Firecracker Review 11/15

Question 1

C diff exotoxin a

Answer 1

enterotoxin)—chemoattracts neutrophils which release cytokines → mucosal inflammation and GI fluid loss

Question 2

C diff exotoxin b

Answer 2

cytotoxin)—disrupts cytoskeleton by depolymerizing actin filaments → GI mucosal cell death → pseudomembranous colitis

Question 3

death in copd

Answer 3

1) resp acidosis + hypercapnic resp failure
2) cor pulmonale
3) massive spontaneous pneumo

Question 4

cyclosporine causes

Answer 4

hyperkalemia and renal failure

Question 5

C diff diagnosis

Answer 5

cytotoxin assy –> most sensitive, gold standard
EIA
PCR

Question 6

Entamoeba complications

Answer 6

toxic megalon, perforation
liver abscess
pericarditis

Question 7

Shigella organisms

Answer 7

S. sonnei (most common in U.S.), S. flexneri (most common in developing countries), S. dysenteriae, and S. boydii

Question 8

AKI - hypervolemia/hypovolemia

Answer 8

hypervolemia due to decreased GFR, activate RAS

hypovolemia due to increase in vascular permeability, causes salt/water wasting

Question 9

UC etiology

Answer 9

genetic
immune system - ANCA
environmental
NSAID use

Question 10

UC age at diagnosis

Answer 10

15-25

55-65

Question 11

UC extraintestinal manifestations

Answer 11

Uveitis (inflammation of the middle layer of eye)
Pyoderma gangrenosum (necrotic ulcerations of legs)
Ankylosing spondylitis (chronic inflammation of the spine)
Primary sclerosing cholangitis (sclerosis of both intrahepatic and extrahepatic bile ducts)

Question 12

UC colonoscopy/biopsy

Answer 12

friable erythematous mucosa
pseudopolyps
inflamm limited to submucosa and crypt abscesses

Question 13

UC labs

Answer 13

anemia

increased CRP, ESR

Question 14

X rays in UC

Answer 14

toxic megacolon

colonic perforation

Question 15

UC Barium Enema

Answer 15

avoid if acute flair –> perforation
Microulcerations
Pseudopolyps
Narrowing of luminal wall

Question 16

UC complications

Answer 16

severe bleeding
colorectal cancer
strictures, colonic perforation, toxic megacolon

Question 17

UC treatment

Answer 17

topical, oral 5-ASA

Question 18

CD mechanism

Answer 18

dysregulated proinflammatory response to the bacteria lining the walls of the GI tract, which ultimately results in the release of inflammatory substances that cause direct mucosal injury

Question 19

CD age

Answer 19

15-30

60-70

Question 20

CD in children

Answer 20

growth failure specifically refers to a vertical growth rate below the appropriate velocity for age.

Question 21

CD in children - location

Answer 21

1) colon + ileum
2) ileum only
3) colon only

Question 22

CD extraintestinal manifestations

Answer 22

same as UC + erythema nodosum

Question 23

CD colonoscopy biopsy

Answer 23

skipped areas of inflammation, cobblestoning of the mucosa, strictures, and even pseudopolyps
transmural inflammation and granulomas

Question 24

imaging study in CD

Answer 24

barium contrast, small bowel follow through

Question 25

CD complication

Answer 25

intestinal strictures, perforation
fistulas, sinus tags
cancer

Question 26

mild to moderate CD rx

Answer 26

mesalamine

Question 27

severe CD rx

Answer 27

azothiopurine, 6mercapturine, MTX

infliximab, adalimuab

Question 28

CD surgical interventions

Answer 28

obstruction, abscess, fistula or stricture formation, bowel perforation, toxic megacolon, and cance