Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI Boards November 20th 2024 > Colon Cancer, Polyps, IBD > Flashcards

Colon Cancer, Polyps, IBD Flashcards

1
Q

If a patient has ≥10 ADENOMATOUS polyps on a SINGLE colonoscopy, what should be TESTED for?

A

GENETICS for POLYPOSIS syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

If a patient has ≥20 ADENOMATOUS polyps on CUMMULATIVE colonoscopies, what should be TESTED for?

A

GENETICS for POLYPOSIS syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If a patient has ≥2 HAMARTOMATOUS polyps on CUMMULATIVE colonoscopies, what should be TESTED for?

A

GENETICS for POLYPOSIS syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

AUTOSOMAL DOMINANT, APC gene (5q21), HUNDREDS of adenomatous polyps, COLON CANCER at YOUNG AGE (39)?

A

Familial Adenomatous Polyposis (FAP) - colon cancer at age 39)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

At what AGE do patients with APC gene (5q21) begin to make colon polyps?

A

15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

OSTEOMAS (skull, long bones, between teeth), SKIN tumors (fibromas, lipomas, epidemoid cysts), EYE (CHRPE lesions), THYROID cancer, HEPATOBLASTOMA, ANGIOFIBROMA are found with what POLYPOSIS syndrome?

A

FAP (AD APC gene 5q21)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can you see on BIOPSY of the NORMAL-APPEARING colon of an FAP patient BEFORE polyps occurr (APC 5q21)?

A

MICROADENOMAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Who should be SCREENED in FAP and how frequently?

A

Test AFFECTED person 1st (father, etc) if suspecting child has it
If father has it, check APC GENE TEST of child at age 10-12
YEARLY COLONOSCOPY
(pretest counseling, informed consent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment for FAP?

A

COLECTOMY (age 15-25)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the POST-COLECTOMY follow-up of an FAP patient?

A

IF POUCH - YEARLY FLEX SIG
EGD for UGI polyps YEARLY (duodenal cancer)
THYROID
DESMOIDS - imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

At what LOCATION on the APC gene are the FAP mutations?

A

CENTER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

At what LOCATION on the APC gene are the ATTENUATED FAP mutations?

A

5’ and 3’ (at both ENDS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A patient that seems to have FAP but instead of HUNDREDS to THUSANDS of ADENOMATOUS polyps, they have < 100 and usually in the ASCENDING RIGHT COLON?

A

ATTENUATED FAP (AD colon cancer at 51)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the SCREENING and TREATMENT for ATTENUATED FAP?

A

GENETIC TESTING of ALL FAMILY MEMBERS (pedigrees)
COLONOSCOPY q1-2 years in LATE TEENS
COLECTOMY when too many adenomatous polyps are found

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A patient that PRESENTS with findings of FAP or ATTENUATED FAP, AUTOSOMAL RECESSIVE inheritance, can also have UGI (duodenal polyps, cancer) and ASSOCIATED with BREAST, OVARIAN, URINARY and SKIN CANCERS (no osteomas, desmoids, thyroid or CHRPE - eye)?

A

MAP (AR MUTYH Associated Polyposis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HUNDREDS of colon polyps, with associated BREAST, OVARIAN, URINARY and SKIN cancers?

A

MAP (AR MUTYH Associated Polyposis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

HUNDREDS -THOUSANDS of colon polyps with associated OSTEOMAS, DESMOID tumors, THYROID cancer and CHRPE?

A

FAP (AD thousands) or ATTENUATED FAP (AD hundreds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

FAP presentation with BRAIN (MEDULOBLASTOMA)?

A

CRAIL’s SYNDROME (APC gene)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

LYNCH presentation with BRAIN (GLIOBLASTOMA)?

A

TURCOT’s SYNDROME (MMR gene - mismatch repair)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Can PEUTZ-JEGHER patients develop polyps in the ESOPHAGUS?

A

NO (arborization and muscle fibers in hamartomas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

STK11 GENE mutation is associated with which POLYPOSIS SYNDROME?

A

PEUTZ-JEGHERS (AD 19p13)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which POLYPOSIS SYNDROME is associated with Small Bowel INTUSUSCEPTION?

A

PEUTZ-JEGHERS (AD 19p13)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

POLYPOSIS SYNDROME associated with CANCERS of the BREAST, OVARY (MAP), PANCREAS, LUNG, CERVICAL (adenoma malignum) TESTICLES?

A

PEUTZ-JEGHERS (AD 19p13)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

This POLYPOSIS SYNDROME is associated with PREMATURE ADOLESCENCE of MALES due to SERTOLI CELL TESTICULAR TUMORS?

A

PEUTZ-JEGHERS (AD 19p13)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which POLYPS should be REMOVED in patients with PEUTZ-JEGHERS?

A

All STOMACH & COLON polyps >5 mm
All SMALL BOWEL polyps >10 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which POLYPOSYIS SYNDROME requires YEARLY surveillance with EGD, COLONOSCOPY, EUS/MRI, SB imaging, MAMMOGRAM, PELVIC/PAP, TESTICULAR exam?

A

PEUTZ-JEGHERS (AD 19p13)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the DIFFERENCE in NUMBER of POLYPS between JUVENILE POLYPS and JUVENILE POLYPOSIS?

