EXAM #3: REVIEW Flashcards
List 7x risk factors for colon cancer.
1) Family history
2) IBD
3) Smoking
4) Alcohol
5) Obesity
6) Inactivity
7) Poor diet
What is the inheritance pattern of the APC mutation seen in FAP?
Autosomal dominant
Name the three scenarios that will give a patient a positive family history for colon cancer.
1) Colon ca in 1st degree relative under 60 y/o
2) 2+ first degree relatives with colon ca at ANY age
3) 2nd degree relative under 50 y/o with colon ca
What is the biopsy protocol for a patient with IBD undergoing colonoscopy?
Collect 4x random samples every 10cm of bowel for a total of 30+ samples
What are the surveillance recommendations following resection of a colon or rectal cancer?
1) H/P + CEA Q3-6 months
2) CT Q1 year for 5x years
List seven diseases that are associated with pancreatic cancer.
1) FAP
2) Peutz-Jegher’s Syndrome
3) Von Hippel-Lindau
4) MEN1
5) HNPCC
6) BRCA
7) FAMMM
List five signs/ symptoms typically seen in the presentation of pancreatic cancer.
1) Abdominal pain
2) Weight loss
3) Jaundice
4) Steatorrhea
5) Pruritus
What should you be concerned about in an elderly, non-obese patient that develops glucose intolerance?
Pancreatic cancer
How is pancreatic cancer diagnosed i.e. what studies are needed for the diagnosis?
1) Spiral CT with IV contrast
2) Biopsy
What are the characteristics of resectable pancreatic cancer?
1) No extrapancreatic disease
2) No tumor extension into:
- Celiac axis
- SMA
What is a non-opiate approach to pain management in pancreatic cancer?
Celiac plexus neurolysis
What are the three hallmarks of a cystic neoplasm?
1) Bloating
2) Obstructive jaundice
3) Weight loss
What are the most common types of cystic neoplasms?
- Mucinous cystadenomas
- Cystadenocarcinoma
Where are mucinous cystadenomas or cystadenocarcinomas located?
Body or tail of the pancreas
What is an intraductal papillary mucinous neoplasm referred to as?
Pancreatic precursor tumor
What studies should be ordered to work up a cystic neoplasm?
1) Abdominal CT
2) EUS
3) Biopsy
What confirms the diagnosis of an insulinoma with a 72 hour fast?
Elevated c-peptide and insulin
What lab is diagnostic for a Gastrinoma?
Elevated serum gastrin
List the four benign liver lesions. Which is the most common?
1) Hemangioma*
2) Focal Nodular Hyperplasia
3) Adenoma
4) Simple cyst
Where is HCC common geographically?
Worldwide except US and Europe
This is b/c of endemic viral hepatitis
What is the tumor marker for HCC?
Alpha-fetoprotein
List four surgical methods for treating HCC.
1) Wedge resection
2) Lobectomy
3) Trisegmentectomy
4) Liver transplant
What are the three major obstacles to liver surgery?
1) Dual blood supply
2) Liver reserve
3) Coagulopathy
List four characteristics of a good surgical candidate for HCC resection.
1) Class A Child Pugh Score
2) Solitary tumor
3) No vascular invasion
4) Tumor less than 3 cm
What drug is specifically used for HCC chemotherapy?
Sorafenib
Note that this drug block angiogensis and targets HCC surface proteins
List three risk factors for cholangiocarcinoma.
1) Primary Sclerosing Cholangitis
2) Liver flukes
3) Choledochal cyst
How does cholangiocarcinoma typically present?
1) Constitutional sx. of cancer
2) Painless jaundice
3) Biliary Tract Obstruction
How is cholangiocarcinoma diagnosed?
1) ERCP
2) CT or MRI with cholangiography
3) US
What surgery is used to treat perihilar cholangiocarcinoma i.e. the most common type of cholangiocarcioma?
Roux-en-Y Hepaticojejunostomy
What patient is most likely to get gallbladder cancer?
Elderly Chilean female from an urban area
List four risks associated with phototherapy to treat neonatal jaudice.
