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Emma's NPLEX II Dx > GI Ddx (Pass NPLEX) > Flashcards

GI Ddx (Pass NPLEX) Flashcards

1
Q

What is the difference between laparoscopy and laparotomy?

A

Laparoscopy uses several small incisions often called “keyhole” incisions, one at the belly button and approx. 2 or more elsewhere, depending on what needs to be done. Since the incisions are smaller, healing time is shorter as well as the hospital stay.

Laparotomy is the traditional open abdominal surgery. Incision can be 4 inches. This method has a much longer recovery (6 to 8 weeks).

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2
Q

Meckel’s Diverticulum may mimic the symptoms of what other condition?

A

Appendicitis.

Therefore during an appendectomy the ileum should be checked for the presence of Meckel’s diverticulum. If it is found to be present it should be removed along with the appendix.

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3
Q

What is the keynote symptom/sign of an ileus?

A

Abdominal distention

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4
Q

Why is a barium X Ray used in Crohn’s Disease?

A

A barium X-Ray can show where lesions are active in the small intestine that can’t easily be viewed

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5
Q

Why does Lactose Intolerance often occur with Celiac Disease?

A

Lactase is produced within the villi, therefore if the villi are damaged there will be insufficient lactase enzyme

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6
Q

What is a Volvulus?

A

Twisting of the intestines; often related to constipation or laxative abuse in adults

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7
Q

What is Curling’s ulceration of the duodenum?

A

Severe stress (such as burns or bodily injuries) that causes shock. The hypotension (from shock) then leads to decreased gastric mucosal blood supply and a resultant ischemic ulcer forms

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8
Q

What is the main investigation method for toxic megacolon?

A

Abdominal plain film repeated every 12-24 hours (because signs can fluctuate rapidly)

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9
Q

What is a common sequela to ileal resection in Crohn’s Disease?

A

Urolithiasis

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10
Q

What is Hirschsprung’s disease?

A

It is an autosomal dominant condition, in which the myenteric plexus does not develop. The affected segment of the colon fails to relax, causing an obstruction.

More common in boys than girls

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11
Q

Why are Meckel’s diverticulum occasionally involved in peptic ulceration?

A

Meckel’s Diverticulum often have ectopic gastric (or pancreatic) tissue. The gastric tissue may increase HCl production and thereby lead to ulceration.

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12
Q

Describe the Rule of 2s with respect to Meckel’s Diverticulum?

A

2% of population
2:1 male-to-female ratio
2% of cases are symptomatic
Found within 2 feet of the ileocecal valve
2 inches in length
2 ectopic types of tissue may be found (gastric or pancreatic)
present by age of 2

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13
Q

What is adynamic ileus? etiology?

A

GI obstruction from motor dysfunction (there is NO physical block present)

Usually occurs in reaction to abdo surgery, hypothyroidism, spinal cord injury

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14
Q

Are perianal skin tags more common in Crohn’s or Ulcerative Colitis?

A

Crohn’s disease (75% of cases

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15
Q

What part of the GI tract is typically spared in toxic megacolon?

A

The rectum

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16
Q

Crohn’s vs Ulcerative Colitis: Which condition is more likely to have fistula as a comorbidity?

A

Crohn’s Disease

a. ) Enterocutaneous (MC)
b. ) Enteroenteral
c. ) Enterovesicular (frequent UTIs)
d. ) Enterovaginal

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17
Q

Is uveitis more common in Crohn’s or Ulcerative Colitis?

A

Crohn’s Disease

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18
Q

Where is the most common location of diverticula?

A

In the sigmoid colon

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19
Q

What is Meckel’s Diverticulum?

A

Meckel’s Diverticulum is a small out-pouching in the small intestine. It is remnant of the embryonic viteline duct

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20
Q

Describe the pathophysiology behind Celiac Disease

A

Celiac disease is an auto-immune reaction that predispose a patient to an averse immunologic response in the presence of prolamines (high proline-containing proteins such as gliadin/gluten from wheat, rye, spelt, and barley).

Upon exposure to gliadin the enzyme tissue transglutaminase cross-links with gliadin/gluten that prompts a cross-reaction B-cell production of anti-tissue transglutaminase antibodies in individuals with variant HLA DQ2 & HLA DQ8. The antibodies then initiate an inflammatory cascade that leads to intestinal villous atrophy. The villous atrophy and truncation leads to a loss of surface area and gross nutrient malabsorption.

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21
Q

What diarrheal cause has an abrupt onset of profusely watery diarrhea without pain or nausea/vomiting?

A

Cholera

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22
Q

What bacterial food poisoning can inoculate in rice?

A

Bacillus cereus

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23
Q

How do you confirm a salmonellosis diagnosis?