A

1-2 POLYPS found in JUVENILE polyps
>5 POLYPS in JUVENILE POLYPOSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which of ALL the POLYPOSIS SYNDROMES is AUTOSOMAL RECESSIVE (both gene copies needed for expression from mom and dad)?

A

MAP (MUTYH Associated Polyposis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Mutations in the SMAD4 and BMPR1A genes with POLYPS that are EDEMATOUS and CYSTIC histologically?

A

JUVENILE POLYPOSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

In patients with JUVENILE POLYPOSIS (>5 polyps) with EITHER SMAD4 or BMPR1A mutations, what SURVEILLANCE is REQUIRED and at what age?

A

EGD/COLONOSCOPY starting at age 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which of the TWO JUVENILE POLYPOSIS MUTATIONS require AVM SCREENING in BRAIN/LUNGS as well as EGD/COLONOSCOPY?

A

SMAD4 (also causes HHT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

This HAMARTOMAROUS disease is caused by a mutation of the PTEN gene, causes GANGLIONEUROMA POYLPS in colon, BREAST CANCER, THYROID CANCER, COLON CANCER, CEREBELLAR GANGLIOCYTOMA, SKIN HAMARTOMAS, MACROCEPHALY?

A

COWDEN’s SYNDROME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What surgical procedure INCREASES one’s risk for COLON CANCER?

A

URETERO-SIGMOIDOSTOMY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

FAMILY HISTORY, RED MEAT, PELVIC Radiation therapy, DERMATOMYOSITIS, STREP BOVIS, ACROMEGALY, METABOLIC SYNDROME, CHOLECYSTECTOMY, I1307K APC mutation, CHOLECYSTECTOMY are all ASSOCIATED with?

A

HIGHER RISK of COLON CANCER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Accumulated somatic mutations in APC, K-RAS, DCC18q, p53 cause what?

A

COLORECTAL CANCER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which are the TWO types of PRE-CANCEROUS colon polyps?

A

ADENOMAS
SERRATED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the THREE types of SERRATED colon polyps?

A

Hyperplastic (benign)
Sessile serrated adenoma
Traditional serrated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Colonoscopy: NO POLYPS, surveillance?

A

10 YEARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Colonoscopy: ALL < 10 mm; 1-2, 3-4, 5-10 ADENOMATOUS POLYPS, surveillance?

A

1-2: 7-10 YEARS
3-4: 3-5 YEARS
5-10: 3 YEARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Colonoscopy: ≥ 10 mm ADENOMATOUS POLYP, surveillance?

A

3 YEARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Colonoscopy: ANY SIZE ADENOMATOUS POLYP with “VILLOUS” HISTOLOGY, surveillance?

A

3 YEARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Colonoscopy: ADENOMATOUS POLYP with HIGH-GRADE DYSPLASIA, surveillance?

A

3 YEARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Colonoscopy: >10 ADENOMATOUS POLYPS, surveillance?

A

1 YEAR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Colonoscopy: ≥ 20 mm ADENOMATOUS POLYP PIECEMEAL REMOVAL, surveillance?

A

6 MONTHS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

TIER 1 AVERAGE RISK COLORECTAL CANCER SCREENING?

A

COLONOSCOPY q10 YEARS
or ANNUAL FIT testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

TIER 2 AVERAGE RISK COLORECTAL CANCER SCREENING?

A

VIRTUAL COLONOSCOPY q5 YEARS
or FLEX SIG q5-10 YEARS
or FIT-DNA q3 YEARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

TIER 3 AVERAGE RISK COLORECTAL CANCER SCREENING?

A

VIDEO CAPSULE ENDOSCOPY q5 YEARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

AFTER what AGE should you STOP colorectal cancer SCREENING?

A

85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

IMMUNOLOGICAL test for human HEMOGLOBIN in stool?

A

FIT (ANNUAL, single-sample)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

TEST for MOLECULAR MARKERS for COLORECTAL CANCER in STOOL

A

FIT-DNA (q3 YEARS, single-sample)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the SERUM test for COLORECTAL CANCER?

A

SEPTIN9 (methylated septin9)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

EXCLUDING COLONOSCOPY, which test has the HIGHEST SENSITIVITY (identify disease when its actually there - rule in) for COLORECTAL CANCER?

A

FIT-DNA (cancer, NOT polyps)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

FAMILY HISTORY of ≥1 FIRST DEGREE RELATIVE with COLORECTAL CANCER at ANY AGE, SURVEILLANCE?

A

Start at AGE 40 or 10 YEARS BEFORE EARLIEST CRC and EVERY 5 YEARS after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

FAMILY HISTORY of ≥1 FIRST DEGREE RELATIVE with ADVANCED ADENOMA or SESSILE SERRATED POLY at ANY AGE, SURVEILLANCE?

A

Start at AGE 40 or AGE of ONSET of ADENOMA and EVERY 5 YEARS after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

FAMILY HISTORY of 2nd or 3rd DEGREE RELATIVES with CRC at ANY AGE, SURVEILLANCE?

A

AS PER USUAL SURVEILLANCE, NO DIFFERENCE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

After diagnosis of COLON CANCER, s/p SURGERY, when do you do SURVEILLANCE if normal SURVEILLANCE previosly? If NONE previously?

A

1 YEAR
3-6 MONTHS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

After diagnosis of COLON CANCER, s/p SURGERY, when do you do SURVEILLANCE if find ADVANCED ADENOMA on the 1 YEAR SURVEILLANCE colonoscopy?

