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GI Flashcards

1
Q

Most common cystic neoplasm of the pancreas?

A

mucinous cystic pancreatic tumor

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2
Q

Findings associated with Gardener syndrome?

A

multiple GI tract neoplasms

osteomas of the facial bones

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3
Q

cystic pancreatic mass with honeycomb appearance

A

serous cystadenoma

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4
Q

Zenker diverticulum is located where?

A

hypopharynx. superior to cricopharyngeus muscles (c5-6)

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5
Q

Location of killian-jamieson diverticulum?

A

cervical esophagus- below cricopharyngeus

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6
Q

Reticular mucosal pattern in esophagram?

A

Barretts

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7
Q

Esophagram with concentric rings

young patient

atopia

ringed esophagus

A

Eosinophilic esophagitis

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8
Q

Esophageal carcinoma assoc with alc, tobacco, alkaloid ingestion, mid esoph

A

squamous

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9
Q

esophageal cancer related to chronic reflux

A

adeno

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10
Q

What is the difference between stage 3 and stage 4 esophageal malignancy?

A

adventitia vs. invasion into adjacent structures. (CT)

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11
Q

UGI demonstrates plaque-like lesions or granularity in esophagus

A

candidiasis.

patient will be immunocompromised

severe form looks shaggy with irregular luminal surface

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12
Q

esophageal ulcer with halo of edema

A

Herpes

Ð herpes has a halo

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13
Q

asymptomatic version of esophageal candidiasis (mult elevated nodules, elderly)

A

glycogen acanthosis

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14
Q

large flat ulcer of esophagus

A

CMV or HIV

they are not distinguishable

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15
Q

Water density mass in posterior mediastinum

A

esophageal (enteric) duplication cysts

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16
Q

How do you distinguish between an epiphrenic diverticula and para-esophageal hernia?

A

Epiphrenic will be on right and hernia on left

epiphren considered a pulson type diverticulum

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17
Q

multiple small outpouchings of the esophagus

A

esophageal pseudodiverticulosis

2/2 chronic gerd

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18
Q

Liver lesion

young woman

large

well-circ

solitary

peripherally draped vascular supply

A

Hepatic adenoma

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19
Q

MC cause of linitis plastica?

A

Scirrhous cardcinoma

2nd most common: lymphoma

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20
Q

ribbon-like bowel (barium)

A

graft vs. host

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21
Q

Irregular, nodular fold thickening, adenopathy, and diarrhea

A

Mycobacterium avium-intracellulare (MAl) infection

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22
Q

soft-tissue thickening centered at the superior mesenteric root, with central calcifications extending outward to produce mass effect on the small bowel.

A

retractile mesenteritis

ddx: Carcinoid: spoked wheel or star burst pattern of mesenteric thickening and retraction with central calcifications. Hypervascular metastases to liver would suggest this. less dense than retractile mesenteritis.

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23
Q

nutcracker esophagus

A

esophageal spasm

manometric findings >180 mmHg

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24
Q

iron deficiency anemia, dysphagia, thyroid issues, spoon shaped nails

A

Plummer-Vinson Syndrome

esophageal web

risk factor for esophogeal and hypopharyngeal carcinoma

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25
Q

dysphagia 2/2 compression by aberrant R SCA

A

dysphagia lusoria

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26
Q

what lung problem occurs with scleroderma?

A

NSIP

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27
Q

H pylori gastritis occurs where in the stomach?

A

antrum

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28
Q

“jejunal ulcer”

also ulcerations in the stomach and duodenal bulb

A

Zollinger Ellison

ZE is from gastrinoma- could test MEN syndromes this way

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29
Q

where in the stomach does Menetriers disease occur?

A

fundus

massive gastric folds

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30
Q

which gastric wall problem “crosses the pylorus”?

A

lymphoma

adenocarcinoma does it too

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31
Q

FAP+ Desmoid tumors, osteomas, papillary thyroid cancers

A

Gardener Syndrom

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32
Q

FAP + gliomas and medulloblastomas

A

Turcots

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33
Q

cancer everywhere in everything (early colon) and DNA mismatch repair

A

Lynch Syndrome

aka Hereditary nonpolyposis syndrome

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34
Q

hamartomas, mucocutaneous pigmentation, small and large bowel CA, panc CA, and GYN CA

A

Peutz-Jeghers

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35
Q

hamartomas, breast CA, thyroid CA, lhermitte-duclose (posterior fossa noncanerous brain tumor)

