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Gastrointestinal
RX Review Round 4
| Question | Answer |
|---|---|
| What are to common expressions of Macrolide Toxicity? | 1. Painful jaundice 2. Acute Cholestatic hepatitis |
| Macrolides are considered CYP450 system __________________. | Inhibitors |
| Which macrolide has the least CYP450 inhibition features? | Azithromycin |
| A patient with chronic and uncontrolled Ulcerative Colitis is at increase risk to develop? | Colitis-associated Colorectal Cancer |
| Long-term inflammation in an uncontrolled UC patient, presents risk of developing what type of CRC? | Colitis-associated Colorectal Cancer |
| What are the features of Colitis-associated Colorectal cancer? | Frequently presents MULTIFOCAL, has high-grade histology, and present with Flat lesions in the PROXIMAL colon and occurs much earlier in life. |
| A young patient with long term colitis, is most likely to develop which kind of CRC? | Colitis-associated Colorectal Cancer |
| Flat lesions in the proximal colon should raise suspicion of? | Colitis-associated Colorectal Cancer |
| Coinsurance: | Insurance plan in which patient pays for a portion util an an agreed deductible, which is then shared with the insurance company. |
| What are the potential factors for polyp malignancy? | 1. Tubular adenocarcinoma < Villous adenocarcinoma 2. Larger polyps > Smaller polyps |
| Which metabolic imbalance is produced by excessive vomiting? | Metabolic Alkalosis |
| What is implied in electrolytes balances in metabolic alkalosis? | Loss of H+ , and Bicarbonate excess. |
| A value greater than _______ mEq/L in bicarbonate (HCO3) is considered excessively high. | 28 |
| What is another term used for Enterokinase? | Enteropeptidase |
| Where is produced Enterokinase? | Duodenum |
| What is the role of Enterokinase? | Activates the conversion of Trypsinogen into TRYPSIN |
| Which is an essential duodenal enzyme in the digestion of complex lipids and proteins? | Trypsin |
| What are the two most common causes of Gastric ulcers? | H. pylori infection and NSAID overuse |
| What are red flags signaling non-ordinary gastric ulcers? | Ulcers refractory to PPI use, and ulcers found DISTAL to duodenum with elevated gastrin levels |
| What syndrome is associated with many gastric ulcers distal to duodenum and with an elevated gastrin level? | Zollinger-Ellison Syndrome |
| What is the MCC of Choledocholithiasis? | Stone obstruction of the Common Bile Duct |
| What is the clinical presentation of Choledocholithiasis? | Constant RUQ pain, jaundice, and cholestatic pattern of liver test results |
| What are the characteristic LFTs of cholelithiasis? | Grossly elevated ALP, bilirubin, and mildly to normal levels of ALT/AST. |
| How does Giardia lamblia affect the intestinal tissue wall? | Small bowel inflammation and villous atrophy, resulting in reduced absorptive capability and malabsorption. |
| What is the treatment of Giardiasis? | Metronidazole |
| Which is the common type of protozoa that is ingested by drinking river (unfiltered) water? | Entamoeba histolytica |
| What is a common hepatic consequence of amebiasis? | Necrotic abscesses ascending from the Portal system |
| What is the treatment for amebiasis? | Metronidazole |
| Yellow fever is caused by what type of viral family? | Flavivirus |
| What is the clinical presentation of Yellow Fever? | Headache, photophobia, musculoskeletal pain, and elevated transaminases with AST>ALT. |
| What is seen in liver bx of a Yellow Fever patient? | Councilman bodies, eosinophilic degeneration and condensed nuclear chromatin. |
| What is the genomic description of Flaviviruses? | Enveloped, (+) ssRNA virus |
| What mosquito transmits Yellow Fever? | AEDES |
| What is the main characteristic/cause of Hirschsprung disease? | Constricted colon that prevents the passage of stool into the anus |
| The "squirt sign" + first 24 hours of failed passed meconium. Dx? | Hirschsprung disease |
| What is the classical sign seen in X-ray of a Hirschsprung disease patient? | Dilated loops of Bowel and absence of gas in the rectum. |
| Double bubble sign in the abdominal x-ray. Dx? | Duodenal atresia |