A

1 YEAR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

ADENOMATOUS POLYP >1 cm; ADENOMATOUS POLYP with >25% VILLOUS component; ADENOMATOUS POLYP with HIGH-GRADE DYSPLASIA; ADENOMATOUS POLYP with EARLY INVASIVE CANCER?

A

ADVANCED ADENOMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

After diagnosis of COLON CANCER, s/p SURGERY, when do you do SURVEILLANCE if NO ADVANCED ADENOMA? THEN if NEGATIVE?

A

3 YEARS
5 YEARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

WHEN should you SCREEN IBD patients with COLONOSCOPY?

A

8 YEARS after DIAGNOSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

HOW do you SCREEN IBD patients with colonoscopy?

A

CHROMO or HD WHITE LIGHT, 4 QUADRANTS every 10 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

HOW FREQUENTLY do you SCREEN HIGH-RISK IBD patient (PSC, EXTENSIVE disease, ACTIVE disease, FAMILY HISTORY of CRC)?

A

YEARLY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

HOW FREQUENTLY do you SCREEN LOW-RISK IBD (REMISSION, LEFT-SIDED) patient?

A

q2-3 YEARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

WHEN do you start SCREENING for CRC in a patient with IBD found to have PSC?

A

IMMEDIATELY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

AD, MISMATCH REPAIR PROTEIN mutation, NO POLYPS, RIGHT-SIDED (proximal) COLON CANCER?

A

LYNCH SYNDROME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

(1,2,3) 1: FAMILY MEMBER diagnosed with colon cancer < 50 yo; 2: 2 GENERATIONS; 3: 3 or more with CRC

A

HNPCC (Hereditary Non-Polyposis Colon Cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

SPORADIC Colon Cancers usually occur in which PART of the COLON?

A

LEFT (mean age of diagnosis is 68)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

HNPCC and LYNCH colon cancers occur in which PART of the colon?

A

RIGHT (mean age of diagnosis is 44)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

LYNCH SYNDROME is MAINLY associated with what EXTRA-COLONIC cancer?

A

ENDOMETRIAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

CRC SCREENING in LYNCH SYNDROME?

A

Starting at age 20-25, q1-2 YEARS or 2-5 YEARS prior to EARLIEST CRC in family if occured < 25 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

BESIDES CRC SCREENING, what else do you SCREEN for in patients with LYNCH SYNDROME?

A

STOMACH - EGD
UTERUS/OVARIES - TV US, CA-125
GU - U/A
PROSTATE - digital exam, PSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

In WOMEN with LYNCH SYNDROME, once OUT of CHILD BEARING age, what should be considered?

A

HYSTERECTOMY + OOPHERECTOMY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What MEDICATION is used PROPHYLACTICALLY for patients with LYNCH SYNDROME?

A

ASPIRIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

MLH1; MSH2; MSH6; PMS2; EPCAM mutations, MICROSATELLITE instability (addition of nucleotide repeats), IMMUNOHISTOCHEMISTRY (stain tumor for ABSENT mismatch repair proteins), BRAF mutation?

A

LYNCH SYNDROME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

If pt HAS MICROSATELLITE INSTABILITY or on IMMUNOHISTOCHEMISTRY, has ABSENCE of the MISMATCH REPAIR PROTEINS, BUT BRAF testing shows POSITIVE MUTATION (SOMATIC MLH1) or MLH1 PROMOTER HYPERMETHYLATION is PRESENT (also SOMATIC MLH1 mutation)?

A

NOT LYNCH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

BRAF mutation POSITIVE or MLH1 PROMOTER HYPERMETHYLATION POSITIVE, REGARDLESS of IMMUNOHISTOCHEMISTRY or MICROSATELLITE INSTABILITY FINDINGS?

A

NOT LYNCH SYNDROME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

BRAF mutation NEGATIVE or MLH1 PROMOTER HYPERMETHYLATION NEGATIVE?

A

LYNCH SYNDROME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

To DIAGNOSE LYNCH SYNDROME, once MICROSATELLITE INSTABILITY is FOUND or IMMUNOHISTOCHEMISRTY is positive for ABSENT MISMATCH REPAIR PROTEINS, what MUST be done NEXT?

A

BRAF and MLH1 PROMOTER HYPERMETHYLATION testing (if POSITIVE, NOT LYNCH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

ANY patient found to have CRC, what TEST is done next to determine if GENETIC COMPONENT exists?

A

IMMUNOHISTOCHEMICAL TESTING (look for ABSENT mismatch repair proteins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

A patient with CRC undergoes IMMUNOHISTOCHEMICAL testing and is found to have ALL mismatch repair proteins PRESENT, none are absent?

A

NOT LYNCH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

A patient with CRC undergoes IMMUNOHISTOCHEMICAL testing and is found to ABSENT MLH1 or PMS2 mismatch repair proteins, what is done NEXT?

A

PROMOTER HYPERMETHYLATION testing
or
BRAF mutation testing
if these are PRESENT - NOT LYMCH
if ABSENT - refer to GENETIC COUNSELOR for GERMLINE TESTING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

A patient with CRC undergoes IMMUNOHISTOCHEMICAL testing and is found to ABSENT MSH2 or MSH6 mismatch repair proteins, what is done NEXT?

