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Random GI CMI
CM1-Fall 2011
| Question | Answer |
|---|---|
| Role of Cox1? Cox2? | 1 = Regulates GI mucosal integrity 2 = Regulates inflammation |
| Stress gastritis most likely d/t? | Mucosal ischemia d/t decrsd gastric blood flow |
| Is a GU or DU more likely to be H.pylori+? | DU |
| NSAID/ASA use is more likely to cause an ulcer where? | Gastric |
| When does pain occur w/ GU and DU? | GU=soon after meals DU=2-5 hrs after meal |
| Which ulcer is more likely to wake pt up at night? | DU |
| Which ulcer type is more likely to be better with food? | DU (GU may or may not) |
| Early satiety and post-prandial fullness is assoc with? | Dyspepsia |
| Which tests for H.pylori should you use (and they distinguish bw active vs non-active infection) | -Fecal antigen immunoassay -Urea breath test (not serology) |
| What is Zollinger-Ellison syndrome? | Hypergastrinemia and acid hypersecretion d/t gastrin-secreting neuroendocrine tumors |
| Multi-step progression to CA? | Gastritis>Atrophy>Metaplasia>Dysplasia>CA |
| MAJOR risk fx for gastric CA? | H.pylori |
| What is the primary and secondary peristalsis involved w/esophageal swallowing? | Primary- Vagal stretch receptors in the wall of the esoph detect distension and induce a vagovagal response secondary-another wave of peristalsis that clears the food from the esophagus |
| >90% of pts w/barrets esoph have? | Hiatal hernia |
| What is the name of the syndrome involving esophageal perforation into the chest cavity? | Boerhaave's syndrome |
| esophageal rings are assoc w/ what? (in almost all cases)? | Hiatal hernia |
| review hormones in intro to GI :) | :) |
| Cascade of protein breakdown? | Protein>ammonia>urea>Elimination |
| Initial presentation hepatitis? | "Flu-like" |
| Which liver enzyme is also in bone, intest, placenta and needs to be confirmed with what? | Alk Phos -Confirm with GGT |
| What aminotransferases >5000..think? | Acetaminophen |
| Which heptitis has the greatest chance of developing in IVDUs? | HepC |
| The majority of those infected with which hep progress on to chronic dz? | HepC |
| HCV "types" (genotypes)? | 1-6 (70% in US = 1) -1 is the least responsive to tx |
| What is the chief cause of cirrosis and HCC? | Chronic HBV |
| What are the phases of chronic HepB? | 1. Immune tolerant 2. Chronic Hepatits 3. Inactive carrier 4. HBeAg- Chronic hepatitis |
| What is stage 4 of fibrosis? | Cirrhosis |
| What is the most common cause of fulminant hepatic failure? | Acetaminophen poisoning (>10g) |
| Liver enzyme levels in autoimmune hepatitis? | -AST and ALT elevated -Alk Phos and GGT nL -^ bilirubin |
| What is the hallmark of AIH? | Hypergammaglobulinemia (IgG) >2x ULN |
| MC single gene d/o inherited in US? | Hereditary Hemochromatosis (Autosomeal recessive) *HFE gene (^^Iron) |
| Role of transferrin? | Helps carry iron in the body |
| Form that iron is stored in, in body? | Serum ferritin |
| What is the autosomal recessive d/o of copper metabolism? | -Wilson's disease |
| What should you suspect in a young pt with liver failure? | -Wilson's dz (dz of the young: usually 12-23 y.o.s) |
| When might you see Kaysar-Fleischer rings? | Wilson's dz |
| What is the inherited d/o that can cause lung and liver dz? | a-1 antitrypsin deficiency (MM=normal, ZZ=assoc w/ cirrhosis, MZ=lung or liver dz) |
| What is the MC metabolic indication for liver transplant w/ an excellent outcome? | a-1 antotryps deficiency |
| Standards for malnutrition? | 85-90% Mild malnut 75-85% Mod <75% Severe |
| Wt loss concern*? | 10% over 6mo or >10# in 6mo |
| What is the test of choice for protein assessment? | Pre-albumin |
| Top Vitamin defic in US? | VitA,C, Iron, Ca2+ (maybe folic acid, too) |
| What is the only water-soluble vitamin that is substatially stored? | B12 |
