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Gastrointestinal

FA review Round 1 2020

QuestionAnswer
What type of drug is Metoclopramide? Dopamine antagonist; Prokinetic medication
What are the clinical uses for Metoclopramide? 1. Antiemetic 2. Treatment of Diabetic gastroparesis
What are the most significant adverse effects of Metoclopramide? Involuntary movements
Which antiemetic is associated with Extrapyridimal effects? Metoclopramide
What is a very important protein pancreatic substance? Trypsin
What is the result of the appropriate conversion of Trypsinogen into Trypsin? Autolysis and Necrosis in pancreatitis
Is the saliva hypotonic or isotonic at high flow rates? Isotonic
Hypotonic or Isotonic saliva at slow flow rates? Hypotonic
Why is saliva hypotonic at slow flow rates? Due to the fact that ductal epithelium has more time to modify secretion by reabsorbing Na+ and Cl-, and secreting K+
Which important electrolyte secretion is increased at high saliva flow rates? HCO3-
A person with a slow flow rate of saliva, will have: Hypotonic saliva due to increased reabsorption of Na+ and Cl-, and the increase secretion of K+
Which electrolyte is found to be more secreted in slow flow rate of saliva? K+
Which common electrolytes are increasingly reabsorbed in a person with a slow flow rate of saliva? Na+ and Cl-
What is Esophagectomy? Partial resection of the esophagus
Which part of the esophagus is more likely to develop Esophageal cancera? Distal (lower) 1/3 of esophagus
What is the arterial irrigation body of the distal 1/3 of the Esophagus? Left Gastric artery
What artery supplies the Proximal 1/3 of the esophagus? Inferior Thyroid artery
What part of the Esophagus is irrigated by the Inferior Thyroid artery? Proximal 1/3
Arterial blood supply to the middle 1/3 of the esophagus is done by the: Bronchial artery and Thoracic aorta
Which part of the Esophagus is irrigated by the Bronchial artery and the Thoracic aorta? Middle 1/3
What is the main associative underlying condition of Primary Sclerosing Cholangitis (PSC)? Ulcerative colitis
What biliary condition is highly associated with Ulcerative colitis? Primary Sclerosing Cholangitis (PSC)
What causes PSC? Periportal fibrosis and alternating stenosis of hepatic bile ducts
Which two viral families have a (+)-sensed, single-stranded RNA virus with non-enveloped, icosahedral capsid? Caliciviridae and Picornaviridae
What is the genetic make up of the Calicivirus? Positive sense, ssRNA virus with non-enveloped, icosahedral capsids
What causes Hepatic Encephalopathy? A setting of chronic liver disease because of buildup of ammonia and the resulting of neurologic function
What is Hepatic Encephalopathy? Neurological dysfunction due to ammonia buildup in the brain, in a patient with chronic liver disease
What is the main treatment option (drug) for Hepatic Encephalopathy? Lactulose
What is the MOA of Lactulose? Acidifying contents and reducing absorption of ammonia from the bowel
What condition is often treated with Lactulose? Hepatic Encephalopathy
What medication works by acidifying contents and reducing absorption of ammonia from the bowel? Lactulose
What causes the infertility in Cystic fibrosis? Result of inadequate mesonephric duct development
The inadequate mesonephric duct development is important in cystic fibrosis because? It leads to the infertility seen in CF
Defect in gene that encodes for the protein HFE. Dx? Hereditary hemochromatosis
What is the result of a mutated HFE protein? Increase efficiency of Iron absorption and hepatic iron (Fe) storage.
What are the levels of serum transferrin saturation, iron, and ferritin elevated or decreased in Hemochromatosis? Elevated
Which iron serum lab is decreased in hemochromatosis? TIBC
- Elevated serum transferrin saturation, serum iron, and serum ferritin. - Decreased TIBC Dx? Hereditary hemochromatosis
What is the most common treatment for Amebiasis? Metronidazole
What are the clinical signs of Amebiasis? Fever, abdominal pain, and liver mass detected on ultrasound
What is the description of diarrhea in amebiosis? Bloody mucoid diarrhea and recent travel to a developing country
How does the endotoxin of V. cholerae work? Permanently activates Gs protein, resulting in an excess of cAMP, which leads to a profuse watery non-bloody diarrhea.