A

Refer to GENETIC COUNSELOR for GERMLINE TESTING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

ALL LYNCH patients with CRC or POSITIVE GENOTYPES should be RECOMMENDED what?

A

HYSTERECTOMY + OOPHERECTOMY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

ALL LYNCH patients with CRC should be RECOMMENDED what?

A

COLECTOMY with SURVEILLANCE of RECTUM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

A patient with FAP with COLECTOMY with RECTUM intact, needs surveillance of RECTUM HOW OFTEN?

A

YEARLY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

DO FAP patients have an increased risk of GU tumors necessitating TV US or U/A?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

A patient with FAP HOW OFTEN do they need surveillance of THYROID?

A

q2-5 YEARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

PRESENCE of MSH2 or MSH6 mutations?

A

LYNCH SYNDROME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

If on ENDOSCOPY, a patient is found to have features of JUVENILE POLYPOSIS SYNDROME (>5 EDEMATOUS, CYSTIC polyps, multiple GASTRIC polyps), what is RECOMMENDED NEXT?

A

GENETIC TESTING (SMAD4, BMPR1A, PTEN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

On COLONOSCOPY, you remove a HYPERPLASTIC POLYP >1 cm, when should you REPEAT colonoscopy?

A

3-5 YEARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What FEATURES does ACUTE COLITIS have that IBD does not?

A

EDEMA, CRYTPTITIS (vs crypt abscess - a chronic process), STRAIGHT CRYPTS (vs short, branched) SURFACE damage (much less), PRESERVED MUCIN (vs decreased)

92
Q

How MANY cases of IBD are UNCLASSIFIED where features of BOTH UC and CROHN’s seem to be present?

A

5-20%

93
Q

What are HIGH-RISK features of both UC and CROHN’s?

A

YOUNGER ONSET (< 30-40), EXTENSIVE INVOLVEMENT, DEEP ULCERS, INFECTIONS, STRICTURING, STEROID REQUIREMENT, LOW SERUM ALBUMIN

94
Q

BEFORE deciding if a patient has IBD FLARE or IBS or BOTH, what should be EVALUATED for?

A

INFLMMATION (CRP, CALPROTECTIN)
STRUCTURAL ABNORMALITIES (histology, imaging)

95
Q

QUITTING SMOKING is a RISK for what IBD?

A

UC

96
Q

The use of what MEDICATIONS in CHILDHOOD is associated with the risk of developing IBD (UC or CROHN’s)?

A

ANTIBIOTICS

97
Q

How does BREASTFEEDING affect the potential of IBD development?

A

PROTECTS AGAINST IT

98
Q

How does OCP USE affect the potential of IBD development?

A

RISK of CROHN’s

99
Q

How does APPENDECTOMY affect the potential of IBD development?

A

RISK for CROHN’s develolment
PROTECTIVE for UC development

100
Q

How does LOW VIT D affect the potential of IBD development?

A

RISK of developing BOTH UC and CROHN’s

101
Q

How does TEA or COFFEE affect the potential of IBD development?

A

PROTECTIVE against develpment of BOTH

102
Q

ASCA and OmpC are BOTH seen in which IBD?

A

CROHN’s

103
Q

DNAse Sensitive pANCA is seen in which IBD?

A

PREDOMINANTLY UC (can be seen in CROHN’s)

104
Q

Is the use of ASCA, pANCA or OmpC antibodies recommended for ESTABLISHING IBD diagnosis or PROGNOSIS?

A

NO

105
Q

What TARGETS should be CONSIDERED when treating IBD besides SYMPTOM IMPROVEMENT and ENDOSCOPIC HEALING?

A

DECREASE of CRP and CALPROTECTIN, NORMAL GROWTH in CHILDREN and HISTOLOGIC healing

106
Q

HOW are 5-ASA drugs EFFECTIVE for IBD?

A

These are effective for INDUCTION and MAINTENANCE therapy for MILD to MODERATE UC

107
Q

What is meant by DELIVERY-RESPONSE relationship of 5-ASA drugs used for mild to moderate UC (both induction and maintenance)?

A

Getting the drug to the LOCATION of the DISEASE

108
Q

What ADVERSE EFFECT is most commonly seen with 5-ASA drugs (UC) which are otherwise VERY SAFE?

A

Interstitial Nephritis

109
Q

In 3% of patients started on 5-ASA drugs (UC), they GET WORSE, why?

A

ALLERGIC or INTOLERANT - STOP THE DRUG

110
Q

HOW should 5-ASA drugs be given for SUPERIOR EFFICACY in UC?

A

ORAL+RECTAL therapy

111
Q

When treating UC, WHEN is it SAFE to REDUCE the DOSE of the ORAL 5-ASA (not the rectal)?

A

When there is evidence of DEEP REMISSION

112
Q

Can STEROIDS (prednisone or budesonide) be used for MAINTENANCE in IBD?

A

NO (INDUCTION of REMISSION ONLY)

113
Q

Which FORMULATION of BUDESONIDE is used for CROHN’s and why?

A

ENTOCORT (Controlled Ileal Release)
Because it is RELEASED and ABSORBED in the TI and CECUM

114
Q

Which FORMULATION of BUDESONIDE is used for UC and why?

A

UCERIS (Extended Release)
Because it is RELEASED THROUGHOUT the COLON

115
Q

What is meant by that the USE of STEROIDS is PROGRNOSTIC in IBD?

