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Gastroenterology Flashcards

1
Q

Inflammatory bowel disease is characterized by recurrent, usually acute episodes of …

a) Diarrhea
b) Abdominal pain
c) Flatulence
d) Borborygmi

A

c) Flatulence

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2
Q

Adynamic ileus is a common sequela to …

a) Hypocalcemia
b) Pancreatitis
c) Abdominal surgery
d) hypokalemia

A

a) Hypocalcemia

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3
Q

What is TRUE about intestinal neoplasia?

a) Lymphomas, adenocarcinomas and mast cell tumors are the most common GI tumors in dogs.
b) The alimentary lymphoma is the most common form of lyphmoma in cats and the most affected cats test positive for FeLV.
c) Alimentary Lymphomas tend to be predominantly more distal in the small intestine.
d) Adenomas and adenocarcinomas are more common in the canine small intestines than in the large intestines.

A

c) Alimentary Lymphomas tend to be predominantly more distal in the small intestine.
a) cats
b) negative
d) large>small

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4
Q

One of your patients, Aiko, male 3 year old Shar-Pei has the main problem aszites, most likely due to a severe hypoalbuminemia. Aiko has a normal skin, normal postprandial bile acids and a UPC of 3. What would be the most interesting diagnostic test for you?

a) Kidney biopsy for work-up of amyloidosis
b) Skin biopsy to exclude PLD
c) Ammonium stimulation test to be absolutely sure that liver function is normal
d) Cobalamin measurement

A

d) Shar-Peis often have severe LPE with hypoproteinemia and extremely low serum cobalamin

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5
Q

Minou, 10 year old female Persian cat is your favorite patient at the moment. Minou was diagnosed as having IBD 4 weeks ago and does not respond properly to your therapy with prednisolone. Which is your next step?

a) Change the diet
b) Deworm the cat
c) Add on Azathioprine
d) Add on Chlorambucil

A

d) Add on Chlorambucil. In cats you should not use Azathioprine because of complete absence of TPMT (thiopurine s-methyltransferase)

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6
Q

Which tumor does NOT belong to the two most common GI tumors in cats?

a) Smooth-musle tumors
b) Lymphoma
c) Adenocarcinoma
d) MC tumors

A

a) Smooth-muscle tumors are more common in dogs

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7
Q

The ideal diet for cases of lymphangiectasia is…

a) fat restricted
b) high content of amino acids
c) calorie dense
d) highly digestible

A

b) high content of amino acids

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8
Q

Lymphangiectasia has been associated with chronic gastritis and gastric carcinoma in…

a) Lundehunds
b) Yorkshire Terrier
c) German Shepard
d) Doberman

A

a) Lundehunds

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9
Q

The underlying mechnism for the breakdown of immunologic tolerance to luminal antigens (bacteria and dietary components) in IBD patients may be…

a) disruption of the mucosal barrier
b) dysregulation of the immune system
c) disturbances in the microbiome
d) loss of lymph

A

d) loss of lymph

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10
Q

Familial PLE and PLN in Soft-Coated Wheaten Terriers - What is wrong?

a) A positive pANCA test may be predictive of the disease.
b) Intestinal biopsy reveals evidence of intestinal inflammation, villus blunting, and epithelial erosions, as well as dilated lymphatics and lipogranulomatous lymphangitis.
c) A genetic basis is likely, although the mode of inheritance is not yet clear.
d) The disease is not immune mediated

A

d) The disease is not immune mediated

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11
Q

IBD – what is right?

a) alterations in immune cell populations in canine lymphocytic plasmacytic enteritis (LPE) include increases in LP t cells (esp CD 4+ cells), IgG + plasma cells, macrophages, and granulocytes
b) marked alterations in cytokine pattern also occur in canine LPE with increased expression of Th1 (IL2, IL12, IFN gamma ), Th2 (IL5), proninflammatory (TNF alpha), and immunoregulatory (TGF beta) cytokines
c) in the bansenji enteroptahy you find as well as in humans IPSID an alpha heavy chain gammopathy
d) LPE is prevalent in German shepherd dogs, Shar peis and pure bred cats

A

c) Basenji – gammopathy, but no alpha chain disease

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12
Q

Secondary Lymphangiectasia is caused by – what is wrong?

a) Intestinal lymphatic obstruction
b) infiltration or obstruction of lymphatics by an inflammytrory fibrosing or neoplastic process
c) obstruction of the thoracic duct
d) left heart failure due to congestive heart failure or cardiac tamponade

A

d) right heart failure

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13
Q

Which of the following signs is the least common observed in cats with pancreatitis?