| What is the most common presentation of Squamous Cell Carcinoma of the larynx? | HOARSENESS, but also with dysphagia dn weight loss. |
| What are common and significant risk factors for Larynx Squamous Cell cancer? | Smoking and alcohol use |
| Patient presents with dysphagia and regurgitation, but no weight loss or hoarseness. Dx? | Achalasia |
| Achalasia is due to: | Loss of Auerbach nerve plexus in the esophagus |
| Increased intracellular cAMP by exotoxins is seen with: | V. cholerae and B. anthracis. |
| What is the name of the exotoxin released by B. anthracis? | Edema factor. |
| What is a common medication used in the relief of symptoms in IBS? | Loperamide |
| Loperamide is an _____________, used in _________________. | Opioid; IBS |
| Abdominal pain relief with defecation? | IBS |
| What is the MCC of LLQ pain in diverticulitis? | Blockage of a Diverticulum |
| What is the histologic characteristics of the muscularis propria affected in diverticulosis? | Areas of attenuated muscularis propria |
| What are manifestations of Acetaminophen toxicity? | Nausea, vomiting, scleral icterus, RUQ pain, and elevations in the LFTs in the first 24 hours. |
| What is used to treat Acetaminophen overdose? | N-acetylcysteine |
| What is N-acetylcysteine? | A reducing agent, that regenerates Glutathione tatha binds to the NAPQI generated. |
| What is the optimal time frame to administer N-acetylcysteine in a Acetaminophen overdose patient? | Within 8 hours from ingestion. |
| Patient with chronic, gnawing pain, and gastric ulcers due to H. pylori infection. Dx? | PUD |
| What causes the gastric mucosa damage in a H. pylori induced PUD? | Ammonia accumulation |
| What does ammonia in PUD causes to the gastric environment? | Neutralization of the gastric environment |
| Important G-protein fro intracellular transmission of signals from Growth hormone? | Ras |
| What is an important characteristic of Ras protein? | Intrinsic GTPase activity which converts GTP ----> GDP inactivating the protein function. |
| Ras protein is associated with which cancers? | Pancreatic, colon, and lung cancers |
| To which kind of receptors are G-proteins, such as Ras, linked to? | Receptor Tyrosine Kinase |
| Where are the Paneth cells found? | Crypts of Lieberkuhn in the Small intestine |
| What is the main function of Paneth Cells? | Immunologic function in clearing pathogens |
| What cytokines/enzymes are released by Paneth cells? | a-defensins, lysozymes, and TNF |
| What is the histologic resemblance of Paneth cells? | Eosinophils |
| What common exotoxin infection is often associated with damage or involvement of Paneth cells? | Cl. difficile infection |
| What is the cause of Hepatic encephalopathy? | The buildup of AMMONIA in liver disease, resulting in the onset of neurologic dysfunction. |
| What is the ACUTE treatment choice for Hepatic encephalopathy? | Lactulose |
| What is the mode of action of Lactulose? | Acidifying colonic contents and reducing the absorption of ammonia from the bowel. |
| The Charcot triad is associated with which disease? | Cholangitis |
| What is the Charcot triad composed of? | 1. Fever 2. Jaundice 3. RUQ pain |
| Besides Charcot triad, what other associated symptoms of Cholangitis? | 1. Leukocytosis with neutrophilia 2. Elevated band cell counts |
| What are the most common EXTRAINTESTINAL manifestations of Crohn's disease? | Uveitis, migratory polyarthritis, Erythema nodosum, and Renal calculi |
| What are kind of renal stones are associated in Crohn's disease? | Calcium - oxalate |
| "Skip lesions", granulomas, fistulas, and stenoses. These are often seen as? | Intestinal manifestations of Crohn's disease. |
| What is the major component of Pigmented Gallstones? | Unconjugated bilirubin |
| Which kind of bilirubin is water insoluble? | Unconjugated bilirubin |
| Water soluble bilirubin is known as? | Conjugated or Direct bilirubin |
| RadioPAQUE gallstone of X RAY appear? | Bright White |
| RadioLUCENT gallstone on X-ray appear? | "gray-black" |
| What are clinical findings of Toxic megacolon? | Severe abdominal pain and visibly distended colon. |
| What are some common predisposing factors for Toxic Megacolon? | 1. Cl. difficile infection 2. Loperamide use (especially in children) 3. Ulcerative colitis |