A

DICTATES SUBSEQUENT OUTCOMES

116
Q

WHICH STEROIDS should be used FIRST in attempting INDUCTION of REMISSION in IBD?

A

NON-SYSTEMIC (budesonide)

117
Q

When TREATING IBD patients and ESPECIALLY when using STEROIDS, what MUST be MONITORED?

A

BONE DENSITY and VIT D levels

118
Q

How LONG does STEROID USE for IBD REQUIRE a TAPER?

A

≥2 WEEKS

119
Q

GENETICALLY-DETERMINED METABOLISM applies to which IBD drug which therefore REQUIRES CHECKING of INDIVIDUAL LEVELS?

A

THIOPURINES (6-MP/AZATHIOPRINE)

120
Q

Explain 6-MP METABOLISM?

A

6-MP is BROKEN into 6-TGN (therapeutic, toxic) by HPRT
6-MP is BROKEN into 6-MMPN (inactive) by TPMT

121
Q

What happens in patients taking 6-MP who GENETICALLY make NORMAL/INTERMEDIATE/LOW TPMT?

A

NORMAL: adequate drug is made, NO TOXICITY
INTERMEDIATE: GIVE LESS DRUG to AVOID TOXICITY
LOW: TOXICITY can develop BONE MARROW SUPPRESSION

122
Q

If an ASIAN or LATINO patient experiences EARLY LEUKOPENIA on AZATHIOPRINE or 6-MP, what is the ISSUE?

A

Presence of NUDT15 enzyme

123
Q

What MUST be done BEFORE starting a patient on THIOPURINES (azathioprine or 6-MP)?

A

Check TPMT levels (because if LOW or ABSENT, this will dictate TOXICITY due to OVERPRODUCED 6-TGN - bone marrow suppression) - can use ALLOPURINOL to block shunting to a predimonant 6-MMP metabolite (inactive)

124
Q

A patient is started on AZATHIOPRINE or 6-MP (1-2 doses) and develops SEVERE JOINT-PAIN and FEVER, what happened?

A

ALLERGIC REACTION to THIOPURINES, STOP the drug (this is NOT an infection)**

125
Q

What IBD DRUG CLASS is associated with LYMPHOMA and Non-Melanoma Skin Cancers?

A

THIOPURINES (azathioprine, 6-MP) - risk returns to normal after discontinuation

126
Q

What occurs if TOO MUCH 6-MMPN (inactive metabolitie) is made by TPMT and not enough 6-TGN

A

LIVER TOXICITY (shunt with ALLOPURINOL)

127
Q

If TOO MUCH of 6-TGN is made (TPMT is intermediate or LOW), what is the TOXICITY?

A

BONE-MARROW SUPPRESSION (reduce dose of thiopurine)

128
Q

Is EARLY use of THIOPURINES more effective than PLACEBO or CONVENTIONAL therapy for CROHN’s disease?

A

NO

129
Q

METHOTREXATE is a drug used for what IBD ONLY?

A

CROHN’s disease

130
Q

Why is METHOTREXATE useful when used in COMBINATION with other drugs when trating CROHN’s disease?

A

Prevents formation of ANTI-DRUG ANTIBODIES

131
Q

What is the MAJOR ADVERSE EFFECT of METHOTREXATE?

A

TERATOGEN (women only) - others are cirrhosis, pneumonitis, bone marrow suppression and rash

132
Q

If a patient on THIOPURINES developes PANCREATITIS?

A

STOP the DRUG (genetically predisposed)

133
Q

NAUSEA with METHOTREXATE is TREATED how?

A

ONDANSETRON

134
Q

What MUST be given WITH METHOTREXATE and what MUST be MONITORED with this drug?

A

GIVE: FOLIC ACID
MONITOR: LFTs every 6 MONTHS

135
Q

, INFLIXI

Antibiologics used in TREATMENT of CROHN’s?

A

CERTOlizumab, ADAlimumab, INFLIXImab, NATAlizumab, VEDOlizumab, USTEkinumab, RISANkinumab

136
Q

Antibiologics used in TREATMENT of UC?

A

ADAlimumab, GOlimumab, INFLIXImab, VEDOlizumab, USTEkinumab (ada go in, vedo use)

137
Q

What IBD severity are anti-TNF drugs used in?

A

MODERATE - SEVERE

138
Q

Which is the ONLY medication LABELED for treatment of PERIANAL CROHN’s?

A

INFLIXIMAB

139
Q

50% LOSS of RESPONSE or DOSE ESCALATIONS are seen with these IBD drugs at ONE YEAR?

A

anti-TNF (Certo, Ada, GO, IN)

140
Q

Risk of INFECTION, REACTIVATION of latent TB and Hep B are seen with these IBD DRUGS?

A

anti-TNF (Certo, Ada, GO, IN)

141
Q

BEFORE starting anti-TNF (Certo, Ada, GO, IN) in a patient with IBD, what should you ALWAYS check for?

A

Latent TB, Hep B

142
Q

Antibody formation to anti-TNF (Certo, Ada, GO, IN) drugs is associated with what?

A

LOSS of RESPONSE & HYPERSENSITIVITY reaction (RASH, tachycardia, anaphylaxis)

143
Q

The ADDITION of what DRUG to INFLIXIMAB (anti-tnf) causes LESS antibody formation, BETTER drug exposure and response, making the combination MORE EFFECTIVE in treating BOTH CROHN’s and UC?