| What mineral is involved as a depletion complication of aggressive refeeding? | Phosphorus and Mg |
| What is the relationship bw folic acid and B12? | Folic acid (supps) can mask B12 deficiency |
| What is the relationship bw neomycin and Vit K?> | Neomycin can decrease the absorption of Vit K |
| Vit A deficiency symptoms? | Night blindness, blindness, corneal ulceration, etc other ophthalmic probs |
| Vit A toxicity? | Vertigo, dermatitis, diplopia, seizures, dry skin, glossitis, alopecia, bone demineralization,amenorrhea |
| Vit D (cholecalciferol) defiency? | Rickets - structural abnormalities in growing bones -Osteomalacia and osteoporosis |
| Vit C (ascorbic acid) deficiency? | Scurvy - bleeding gums, petechiae |
| Vitamin B1 aka? Defic? | Thiamine -Beri Beri (common defic in alcoholics) =Weak, anorexia, memory loss, muscle wasting.. |
| Vitamin B2 aka? Symptoms of deficiency? | -Riboflavin -Magenta tongue, cheilosis |
| Vitamin B3 aka? Defic? | Niacin -Pellagra: 4 D's: -Dermatitis, Dementia, Diarrhea, Death (sun=Casal's necklace) |
| What happens w/ iodine defic? | Mom gives birth and child has Cretinism = severe MR |
| Glucocorticoids can cause weight gain, central fat, and what else? | Decrsd protein synthesis |
| What is the state of general protein deficiency called? | Kwashiorkor |
| What is recognized as the most common chronic liver dz in the western world? | NAFLD (major RF=obesity) |
| What are the probable primary pathogenic fxs in steatosis? | Insulin and leptin resistance |
| 2ndary causes of NAFLD? | Polycystic ovary syndrome, drugs, toxins, nutritional |
| When would you see acanthosis nigrans? | NAFLD |
| What is the test that uses US waves to measure the liver stiffness in NAFLD? | Fibroscan (transient elastography) [Reliable for assessing liver fibrosis] |
| Assessing maladaptive patterns of alcohol use? | RISK of bodily harm; RELATIONSHIP TROUBLE; ROLE FAILURE; RUN-INs w/ the law |
| Which vitamins are recommended for chronic alc liver dz assoc w/PCM? | -Thiamine and folate |
| TX options for severe alc hep? | Corticosteroids, pentoxifylline (may decrs renal failure) |
| Initial treatment therapy for ascites? | Na+ restriction (diuretics?) |
| Transudate vs. exudate in ascites? | Transudate=low protein=liver failure Exudate=high protein=CA |
| Surveillance in cirrhosis is done with an ultrasound q6mo..why? | HCC dbling time = 6mo |
| What are the early lesions called from which most CRCs arise? | Adenomatous polyps |
| Who gets CRC? | MC is sporadic! -Familial, genetic predisposition |
| What is the time for devt of adenomas to CA? | ~7-10 yrs |
| Which other CAs are assoc w/CRC and what should be done? | Ovarian and endometrial CAs -Screen q5 yrs beginning at age 40 |
| Familial adenomatous polyposis involves? | >100 polyps |
| Colonoscopy = preferred test for CRC, start at age 50, except for? | Af Ams start at age 45 |
| Screening rec's for pts with h/o colitis? | Initiate screening 8-10 yrs after the onset of sxs of colitis/IBD; colonoscopy q1-2 yrs |
| What glycoprotein test can be used if pt has KNOWN CRC and rises usually w/ CR tumor cells that have penetrated thru the bowel wall? | CEA |
| What odd things may decrs risk of UC? | Smoking, appendectomy |
| Bloody diarrhea is hallmark of dx for which IBD? | UC |
| String sign in which IBD? | CD |
| Loss of haustral markings in which IBD? | UC |
| Toxic megacolon in? | UC |
| Bile stones, kidney stones, canker sores, and erythema nodosum complications of? | CD |
| Which symptom implies proximal bowel involvement? | Vomiting |
| Vomiting w/o diarrhea cannot be called what? | Gastroenteritis |
| MC bacterial cause of toxigenic infectious diarrhea? | E.coli |
| 50-70% of all infectious viral diarrhea? | Norwalk Virus |
| Stool characteristics of SB issues? | -Watery -Large amount -Frequent -Not usually bloody |
