and lipomas throughout the GI tract and Cerebellum?
PTEN (Cowden)
110
What auto-antibodies can you expect to find in Celiac Disease?
IgA Tissue Transglutaminase (tTG)
| IgG Anti-Gliadin
111
What are the TNF-a inhibitors used to treat Crohn's?
adalimuMAB*
certoilzuMAB
inflixiMAB*
112
What is the maintenance dosing of Certolizumab?
SW every 4 weeks
113
How do a-4 Integrin inhibitors work?
Limits Integrin-associated Cell adhesion and migration
114
What tropism of Shigella causes the ulcerations and stuff like you'd see in Crohn?
M Cells
115
What three patient groups are at higher risk for reactive arthritis from Campylobacter infectioins?
Those with HLA B-27, Guillain-Barre, and Erythema Nodosum
116
How would you differentiate Celiac Disease and IPEX by infiltrate?
IPEX shows neutrophils infiltrating gut mucosa, celiac doesnt
117
What are the cytokines associated with Crohn's?
DC and MO making IL-12/6/23
Activates Th1: secretes IL-2, IFN-y, and TNF
Activates Th17: secretes IL-17
118
What is the significance of SCFA's in the digestive tract?
They induce Tregs, reduce inflammation
Induce IgA and mucus secretion
Barrier integrity and pathogen prevention
119
What is the maintenance dosing for Natalizumab?
IV every 4 weeks
120
Where is the IBD susceptibility locus?
IBD-1 is found on Chr 16, containing the CARD15 aka NOD2 Gene ex[ressed mainly in Macrophages and DCs
121
Who is at greater risk for sepsis and death resulting from a Yersinia infection?
Those with more non-heme Iron.
122
What is the agent of choice in treating Enterobius Vermicularis / Pinworm?
Mebendazole
123
What mediates outside-to-inside signaling in IBD?
tmTNF
124
What infection leads to the Stacked Brick morphology in epithelial cells?
EAEC (enteroaggregative E Coli)
125
Which forms of diarrhea go away with fasting and which persist?
Persists: Secretory and Exudative
Relieved: Osmotic and Malabsorptive
126
What must happen to Castor oil for it to stimulate peristalsis?
Must be hydrolyzed into Ricinoleic Acid
127
What are the indications for Lubiprostone?
IBS-C
CIC
Opioid-Induced Constipation (OIC)
128
What are the major side effects of Secukinumab / Ustekinumab?
Infections (screen for Tb first)
129
What does giving TNF-a do?
Increases surface adhesion molecules for leukocyte adhesion
130
What are the indications of Adalimumab?
moderate to severe UC and CD
131
What is the agent of choice for Ancylostoma / Hookworm?
Albendazole
132
What are the three major complications of Shigellosis?
Toxic Megacolon
HUS
Reactive Arthropathy
133
What are the cytokines associated with UC?
TH2 and NK making IL-4 (Th2), IL-5, and IL-13 (TH2 and NK)
134
What infection can cause gallstones and a chronic carrier state?
Gallbladder colonization with Salmonella
135
What are the TNF-a inhibitors that are used to treat UC?
adalimuMAB*
golimuMAB
inflixiMAB*
136
What are the three consequences of NOD2 mutations that lead to Crohn's?
Defective Macrophage Function
Defective Epithelial Cell Responses
Defective APC Conditioning
137
What antibodies would you expect to see in IPEX?
Enterocytes, Goblet Cells, Parietal, Islet Cells
138
What do Treg cells use to suppress TH17 (Crohn's) cells?
Retinoic Acid
139
What are the three mu-opioid antagonists you can use to treat constipation?
Methylnaltrexone
Naloxegol
Alvimopan
140
What is the agent of choice to treat Schistosoma?
Praziquantel with steroids
141
What mutation is associated with Familial Juvenile Polyposis?
AD MADH4 and BMPR1A
142
What 4 things does the microbiota use to induce host tolerance to commensal bacteria?
MAMPs
Polysaccharide (PSA) Signaling
SCFA production
Intestinal Alkaline Phosphatase (IAP)
143
A patient has back and abdominal pain relating to IgG4. What elevated lab values would you expect to find?
Elevate Erythrocyte Sedimentation
Elevated CRP
This is Idiopathic Retroperitoneal Fibrosis
144
What do Segmented Filamentous Bacteria do?
(Bacteroides Fragilis and Clostridium)
Induce Tregs in the Lamina Propria
Basal Level Activation Th17 Cells for Epithelial integrity
145
What is Tofacitinib?
JAK kinase inhibitor used to treat UC
146
There are two Antimuscarinic agents you can use to treat abdominal pain. What are they?
Hyoscyamine
| Dicyclomine
147
How do you treat Campylobacter?
Ciprofloxacin