A

AZATHIOPRINE

144
Q

Do USTEkinumab or VEDOlizumab benefit from COMBINATION therapies?

A

NO

145
Q

Are 5-ASA drugs helpful when ESCALATING to ADVANCED THERAPIES?

A

NO (stop these when escalating)

146
Q

Does the use of anti-TNF (Certo, Ada, GO, IN) drugs risk formation of SOLID TUMORS?

A

NO

147
Q

IMMUNOGENICITY (immune system deactivates drug), AUTOIMMUNITY, INFECTION (fungal pneumonia, histoplasmosis, listeria, TB, viral), LYMPHOMA, MELANOMA, PSORIASIS, CHF, DEMYELINATION (optic neuritis, MS, transverse myelitis) can all be seen with these IBD drugs?

A

anti-TNF (Certo, Ada, GO, IN)

148
Q

What should be used to guide TREATMENT CHANGES when using anti-TNF (Certo, Ada, GO, IN) drugs in patients with IBD, ONLY if treatment DOESN’T seem to work or STOPS working?

A

REACTIVE Therapeutic Drug Monitoring (TDM)

149
Q

When DOSING and CHNAGING THIOPURINE theray, what is RECOMMENDED?

A

TPMT testing and 6-TGN/6-MMPN (metabolite) monitoring - NOT ROUTINELY when just on therapy

150
Q

An IBD patient is LOSING RESPONSE to an anti-TNF (Certo, Ada, GO, IN) drug, what do you do NEXT?

A

MEASURE anti-TNF drug LEVES and formation of ANTIBODIES

151
Q

An IBD patient is LOSING RESPONSE to an anti-TNF (Certo, Ada, GO, IN) drug, they have LOW anti-TNF drug levles and NO drug antibodies?

A

INCREASE anti-TNF DOSE or DECREASE administration INTERVAL

152
Q

An IBD patient is LOSING RESPONSE to an anti-TNF (Certo, Ada, GO, IN) drug, they have HIGH anti-TNF drug levles and POSITIVE or NEGATIVE drug antibodies?

A

SWAP to another drug CLASS (no anti-TNF drugs)

153
Q

An IBD patient is LOSING RESPONSE to an anti-TNF (Certo, Ada, GO, IN) drug, they have LOW anti-TNF drug levles and HIGHLY-POSITIVE drug antibodies?

A

CYCLE to another anti-TNF drug (NOT biosilimar)
or
SWAP drug CLASS

154
Q

An IBD patient is LOSING RESPONSE to an anti-TNF (Certo, Ada, GO, IN) drug, they have LOW anti-TNF drug levles and LOW-POSITIVE drug antibodies?

A

TRANSIENT, so INCREASE DOSE
If NO RESPONSE, CYCLE or SWAP

155
Q

What CROHN’s DRUGS should be used to PREVENT RECURRENCE after SURGERY?

A

anti-TNF

156
Q

What is the RUTGEERT SCORE?

A

Assessment of the CROHN’s POST-SURGICAL anastomosis for presence of ulcers and stricturing (0-4)

157
Q

If a patient is on an anti-TNF drug for CROHN’s POST-SURGICAL anastomosis and on colonoscopy they scored at a RUTGEERT score of ≥2 (0-4), what is RECOMMENDED?

A

CHANGE TREATMENT STRATEGY

158
Q

Should a 5-ASA drug or STEROID be used to treat a CROHN’s patient POST-SURGERY?

A

NO (use anti-TNF)

159
Q

After a patient with CROHN’s has surgery for CROHN’s whetehr or not they have been STARTED on anti-TNF prophylactic therapy, WHEN should colonoscopy SURVEILLANCE resume?

A

6 MONTHS

160
Q

Which are the anti-IL12/23 and anti-IL23 IBD drugs BOTH of which are used in moderate to severe UC and CROHN’s?

A

anti-IL12/23: USTEkinumab
anti-IL23: RISANkizumab
BOTH are EQUALLY EFFICACIOUS

161
Q

How MANY patients on the anti-IL12/23 and anti-IL23 drugs used to treat moderate to severe UC and CROHN’s (ustekinumab/risankizumab) require DOSE ESCALATION?

A

20%

162
Q

Is USTEkinumab more effective than ADAlimumab?

A

NO (no difference)

163
Q

In what UC/CD patients would you use the anti-IL12/23 and anti-IL23 (ustekinumab/risankizumab) drugs?

A

Those with SKIN DISEASE (psoriasis) as well as those who have had ANTIBODIES against anti-TNF drugs (certo, ada, go, in)

164
Q

Which are the TWO anti-INTEGRIN drugs used to treat IBD?

A

NATAlizumab and VEDOlizumab

165
Q

This anti-INTEGRIN DRUG is limited to the GUT (selects for alpha-4, beta-7 integrins) and is used for INDUCTION and MAINTENANCE of moderate-severe UC and CROHN’s?

A

VEDOlizumab

166
Q

Whis was foud to be SUPERIOR for treatment of UC, ADAlimumab (anti-TNF) or VEDOlizumab (anti-INTEGRIN)?

A

VEDOlizumab (does NOT work on ANY outside of the GUT manifestations of IBD)

167
Q

Was VEDOlizumab found to be a SAFE drug?

A

YES!!
No INFECTIONS, No CANCERS, No PML, No IMMUNOGENICITY

168
Q

What is the RECOMMENDED 1st LINE AGENT after using 5-ASA in UC?

