EPIC PATHOPHYS

Question 1

A 25 yo w/ a history of Hepatitis B, what do you think about in regards to Hep B?

Answer 1

That Hep B should be on your list of STI’s/household contacts

Question 2

Hep B is preventable with what?

Answer 2

A vaccine, and 25+ sometimes not vaccinated

Question 3

Chronic Hep B is treatable, what do you need to screen for?

Answer 3

HCC

Question 4

55 y/o Hep C w/ stage 2-3 fibrosis (stage 4 = cirrhosis), what do you do?

Answer 4

Because Hep C is curable; Anti-retroviral treatment should be started and it has a very high likelihood of high, sustained viral clearance

Question 5

Risk Factors for PUD

Answer 5

H. Pylori, smoking, NSAIDs, Clopidogrel (all of the above)

Question 6

NSAIDs can cause

Answer 6

All of the above (worsened fluid retention in ascites, worsened PUD, worsened renal fxn) (all of the above)

Question 7

Most etiology of cirrhosis of patients waiting for liver tx in the US?

Answer 7

Hep C

Question 8

Most frequent bile stone?

Answer 8

Cholesterol

Question 9

MC cause of hospitalization for acute lower GI bleed in adultes

Answer 9

Diverticulosis

Question 10

Best description of acute mesenteric ischemia - SMA MC involved

Answer 10

Severe pain out of proportion to physical tenderness; surgical emergency

It is NOT measured w/o surgery, not treated with anticoag

Question 11

Which best describes ischemic colitis?

Answer 11

Moderate ab pain, hematochezia, recto and splenic flexure ulcers, thickening of wall of bowel; short section of bowel (one little branch of an artery involved); This can get better and completely heal over, no surgery needed (answer is NOT B)

Question 12

A1At is associated with liver dz because? What can be affected? What genotypes?

Answer 12

Hepatocytes are packed with defective A1AT (not low concentration of A1); Lungs CAN be affected but don’t have to be, look for ZZ, SZ, or MZ

Question 13

GI stromal tumor location?

Answer 13

Stomach

Question 14

MALToma associated with?

Answer 14

H. Pylori

Question 15

Lubiprostone? Recently approved for tx of constipation

Answer 15

Cl- channel activator

Question 16

Disinergic defecation?

Answer 16

Inappropriate contraction or failure to relax puborectalis

Question 17

5 y/o with livelong constipation; mod distended abdomen?

Answer 17

Hirschprungs - absence of enteric neurons in distal rectul

Question 18

Achalsia? Treatment? What is seen on biopsy?

Answer 18

LES does not relax and no peristalsis; risk for SCC of esophagus. Tx: Botox not as good as laproscopic myotomy. On biopsy, loss of ganglion cells in wall of esophagus

Question 19

What is in a MELD score? What does it tell you?

Answer 19

Bilirubin, INR, Creatinine; it measures the severity of chronic liver disease and useful in determining prognosis and prioritization for a receipt of a liver transplant, operative risk

Question 20

What is the Child Pugh score? What does it tell you?

Answer 20

Bilirubin, INR, albumin; prognosis of chronic liver disease, mainly cirrhosis (prognosis, and strength of treatment and the necessity of liver transplant), operative risk

Question 21

Alcoholic cirrhosis and quit 6 months ago w/ MELD of 15 and encephalopathy?

Answer 21

TRANSPLANT

Question 22

Moderate drinking vs abstinent drinking

Answer 22

Key thing is abstinence

Question 23

Active alcoholics have increased risk for hepatotox w/ acetaminophen because?

Answer 23

Increased P450 and decreased glutathione

Question 24

Most useful tests to measure liver fxn?

Answer 24

INR, albumin synthesis, bilirubin clearance

Question 25

Liver enzyme most associated with enzyme induction?

Answer 25

GGT (liver biopsy can be normal with high GGT)

Question 26

Most helpful test regarding prognosis?

Answer 26

INR

Question 27

50 y/o white male w/ no GI symptoms; every lab normal. What do you screen with beginning at when?

Answer 27

Colonoscopy beginning at age 50

Question 28

Most common precursor lesion of colon cancer?

Answer 28

Adenomatous polyp

Question 29

MC and most rapidly increasing liver dz in the US

Answer 29

NAFLD; NOT alcohol because only minority of alcoholics have it, not acute Hep C or hemo

Question 30

Ischemic events happen MC where?

Answer 30

recto-sigmoid and splenic flexures

Question 31

Most important RF's for colon cancer?

Answer 31

>50 and family history

Question 32

2nd MCC cause of cancer deaths?

Answer 32

Colon cancer

Question 33

60 yo female with 15 lb weight loss, CT shows diffusely thickened stomach wall, stomach did not distend, anemia, no discrete mass

Answer 33

Linitis Plastica

Question 34

60 yo w/ abdominal pain when eating and wt. loss; PUD in past; on PPI; anemia all due to what?

Answer 34

Gastric adenocarcinoma from H. pylori

Question 35

Dysphagia and wt loss w/ long standing reflux?

Answer 35

Barrett's = adenocarcinoma of esophagus

Question 36

55 yo AA male, smokes, alcohol, dysphagia foods and now liquids; recent odonophagia, anemia, hypercalcemia?

Answer 36

SCC of esophagus

Question 37

Pts with cholangitis?

Answer 37

PAIN, fever, jaundice

Question 38

MCC gallstone?

Answer 38

cholesterol

Question 39

Pigment stone?

Answer 39

Hemolysis and infection

Question 40

Malabsorption of fat due to?

Answer 40

Chronic panc, bact overgrowth, ileal resection (All of the above)

Question 41

Most frequent nutrient malabsorbed?

Answer 41

Fat

Question 42

Most frequent GI lymphoma?

Answer 42

B cell non-hodgkins lymphoma

Question 43

Most frequent type of gastric carcinoid develop in patients with high?

Answer 43

Gastrin

Question 44

Severe hematochezia?

Answer 44

Diverticular bleed

Question 45

Acute mesenteric ischmia?

Answer 45

Severe abdominal pain, few findings early