  1. Vomiting
  2. Abdominal Pain
  3. Lethargy
  4. Reduction of appetite
A
  1. Abdominal Pain
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14
Q

Which of the following does not increase the output of glucose from the liver?

  1. Adrenaline
  2. Fasting
  3. Glucagon
  4. Insulin
A
  1. Insulin
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15
Q

Which hormones is involve in causing both gallbladder contraction and pancreatic enzyme secretion?

  1. Cholecystokinin
  2. Secretin
  3. Somatostatin
  4. Ghrelin
A
  1. Cholecystokinin
Secretin = stimulation of pancreatic fluid and bicarbonate secretion
Somatostatin = inhibitor of gastrin release
Ghrelin = stimulatory effects on food intake, fat deposition and growth hormone release
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16
Q

Which of the following statement is more accurate regarding chronic hepatitis?

  1. Unexplained increases in serum ALT activity with or without other laboratory changes is the best screening test for early detection of chronic hepatitis
  2. Abnormal total serum bile acid and blood ammonia most often are early markers of CH in dogs
  3. Hyperammonemia has similar sensitivity to detecting CH or cirrhosis and APSS as do TSBA, and it is more specific because it is not affected by cholestasis.
  4. With the progression of CH, GGT and ALP increase but they remain lower in magnitude compared to ALT
A
  1. Hyperammonemia has similar sensitivity to detecting CH or cirrhosis and APSS as do TSBA, and it is more specific because it is not affected by cholestasis.
  2. PERSISTENT (>2 MONTHS) unexplained increases in serum ALT activity with or without other laboratory changes is the best screening test for early detection of
    chronic hepatitis.
  3. Abnormal total serum bile acid and blood ammonia most often OCCURS LATE DURING THE COURSE of CH in dogs.
  4. With the progression of CH, GGT and ALP increase AND they BECOME HIGHER in magnitude compared to ALT (THAT REDUCE)
17
Q

Which of the following sentence regarding treatment of chronic hepatitis induced by CU is more correct?

  1. Start with food only
  2. Start with food and zinc
  3. Start with penicellamine and food
  4. Start with penicellamine, food and Zinc
A
  1. Start with penicellamine and food

it is contraindicated to combine zinc and penicellamine as they inhibit each other

18
Q

Which of the following statement regarding hepatic shunt is true?

  1. Cats are more predisposed to have intrahepatic shunts
  2. Large breeds are more predisposed to have intrahepatic shunts
  3. On the contrary of dogs, there is no predisposition of breed in cats
  4. Congenital shunts are typically multiple intra-hepatic and/or extra hepatic
A
  1. Large breeds are more predisposed to have intrahepatic shunts
  2. Cats are more predisposed to have EXTRAhepatic shunts
  3. On the contrary of dogs, there is no predisposition of breed in cats: DSH, persian, siamese, himalayan burmese
  4. Congenital shunts are typically SINGLE intra-hepatic and/or extra hepatic
19
Q

Which essential amino acid is depleted in cats following starvation, causing hepatic encephalopathy?

  1. Taurine
  2. Arginine
  3. Lysine
  4. Methionine
A

2 Arginine. This aa is essential to complete the UREA circle and therefore detoxify the ammonia

all the others are still essential aa in cats

20
Q

Which organ contain more ALP?

  1. Liver
  2. Bone
  3. Intestinal mucosa
  4. Kidney
A
  1. Intestinal mucosa

In descending order:
Intestinal mucosa, placenta, kidney, liver and bone.

21
Q

Which of the following sentences is false?