A

VEDOlizumab

169
Q

Which NEW IBD drugs TARGET INFLAMMED TISSUES?

A

S1P (1-5) DRUGS
the ONLY one available is OZANIMOD (for UC) S1P1,5

170
Q

How does the ORAL S1P1,5 drug for UC, OZANIMOD compare to anti-TNF?

A

LESS EFFECTIVE
only causes elevated LFTs which resolve spontaneously

171
Q

Which are the TWO JAK-inhibitors used in IBD?

A

TOFAcitinib (UC) JAK 1-3
and
UPADAcitinib (UC & CD) JAK-1

172
Q

When are the JAK-inhibitors (TOFAcitinib - UC and UPADAcitinib - UC & CD) RECOMMENDED for use for IBD?

A

ONLY after anti-TNF treatment FAILURE

173
Q

Patients with IBD who have LOW ALBUMIN, ARTHROPATHY and SPONDYLOARTHROPATHY and have FAILED anti-TNF drugs, would do well on which drugs?

A

TOFAcitinib (UC) JAK 1-3
and
UPADAcitinib (UC & CD) JAK-1

174
Q

What IBD drugs can be used WITHOUT STEROIDS as they work VERY FAST (8-12 week induction) but have to be used ONLY after anti-TNF failure (can sometimes have a delayed repsonse of 16-24 weeks)?

A

TOFAcitinib (UC) JAK 1-3
and
UPADAcitinib (UC & CD) JAK-1

175
Q

What VACCINE MUST be given prior to using TOFAcitinib or UPADAcitinib?

A

HERPES ZOSTER (shingles) vaccine

176
Q

WHEN should ANTI-BIOLOGICS be used in IBD?

A

THE SOONER THE BETTER (higher likelihood of response and lower likelihood of losing response)

177
Q

WHICH of the anti-biologics are preferred in patients with ECZEMA or PSORIASIS?

A

IL-23 (USTEkinumab, RISANkizumab) - because its a clue to an IL-23 dominant pathway

178
Q

WHICH of the anti-biologics are preferred in patients with ATOPIC DERMATITIS or JOINT problems (arthropathies/spondyloarthropathies, ankylosing spondylitis, sacroiliitis)?

A

TOFAcitinib (UC) JAK 1-3
and
UPADAcitinib (UC & CD) JAK-1

179
Q

If a patient with IBD has DIABETES, which treatmet should you AVOID?

A

STEROIDS (use the JAK-inhibitors instead if FAILED anti-TNF)

180
Q

In a patient who has IBD and ATOPIC DERMATITIS and would benefit from a JAK-inhibitor (TOFAcitinib or UPADAcitinib) what REQUIREMENT are they EXEMPT from?

A

Failing anti-TNF therapy first (can use right away)

181
Q

What are the TWO drugs to consider as FIRST-LINE for UC (after 5-ASA + STEROIDS)?

A

VEDOlizumab (anti-integrin alpha-4, beta-7) or OZANIMOD (S1P1,5)

182
Q

What are the TWO drugs to consider as FIRST-LINE for CROHN’s WITHOUT peri-ANAL involvement?

A

VEDOlizumab (anti-integrin alpha-4, beta-7) or USTEkinumab (IL-23)

183
Q

What are the TWO drugs to consider as FIRST-LINE for CROHN’s WITH peri-ANAL involvement?

A

INFLIXIMAB (anti-TNF) + AZATHIOPRINE

184
Q

In a patient with CROHN’s who FAILED anti-TNF, what do you use NEXT?

A

USTEkinumab or RISANkizumab (IL-23)

185
Q

In a patient with UC who FAILED anti-TNF, what do you use NEXT?

A

TOFAcitinib or VEDOlizumab or USTEkinumab

186
Q

What DIET is RECOMMENDED in patients with CROHN’s disease which IMPROVES SYMPTOMS but does NOT CHANGE INFLAMMATORY markers?

A

Mediterranean Diet (olive oil, fruits and vegetables, nuts and cereals, nor red meat, processed foods or sweets)

187
Q

Which COLONIC INFECTION is COMMON in IBD (CROHN’s and UC) even WITHOUT antibiotic exposure?

A

C.diff

188
Q

All patients who PRESENT with IBD FLARE should be tested for what?

A

C.diff

189
Q

What is the RECOMMENDED treatment of C.diff in IBD patients?

A

VANCOMYCIN

190
Q

If patient with C.diff and IBD has PERSISTENT or RECURRENT DIARRHEA what MUST be done?

A

TEST for recurrence of C.diff

191
Q

WHERE should patients with IBD and C.diff be treated?

A

HOSPITAL

192
Q

How do you treat an IBD patient with RECURRENT C.diff infection?

A

Fecal Microbiota Transplant (FMT)

193
Q

How many people with UC get POUCHITIS after an ILEOANAL anastomosis?

A

50%

194
Q

Having PSC, SMOKER, EXTENSIVE UC, BACKWASH ILEITIS, pANCA, NSAID use are all RISK factors for what POST-COLECTOMY issue in UC patients?

A

POUCHITIS

195
Q

If you SUSPECT POUCHITIS in a post-colectomy UC patient, what is the FIRST STEP?

A

ENDOSCOPIC CONFIRMATION

196
Q

What is the PREFERRED INITIAL TREATMENT for POUCHITIS?