V. cholerae diarrhea description: Rice-watery stools
What is the description of Rice water diarrhea due to V. cholerae? Watery stools with flecks of mucus
Where in the GI tract is Iron (Fe) absorbed? Duodenum
Which metal or mineral is primarily absorbed in the Duodenum? Iron (Fe)
What condition can be due to poor absorbed Iron in the doudenum? Microcytic anemia
Increasing polyp malignancy: Tubular< Tubulovillous < Villous
Do larger or smaller polyps are more common to become malignant (adenocarcinoma)? Larger
True or False. Larger polyps have greater chance of becoming malignant. True
What is the definition of Attributable risk? Risk between exposed and unexposed groups of developing disease
What type of study often calculates attributable risk? Cohort studies
What is the equation of Attributable risk (AT)? a c -------- - ---------- (a + b) (c + d)
Common bile ducts stones are often due to: Direct hyperbilirubinemia
What are clinical features of Cholangitis? Ascending bacterial infection that results in fever, RUQ pain, and jaundice
What condition is associated with Charcot triad? Cholangitis
What is the treatment for common bile duct stones that are causing evident obstruction ERCP? IV fluids and antibiotics
(+) anti-HBs (+) anti-HBc Dx? Patient completely recovered from a Hep B viral infection
What damage or injury is seen in hepatic cells with an Acetaminophen overdose? Centrilobular necrosis
What cause centrilobular necrosis in Acetaminophen overdose? It overwhelms the normal metabolic systems, leading to metabolism by P5450 system and resulting in centrilobular necrosis
What are the classical findings of TEF with Esophageal atresia? Choking, coughing and air bubble on stomach x-ray.
What are associations that are often seen with TEF with esophageal atresia (EA)? 1. Vertebral anomalies 2. Anal atresia 3. Cardiac defects 4. Tracheo-Esophageal fistula 5. Renal and GU anomalies 6. Limb deformities
Congenital condition that shows a constricted colon that prevents the passage of stool into the anus. Hirschsprung disease
What are the two main clinical signs indicating Hirschsprung disease? 1. Failure to pass meconium in the 1st 24 hours 2. "Squirt sign"
X-ray description of Hirschsprung disease findings. Dilated loops of bowel and absence of gas in the rectum
Which condition is seen on x-ray with a dilated rectum? Anal atresia
What part of the GI tract is most affected by Chron's disease? Terminal ileum
Resection of Ileum in treatment of Crohn's disease may lead to: Decreased bile acid reabsorption and increased formation of cholesterol stones due to decreased lipid emulsification
What causes the formation of cholesterol stones in Crohn's disease patients? Decreased lipid emulsification due to decreased bile acid reabsorption in the ileum
Condition seen with overproduction of NADH, leading to an increased NADH: NAD+ ratio. Acute Ethanol intoxication
Which metabolic product is seen produced in excess in acute ethanol intoxication? NADH
What is the result of the elevated NADH:NAD+ ratio in alcohol intoxication? Increases the conversion of Pyruvate to lactate and limits available Pyruvate for Gluconeogenesis
What are metabolic signs of Acute Ethanol Intoxication? Hypoglycemia and high anion gap metabolic acidosis
Where are Paneth cells found? Crypts of Lieberk├╝hn in the small intestine
What is a common pathogen that is combated with secretions of the Paneth cells? C. difficile
What is secreted by Paneth cells? alpha-defensins, lysozymes, and TNF
What is the histological WBC resemblance of Paneth cell secretions? Eosinophilic appearance
What cells are found in the crypts of Lieberkuhn in the small intestine? Paneth cells
Classic presentation in vignette of a Diverticulitis paient? Elderly patient with acute onset of Lower Left Quadrant (LLQ) pain and a history of constipation or painless rectal bleeding
Once the acute symptoms of Diverticulitis are controlled, what other measure should be taken in an elderly patient? Colonoscopy to rule-out malignancy
What lab measure is elevated in Hepatocellular carcinoma? AFP
Which hepatitis virus is highly associated with development of HCC? Hepatitis C virus