1) Retinal degeneration
2) Increased fluid loss
3) Bronze Baby Syndrome
4) Congenital Erythropoietic Porphyria
What are the four different types of gallstones?
1) Cholesterol-mixed
2) Pigmented
3) Sludge
4) Single large
What are the signs and symptoms of a simple gallstones?
- RUQ pain
- Exacerbated with eating
- Murphy’s sign
How do you initially manage cholecystitis in the ED?
1) NPO
2) Hydration
3) Ketorlac
Name four criteria that would warrant admission to the hospital with cholecystitis.
- Impacted stone
- Sepsis
- Unrelenting pain
- Uncertain diagnosis
What are three medical therapies for gallstones?
1) Ursodiol
2) ESWL shock waves
3) Contact dissolution
What are the quasi medical therapies for gallstones?
1) ERCP
2) Transcutaneous drain
What is Charcot’s triad of cholangitis?
1) Fever
2) RUQ pain
3) Jaundice
What are the three infectious etiologies of pancreatitis?
1) Mumps
2) Coxsackievirus
3) Mycoplasma pneumonia
List seven complications of acute pancreatitis.
1) Shock
2) ARDS
3) Acute renal failure
4) DIC
5) Pancreatic abscess
6) Pancreatic pseudocyst
7) Duodenal obstruction
How would you describe the microscopic appearance of chronic pancreatitis?
1) Acinar drop out
2) Inflammatory infiltrate
3) Fibrosis
4) Protein/ductal plugs
What are the important clinical features of Von Hippel Lindau disease?
- Mutation of chromosome 3
- Renal cell carcinoma and pheochromocytoma are common
- CYSTS in the PANCREAS, liver, and kidneys
- Angiomas in the retina, cerebellum, and brainstem
List the three major types of cystic neoplasia involving the pancreas.
1) Microcystic serous cystadenoma
2) Mucinous cystic tumor
3) Solid pseudopapillary tumor
What are the major complications of cholecystitis?
1) Bacterial superinfection
2) Perforation/abscess formation
3) Fistula formation
Name three functional disorders of the GI system.
1) Gastroparesis
2) IBS
3) Non-ulcer dyspepsia
Name four organic disorders of the GI system.
1) Hepatitis
2) Pancreatitis
3) Cholecystitis
4) IBD
What two things make constant bloating a red flag?
1) Ovarian cancer
2) Ascites
How do you repair a TE fistula?
Right thoracotomy and extrapleural repair
What does the VACTERL associated with TE fistuala stand for?
Vertebral Anorectal Cardiovascular Tracheal Esophageal Renal Limb
Any patient with a TE fistual needs to be assessed for issues with these associated structures.
What anomalies are associated with omphalocele?
1) Heart
2) Urinary tract
3) Beckwith-Wiedeman
What is the classical sign for duodenal atresia with imaging?
Double bubble sign
What is the US finding that is indicative of intussusception? What should you do if you see this?
“Target sign”
–>Barium enema
How does biliary atresia present?
Persistent direct hyperbilirubinemia
List 4x signs/sx. of pediatric cholestasis.
1) Jaundice
2) Dark urine
3) Pruritus
4) RUQ pain
What does acholic stool suggest in an child?
Obstructive jaundice
Outline the sequence required to diagnose pediatric biliary atresia.
1) Elevated direct bilirubin
2) US
3) Biopsy
4) Laparotomy
5) Intraoperative cholangiography
How are choledochal cysts treated?
Roux-en Y cholechocojejunostomy
What five anomalies are associated with Alagille Syndrome?
1) Facial changes
2) Peripheral pulmonic stenosis
3) Butterfly vertebrae
4) Posterior embryotoxon
5) Growth retardation
What are the major criteria for Hy’s Law?
1) 3x normal transaminases
2) 2x normal bilirubin
3) No alternative explanation for elevation
What is the definition of acute DILI?
Onset of sx. within 3 months of starting drug
Name three extrahepatic manifestation of DILI.
- Rash
- Fever
- Eosinophilia
What are the three methods of indirect hernia repair with a “tissue repair?”
1) Bassini= 1 level
2) Shouldice= 4 level
3) McVay= Cooper’s ligament