A

ANTIBIOTICS (CIPRO or METRONIDAZOLE x 2 WEEKS)

197
Q

How does PERIPHERAL ARTHROPATHY present in IBD?

A

SYMMETRICAL, related to DISEASE ACTIVITY

198
Q

Which ARTHROPATHIES in patients with IBD MUST be treated SEPARATELY and may NOT respond to treatment of the underlying IBD that sparked them?

A

Ankylosing Spondylitis and Sacroileitis

199
Q

What IBD is this manifestation associated with?

A

CROHN’s - Erythema Nodosum (tibia)

200
Q

What IBD is this manifestation associated with?

A

UC - Pyoderma Gangrenosum (caused by TRAUMA to the skin - around STOMAS as well)

201
Q

This manifestation is seen in IBD patients treated with what?

A

Palmar Plantar Pustulosis (anti-TNF)

202
Q

On a colonoscopy of an IBD patient, histology looks like this, what is it?

A

DYSPLASIA (elongated nuclei)

203
Q

What is the PRIMARY RISK factor of development of NEOPLASIA in IBD patients?

A

HISTOLOGIC INFLAMMATION

204
Q

Smoking Cigarettes (reduces inflammation), STATINS, 5-ASA drugs and THIOPURINES are ALL PROTECTIVE factors against formation of NEOPLASIA in what?

A

IBD

205
Q

What ENDOSCOPIC feature is PREFERRED when examining an IBD patient?

A

High-Definition White Light (HD) +/- NBI
or DYE-SPRAY CHROMOENDOSCOPY if standard definition light

206
Q

When a SUSPICIOUS lesion is noted in an IBD patient, what INTERVENTION is PREFERRED?

A

ENDOSCOPIC RESECTION

207
Q

What IBD serologic marker is NOT repliable in PREGNANCY? Which one is?

A

CRP (unreliable in pregnancy)
Fecal CALPROTECTIN is!!

208
Q

When is it SAFE to do an MRI for an IBD patient that is PREGNANT? COLONOSCOPY?

A

2nd TRIMESTER

209
Q

Which IBD medications are NOT PREGNANCY SAFE?

A

METHOTREXATE, THALIDOMIDE, TOFAcitinin (JAK), UPADAcitinib (JAK), OZANIMOD (S1P1,5)

210
Q

Is it OK to VACCINATE IBD patients?

A

YES

211
Q

Colitis caused by these ONCOLOGY drugs looks like IBD?

A

CHECKPOINT INHIBITORS (CTLA-4, PD-1)

212
Q

WHEN does COLITIS and DIARRHEA caused by a checkpoint inhibitor require treatment?

A

When the DIARRHEA is MODERATE(4-6 BM/day) to SEVERE (>6 BM/day)

213
Q

In a patient taking a checkpoint inhibitor having 4-6 BMs/day, what is the TREATMENT?

A

ORAL STEROID (budesonide) and STOP checkpoint inhibitor (moderate diarrhea)

214
Q

In a patient taking a checkpoint inhibitor having >6 BMs/day, what is the TREATMENT?

A

HOSPITALIZATION, IV STEROIDS and if doest stop in 3-5 days, INFLIXImab or VEDOlizumab

215
Q

In a UC patient who is NOT RESPONDING to STEROIDS, what should you check for prior to MODIFYING treatment?

A

CMV or C.diff Infection (even without takign antibiotics or seeing pseudomembranes)

216
Q

On SURVEILLANCE COLONOSCOPY, a patient with IBD is noted to have HIGH-GRADE dysplasia or FLAT, LOW-GRADE dysplasia around an adenoma, what do you RECOMMEND?

A

COLECTOMY

217
Q

How OFTEN do you repeat a COLONOSCOPY in an IBD patient with PSC?

A

YEARLY

218
Q

If a patient presents with POUCHITIS SYMPTOMS but NO POUCHITIS is noted on ENDOSCOPY?

A

Irritable POUCH Syndrome

219
Q

In a patient with POUCHITIS that is LIMITED to the ANAL TRANSITION zone?

A

CUFFITIS

220
Q

In a patient with POUCHITIS that is TRACKING up into the AFFERENT LIMB?

A

CROHN’s DISEASE

221
Q

What TWO diseases can MIMIC IBD?

A

TB and LYMPHOMA

222
Q

What differentiates HISTOLOGICALLY diagnosis of IBD vs COLITIS?

A

CHRONICITY (CRYPT ABSCESSES, etc.)

223
Q

If an IBD patient presents with BACK PAIN, what should you do NEXT?

A

X-RAY, then MRI (spondyloarthropathy - bamboo spine)

224
Q

What MEDICATIONS are PREFERRED in treating IBD in a patient with JOINT PAINS?

A

SULFASALAZINE (5-ASA), METHOTREXARE, anti-TNF and JAKtinibs

225
Q

If on a colonoscopy, one finds < 20 HYPERPLASTIC < 10 mm POLYPS, when should the next SCREENING COLONOSCOPY be?

A

10-YEARS

226
Q

If on a colonoscopy, one finds >20 HYPERPLASTIC POLYPS or ANY HYPERPLASTIC POLYPS >10 mm or RIGHT COLON HYPERPLASTIC POLYPS, when should the next SCREENING COLONOSCOPY be?

A

3-5 YEARS

GI Boards November 20th 2024 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions