GI Flashcards
A 32 yr. old man is brought to the emergency department due to severe abdominal pain, fever, nausea, and vomiting. The patient states that the pain started near the umbilicus yesterday evening but has since moved towards the lower right side. he also reports that the pain increased in severity overnight, rating it up to a 10 on a 10-point scale. However, he now feels that the pain has diminished slightly. He describes the pain as sharp and states that it was especially bad en route to the hospital when the ambulance drove over bumps in the road. The patient has no past medical history and consumes a vegan diet. T102.7, P 124, R 24, BP 86/60. Abdominal examination shows tenderness over the right lower quadrant. The patient is noted to tighten his abdominal muscles to lessen the pain. Which of the following physical examination signs is most likely to be present in this patient?
1. inspiratory arrest with palpation of right upper quadrant
2. nontender, palpable gallbladder in the right upper quadrant
3. rebound tenderness
4. costovertebral angle tenderness
5. Periumbilical edema and ecchymosis
Rebound Tenderness
A 65-yr old woman comes to the clinic due to difficulty swallowing and retrosternal pain. For the past 2 days, she has had pain with swallowing which has progressively worsened to the point of avoiding all food and drinks. She has not had similar symptoms in the past. Medical history is significant for coronary artery disease, hyperlipidemia, seasonal allergies, and osteoarthritis. The patient has smoked 1 pack of cigarettes per day for 30 years. Medications include aspirin, metoprolol, loratadine, lovastatin, and piroxicam as needed. T37, P 80, BP 125/85. The oral mucosa is clear without erythema or exudate. Cardiac auscultation reveals no murmurs, and ECG shows normal sinus rhythm without ischemic changes. The rest of the physical examination is normal. Endoscopy is obtained and shows multiple round ulcers in the proximal esophagus with relatively normal surrounding tissue. Which of the following is the most likely diagnosis?
1. GERD
2. Eosinophilic esophagitis
3. Pill-induced esophagitis
4. Candida esophagitis
5. Viral esophagitis
Pill induced esophagitis
A 55yr old man comes to the clinic due to the recent onset of throat pain, fever, and substernal burning pain. Medical history is notable for hypertension, hyperlipidemia, and end-stage renal disease, for which he received an allograft renal transplantation from a deceased donor 6 months ago. Medications include azathioprine and TMP-SMX. T 38.4, P 80, BP 145/85. Cardiopulmonary examination is WNL. Examination of the oropharynx is normal without exudate or erythema. The abdomen is soft with mild epigastric tenderness. Luekocyte count is 5000/mm3. An endoscopy is obtained and reveals multiple shallow linear ulcers in the distal esophagus. Thich of the following best characterizes the organism responsible for this patient’s finding?
1. Enveloped double stranded DNA virus
2. Non-enveloped single stranded RNA virus
3. Non-enveloped double stranded DNA virus
4. Enveloped single stranded RNA virus
5. Dimorphic Fungi
Enveloped double stranded DNA virus
A 35-yr old man comes to the office due to difficulty swallowing, food regurgitation, and chest pain for the past several months. The patient describes difficulty swallowing both liquids and solids. He often regurgitates large pieces of undigested food mixed with saliva. History is notable for drinking 2 beers every night and smoking 1 pack of cigarettes per day for the past 5 years. He has had no recent illness, weight loss, or fatigue. He has not traveled out of the country recently. VS are WNL. Physical examination, including cardiopulmonary examination is normal. Which of the following is the most likely diagnosis?
1. GERD
2. Diffuse esophageal spasm
3. Achalasia
4. Esophageal Cancer
5. Globus Sensation
Achalasia
A 55-yr old woman comes to the office due to difficulty swallowing for the past 2 months. The patient describes intermittent difficulty swallowing solids which improves with water or by chewing her food more. She also reports feeling more tired during this time period. Medical history is noncontributory. T 36.5, P 110 and BP 135/85. Physical examination reveals pale conjunctiva. Which of the following may be seen on further evaluation of this patient?
1. Koilonychia
2. Delayed wound healing
3. Scaly skin
4. Swollen gums
5. Subacute combined degeneration
Koilonychia
A 60-yr old man comes to the clinic for evaluation of difficulty swallowing accompanied by chest pain. The patient had a few of these episodes in the past but did not seek treatment. The episodes occur while he is having a meal, but only occasionally. He describes difficulty in swallowing both liquids and solids. He has not noticed any pain during exertion. Medical history is noncontributory. The patient does not smoke or use illicit drugs, and he drinks alcohol socially. T 37, P75, BP 125/85. ECG show no abnormalities or ischemic changes. To subsequent troponin measurements are WNL. Which of the following is most likely seen in this patient on further evaluation?