| At what level does IVC traverses the diaphragm? | T8 |
| The IVC travels directly through the _______________________ of the diaphragm. | Central tendon |
| Which two main structures traverse the diaphragm at T10? | Esophagus and Vagus nerve |
| Which two vessels traverse the diaphragm at T12? | Aorta and the Azygos vein |
| The _______ and _______ ________ travel through the ________________, alongside the _____________, to traverse the diaphragm. | Aorta; Azygos vein; Aortic hiatus; Thoracic duct |
| How does the toxin in V. cholerae cause diarrhea? | Irreversibly activating Gs |
| Motile, comma-shaped organism that does not ferment lactose and is oxidase (+)? | V. cholerae |
| What is the first line of treatment for chemotherapy-induced nausea and vomiting? | Ondansetron |
| What is the mode of action of Ondansetron? | Blocks the Serotonin 5-HT3 receptors and decreases vagal stimulation. |
| What is the strongest anti-emetic available? | Ondansetron |
| Neonate with acute abdomen, abdominal distension, bilious vomiting, and failure to pass stool. Suspected diagnosis? | Volvulus |
| Which cardiac abnormality is associated with Volvulus? | Situs inversus |
| What are the imaging findings of volvulus? | 1. "Bird beak" and/or "coffee bean" appearance 2. Multiple air fluid levels |
| What are the most common sites and their respective draining veins for the development of Volvulus? | #1 ---> Sigmoid colon which drains by the sigmoid veins #2 ---> Ileocecal junction, which is drained by the Ileocecal veins |
| What arterial body irrigates the Jejunum? | SMA |
| What are common predisposing factors for SMA ischemia? | Atrial fibrillation and Atherosclerotic disease |
| What is the clinical profile of Midgut ischemia? | Severe abdominal pain that is out of proportion to physical findings. |
| Acute Mesenteric events are due to ______________ events. | Embolic |
| Chronic mesenteric events are due to ___________________ events. | Thrombotic |
| What are the main 3 factors to develop edema? | 1. Decrease in blood oncotic pressure 2. Increase in capillary hydrostatic pressure 3. Lymphatic blockage. |
| What are examples of edema causes in a decrease in blood oncotic pressure? | Liver failure and/or Nephrotic syndrome |
| Congestive heart failure causes edema due to: | Increase in capillary hydrostatic pressure |
| Description of structure of Campylobacter jejuni: | gram negative, oxidase positive, comma-shaped organism |
| What are the most common forms of acquiring C. jejuni? | Consumption of undercooked poultry or contact with infected animals |
| What is a common physical activity associated with C. jejuni infection? | Camping |
| One is one of the MCC of bloody diarrhea? | Campylobacter jejuni infection |
| What are the arterial irrigation of the esophagus? | - Inferior Thyroid artery ---> proximal 1/3 - Bronchial artery and Thoracic Aorta ----> middle 1/3 - Left gastric artery ----> Distal 1/3 |
| Diffuse Esophageal Spasms (DES) is: | Periodic, uncoordinated, non-peristaltic contraction of the esophagus that lead of episodic substernal chest pain accompanied by dysphagia. |
| What is the common sign seen in Barium swallow in a DES patient? | "Corkscrew" esophagus |
| What is the imaging characteristics of Eosinophilic esophagitis? | Endoscopy shoes Esophageal rings and linear furrows |
| What esophageal disorder is suspected in a patient with chest pain, with normal EKG and normal upper endoscopy? | Diffuse Esophageal Spasms |
| What are the common ways of Brucella transmission? | Contaminated dairy products and livestock |
| What are is the common presentation of Brucellosis? | Undulant fever, myalgia, and arthralgia |
| What are the most significant or characteristic findings of Brucellosis? | 1. Undulant fever 2. Strong moldy odor 3. Myalgia and arthralgia |
| Brucell is an: | Gram negative, aerobic, coccobacillus |
| In which structure provides survival of Brucella? | Macrophages of the Reticuloendothelial system |
| What is the common treatment of Brucellosis? | Doxycycline + rifampin (or streptomycin) |
| Bartonella Henselae causes: | 1. Cat Scratch Disease (CSD) 2 .Bacillary Angiomatosis in those immunocompromised |