A

A Rise in serum O and H agglutinin titers 3-4 weeks post-infection

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24
Q

Aside from diarrhea, what are the main symptoms of botulism?

A
  1. ) Bilateral descending flaccid paralysis
  2. ) Loss of Pupillary light reflex
  3. ) Double vision or blurred vision
  4. ) Eventual constipation
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25
Q

MC cause of traveler’s diarrhea?

A

Enterotoxigenic Echerichia coli (ETEC)

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26
Q

What is Hemolytic Uremic Syndrome?

A

A triad of:

  1. ) Hemolytic Anemia
  2. ) Thrombocytopenia
  3. ) Acute renal failure

Related to EHEC, Shigella, or Staphylococcus gastrointestinal infection

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27
Q

When do Sx of HUS start?

What are the symptoms of hemolytic uremic syndrome?

A

The symptoms develop about 5-10 days after the onset of EHEC (Shiga-like toxin) diarrhea:

  1. ) Thrombocytopenia (purpura, epistaxis, hemoptysis, GI bleeding)
  2. ) Microangiopathic hemolytic anemia (MAHA)
    i. ) The endothelial layer of small vessels becomes damaged and results in fibrin deposition and platelet aggregation. Then as RBCs travel through the damaged blood vessels they are fragmented (into schistocytes) resulting in intravascular hemolysis.
  3. ) Renal Failure (oliguria, hematuria)
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28
Q

What are the different types of E coli?

A
  1. ) Enterotoxigenic (ETEC) - produces enterotoxins and Traveller’s diarrhea. There is no inflammation or invasion
  2. ) Enteropathogenic (EPEC) - adheres to apical membrane and flattens villi resulting in decreased absorption. No toxin produced. Usually in children (P for pediatrics)
  3. ) Enteroinvasive (EIEC) - plasmid mediated invasiveness that is similar to shigella. It causes dysentery. Necrosis and inflammation are present.
  4. ) Enterohemorhagic (EHEC) - produces shiga-like toxin with dysentery and Hemolytic-uremic syndrome
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29
Q

What is the most common viral cause of diarrhea?

A

Rotavirus

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30
Q

What are the most concerning complications of botulism?

A

Aspiration pneumonia and respiratory failure

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31
Q

In staphylococcal food poisoning, how will an investigative stool culture and gram stain come back?

A

Both the stool culture and gram stain will be negative because the food poisoning is toxin-mediated not pathogen mediated

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32
Q

What is the most common bacterial cause of bloody diarrhea in USA?

A

Campylobacter jejuni

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33
Q

What parasitic infection produces respiratory complaints such as a cough, dyspnea, and pulmonary infiltrates from larval migration?

A

Ascaris lumbricoides (roundworm)

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34
Q

1.) What form of E.coli infectious diarrhea is accompanied by bloody diarrhea? 2.) What is the toxin found in this particular strain of E coli?

A

Enterohemorrhagic E.coli (EHEC) with Shiga-like toxin

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35
Q

Why is botulism a greater concern in infants?

A

Clostridium botulinum spores are able to colonize in the colon of infants, whereas in adults the botulism experienced is solely from preformed toxin

36
Q

What parasitic infection is often associated with drinking water from streams while camping?

A

Giardia lamblia

37
Q

How can you rule out Guillain-Barre Syndrome in the investigation of Botulism?

A

Electromyography

38
Q

Which parasite is hallmarked by nocturnal rectal pruritis?

A

Enterobius vermicularis (pinworm)

39
Q

What are the 4 most common viral causes of diarrhea?

A 
Norwalk Virus
Adenovirus
Rotavirus
Calci Virus
Mnemonic: NARC
40
Q

What food poisoning may present similarly to appendicitis?

A

Yersinia enterocolitica

41
Q

Shigellosis vs Salmonellosis: Which requires a very small inoculum concentration?

A

Shigellosis requires a very small inoculum concentration (it is very contagious)

Salmonellosis requires a large inoculum concentration

42
Q

What toxin is associated with hemolytic uremic syndrome?

A

Shiga toxin generally from EHEC and sometimes from Shigella or Campylobacter

43
Q

What are the main signs and symptoms of typhoid fever?

A
  1. ) Rose spots on the abdomen
  2. ) Fever
  3. ) Headaches
  4. ) Diarrhea
44
Q

What parasitic infection is identified using the scotch tape test?

A

Enterobius vermicularis because the pinworms lay eggs at night around the rectal sphincter

45
Q

Hookworms (Necator americanus & Ancylostoma duodenale) may cause what extra-intestinal condition?

A

Anemia

46
Q

What bacteria can cause Reactive Arthritis? What are the symptoms of reactive arthritis?