1. Irregular mass on endoscopy
2. Contrast-filled pouch in the esophagus on barium swallow
3. Low ferritin on iron studies
4. simultaneous contractions of the lower esophagus on manometry
5. Distal esophageal stenosis on barium swallow test
6. ST-segment depression on cardiac stress test
Simultaneous contractions of the lower esophagus on manometry
Endoscopic mucosal resection or mucosal ablation, esophagectomy and chemoradiation are treatment options for _______ cancer.
Esophageal
The _______ segments of the esophagus are typically affected by esophageal squamous cell carcinoma.
upper two thirds
______ is the most common type of esophageal carcinoma in the US.
Adenocarcinoma
The ______ segment of the esophagus is typically affected by esophageal adenocarcinoma.
lower third
_____ is a neoplasm associated with Barret esophagus.
Esophageal adenocarcinoma
The most common presenting sign of esophageal cancer is ______, initially for solids and then for liquids.
dysphagia
Risk factors for squamous cell esophageal carcinoma include ________.
alcohol, hot liquids, caustic strictures, smoking and achalasia.
_______ is the most common type of esophageal carcinoma worldwide.
Squamous cell carcinoma
_____ is the imaging study that allows direct visualization and biopsy of esophageal cancer.
Esophagogastroduodenoscopy (EGD)
A 42-yr old man presents to the emergency department with a 2-month history of chest pain and cough. The patient reports he frequently wakes up coughing with substernal burning sensation. He has no significant past medical history but reports a 20-pack year smoking history. T 37, P 68, BP 130/82, R 14. Physical examination shows faint end-expiratory wheezing bilaterally on chest auscultation. Initial troponin level is normal, and an ECG reveals normal sinus rhythm. Which of the following best describes the mechanism of action of the medication used to treat this condition?
1. dilatation of large coronary arteries and arterioles
2. stimulates angiogenesis and the formation of granulation tissue
3. Beta-2 agonist of bronchial smooth muscle cells
4. Na+ channel blockade and inhibition of depolarization
5. Inhibition of the parietal cell H+/K+ ATP pump
Inhibition of the parietal cell H+/K+ ATP pump
A 77-yr old man presents to the primary care physician with a painless mass in his left neck. The patient reports rapid enlargement of this mass over the past several weeks. In addition, he reports a 20lb weight loss, fatigue, and decreased appetite. Past medical history is notable for recurrent peptic ulcer disease, hypertension, and hypercholesterolemia. He reports a 10-pack year smoking history but quit 25 years ago. He reports drinking 1-2 beers per day. T37, P 65, R 12, BP 142/62. Physical examination shows a hard 3 cm X 3cm mass in the left supraclavicular fossa, temporal wasting, epigastric tenderness to palpation, and a small periumbilical subcutaneous nodule. Which of the following is the most likely diagnosis?
1. Hepatocellular carcinoma
2. Hodgkin Lymphoma
3. Gastric adenocarcinoma
4. Colonic adenocarcinoma
5. Pancreatic adenocarcinoma
Gastric adenocarcinoma
A 58-year-old woman presents to the emergency department with acute epigastric pain, dark stools, and lightheadedness. The patient reports abdominal pain over the past several weeks, but today the pain acutely worsened after eating breakfast. She reports passing out in the bathroom after passing a large volume of dark stool. Medical history includes hypertension and chronic gastroesophageal reflux. Temperature is 37 °C (98.6 °F), pulse is 111/min, respirations are 24/min, and blood pressure is 104/62 mmHg. Physical examination shows tenderness on palpation of the epigastrium. The patient undergoes emergent upper endoscopy which reveals active bleeding just distal to the pylorus. Which of the following vascular structures is most likely implicated as a consequence of this patient’s disease process?