| What disease is suspected in a AIDS patient with a newly acquired cat as a pet? | Bacillary angiomatosis |
| What is the difference in lymphadenopathy between Brucellosis and Bartonella infection? | Brucellosis is seen with generalized lymphadenopathy and Bartonella henselae is seen with regional lymphadenopathy. |
| What is the characteristic of fever of Borrelia recurrentis? | Fever of 3-5 days with 7-9 days between relapses |
| What is the clinical features of Borrelia recurrentis? | Jaundice, ecchymosis, petechiae, mental status changes, focal neurological findings, and respiratory distress |
| What are the liver test abnormalities in CHOLESTATIC conditions? | 1. Grossly elevated ALP (>140) - Elevated Conjugated (direct) bilirubin - Mildly to normal AST and ALT |
| What are labs seen in Hepatocellular conditions? | 1. Grossly elevated ALT/AST (compared to ALP) - Elevated bilirubin |
| Isolated hyperbilirubinemia is seen with: | - Elevated bilirubin - Normal ALP, AST, and ALT |
| What is the normal levels of ALP? | 20-140 IU/L |
| What are the normal range of AST and ALT? | 8-20 IU/L |
| Which type of Crigler-Najjar Syndrome is the most severe? | Type 1 |
| What is the effective treatment for Type 1 Crigler-Najjar syndrome? | Liver transplant |
| Crigler-Najjar is due to: | Absence of Uridine diphosphate glucuronyl transferase |
| What is the treatment of Type 2 Crigler-Najjar syndrome? | Phenobarbital, as it increases liver enzyme synthesis |
| Which two Hereditary Hyperbilirubinemias are seen with elevated Unconjugated Bilirubin? | Gilbert syndrome and Crigler-Najjar syndrome |
| Elevated Conjugated bilirubin is seen in which hyperbilirubinemias? | Dubin-Johnson syndrome and Rotor syndrome |
| Which hyperbilirubinemia condition is associated with "Dark liver"? | Dubin-Johnson syndrome |
| What are the acute or first symptoms of Vitamin A deficiency? | Night blindness and dry conjunctiva in malnourished and those with measles infection. |
| Which vaccine prevented condition is associated with Vitamin A deficiency? | Measles |
| What is Keratoconjunctivitis sicca? | Stinging, burning, and blurry vision seen with vitamin A deficiency. |
| Which are the two ocular late symptoms of vitamin A deficiency? | Keratoconjunctivitis sicca and Keratomalacia |
| What is Keratomalacia? | Corneal ulceration or melting |
| How is vitamin A absorbed in the GI tract? | Micelle-mediated transport |
| Which type of bilirubin is bounded to Albumin? | Unconjugated bilirubin |
| Bilirubin diglucuronide is seen with: | Conjugated bilirubin |
| What structures drain lymph to the Superior Mesenteric lymph nodes? | Lower duodenum, jejunum, ileum, and colon to splenic flexure |
| What are associated etiologies associated with affected Superior Mesenteric lymph node drainage? | Mesenteric lymphadenitis, Typhoid fever, Ulcerative colitis, and Celiac Disease. |
| Sentinel lymph nodes are associated to with which main lymph drainage? | Superior Mesenteric Lymph nodes |
| Milk-Alkali syndrome is due to: | Chronic use of Calcium Carbonate |
| What are the clinical characteristics of Milk-Alkali syndrome? | Hypercalcemia, metabolic alkalosis, and renal insufficiency. |
| What are characteristic of Hypercalcemia? | Depression, constipation, weakness, fatigue |
| What are possible results of chronic use of Calcium Carbonate? | 1. Milk-Alkali syndrome 2. Rebound Gastric acid hypersecretion |
| What is the clinical profile of Zollinger- Ellison Syndrome? | Multiple gastric and duodenal ulcers, diarrhea, and epigastric pain |
| What kind of Pancreatic tumor is MOST associated with Zollinger-Ellison syndrome? | Pancreatic Gastrinoma |
| Which cells in the stomach produce Gastrin? | G-cells |
| Obstructing Gallstone produces what kind of bilirubinemia? | Obstruction of Common bile duct can lead to Obstructive jaundice because of Conjugated bile cannot pass through the common bile duct. |
| Increased ALP and Increased direct bilirubin levels. Suspect diagnosis? | Cholestasis |
| Metoclopramide is a: | Prokinetic medication as an D-2 antagonist |
| What are the common uses of? | 1. Antiemetic 2. Tx of Diabetic gastroparesis |