A

Salmonella, Shigella, Campylobacter, Chlamydia, Streptococcus (post-streptococcal reactive arthritis), Yersinia

Symptoms = Uveitis, Urethritis, Arthritis

Mnemonic: Can’t See, Can’t Pee, Can’t Climb a Tree

47
Q

Hepatocellular carcinoma can stem from what condition?

A

Liver cirrhosis

48
Q

What is the incubation period for Hepatitis A Virus?

A

30 days (average)

2-6 weeks

49
Q

What are your main DDxs for hepatomegally?

A

1.) Congestive (Right) Heart Failure

  1. ) Infiltrative
    i. ) Malignancy (leukemia, hepatocarcinoma)
    ii. ) Benign (fatty liver, cysts, hemochromatosis, amyloidosis)
  2. ) Proliferative
    i. ) Infectious/Inflammatory (viral, TB, abcess, granulomas)
50
Q

What are the 2 major complications associated with hereditary hemochromatosis?

A
  1. ) Liver cirrhosis

2. ) Pancreatic Failure resulting in diabetes

51
Q

Caput medusae occurs in what condition?

A

Liver cirrhosis.

Caput medusae is the appearance of distended and engorged paraumbilical veins

52
Q

What percent of patients with Hepatitis C develop cirrhosis or hepatocarcinoma?

A

20%

53
Q

What do interferons do?

A

They interfere with viruses

IFN alpha + beta inhibit viral protein synthesis by inducing the production of ribonuclease which degrades the mRNA of the virus

IFN gamma increases MHC 1 and 2 expression

54
Q

What is Primary Sclerosing Cholangitis?

A

The inflammation (cholangitis) and scarring (sclerosing) of the bile ducts either in the liver (intrahepatic) or extrahepatically.

The scarring impedes bile flow (cholestasis) and results in liver cirrhosis, liver cancer, and liver failure.

55
Q

Hepatomegally is present at what stage of alcoholic hepatitis?

A

Early on. In later stages of hepatitis the liver shrinks.

56
Q
  1. ) What does AST do?

2. ) Where is it found?

A

1.) Aspartate Transaminase catalyzes the interconversion of aspartate and a-ketoglutarate to oxaloacetate and glutamate.

Aspartate (Asp) + a-ketoglutarate ? oxaloacetate + glutamate (Glu)

2.) Found in cardiac tissue, liver, skeletal muscle, RBCs

57
Q

What should the practitioner screen for in patients with unexplained NASH?

A
  1. ) Diabetes & Insulin Resistance

2. ) Hemochromatosis

58
Q

What are the causes of biliary tract obstructions?

A
  1. ) Gall stones
  2. ) Cancer
  3. ) Hemobilia - occurs when there is a fistula between the splanchnic circulation and the hepatic biliary system
  4. ) Sclerosing cholangitis
59
Q

What are the 3 major types of Jaundice?

A
  1. ) Hemolytic = the breakdown of red blood cells
  2. ) Hepatic = the excretion of bile is impaired due to dysfunctional hepatocytes
  3. ) Cholestatic = obstruction of the bile duct prevents the successful excretion of bile
60
Q

What is Charcot’s triad?

A
  1. ) RUQ pain
  2. ) Fever
  3. ) Jaundice

The three most common symptoms in cholangitis (bacterial infection of gallbladder that requires emergency antibiotics and/or surgery)

61
Q

What population group is at the greatest risk of hereditary hemochromatosis?

A

Celtic, British, and Sacndinavian people

62
Q

What is the cause of primary sclerosing cholangitis?

A

It is thought to be autoimmune; more than 80% of cases occur in patients with ulcerative colitis.

63
Q

What are the main risk factors associated with chronic pancreatitis?

A
  1. ) Alcoholism
  2. ) Hypercalcemia (rare)
  3. ) Pancreatic Cancer
  4. ) Cholelithiasis that is obstructing the pancreatic duct
64
Q

H. Pylori infected gastritis most commonly affects what part of the stomach?

A

The antrum

65
Q

Describe the difference between Type-A and Type-B Gastritis

A

Type-A Gastritis (causing pernicious anemia) = autoimmune antibodies against parietal cells leading to achlorhyrdia and a decrease in Intrinsic Factor

Type-B Gastritis (from H.pylori)
a.) Other causes = NSAIDs, alcohol, smoking, elderly, stress

66
Q

What is Zollinger-Ellison Syndrome?

A

Triad of:

  1. ) Gastrinoma tumour in the pancreas or duodenum, causing:
  2. ) Gastric acid hypersecretion , causing:
  3. ) Severe peptic ulceration
67
Q

If you have an esophageal condition resulting in dysphagia and iron deficiency, what is the most likely diagnosis?

