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Gastrointestinal
FA review Round 1 2020
| Question | Answer |
|---|---|
| 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 Lieberkühn 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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