GI

Question 1

Pleomorphic adenoma

Answer 1

Most common salivary gland tumor
Painless, mobile mass
Composed of chondromyxoid stroma and epithelium

Question 2

Warthin tumor

Answer 2

Benign cystic salivary gland tumor with germinal center

Question 3

VIPoma

Answer 3

Secrete vasoactive intestinal polypeptide
Associated with MEN I
Copious watery diarrhea, hypokalemia, and achorhydria (WDHA syndrome)

Question 4

Mucoepidermoid carcinoma

Answer 4

Most common MALIGNANT salivary gland tumor
Mucinous and squamous components
Painless slow growing mass

Question 5

Gastroschisis

Answer 5

Extrusion of abdominal connotes through abdominal folds, not covered by peritoneum

Question 6

Omphalocele

Answer 6

Persistence of herniation of abdominal content into umbilical cord, SEALed by peritoneum

Question 7

Plummer-Vinson syndrome

Answer 7

Triad of dysphagia (due to esophageal webs), iron deficiency anemia, and glossitis

Question 8

Acute gastritis

Answer 8

Disruption of mucosal barrier leading to inflammation
Caused by stress, NSAIDS, alcohol, burns (Curling ulcer w/ sloughing of gastric mucosa), and brain injury (Cushing ulcer, increased H+ production due to increased vagal tone)

Question 9

Chronic gastritis

Answer 9

Type A (fundus body): autoimmune, autoantibodies, anemia, achloryhydria

Type B (antrum): H pylori infection, increased risk of MALT lymphoma and gastric adenocarcinoma

Question 10

Menetrier disease

Answer 10

Gastric hypertrophy w/ protein loss, parietal cell atrophy, and increased mucous cells
Precancerous

Question 11

Tropical sprue

Answer 11

Acute diarrhea, fever, malaise leading to malabsorption
Affects small bowel
Recent visitors to tropic
Responds to antibiotics

Question 12

Whipple disease

Answer 12

Infection w/ Tropheryma whipplei
Foamy macrophages
Diarrhea leading to malabsorption, cardiac symptoms, arthralgias, and neurologic symptoms

Question 13

Celiac sprue

Answer 13

Autoimmune mediated intolerance of wheat leading to malabsorption and steatorrhea
Labs show anti-endomysial, anti-tissue transglutaminase, and anti-glaidin (wheat) antibodies
Blunting of villi
Lymphocytes in the lamina propria
Affect distal duodenum and/or proximal jejunum

Question 14

Crohns dieseas

Answer 14

Autoimmune, possible due to disordered response to intestinal bacteria

Involves any portion of GI tract, skip lesions, rectal sparing usually

Transmural inflammation, cobblestone mucosa, bowel wall thickening (string sign)

Noncaseating granulomas (Th1) and lymphoid aggregates

Can cause strictures leading to obstruction, fistulas, colorectal cancer

Often manifest w/ diarrhea (non-bloody usually), polyarthritis, kidney stones, erythema nodosum

Treat w/ steroids, infliximab, adalimumab

Question 15

Ulcerative colitis

Answer 15

Autoimmune

Continuous colonic lesion always starting from rectum

Mucosal and submucosal inflammation w/ friable mucosa and loss of haustra “lead pipe”

Crypt abscesses and ulcers, no granulomas (Th2)

Can cause sclerosing cholangitis, toxic megacolon, colorectal carcinoma

Present w/ bloody diarrhea, uveitis

Treat w/ ASA, colectomy

Question 16

Reye syndrome

Answer 16

Rae but often fatal childhood hepatocencephalopathy

Mitochondrial abnormalities leading to fatty liver, hypoglycemia, hepatomegaly

Associated w/ viral infections especially VZV and influenza that has bent rested w/ aspirin

Mechanism: aspirin metabolites decrease beta oxidation by reversibly inhibiting mitochondrial enzymes

Question 17

Cavernous hemangioma

Answer 17

Common benign liver tumor
Typically occurs between age 30-50
Biopsy contraindicated because of risk of hemorrhage

Question 18

Hepatic adenoma

Answer 18

Rare, benign tumor, often related to oral contraceptive or anabolic steroid use
May regress spontaneously or rupture (abdominal pain and shock)

Question 19

Hepatic angiosarcoma

Answer 19

Malignant tumor of endothelial origin

Associated w/ exposure to arsenic, vinyl chloride

Question 20

Budd-Chiari syndrome

Answer 20

Occlusion of IVC or hepatic veins w/ centrilobular congestion and necrosis leading to congestive liver disease (ascites, liver failure)

Can develop varicose and visible veins w/ absence of JVD

Associated w/ hyper coagulable states, polycythemia vera, pregnancy, and HCC

Question 21

Gilbert syndrome

Answer 21

Mildy decreased UDP-glucuronsyltransferase conjugation activity leading o decreased bilirubin intake by hepatocytes

Asymptomatic or mild jaundice

Elevated unconjugated bilirubin w/o overt hemolysis

Question 22

Crigler-Najja syndrome

Answer 22

Absent UDP-glucuronosyltransferase

Presents early in life w/ pts die within a few years

Jaundice, kernicterus (bilirubin deposits in brain), increased unconjugated bilirubin

Treat w/ phototherapy and plasmapheresis

Question 23

Dubin-Johnson syndrome

Answer 23

Conjugated bilirubinemia due to defective liver excretion of conjugated bilirubin

Benign

Grossly black lier

Question 24

Sulfasalazine

Answer 24

Combination of slufapyridine (anti-bacterial) and 5-aminosalicycl acid (anti-inflammatory)
Activated by colonic bacteria
Treat UC and CD

Question 25

Metoclopramide

Answer 25

D2 receptor antagonist
Increase resting tone, LES tone, motility
Treat diabetic and post-surgery gastroparesis, antiemetic
Can increase parkinsonian effects, restlessness, drowsiness

Question 26

Octreotide

Answer 26

Long acting somatostatin analog

Treat acute variceal bleeding, acromegaly, VIPoma, and carcinoid tumors

Question 27

Misoprostol

Answer 27

Prostaglandin E1 analog
Increase production and secretion of gastric mucous barrier
Decrease acid production
Prevent NSAID induced peptic ulcers
Also used to induce labor