GI IV

Question 1

celiac

Answer 1

intolerance to gliadin

HLA DQ2, DQ8

dermatitis herpetiforms - extensor surfaces

decreased bone density

blunted villi

risk of T cell lymphoma

tx - gluten free diet

distal duodenum and prox jejunum absorption problems

Question 2

celiac Abs

Answer 2

anti endomysial
anti transglutaminase
anti gliadin

Question 3

lactase deficiency

Answer 3

osmotic diarrhea

lactase - tips of vill - can follow injury - viral enteritis

lactose tolerance test - if

Question 4

whipple disease

Answer 4

tripheryma whiplei - gram positive

PAS foamy macros in intestinal lamina propria
-mesenteric ndes

cardiac sx
arthralgia
neuro sx

often older men

Question 5

PAS foamy macros in intestinal lamina propria with arthritis, neuro, and cardiac sx

Answer 5

whipple disease

Question 6

crohns

Answer 6

often terminal ileum and colon
transmural
skip lesions - cobblestone
noncaseting granulomas
Th1 mediated
stricture, fistula, perianal disease
tx - corticosteroid, azathioprine, cipro, metro, infliximab, adalimumab

extraintestinal:

• migratory polyarthritis
• pyoderma gangrenosum
• kidney stones

also - aphthous ulcer, uveitis, ankylosing spondylitis, erythema nodosum

Question 7

ulcerative colitis

Answer 7

rectal involvement
continuous
only submucosa and mucosa
pseudopolyps
crypt abscess - Th2 mediated
bloody diarrhea
tx - 5-aminosalicyclic prep - mesalamine

extraintstinal:
-priamry sclerosing cholangitis

also - aphthous ulcer, uveitis, ankylosing spondylitis, erythema nodosum

Question 8

mesalamine

Answer 8

5-aminosalicyclic prep

tx of ulcerative colitis

Question 9

IBS

Answer 9

recurrent abdominal pain

• better with defecation
• change stool frequency
• change stool appearance

middle aged women

Question 10

appendictis

Answer 10

adult - fecalith obstruction
children - lymphoid hyperplasia

sx - periumbilical pain to mcburney point

nausea, fever

perforation - peritonitis - rovsing sign

• rebound tenderness
• psoas and obturator

rule out - pregnancy - B-hCG

Question 11

true diverticulum

Answer 11

all 3 layers

often sigmoid colon

Question 12

false diverticulum

Answer 12

pseudodiverticulum

only mucosa and submucosa

Question 13

diverticulosis

Answer 13

many false diverticula of colon
-often sigmoid

increased intraluminal P - weak colon wall

with low fiber diet

Question 14

diverticulitis

Answer 14

inflamed diverticula

LLQ pain, fever, leukocytosis

perforate - peritonitis, abscess formation

like left sided appendicitis

Question 15

zenker diverticulum

Answer 15

pharyngoesophageal false diverticulum

herniation mucosa tissue at killian triangle
-between thyropharyngeal and cricopharyneal parts of inferior pharyngeal constrictor

dysphagia, obstruction, foul breath (halitosis)

MC elderly men

Question 16

meckel diverticulum

Answer 16

true diverticulum

persistent vitelline duct

ectopic gastric mucosa or pancreas tissue
-tec99 scan - for gastric mucosa

rule of 2’s - 2 inches long, 2 feet from ileocecal valve, 2% population, 2yo

Question 17

ladd bands

Answer 17

with malrotation

Question 18

volvulus

Answer 18

twisting bowel around mesentery

midgut - infant and child
sigmoid - elderly

Question 19

intussusception

Answer 19

telescoping - prox bowel to distal bowel

at ileocecal jxn commonly
currant jelly stools

majority in children

bulls eye on U/S

emergency

Question 20

hirschsprung disease

Answer 20

megacolon

lack of enteric nervous plexus

mutation of RET

chronic constipation

dilated normal portion proximal to aganglionic segment
-transitionzone

tx - resection

Question 21

risk of hirschspring

Answer 21

down syndrome

Question 22

MCC small bowel obstruction

Answer 22

adhesions after surgery

Question 23

duodenal atresia

Answer 23

double bubble X-ray

failure of small bowel recanalization

with down syndrome

Question 24

tx of ileus

Answer 24

cholinergic drug - stimulate intestine motility

Question 25

meconium ileus

Answer 25

CF - meconium plug obstruct intestine

Question 26

vollous adenomatous polyp

Answer 26

malignant potential

Question 27

hamartomatous polyp

Answer 27

non-neoplastic

with peutz jeghers and juvenile polyposis

Question 28

serrated polyp

Answer 28

premalignant

CpG hypermethylation

microsatellite instability
-BRAF mutation

saw tooth crypts

Question 29

familial adenomatous polyposis

Answer 29

chromosome 5 - APC tumor suppressor gene
-two hit hypothesis

thousand polyps after puberty

Question 30

turcot syndrome

Answer 30

FAP and CNS tumor

Question 31

gardner syndrome

Answer 31

FAP and bone/soft tissuetumor

Question 32

peutz jeghers syndrome

Answer 32

auto dom

numerous hamartoma polyps
-also hyperpigmented

more colorectal, breast, stomach, small bowel cancers

Question 33

lynch syndrome

Answer 33

auto dom
-DNA mismatch repair mutation - microsatellite instability

3 relatives, 2 generations, 1 diagnosed before 50yo

Question 34

risk fx colorectal cancer

Answer 34

adenomatous or serrated polyp
familial cancer syndrome
IBD
tobacco
processed meat and low fiber

Question 35

ascending colon cancer

Answer 35

iron deficient anemia, weight loss

Question 36

descending colon cancer

Answer 36

obstruction, hematochezia

Question 37

strep bovis

Answer 37

colon cancer

Question 38

apple core lesion on X-ray

Answer 38

colorectal cancer

Question 39

CEA marker

Answer 39

monitor colorectal cancer

Question 40

mutations of colorectal cancer

Answer 40

APC/beta-catenin pathway - sporadic cancers
1 - APC
2 - KRAS
3 - p53 and DCC