A

Plummer-Vinson Syndrome that results in upper esophageal webs, iron deficiency, glossitis, and cheilosis

68
Q

Esophageal webs are most commonly associated with what condition?

A

Plummer-Vinson Syndrome

Marked by: esophageal webs, iron deficiency, cheilosis/angular stomatitis (dry scaling lips), and glossitis. The condition typically occurs in middle-aged females

69
Q

What are the 3 most common causes of Parotiditis?

A
  1. ) Mumps virus
  2. ) S.aureus (suppurative parotiditis)
  3. ) Sjorgren’s disease
70
Q

Plummer-Vinson Syndrome increases the risk of what cancer?

A

Post-cricoid Cancer

71
Q

What is Barrett’s Esophagus?

A

The metaplastic change of stratified squamous cells in the lower esophagus to columnar epithelia normally found in the lower GIT

This can result in esophageal stricture, ulceration, or cancer

72
Q

Diverticulum in the oropharynx just above the cricopharyngeal muscle (above the upper esophageal sphincter) is called?

A

Zenker’s Diverticulum

73
Q

If you have an esophageal condition resulting in dysphagia that is made worse by anxiety, what is the most likely diagnosis? How would you evaluate it?

A

Globus sensation

All evaluations will come back negative because there is no organic pathology.

74
Q

What is Esophageal Atresia?

A

A congenital condition where the esophagus ends in a blind-ended pouch rather than connecting normally to the stomach. It often results in fistula with the trachea

75
Q

What is Zenker’s Diverticulum?

A

It is a herniation/out-pouching of the esophagus generally at Killian’s trinagle (the point of least resistance) in the proximal posterior esophagus that occurs because of increased traction and pulsation mechanisms of the esophagus.

76
Q

What are the main symptoms of Zenker’s Diverticulum?

A
  1. ) Dysphagia
    a. ) < supine (b/c the diverticulum is posterior)
  2. ) Regurgitation of food & halitosis
  3. ) Sometimes a cough (d/t aspiration)
77
Q
  1. ) What is achalasia?

2. ) What are the complications?

A
  1. ) The loss of lower esophageal motility, causing an inability to relax the LES. This results in an enlarged esophageal lumen with chronic food stasis
  2. ) Complications = aspiration pneumonia and esophageal cancer
78
Q

What would your management plan for Plummer-Vinson’s esophageal webs be?

A

Refer to a gastroenterologist

79
Q

What is the difference between a true and false diverticulum?

A

True Diverticulum is the outpouching of the colon wall (typically located in the sigmoid) that contains all layers, including the muscularis and adventitial layers. True Diverticulum are congenital and typically occur on the right side.

False Diverticulum (Pseudodiverticulum) is the outpouching of the colon wall that only contains the mucosal and submucosal layers. It is acquired and typically increases in incidence with age (>40 yoa). Generally located on the left side

80
Q

What are the main interventions for diverticulosis?

A
  1. ) High Fiber Diet
  2. ) Avoid Seeds/nuts
  3. ) Probiotics
  4. ) Castor Oil Packs & Avoid Constipation
    a. ) Constipation increases colonic pressure and may worsen any herniated colonic tissue
  5. ) Weight Loss & Exercise
81
Q

What are the 4 degrees of Internal Hemorrhoids?

A

First Degree - no prolapse
Second Degree - prolapses during defecation but reduces spontaneously
Third Degree - prolapses and requires manual correction
Fourth Degree - Prolapses out of anus and is not reducible

82
Q

What are the main risk factors for Toxic Megacolon?

A

Risk Factors:

i. ) IBD (Crohn’s & Ulcerative Colitis)
ii. ) Pseudomembranous colitis
iii. ) antimotility drug use
iv. ) HIV infection

83
Q

What are the two shapes of colorectal polyps?

A

Sesile (flat) & Pedunculated (on a stalk)

84
Q

Compare and contrast Tubular (Pedunculated) and Villous (Sessile) Polyps:

  1. ) Incidence rate
  2. ) Size
  3. ) Malignant Potential
  4. ) Distribution
A
  1. ) Tubular polyps are more common (60-80%) whereas villous polyps are less common (10%)
  2. ) Tubular polyps are small (<2cm) while Villous polyps are large (>2cm)

3.) Tubular polyps have a low malignancy potential. Villous polyps infer a high malignancy risk.
Note: the larger the polyp, the greater the cancer risk

4.) Villous polyps typically occur on the left side. Tubular polyps are evenly distributed

85
Q

Rubber band ligation of hemorrhoids. Is it performed on internal or external hemorrhoids?

A

Internal hemorrhoids of any grade.

86
Q

What part of the GI tract is typically spared in toxic megacolon?

A

The rectum.

Emma's NPLEX II Dx (10 decks)

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