A

Cowden’s

***likely to be asked

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36
Q

hamartomas with stomach, small bowel, colon, and ectodermal stuff (skin, hair, nails)

A

Conkite-Canada

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37
Q

Hamartomas + nada

A

Juvenile polyps

38
Q

MC mesenchymal tumor of the GI tract

A

GIST

70% in the stomach.

rare before age 40

** no LN involvement, malignant can be huge, NF-1 association

39
Q

Carney’s Triad

A

chordoma

extra adrenal pheo

GIST

carney’s eat garbage

40
Q

features of malignant stomach ulcers

A

wider than tall

located within lumen

nodular/irreg edges

folds adjacent to ulcer

can be anywhere

41
Q

features of benign stomach ulcers

A

deeper than wide

project beyond lumen

sharp contour

folds radiate to ulcer

lesser curvature

42
Q

risk factor associated with gastric carcinoma

A

H pylori

median age 70

43
Q

metastatic spread of gastric carcinoma to the ovary

A

Krukenberg tumor

44
Q

MC location for sarcoid in the GI tract

A

stomach

45
Q

sand like nodules and thickened irregular mucosal folds of duodenum and prox jejunum

A

Whipples

“like a stripper”

look for near-fat LNs

46
Q

findings of whipples (sand like nodules in jejunum with mucosal fold thickening) + big spleen and RP LNs

A

Pseudo Whipples/ MAI infection

47
Q

Clinical stuff related to celiac’s

A

malabsorption of iron

idiopathic pulmonary hemosidrosis (Lane Hamilton Syndrome)

increased risk of bowel wall lymphoma

Gold standard is bx

dermatitis herpetiformis

48
Q

fold reversal (feathery jejunum looks like ileum and vice versa)

cavitary LNs

splenic atrophy

A

Celiac sprue

49
Q

intestinal lymphangiectasia

A

obstruction of the flow of lymph from the small intestine into the mesentery

50
Q

SMA syndrome

A

obstruction of 3rd portion of the duodeum by the SMA

recent weight loss

51
Q

Meckel’s Diverticulum

  1. Rule of 2’s
  2. NM scan
A
  1. 2 feet from IC valve, 2 inches long, 2cm in diameter, symptoms before age 2
  2. Tc-Pertechnetate
52
Q

MC primary location of carcinoid

A

distal appendix

and terminal ileum

53
Q

Epidemiology of SPEN?

solid psuedopapillar epithelial neoplasm.

A

They are extremely rare and thought to account for 1-2% of exocrine pancreatic tumours. They tend to present in young non-Caucasian females around the 2nd and 3rddecades of life.

54
Q

venous drainage of the adrenal glands

A

R: IVC

L: L renal vein

55
Q

Where is aldosterone made?

A

Zona glomerulosa

regulator of Na, K and HTN

56
Q

Where is cortisol made?

A

zona fasiculata

57
Q

where are androgrens made (in regards to adrenal gland)?

A

zona reticularis

58
Q

Where are catecholamines made?

A

Medulla of adrenal gland

59
Q

You are shown an thickened adrenal gland with loss of the central hperechoic stripe.

A

21-Hydroxylase Deficiency/ Congenital adrenal hypertrophy

in girls, genital ambiguity

in boys, salt loosing pathology which can be lethal

60
Q

Bilateral adrenal gland hyperplasia in a patient with small cell lung cancer

A

Cushing syndrome= too much cortisol. ectopic production from small cell.

cushings can also be from pituitary adenoma (75%) and adrenal adenoma (20%)

61
Q

What are some of the causes of adrenal hemorrhage?

A

Stress: breech, fetal distress, calcs as end result, should be avascular. (neuroblastoma will not get smaller)

Trauma: more common on R

Waterhouse-Friderichesen Syndrome: in the setting of fulminantn meningitis from Neisseria Meningitidis

62
Q

Heterogenous adrenal mass that is T2 bright.

A

pheochromocytoma

usually larger than 3cm on presentation

MIBG>octreotide

also organ of Zuckerkandl

63
Q

Rule of 10s with pheo?

A

10% are:

extra adrenal

bilateral

in children

hereditary

NOT active (no HTN)

64
Q

Syndromes associated with pheochromocytoma?

A

Von Hippel Lindau

MEN IIa, IIb

less likely: NF-1, Sturge Weber, TS

65
Q

Carney Triad? (not carney complex)

A

Extra-adrenal pheo, GIST, pulmonary chondroma (hamartoma)

66
Q

Adrenal tumor that contains bulk fat?