1. Splenic Artery
2. Right gastroepiploic artery
3. Left gastric artery
4. Left gastroepiploic artery
5. gastroduodenal artery
gastroduodenal artery
An 80-year-old man presents to the primary care physician with a chief complaint of a new rash that suddenly appeared several days ago. He reports the rash is not itchy, and he has not had a similar rash in the past. When questioned further, the patient reports a several-month history of abdominal pain, weight loss, early satiety, and fatigue. He reports discomfort in the mid-epigastrium postprandially that started one year ago and has worsened. The patient took a proton pump-inhibitor, which initially alleviated the pain but now has no effect on symptoms. He has lost 9.1-kg (20-lb) over the past six months. Further past medical history includes coronary artery disease, hypertension, recurrent H. pylori gastritis, and a twenty-one-pack year smoking history. Physical examination shows multiple seborrheic keratoses on his chest and back, as well as temporal wasting. Multiple enlarged supraclavicular lymph nodes are noted, predominantly on the left side. Laboratory results reveal a hemoglobin level of 8.0 g/dL and mean corpuscular volume of 70 fL. Which of the following findings is most likely to be present on endoscopic evaluation?
1. ill-defined white-yellow mass extruding from the sphincter of Oddi
2. Fibrotic tissue at the pyloric sphincter
3. Ulcerated mass on the lesser curvature with raised margins
4. Round defect with a smooth base on the lesser curvature
5. Grossly thickened stomach wall with a leathery appearance.
ulcerated mass on the lesser curvature with raised margins
A 44-year-old man comes to the office because of persistent dyspepsia. The patient has been taking a high dose of omeprazole for two months with some improvement in the symptoms, but he still complains of mild, burning epigastric pain alleviated by eating. As a result, he has gained 6.8-kg (15-lb) over this period of time. In addition, he complains of foul smelling, non-bloody diarrhea 1-2 times daily. Temperature is 37°C (98.6°F), pulse is 86/min, respirations are 16/min, and blood pressure is 142/62 mmHg. Physical examination is unremarkable. The patient undergoes esophagogastroduodenoscopy, which reveals multiple ulcers in the proximal and distal duodenum. Biopsies of the ulcers are negative for Helicobacter pylori. Which of the following findings is diagnostic of this patient’s underlying condition?
1. Elevated serum cancer antigen 19-9 levels
2. Elevated serum gastrin levels
3. Elevated CEA levels
4. Elevated serum chromogranin A levels
5. Genetic analysis of RET
Elevated serum gastrin levels
A group of investigators are studying the gastrointestinal ligament and the structures housed within. They discover the hepatoduodenal ligament contains the portal triad, which consists of the proper hepatic artery, hepatic portal vein, and common bile duct. Which of the following structures form the hepatic portal vein?
1. Inferior mesenteric and splenic veins
2. Superior mesenteric and splenic veins
3. Inferior mesenteric and superior mesenteric veins
4. external iliac and internal iliac veins
5. Collecting and central veins
Superior mesenteric and splenic veins
Hepatitis C shows lymphoid aggregates with focal areas of ______ on liver biopsy.
macrovesicular steatosis
Hepatitis B virus is not a retrovirus but has _____________ .
reverse transcriptase
________ are the transmission modes for hepatitis B.
Blood (parenteral), Baby making (sexual), and Birthing (perinatal)
Treatment for hepatitis E is generally (surgical/medical/supportive)
supportive
_______ is a hepatitis C drug that inhibits viral protease enzymes to prevent viral replication.
Simeprevir
A patient with _________ hepatitis B has the following serologic markers: hepatitis B surface antigen, hepatitis B early antigen, and IgM antibody to hepatitis B core antigen.
Acute
Most adults with hepatitis B will progress to (chronic infection/full resolution)
full resolution
Hepatitis D requires the ________ in order to be infectious.
hepatitis B infection
Hepatitis B virus ________ has DNA- and RNA-dependent activities.
DNA polymerase
The hepatitis C virus is a(n) (naked/enveloped) virus.
enveloped
Membranous glomerulonephritis and membranoproliferative glomerulonephritis are renal extrahepatic manifestations of hepatitis B and hepatitis _________.
C
Hepatitis E (does/does not) have a carrier state.
does not
Hepatitis B virus belongs to the _______ family.
DNA hepadnaviral
Hepatitis B infection is a risk factor for cirrhosis and __________ carcinoma.
hepatocellular
The gold standard test for Hepatitis C infection is _________ and can tell us the level of circulating virus
HCV RNA Test
Hepatitis E infections are usually (chronic/not chronic).
not chronic
A patient during the _________ period of hepatitis B has the following serologic markers: IgM antibody to hepatitis B core antigen and the anti-HBe antibody.
window
Increased risk of __________ and autoimmune hypothyroidism are extrahepatic manifestations of hepatitis C.
diabetes mellitus
________ is a vascular extrahepatic manifestation of hepatitis C.
Leukocytoclastic vasculitis
Hepatitis C infection may progress to___________ or carcinoma.
cirrhosis
