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
________ is a skin disease, often associated with hepatitis C, that presents with purple, pruritic, polygonal planar papules and plaques.
Lichen planus
Only patients who have been infected with hepatitis B virus will be positive for (antibody)________ after clearing the infection or transitioning to chronic infection.
IgG to hepatitis B core antigen
The hepatitis C virus has a(n) (helical/icosahedral) capsid symmetry.
icosahedral
There is a hepatitis _________ seropositivity in 30% of patients with polyarteritis nodosa.
B
Renal dialysis units and needlesticks are risk factors for nosocomial infection by hepatitis (2 types) ____________.
B and C
Hepatitis E mode of transmission is _________.
fecal-oral, especially waterborne
_________ may be the sole positive marker of hepatitis B virus infection during the window period.
IgM antibody to hepatitis B core antigen
Membranoproliferative glomerulonephritis type I may be secondary to hepatitis__________ or C infection.
B
Upon entry into nucleus, the hepatitis B virus _________ completes the partial dsDNA which is used by the host RNA polymerase to transcribe mRNA and make viral proteins.
DNA polymerase
Two glomerular diseases associated with hepatitis B are _________.
membranous nephropathy and type I membranoproliferative glomerulonephritis
The hepatitis C virus (The hepatitis C virus (does/does not) have a carrier state.
does
Hepatitis B and _________ are oncogenic microbes associated with hepatocellular carcinoma.
C
The liver biopsy of a hepatitis E patient shows _______ (histopathology).
patchy necrosis
_________ are the autoantibodies that cause disease in the distal extremities in patients with hepatitis C.
Cryoglobulins
Active hepatitis E infections can be detected by high levels of _______.
HEV-IgM antibodies
_______ is an RNA flavivirus that infects the liver.
Hepatitis C
_______and blood transfusion are the most common methods by which patients acquire hepatitis C.
Intravenous drug use
The liver biopsy of hepatitis B shows a(n) ________; cytotoxic T-cells mediate damage.
granular eosinophilic “ground glass” appearance
Combined passive and active immunizations can be given for hepatitis __________exposure.
B
The hepatitis B virus __________ reverse transcribes the previously transcribed viral RNA to DNA, which is the genome of the progeny virus.
DNA polymerase
A patient during the ________ period of hepatitis B has the following serologic markers: antibody to hepatitis B surface antigen, hepatitis B envelope antibody, and IgG antibody to hepatitis B core antigen.
recovery
Hepatitis E virus infection (does/does not) confer increased risk of hepatocellular carcinoma.
does not
The hepatitis C virus has a (short/long) incubation period.
long
The hepatitis C virus belongs to the _______family of viruses.
Flaviviridae
Newborns infected with hepatitis B have a 90% chance of developing a(n) (acute/chronic) infection.
chronic
(IgM/IgG) antibody to hepatitis B core antigen means there is an acute/recent infection of hepatitis B virus.
IgM
Historically, intravenous drug use and __________have been the most common methods by which patients acquired hepatitis C.
blood transfusions
The clinical course of hepatitis ______ is initially like serum sickness (fever, arthralgias, rash).
B
_______ indicates active viral replication and therefore high transmissibility and poor prognosis of hepatitis B.
Hepatitis B e antigen
Both hepatitis _______ viruses affect the kidneys and are associated with membranous and membranoproliferative glomerulonephritis.
B and C
Carrier state is common in hepatitis ______.
B and C
Hepatitis C virus is a (DNA/RNA) virus.
RNA
Hepatitis B has a (long/short) incubation period.
long (months)
The majority of patients with hepatitis_______ virus infection develop stable, chronic hepatitis.
C
(IgM/IgG) antibody to hepatitis B core antigen means that there was a prior exposure, and it can also be seen in a chronic infection due to hepatitis B virus.
IgG
The hepatitis C virus is a (single/double) stranded RNA virus.
single
Hepatitis ___ and C are oncogenic microbes associated with hepatocellular carcinoma.
B
A patient with a (high/low) infectivity, chronic hepatitis B has the following serologic markers: hepatitis B surface antigen, antibody to hepatitis B early antigen, and IgG antibody to hepatitis B core antigen.
low
______ and lichen planus are dermatologic extrahepatic manifestations of hepatitis C.
Sporadic porphyria cutanea tarda
Essential mixed cryoglobulinemia, increased risk of B-cell non-Hodgkin lymphoma, immune thrombocytopenia, and autoimmune hemolytic anemia are hematologic extrahepatic manifestations of hepatitis _______.