MOA of Infliximab: Binds and neutralize TNF-alpha
What inflammatory cytokine is found in high concentration in Crohn disease? TNF-alpha
Monoclonal antibody drug that binds and neutralizes TNF-alpha in Crohn patients. Infliximab
Genetic makeup of Hepatitis E virus: Non-enveloped, single stranded-RNA virus with icosahedral capsid
Is hepatitis E virus, enveloped or non-enveloped? Non-enveloped
Hepevirus are Positive or Negative sensed? Positive
Condition due to persistence of Vitelline duct. Meckel diverticulum
What congenital condition is featured by attaching the Vitelline duct to the Ileum? Meckel diverticulum
What are the clinical manifestations of Meckel diverticulum? Melena or intestinal obstruction caused by intussusception or volvulus
What is histological key finding in Meckel diverticulum? Heterotrophic gastric and/or pancreatic tissue
What is Strongyloidiasis? Parasitic infection that presents with chronic rash, cough and eosinophilia
What is the most common test to diagnose Strongyloides? Stool sample for Rhabditiform larvae
What condition is associated with Larva currens? Strongyloidiasis
What is Larva currens? Mobile, erythematous urticarial plaques on eh feet, buttocks, upper thighs, and lower abdomen
What causes the characteristic serpentine description of Larva currens? Larvae movement in the dermis
What are the two main signs and/or symptoms suggesting Pancreatic cancer? 1. Painless jaundice 2. (+) Courvoisier sign (Palpable gallbladder)
What jis the Courvoisier sign? Palpable gallbladder
What malignancy is associated with painless jaundice and a palpable gallbladder? Pancreatic cancer
What are common symptoms that indicate common bile duct and Pancreatic duct obstruction in Pancreatic cancer? Jaundice and new onset diabetes mellitus in late stage of disease
A person with asymptomatic jaundice, develops new onset of diabetes, without any previous risk factors . Suspected Dx? Pancreatic cancer
What is the intestinal affection of Giardiasis trophozoites? Small bowel inflammation and villous atrophy
Small bowel inflammation and villous atrophy are common bx findings of which diarrheic condition? Giardiasis
What is common function of Malonyl-CoA? Inhibition Of CAT I in Fatty acid degradation, preventing mitochondrial entry of fatty acids
What substrate is seen with low levels in a person with Acetyl-CoA carboxylase deficiency? Malonyl-CoA
What is the role of Acetyl-CoA carboxylase? Conversion of Acetyl-CoA into Malonyl-CoA
Acetyl-CoA carboxylase is essential in synthesis of : Fatty acids
What is another way to refer to Hereditary Non-polyposis Colon cancer? Lynch syndrome
AD condition, that has increased risk of colorectal cancer and other types included those found in GI, urinary, and female reproductive organs Lynch syndrome
What is a common manifestation of chronic pancreatitis? Malabsorptive diarrhea
What causes malabsorption in the setting of chronic pancreatitis? Pancreas is no longer able of secreting aduacque amounts of amylase and lipase
Which enzymes are seen decreased in Pancreatic malabsorption? Amylase and Lipase
What is the main function of Pancreatic amylase and lipase? Digestion of carbohydrates and lipids
What is the best test for malabsorptive diarrhea? 72-hour fecal fat collection
What enzyme is inhibited by Citrate? PFK
What is known to inhibit PFK? Citrate
What is the role or function of PFK? Acts as rate-limiting step of carbohydrate metabolism in glycolysis
What is the main adverse effect of 6-MP? Leukopenia
The leukopenia caused by the use of 6-MP, leads to: Increased susceptibility for infection
What is the Chvostek sign? Facial muscle twitch that occurs on tapping over CN VII on the cheek
What serum imbalance is tested with a (+) Chvostek sign? Hypocalcemia
Acute pancreatitis is seen with hyper- or hypocalcemia? Hypocalcemia
What condition is associated with Celiac Sprue ? Dermatitis herpetiformis
Dermatitis herpetiformis is seen in _____________________ patients. Celiac disease
Description of Dermatitis herpetiformis Pruritic, vesicular rash on the extremities
How does the V. cholerae exotoxin work? Permanently activates Gs protein, resulting in excess cAMP, which produces profuse non-bloody, watery diarrhea