| What are some SE of metoclopramide? | - EPS (tremor, akathisia, dystonia, and tardive dyskinesia) |
| Hyperplasia of Brunner glands is associated with which kind of ulcers? | Duodenal |
| Which times at day (periods of day) do Duodenal ulcers cause the most pain? | Nighttime and/or upon waking up in the morning |
| What kind of tissue is seen hyperplastic in duodenal ulcers? | Brunner glands |
| What is Brunner glands function? | Bicarbonate (HCO3-) secreting cells of submucosa of duodenum |
| What are Crypts of Lieberkuhn? | Contain stem cells that replace enterocytes/Goblet cells and Paneth cells that secrete a-defensins, lysozymes, and TNF. |
| What is secreted by Paneth cells? | a-defensins, lysozymes, and TNF |
| Where are Peyer Patches found? | Lymphoid tissue found in the last segment (ileum) of small intestine |
| Peyer Patcher hyperplasia is an common cause of? | Intussusception in pediatric patients |
| A GI infection of the ileum is often accompanied of __________________. | Peyer patches hyperplasia |
| How is Pancreatic adenocarcinoma presented? | 1. Painless jaundice 2. Weight loss 3. Palpable, NON-tender gallbladder (Coursevoir sign) |
| Positive Coursevoir sign is associated with: | Pancreatic adenocarcinoma |
| What is the most important risk factor of Pancreatic adenocarcinoma? | Smoking |
| What kinds of Jaundice is seen with Pancreatic adenocarcinoma? | Obstructive (post-hepatic) jaundice |
| Conjugated bilirubin is: | - Water soluble - Detectable in Urine |
| How do Opioids cause constipation? | Activating mu-receptors in the gut, which slows peristalsis |
| How is opioid-induced constipation prevented? | Use of Senna |
| What is the mode of action of Senna? | Stimulates peristaltic activity in the intestine |
| Describe the rate-limiting step of Fatty Acid synthesis? | Involves carboxylation of Acetyl-CoA to Malonyl-CoA |
| What is the substrate of the rate limiting step in fatty acid synthesis? | Malonyl-CoA |
| What is inhibited by Malonyl-CoA? | CAT I, in the fatty acid degradation, preventing mitochondrial entry of Fatty acids |
| What is the main cause of Renal calculi in Crohn's Disease? | Excess of lipid in the large intestine |
| Which two substances compete for calcium binding in the large intestine in Crohn's disease? | Oxalate and lipids |
| Crohn's disease is seen with __________________ in the urine. | Hypercalciuria |
| The elevated levels of oxalate in urine in Crohn's disease lead to the development of? | Calcium-Oxalate kidney stones |
| What are hepatic adverse effects seen with Antifungal azoles? | Impaired liver function -----> hepatotoxicity |
| Antifungal azoles ____________________ CYP450 system. | Inhibit |
| Propionyl-CoA carboxylase deficiency causes ______________. | Propionic Acidemia |
| What is the clinical profile of Propionic Acidemia? | Neonatal hepatomegaly, seizures, hypotonia, vomiting, poor feeding, and metabolic acidosis with increased anion gap. |
| What are the main lab results seen in Propionic acidemia? | 1. Elevated Propionyl-CoA 2. Decreased Methylmalonic acid |
| What is the Charcot triad? | Fever, RUQ pain, and Jaundice |
| What is the most common treatment of Cholangitis? | IV fluids and antibiotics |
| What is a common cause of Cholangitis? | Common bile duct stones |
| What are the main signs of VIPoma? | - Watery diarrhea - Hypokalemia - Achlorhydria |
| What levels of Potassium are seen in VIPoma? | Hypokalemia |
| What are the functions of VIP? | 1. Increase secretion of water and electrolytes into GI lumen 2. Relaxation of smooth muscle and sphincters. |
| What is achlorhydria? | Absence of hydrochloric acid in gastric secretion |
| The lack of HCL in gastric content is named _______________. | Achlorhydria |
| What are the two MC population/activities that predispose for Giardiasis? | Immunocompromised and Exposure to UNFILTERED water |
| What are the most common treatments for Giardia lamblia infection? | Tinidazole, Nitazoxanide, and Metronidazole |
| What are the most characteristic symptom of Giardiasis? | Chronic and acute diarrhea with bulky fatty stools, as well as nausea and vomiting |
| What is a common connective tissue disease affecting African-American women? | Scleroderma |