C
_____ is a vascular extrahepatic manifestation of hepatitis B.
Polyarteritis nodosa
There is a (high/low) mortality rate in pregnant patients with hepatitis E infection.
high
A patient with a (high/low) infectivity, chronic hepatitis B has the following serologic markers: hepatitis B surface antigen, hepatitis B envelope antigen, and IgG antibody to hepatitis B core antigen.
high
In viral hepatitis B infection, the liver enzyme alanine aminotransferase (ALT) will be elevated (more/less) than aspartate aminotransferase (AST).
more
Zone _____ of the liver is the zone first affected by hepatitis C infection.
1
Hepatitis C can lead to _________ carcinoma.
hepatocellular
The best screening test for Hepatitis C infection is _______.
HCV-IgG antibody assay
Membranous glomerulonephritis (more common) and membranoproliferative glomerulonephritis (less common) are renal extrahepatic manifestations of hepatitis_______.
B
_______ is a hematologic extrahepatic manifestation of hepatitis B.
Aplastic anemia
A patient immunized for hepatitis B has the following serologic marker:
IgG antibody to hepatitis B surface antigen
Hepatitis B in_______ has a worse prognosis than in adults.
neonates
The hepatitis E virus has a (long/short) incubation period.
short
The hepatitis___ virus causes fulminant hepatitis in pregnant patients.
E
Autoimmune hepatitis is associated with surface receptors _____.
HLA-DR3 and HLA-DR4
Autoimmune hepatitis is more common in (females/males).
females
Common initial symptoms of autoimmune hepatitis include ________.
fatigue or muscle aches or signs of acute liver inflammation including fever, jaundice, and right upper quadrant abdominal pain
________ is the autoantibody associated with autoimmune hepatitis.
Anti-smooth muscle antibody
Autoimmune hepatitis, if left untreated, can result in _______.
cirrhosis
________ is the treatment of choice for end-stage liver disease resulting from autoimmune hepatitis.
Liver transplant
A 61-year-old man is brought to the emergency department by his partner after a 2-day history of abdominal pain, fever, and altered mental status. He is oriented only to self and is unable to name the city in which he lives or the current year. The patient has a history of chronic alcohol use and was found to have cirrhosis several years ago. His other medical conditions include hypertension, hypercholesterolemia, and type II diabetes mellitus. His temperature is 39.0°C (102.2°F), pulse is 109/min, and blood pressure is 130/84 mmHg. Physical examination reveals jaundice and palmar erythema. The abdomen is tense, distended, and tender to palpation. Shifting dullness to percussion is present. Which of the following is the most likely cause of this patient’s clinical presentation?
1. infection of lung parenchyma
2. Microbial infection of ascitic fluid
3. Bacterial infection of the meninges
4. Occlusion of the anterior cerebral artery
5. Inflammation of brain parenchyma
Microbial infection of ascitic fluid
A 47-year-old man presents to the emergency department due to bloody vomiting. The patient was at home watching television when he felt nauseated and threw up “a cup full” of bright red blood. He has not experienced any chest pain. The patient has a history of hepatitis C infection that was diagnosed 7 years ago, but he was not treated due to a lack of medical follow-up. He has never consumed alcohol but smokes a pack of cigarettes daily. He does not consume illicit substances. At arrival, his temperature is 37.0°C (98.6°F), pulse is 109/min, and blood pressure is 98/64 mmHg. Physical examination reveals scleral icterus and palmar erythema. Paraumbilical veins are visible. There is 1+ pitting edema of the lower extremities. This patient’s condition is most likely related to which of the following?
1. Decreased lower esophageal sphincter tone
2. Increased esophageal venous pressures
3. Infiltration of eosinophils in the esophagus
4. Rupture of the esophageal wall
Increased esophageal venous pressures
A 52-year-old man is brought to the emergency department after being found unconscious on the sidewalk. He is arousable to sternal rub. The patient’s family is contacted, and his next of kin reports that the patient is currently undomiciled. Past medical history is notable for hypertension. The patient has been drinking a pint of vodka daily for the last 12 years but does not consume tobacco or illicit substances. Temperature is 37.0°C (98.6°F), pulse is 92/min, respirations are 13/min, and blood pressure is 156/95 mmHg. Physical examination reveals jaundice, palmar erythema, and pungent breath. The lungs are clear to auscultation. The abdomen is soft and mildly tender to palpation; there is shifting dullness to percussion. The liver is not palpable. Which of the following is most likely to be present if a biopsy of the patient’s liver is performed?
1. Regenerative nodules surrounded by fibrous bands
2. Hepatocellular swelling and cytoplasmic emptying with diffuse neutrophilic infiltration
3. accumulation of glucocerebrosidase within hepatic macrophages
4. periodic acid-Schiff positive spherical inclusion bodies in hepatocytes
5. Prussian- blue staining of hepatocytes
Regenerative nodules surrounded by fibrous bands