| Stool characteristics of LB issues? | -Mucoid/bloody -Small -frequent -possibly grossly bloody |
| Which is the "common human bacteria" that results from toxin produced in contam food stored at room temp? | Staph aureus |
| Which pathogen is considered the "cafeteria germ" and results d/t food make in large quantities.."24-hr flu"? | Clostridium perfringens |
| Pathogen produced in improperly canned foods and can be fatal? | Clostridum botulinum (progressive paralysis of resp system) |
| Which FBI pathogens can be FATAL? | Clostridium botulinum, E coli, Listeria monocytogenes, Salmonella |
| common cross-contam pathogen? | Salmonella |
| Which pathogen may not make you "sick" for up to 30 days post ingestion? Also can result in fetal loss, (usually hospitilization), relation to mexican chz and frts? | Listeria monocytogenes |
| Human fecal matter pathogen? | Shigella |
| Parasite seen in wide game and causes muscle wkness? | Trichinosis parasite |
| What is most likely to rebleed? | Esophageal varices |
| MC cause of UGI bleed? | GU/DU |
| MC cause of true LGI bleed? | Diverticulosis |
| What can "stimulate" melena? | Bismuth, iron (and CHECK TONGUE!) |
| What is a very sensitive test for GI bleeds? | Technicium-labeled RBC scan |
| primary management of acute GI bleed? | O2, Intubate?, IV, cardiac monitor, transfuse?, NG! |
| Rovsing's sign? | Palpate LLQ and causes RLQ pain |
| RFs for cholecystitis/lithiasis? | Fat, Female, Fertile |
| If suspect cholecystitis/lithiasis and tests are not adding up, can do? | Hida Scan--Radionuclide IV isotope given....taken up by NL gb, but not in cholecystitis d/t inflamm |
| Charcot's triad? | For ascending cholangitis: Fever, Jaundice, RUQ pain; life-threatening bc bacteria get into hepatic vein and to systemic circulation |
| When to do plain Xray (flat and upright) for abd pain? | -Perf ulcer (looking for free air) -SBO |
| Pancreatitis and hypoCa2+? | Inflammed pancreas may suck in all Ca2+ |
| VODKA? | BO: Vomiting, Obstipation (not passing stool or gas), Distention, Krampy Abd pain |
| Thumb-printing? | Ischemic bowel on XR showing bowel wall thickening |
| Collins sign? | Pain w/ cholelithiasis that radiates to the right scapular tip |
| Medication that helps dissolve gallstones? | Ursodiol |
| Cholecystitis is differentiated from biliary colic how? | constant severe pain for >6hr |
| MC cause of cholangitis? | Choledocholithiasis |
| Pancreatic enzymes packaged into storage vescicles called? | Zymogens |
| Discomfort is more intense when in pancreatitis? | Supine postition |
| Cullens and Turner signs in acute pancreatitis? | C=bluish discoloration around umbilicus T=bruising of the flanks |
| MC causes of chronic pancreatitis? | Adults=alcohol Kids=CF |
| DX of chronic pancreatitis? | -Secretin stimulation test -MRCP |
| Intermittent/bolus tube fding is only suitable for? | Gastric feedings (NG or PEG) |
| In PN, what are the forms of fat, protein, chos? | TGs, Free aa's, Dextrose |
| Allergies assoc with PN? | Eggs, soy (d/t the lipids) |
| In PN, bicarb is not stable, and is replaced w/? | Acetate |
| Possible prophylactic to prevent phlebitis w/PPN? | Heparin and hydrocortisone?? |
| What complication is more commin w/femoral hernias? | Incarceration bc smaller opening |
| MC abscesses? | Perianal (complication = fistula formation) |
| MC sources for supralevator abscess? | PID, Diverticulitis, Appendicitis |
| For risk of perforation, avoid what in diverticulitis? | NSAIDs, Steroids |
| Studies suggest that a diet high in what can help prevent progression of diverticulosis? | Fiber |
| Vitamins that should be supp to alcoholics? | Folic acid, thiamin, vit B12, vit K |
| No what with celiac dz? | Wheat, Rye, Barley, Oats |
| Colon CA RFs? | -Low Ca2+ and folic acid -Alcohol(beer) -High meat intake -Obesity |
Created by:
ferrier.kath
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