A

Myelolipoma

B9

if bigger than 4cm, can bleed

67
Q

If a pt has a known primary and an adrenal lesion that looks like lipid poor adenoma?

A

Adrenal met. (esp lung, breast, melanoma)

68
Q

LARGE adrenal mass, 20% have calcs and met everywhere with direct extension first

A

Adrenal cortical carcinoma

69
Q

Absolute equation for adrenal washout? what value = adenoma?

A

(enahnced CT-Delayed CT)/(enhanced CT- unenhanced CT) x 100

Greater than 60%=Adenoma

ÐAbsolute Vodka is clear (unenhanced) and 60 proof

70
Q

What is the equation for relative washout for adrenal adenoma? What value = adenoma?

A

(Enhanced CT- Delayed CT)/Enahnced CT x 100

Greater than 40% = Adenoma

Your relatives drink brandy, which is not clear (unenhanced) and it is 40 proof

71
Q

Which syndrome = too much aldosterone?

A

Conn. most commonly caused by benign adenoma.

72
Q

what are some of the causes of adrenal calcs?

A

prior trauma

prior infxn (TB)

cortical carcinoma, neuroblastoma, melanoma

73
Q

bialteral enlarged calcified adrenals (peds)

A

Wolman disease

fat metabolism error that kills in 6 mos

74
Q

Can you think of a way to remember the MEN syndromes?

A

MEN 1: parathyroid hyperplasia, pituitary adeno, pancreatic tumor (gastrinoma)

MEN 2a: medullary thyroid, parathyoid hyperplasia, pheo

MEN 2b: medullary thyroid, pheo, mucosal neuroma, marfanoid body habitus. (Lincoln had this? he is a Man2Be)

75
Q

microcalcifications in a thyroid nodule

A

papillary thyroid cancer

76
Q

what do you do with a cold nodule on thyroid scan?

A

usually B9, but cancer 15% of the time- deserve futher workup

77
Q

why care about thyroglossal duct cyst?

A

can get infected, can rarely have papillary thyroid cancer

78
Q

most common location for ectopic thyroid?

A

base of the tongue- will look hyperdense because of iodine (just like thyroid)

79
Q

most common cause of goiter?

A

North America: multi-nodular goiter/graves

Africa: low iodine

80
Q

What is Grave’s dz?

A

autoimmune dz -> HYPERthyroid ism, antibody directed at TSH receptor

81
Q

I-123 scan value indicateing Graves?

A

usually 50-80% uptake

82
Q

What is Hashimotos?

A

autoimmune dz -> hyper and hypo thyroid MC cause of goitrous hypo

Abs against TPO and anti-thyroglobulin

83
Q

U/S appearance of Hashimotos?

A

Giraffe skin heterogenous appearance

white knights (hyperechoic regenerative nodules)

84
Q

Solid, asymptomatic pancreatic tumor.

A

Pancreatic neuroendocrine tumors are usually solid and hypoechoic or isoechoic in appearance.

85
Q

jejunal ulcer

A

buzzword for ZE.

ZE is from gastrinoma, could test MEN syndromes this way

duodenal bulb is actually MC location for ulcers in ZE

86
Q

menetriers dz

A

enalrgement gastric folds of fundus

87
Q

diff bw Gardner and Turcots?

A

both have FAP, but Gardener has desmoids, osteomas, and papillary thyroid CA while Turcots has gliomas and medulloblastomas

88
Q

Cowden’s syndrome

A

hamartomas

Breast CA

Thyroid CA

Lhermitte-Dulcose (posterior fossa non-CA brain tumor)

89
Q

What defines stage T3 rectal cancer?

A

breaking out of the rectum and into the perirectal fat- changes managment to neoadjuvant

90
Q

Nuc Med studies: which liver lesions are hot (with what tracer) and just plain cold?

  1. Hepatic adenoma
  2. FNH
  3. Cavernous Hemangioma
  4. HCC
  5. Cholangiocarcinoma
  6. Mets
  7. Abscess
  8. Focal Fat
A
  1. cold
  2. Sulfur colloid hot- 40%
  3. RBC hot
  4. Gallium hot
  5. cold
  6. cold
  7. gallium hot
  8. xenon hot
91
Q

High liver signal on in phase imaging

A

hemachromatosis

92
Q

Pancreatic lesions with subtle mutliple cysts, septa, and central scar

A

microcystic adenoma

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