V. cholerae mode of action causes increased concentration of cAMP or cGMP? cAMP
What protein is permanently activated by V. cholerae exotoxin? Gs protein
What is the medication or treatment for Acetaminophen overdose? N-Acetylcysteine (NAC)
NAC is a reducing or oxidizing agent, that treats Acetaminophen OD? Reducing agent
MOA of N-Acetylcysteine: Generates glutathione that binds to toxic NAPQI generated
Which antidote medication is known to work by regenerating glutathione? N-Acetylcysteine (NAC)
What is generated by NAC? Glutathione
Ranitidine is an H1 or H2-blocker? H2-blocker
MOA of Ranitidine Reversible block Gs-coupled H-2 receptors to decrease hydrogen ion (H+) secretion by the Parietal cells
On which stomach cells does Ranitidine work on? Parietal cells
Ranitidine mode of action reduces the secretion of what in Parietal cells? Hydrogen ion (H+)
What is Budd-Chiari syndrome? Nearly complete obstruction of blood flow by an acute clot in hepatic veins or IVC, causing centrilobular congestion and necrosis in the liver
Budd-Chiari syndrome, is a condition of the liver or gallbladder? Liver
What vessels are involved in Budd-Chiari syndrome Hepatic veins and/or IVC
What type of conditions increase the risk of developing Budd-Chiari syndrome? Hypercoagulable states
What are two very common examples of Hypercoagulable states, ath often lead to Budd-Chiari syndrome? Antiphospholipid antibody syndrome and Polycythemia vera
Which rare liver condition is associated by vessel blockage in a hypercoagulable state? Budd-Chiari syndrome
Which is more severe, Crigler-Najjar type I or type II? Type I
Which type of Crigler-Najjar syndrome responds well to Phenobarbital? Type II
How is the common manifestation of Gastric ulcers? Punched-out lesions with scar tissue and chronic inflammatory cells
Histological description of Gastric ulcers Regular, sharply-demarcated borders and smooth base filled with exudate
What infection is highly associated with Gastric ulcers? H. pylori
What are the HLA-B27 diseases? 1. Psoriasis 2. Ankylosing spondylitis 3. Inflammatory Bowel diseases (Crohn's and UC) 4. Reactive arthritis
What are the slow waves? Rhythmic depolarization and repolarization of the smooth muscle cells within the muscularis propria of the stomach and intestines
Depolarization and repolarization of smooth muscle cells in the muscularis propia of the stomach and intestines Slow waves to the GI tract
What are common symptoms and clinical clues for Laryngeal squamous cell carcinoma? Hoarseness primarily, as well as dysphagia and loss of weight
What are the two most important factors for Squamous cell carcinoma of the Larynx? Tobacco smoking and chronic alcohol abuse
Which trisomy is associated with Duodenal atresia? Trisomy 21 (Down syndrome)
What is the cause Duodenal atresia? Failure of recanalization of the GI tract during embryogenesis
On which weeks is duodenal atresia developed? 8-10th week of gestation
Classica X-Ray sign or finding of Duodenal atresia? Double-bubble sign
An abdominal x ray showing a "double-bubble" sign. Dx? Duodenal atresia
What type of emesis is seen in babies with Duodenal atresia? Bilous and Non-bilious
In Jejunal or Ileal atresia the emesis is only __________________ content Billous
What are the EXTRAINTESTINAL manifestations of Crohn disease? 1. Uveitis 2. Migratory Polyarthritis 3. Erythematous nodosum 4. Renal calculi
What are the GI manifestations of Crohn disease? "Skip lesions", granulomas, Fistulas, and structures
Arterial supply of the Midgut Branches of the SMA
Venous drainage of the Midgut Superior Mesenteric vein
What is the lymphatic drainage of the Midgut? Superior Mesenteric nodes
Which is has its lymph drained by the Superior Mesenteric nodes, the Foregut, Midgut, or Hindgut? Midgut
What is another name for the Superior Mesenteric nodes? Sentinel lymph nodes
Which GI hormone is known o oppose the effects of increased acid in stomach? Secretin
What are the actions of Secretin? 1. Oppose effects of increased stomach acid levels 2. Increase Pancreatic and BIliary bicarbonate secretion