| How is the dysphagia in Scleroderma described? | Difficulty to swallow solids and liquids |
| Why does dysphagia occur in Scleroderma patients? | Secondary to atrophy of smooth muscle of the lower 2/3 of the Esophagus and incompetence of the lower esophageal sphincter, leading to reflux |
| Which third(s) of the the esophagus are involved in dysphagia development in Scleroderma patients? | Lower 2/3 |
| Why is there reflux in Scleroderma patients? | Incompetency of the lower esophageal sphincter (LES) |
| What is the MCC of HCC? | HBV infection |
| Which continents are endemic of HBV infection? | Asia and Africa |
| What are some relevant distingctions between HCC caused by HBV and HCV? | HBV-associated HCC occurs in the absence of cirrhosis and at an earlier age than HCV-associated HCC |
| Which type of HCC is associated at a younger age? | HBV-associated HCC |
| Why is HBV - associated hepatocellular carcinoma associated without liver dysfunction and at an earlier age? | HBV DNA directly integrate into the host genome predisposing hepatocytes to neoplastic changes. |
| To which specific condition is Hepatic Encephalopathy most likely due to? | Hyperammonemia |
| What are the clinical signs seen in a patient with Cirrhosis? | Altered metal statues, hepatic encephalopathy (secondary to hyperammonemia). |
| Which biochemical cycle is involved in the conversion of ammonia into urea? | Urea cycle |
| Which organ harbors the metabolism of Ammonia during the Urea cycle? | Liver |
| Which amino acid is responsible to transfer ammonia into the liver? | Alanine |
| Ammonia's amino group is transferred to _____________ in order to form ________________, a precursor in the Urea cycle. | a-Ketoglutarate; GLUTAMATE |
| Common precursor in Urea cycle that involves the transfer of Ammonia amino group to a-KG? | Glutamate |
| Excess ammonia, as seen in Hepatic Encephalopathy, will deplete with amino acid? | a-Ketoglutarate |
| What is the cause of Duodenal atresia? | Failure of recanalization of the GI tract during embryogenesis |
| What word is used to describe the emesis produced by Duodenal atresia? | Intractable |
| Which trisomy is often associated with Duodenal atresia? | 21 |
| Lynch Syndrome is also known as? | HNPCC |
| What is the cause of Lynch syndrome? | Mutation in DNA mismatch repair genes |
| What are other cancers, besides colon carcinoma, associated with Lynch syndrome? | Endometrial, urinary, GI, and female reproductive tract cancers. |
| What is the most common Female reproductive tract cancer associated with Lynch syndrome? | Endometrial carcinoma |
| What is Celiac Sprue disease? | Autoimmune disorder with intolerance to gluten. |
| Clinical picture of Celiac sprue disease patient: | Foul-smelling diarrhea, steatorrhea, decrease weight, fatigue, and abdominal pain, and cutaneous rash |
| What is the skin involvement characteric of Celiac disease? | Dermatitis herpetiformis |
| What is Dermatitis herpetiformis? | Skin disorder with clustered vesicles that often appear in a SYMMETRIC pattern in Celiac sprue patients. |
| Punched-out lesions in the gastric mucosa, should raise suspicion of? | Chronic H. pylori-associated gastric ulcers |
| What organism produces urease that hydrolyse urea to ammonia and carbonate? | H. pylori |
| MC organism involved in presence of gastric ulcers, especially in the antrum of stomach? | H. pylori |
| What is the role of ammonia in H. pylori-associated gastric ulcer? | Acts as an "cloud" to buffer the H. pylori from the acidic environment of the stomach lumen |
| Breath test result Urease +, and patient complains of intermittent postprandial abdominal pain. Suspected diagnosis? | Chronic H. pylori-associated gastric ulcers |
| Severe cases of B-Thalassemia may result in the development of which iron disorder? | Secondary Hemochromatosis |
| What is the main imbalance of Hemochromatosis? | Iron overload |
| Iron overload, often refers to which iron imbalance disease? | Hemochromatosis |
| What is an common therapeutic action of a severe B-Thalassemia patient that develops secondary Hemochromatosis? | Recurrent blood transfusions |
| Which ulcer is associated with increased ICP and parasympathetic activity from trauma or illness? | Cushing ulcer |
