Lab Review

Question 1

Possible causes of an epigastric mass

Answer 1

Non-neoplastic: Bezoar, pseudocyst, gastric distension

Neoplastic: Carcinoma, lymphoma, GIST

Question 2

Types of gastric adenocarcinoma

Answer 2

Diffuse

Intestinal

Question 3

Cutaneous signs of gastric adenocarcinoma

Answer 3

Leser trelat sign= acanthosis nigricans

Question 4

Exposures associated with intestinal gastric adenocarcinoma

Answer 4

H pylori, smoked foods, tobacco, achlorydia, chronic gastritis

Question 5

Appearance of intestinal gastric adenocarcinoma

Answer 5

gland-forming, ulcerated with heaped margins, lesser curvature

Question 6

Exposures associated with diffuse gastric adenocarcinoma

Answer 6

none

Question 7

Appearance of gastric diffuse adenocarcinoma

Answer 7

signet ring cells, linitis plastic (leather stomach)

Question 8

stool gap calculation

Answer 8

Stool osmgap=290-2(stoolNa+stoolK

Question 9

duodenal scalloping

Answer 9

celiac disease

Question 10

Marsh classification used to classify what

Answer 10

histologic findings present in celiac disease

Question 11

abdominal angina with postprandial abdominal pain and sitophobia

Answer 11

small bowel ischemia

Question 12

on KUB, thumbprinting of colonic mucosa

Answer 12

ischemic colitis

Question 13

how to treat pseduomembranous colitis

Answer 13

Metronidazole, oral vancomycin

Question 14

Sequesters iron to limit bacterial growth

Answer 14

lactoferrin

Question 15

Composition of esophagus muscle: upper 1/3

Answer 15

skeletal only

Question 16

Composition of esophagus muscle: middle 1/3

Answer 16

both skeletal and smooth

Question 17

Composition of esophagus muscle: lower 1/3

Answer 17

smooth only

Question 18

Centrilobular coagulative necrosis without significant infiltrate indicates what etiology

Answer 18

Acetaminophen toxicity (or other drug induced toxicity)

Question 19

Mutation of C282Y

Answer 19

mutation of HFE gene causing hemochromatosis

Question 20

Less common mutations causing hemochromatosis

Answer 20

H63D (HFE), or hemojevulin, hepcidin, ferroportin)

Question 21

Gland forming tumor with marked desmoplasia

Answer 21

cholangiocarcinoma

pancreatic, colonic and gb adenos also have this appearance

Question 22

Tumor associated with PSC

Answer 22

Cholangiocarcinoma

Question 23

tumor that leads to thickened hepatic plates with unpaired arteries

Answer 23

hepatocellular carcinoma

Question 24

tumor that occurs almost exclusively in cirrhotics

Answer 24

hepatocellular carcinoma

Question 25

tumor of the liver that predominates in females

Answer 25

hepatocellular adenoma

Question 26

tumor that forms a normal thickness hepatic plate with unpaired arteries

Answer 26

hepatocellular adenoma

Question 27

tumor of the liver associated with OCPs

Answer 27

hepatocellular adenoma

Question 28

most common tumor of the liver

Answer 28

hemangioma

Question 29

tumor of the liver that forms a central scar with malformed vessels

Answer 29

focal nodular hyperplasia

Question 30

PAS-positive, diastase resistant globules in hepatocytes

Answer 30

alpha 1 antitrypsin

Question 31

If patient has high IgM think...

Answer 31

PBC, Autoimmune hepatitis

Question 32

plasma cell rich centrilobular hepatitis

Answer 32

autoimmune hepatitis

Question 33

Male > Female predominance of disease

Answer 33

primary sclerosing cholangiitis

Question 34

Diffuse septation and parenchymal nodularity

Answer 34

liver cirrhosis

Question 35

Granulomatous lymphocytic cholangitis / florid duct lesion

Answer 35

PSC

Question 36

Aspects that figure into MELD calculation

Answer 36

Bilirubin, INR, Creatinine

Question 37

Criteria for dx of IBS

Answer 37

recurrent abdominal pain or discomfort for at least 3 days per month in the last 3 months associated with 2 or more of the following – improvement with defecation, onset associated with a change in frequency of stool, and onset associated with a change in form (appearance) of stool.

Question 38

Risk factors for CRC

Answer 38

* Advanced age * Obesity * FAP/HNPCC * Long-standing ulcerative colitis * Excessive alcohol * Smoking

Question 39

CRC patients are all screened for what mutation to guide therapy

Answer 39

KRAS (if constitutively activated, our EGFR inhibitors won't work)

Question 40

HRS Criteria

Answer 40

``` Cr >1.5mg/dl or Cr Clearance <40 ml/min No shock, infection, nephrotox No GI/renal source of fluid loss No improvement with 1.5 L saline Urinary protein <500 mg/dl ```

Question 41

Causes of extreme AST/ALT elevation

Answer 41

Ischemia, Acute viral hepatitis (hepatitis A, B, C, E and herpes), medications leading to hepatic necrosis (e.g. acetaminophen), autoimmune hepatitis, Wilson’s disease, and acute Budd-Chiari syndrome

Question 42

What percentage of alcoholics will develop pancreatitis ?

Answer 42

10%

Question 43

Charcot's triad indicates

Answer 43

acute bacterial cholangitis: pain, jaundice, fever

Question 44

Reynaud's pentad indicates

Answer 44

acute bacterial cholangitis: pain, jaundice, fever, hypotension, AMS

Question 45

``` Predominant cell -> what type of liver injury? Lymphcytes Eosinophils Neutrophil Plasma cell ```

Answer 45

Viral Drug induced Steatohepatitis Autoimmune hepatitis

Question 46

Councilman bodies are present in

Answer 46

acute hepatitis (irreversible injury), eosinophilic body

Question 47

Ground glass in hepatocytes

Answer 47

HBV infection

Question 48

lymphoid aggregate near portal tract

Answer 48

chronic hepatitis B

Question 49

Non Liver sources of AST

Answer 49

cardiac myocytes, skeletal muscle, hemolysis

Question 50

Non liver sources of ALT

Answer 50

bone, placenta, intestine

Question 51

Mallory Body associations

Answer 51

alcoholic liver disease. Also seen in NASH, biliary disease, and copper toxicity (Wilson’s disease or Indian childhood cirrhosis – due to excessive copper intake), hepatocellular carcinomas.

Question 52

Phases of gastric acid secretion

Answer 52

Cepahlic Gastric Intestinal

Question 53

Serious side effect of metoclopramide

Answer 53

tardive dyskinesia

Question 54

Four differences b/w salivary and pancreatic secretions

Answer 54

1. Salivary have myoepithelial cells 2. Salivary have KHCO3 while pancreatic have NaHCO3 3. Salivary are neuronally mediated only (pancreatic both neuronal and hormonal 4. Salivary secretions change significantly with flow rate, pancreatic do not