  1. Bone induced (B-ALP) is one of the major canine serum isoenzymes
  2. Corticosteroid induced (C-ALP) is one of the major canine serum isoenzymes
  3. Liver induced (L-ALP) is one of the major canine serum isoenzymes
  4. Intestinal induced (I-ALP) is one of the major canine serum isoenzymes
A
  1. Intestinal induced (I-ALP) is one of the major canine serum isoenzymes

the ALP isoenzymes from intestine, placenta and kidney have short half life and contribute minimally to serum ALP

22
Q

In a cat fed a commercial diet which contains organic based phosphorus, what the absorption of the phosphorus would be if the Ca/P ratio in the food is 0.4/1 and 2/1?

  1. normal normal
  2. increased decreased
  3. decreased decreased
  4. The Ca/P ratio doesn’t affect the Pi absorption, is the Pi source in the food that matters
A

increased decreased

23
Q

Which ONE of the following regarding disease of the gall bladder and biliary tree is correct?

  1. Canine choleliths are normally composed of cholesterol, calcium salts and bilirubin.
  2. Biliary cystadenomas are a common incidental finding in older male dogs.
  3. Emphysematous cholecystitis has been associated with diabetes mellitus in dogs.
  4. Dyslipidaemia, dysmotility of the gall bladder and hypoadrenocorticism are risk factors for the development of gall bladder mucocele.
A
  1. Emphysematous cholecystitis has been associated with diabetes mellitus in dogs.

NB: calcium-based choleliths rare in dogs, as can absorb free calcium in the gall bladder

24
Q

Which ONE of the following is false?

  1. Acetaminophen causes hepatotoxicity on dogs via oxidative stress, resulting in acute centrilobular hepatic necrosis.
  2. Phenobarbital causes marked elevations in ALKP, GGT, ALT and bilirubin.
  3. Idiosyncratic hepatotoxicity has been reported following treatment with methimazole
  4. Xylitol can cause hepatic necrosis within 6-72hours of ingestion.
A
  1. Phenobarbital causes marked elevations in ALKP, GGT, ALT and bilirubin.
25
Q

In which of the following breeds has progressive vacuolar hepatopathy been associated with hepatocellular carcinoma?

  1. Soft-coated Wheaton terrier.
  2. Dalmation.
  3. Doberman
  4. Scottish Terrier
A
  1. Scottish Terrier
26
Q

Which ONE of the following is correct?

  1. Markedly elevated ALT, ALP, bilirubin and bile acids are common findings in dogs with congenital extrahepatic PSS.
  2. mild to moderate, normocytic, normochromic regenerative anaemia is common in dogs with congential PSS
  3. Cats with congenital PSS show a higher frequency of neurological signs pre-and post-operatively compared to dogs, with a worse long-term prognosis.
  4. Dogs with hepatic arteriovenous malformations (HAVMs) typically don’t develop clinical signs until old age.
A
  1. Cats with congenital PSS show a higher frequency of neurological signs pre-and post-operatively compared to dogs, with a worse long-term prognosis.
27
Q

An 8 year old female neutered Labrador Retriever is clinically well but has persistently increased alanine aminotransferase (ALT) activity, which is approximately five times the upper limit of the reference range. There is no biochemical or clinical evidence of hepatic failure. Liver biopsy shows mononuclear inflammation, hepatocellular apoptosis, regenerative nodules and mild hepatic fibrosis. Rubeanic acid stain shows numerous grey-black granules within approximately 50% of the hepatocytes within the centrilobar areas (zone 3). Which treatment regimen is MOST APPROPRIATE?

  1. Prednisolone, azathioprine, s-adenosylmethionine and ursodeoxycholic acid
  2. Prednisolone, ciclosporin, s-adenosylmethionine and ursodeoxycholic acid
  3. Prednisolone, penicillamine, s-adenosylmethionine and ursodeoxycholic acid
  4. S-adenosylmethionine and ursodeoxycholic acid
A
  1. Prednisolone, penicillamine, s-adenosylmethionine and ursodeoxycholic acid

Rubeanic acid stain it is used for copper.

28
Q

Periodic acid-Schiff (PAS) can be used on histology samples to identify:

  1. amyloid
  2. Copper
  3. Lipid
  4. Glycogen
A
  1. Glycogen
Oil red o- lipid
Congo red- amyloid
Rhodanine/rubeanic acid- copper
Trichome- Collagen
Perl's Prussian blue- iron

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