| What does the elevated ICP produced by a Cushing ulcer also causes? | Increased stimulation of Vagus nerve |
| Most cases of HCV infected patients are untreated because it goes mostly _________________. | Undetected |
| Over 60-85% of HCV untreated patients will manifest _____________________ hepatitis. | Chronic |
| How is HCV infection defined clinically? | Presence of viral RNA and the absence of antiviral antibodies |
| Which kind of antifungals are often used in local or less severe systemic mycoses? | Azoles |
| Antifungal azoles are CYP450 system ______________________. | Inhibitors |
| Itraconazole is often used in treatment of the following fungal infections: | Blastomyces, Coccidioides, Histoplasma, and Sporothrix schenckii |
| Approximately 70% of Ulcerative colitis patients also present with? | Primary Sclerosing Cholangitis |
| PSC causes: | Periportal fibrosis and ALTERNATING stenosis (and dilations) of hepatic bile ducts |
| PSC is positive for? | p-ANCA |
| Cholecystitis is MCC to? | Obstruction of biliary duct system at the level of the Cystic duct |
| At what is most commonly found the obstruction of Biliary duct system in a cholecystitis patient? | Cystic duct |
| How are the liver function test levels in a patient with Cholecystitis? | Normal to mildly elevated |
| What are the 4 virulence factors seen in Neisseria species? | IgA protease, pilli, endotoxin, and capsule |
| Which virulence factors of Neisseria species cause Nasopharynx colonization possible? | IgA protease and pilli |
| What does the IgA and pili of Neisseria work in causing infectinction? | Via cleavage of immunoglobulin into Fab and Fc fragments |
| Which parasitic infection presents with chronic rash, cough, and eosinophilia? | Strongyloidiasis |
| What is the most commonly used form of diagnosing or identifying a Strongyloides infection? | Microscopic examination of stool for RHABDITIFORM larvae |
| What is larva currens? | Associated rash seen in Strongyloidiasis infection |
| How is pattern of larva currens distinctive? | It reflects the mobilization of the parasite along the affected areas, leaving a serpentine-like pattern of the rash, easy to distinguish. |
| Which part of the colon is always involved in Lynch syndrome? | Proximal colon |
| Microsatellite instability due to mutation of DNA mismatch repair genes is seen in? | Lynch syndrome |
| What is the cause of Kernicterus? | Increased unconjugated bilirubin crossing the Blood-Brain Barrier. |
| To which protein is unconjugated bilirubin bounded in serum? | Albumin |
| Conditions that decrease the amount of Albumin in serum, will indirectly increase the risk of developing which bilirubin related neurological condition? | Kernicterus |
| How does decreased levels of serum Albumin lead to prompt development of Kernicterus? | Less Albumin in blood leads to minimal Albumin-Indirect bilirubin complexes, leading to increase unconjugated bilirubin to cross the BBB. |
| What are two conditions that often lead to Kernicterus? | Serious neonatal illness and preterm baby |
| What is an important risk factor to the development of Duodenal ulcers, not associated with H. pylori and/or NSAID use? | Smoking |
| What is Linezolid? | antibiotic and MAO-Inhibitor used in the treatment of Gram positive species |
| What is the clinical presentation of Serotonin Syndrome? | Autonomic instability, altered mental status, and neuromuscular hyperactivity |
| Which antibiotic is often associated with development of Serotonin syndrome? | Linezolid |
| Esophageal Squamous Cell Carcinoma is most often seen in the ---> | Upper 2/3 of the Esophagus |
| Which kind of Esophageal cancer is associated with the lower third of the esophagus? | Adenocarcinoma |
| Is Squamous cell or Adenocarcinoma, most likely seen in the distal part of the Esophagus? | Adenocarcinoma |
| Esophageal adenocarcinoma stains positive for? | Cytokeratin |
| How is Acute Bowel ischemia often presented? | Acute-onset of abdominal pain out of proportion in physical examination, and with rebound tenderness |
| What is the MCC of acute bowel ischemia? | Thrombotic arterial occlusion |
Created by:
rakomi
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