How does secretin oppose the effect of increased acid by the stomach? Increasing Somatostatin and PGE2 production in the intestinal mucosa
What is the most common clinical presentation of a child with a Meckel diverticulum? Asymptomatic rectal bleeding
In symptomatic cases of Meckel diverticulum, the patient may develop? Intestinal obstruction, acute abdominal pain, and intussusception, along with asymptomatic rectal bleeding
Persistence of Omphalomesenteric (Vitelline) duct. Dx? Meckel diverticulum
What are some intestinal characteristics of UC? Basal plasmacytosis, Crypt abscess, Mucosal erosion, and ulcers
Does Crohn or UC present with friable mucosal polyps with freely hanging mesentery? Ulcerative colitis
Crohn disease of UC present with Rectal involvement? Ulcerative colitis
Non-caseating granulomas and rectal sparing, UC or Crohn disease? Crohn disease
What is intussusception? Proximal segment of bowel telescopes into distal segment
What are clinical signs or symptoms seen with Intussusception? Intermittent, colicky pain in young children, otherwise health
What are the X RAY of Intussusception findings? Dilated loops of the small bowel
What is Whipple disease? Condition with the presence of numerous foamy macrophages in the lamina propria of small intestine
What type of stain is used to see macrophages in Whipple disease? Hematoxylin and Eosin stain
What infection causes Whipple disease? Tropheryma whipplei bacteria
What features and characteristics of Whipple disease? Diarrhea, steatorrhea, lose weight, weakness, and vitamin and mineral deficiencies due to mlpstopmotion
What are the three main type of deficits or defects seen in Whipple disease? Cardiac, Arthralgias, and Neurologic symptoms
What are the histological findings of Celiac sprue? VIllous flattening and lymphocytic infiltrate
Where is IgA located? Breast milk, which supports infant immune function
What GI structures secrete IgA ? Peyer Patches
Where is the strongest anti-emetic available? Ondansetron
What conditions are treated with Ondansetron? Chemotherapy-induced nausea and vomiting
MOA of Ondansetron Block 5-HT3 (serotonin) receptors
What common medication used as adjuvants in the treatment of Hepatitis C infection? Ribavirin and Pegylated interferon
What is the associated adverse effect of Pegylated interferon? Flu-like sequelae and depression
What is the associated adverse effect seen with Ribavirin? Hemolytic anemia
Diverticulitis is due to: Increased intraluminal pressure that can lead to microperforations of the diverticulum
What condition is seen with elevated intraluminal pressure in the diverticulum with risk of microperforations? Diverticulitis
What are the common or characteristic CT findings of Diverticulitis? 1. Bowel wall thickening with enhancement 2. Significan Pericolic Fat stranding
CT finding --> Pericolic fat stranding along the GI structure. Possible dx? Diverticulitis
Sudden-onset abdominal pain out-of proportion to physical exam findings with rebound tenderness. Dx? Acute Bowel Ischemia
What is the MCC of acute Bowel ischemia? Thrombotic arterial occlusion
What is the most common artery affected in acute Bowel Ischemia? Superior Mesenteric artery
What are the tumor markers for Pancreatic cancer? CA19-9 and CEA
(+) CA19-9 indicate recurrence of which type of cancer? Pancreatic cancer
True or False. Tumor markers are used as diagnostic tools. False. Tumor markers only serve to monitor recurrence and evaluate therapy response
What is the drainage of External hemorrhoids? Inferior rectal vein drains into the IVC
Which type of hemorrhoids have drainage of venous blood form the Inferior rectal vein into IVC? External hemorrhoids
What is choledocholithiasis? Stone obstruction of the Common Bile duct
What are the clinical features of Choledocholithiasis? 1. Constant RUQ pain 2. Jaundice 3. Abnormal LFTs
What are the characteristic LFTs of Choledocholithiasis? Extremely elevated ALP Elevated Bilirubin Mildly elevated to normal AST and ALT
Which LFT measure is the most elevated in Choledocholithiasis? ALP
Levels of AST and ALT in stone obstruction of the common bile duct are: Mildly elevated to normal
Created by: rakomi
 

 



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