Pathophys Review Questions

Question 1

A 25yo w/ HepB. How could he have acquired it?

Is it preventable? Can it be treated?

Answer 1

parenteral, as an STD, or from household contacts.

Prevented w/vaccination and chronic B can be treated. Should also screen for HCC

Question 2

Should Hep C be treated if liver labs are normal?

Answer 2

YES. always treat w/antivirals

Question 3

Risk factors for ulcers?

Answer 3

H. pylori, NSAIDs, smoking, clopidogrel

Question 4

NSAIDs can cause?

Answer 4

all of the above. (not sure what he said here but that’s the answer)

Question 5

Most common etiology of cirrhosis in pts waiting for liver transplant is?

Answer 5

Hep C

Question 6

largest component of most common biliary stone is?

Answer 6

cholesterol

Question 7

most common cause of hospitalizations for acute lower GI bleed in adults is?

Answer 7

diverticulosis

Question 8

best description for acute mesenteric ischemia (emboli to SMA)? Will anticoagulation work?

Answer 8

severe abdominal pain and tenderness

Anticoagulation does NOT work (surgical emergency)

Question 9

cholonic ischemia/ischemic colitis (emboli to a small branch of mesenteric artery) presents as?

Answer 9

moderate abdominal pain, thickening of colon on CT, and hematoschezia

Question 10

Why is alpha1AT associated with liver disease? What are the possible genotypes?

Answer 10

buildup of a1AT in hepatocytes, lungs not necessarily affected.
ZZ, SZ, or MZ genotypes

Question 11

Most frequent location for GI stromal tumors is?

Answer 11

stomach

Question 12

MALT lymphoma is associated with?

Answer 12

H. pylori

Question 13

Lubiprostone is a ?

Answer 13

Cl- channel activator used to treat constipation

Question 14

Best observation in patients w/ dyssenergic defecation is ?

Answer 14

inappropriate contraction or failure to relax the puborectalis

Question 15

5 yo w/ lifelong constipation, never seen by pediatric GI doc, w/ moderate abdominal distention, normal anus, no stenosis, no stool is suggestive of?

Answer 15

Hirschprung’s disease (absence of enteric neurons)

Question 16

Cause of achalasia is?
how is it diagnosed?
How is it treated?
What more severe disease are they at risk for?

Answer 16

failure of LES relaxation w/ swallowing and absence of esophageal peristalsis.
Diagnose by loss of ganglion cells in the wall of esophagus.
Treat with botox or laproscopic myotomy
Risk of SCC.

Question 17

Child-Pugh and MELD score both provide?

Answer 17

operative risk, prognostic info, and staging of liver cancer.

Question 18

What info does MELD use?

Answer 18

INR, bilirubin and creatinine

Question 19

What is treatment for alcoholic cirrhosis patient who quit drinking 6 mo/s ago, MELD of 15, w/ encephalopathy?

Answer 19

transplant

Question 20

active alcoholics have increased toxicity risk w/ acetaminophen due to ?

Answer 20

increased P450 and decreased glutathione

Question 21

most commmon and rapidly increasing liver disease in US?

Answer 21

Non-alcoholic liver disease

Question 22

Most useful test to measure liver function?

Answer 22

INR, albumin and bilirubin

Question 23

Liver enzyme most associated with enzyme induction (not actual liver injury)?

Answer 23

GGT (can be elevated due to induction through drugs or other causes, even though no actual injury or damage exists)

Question 24

Test most helpful for info regarding prognosis of liver disease?

Answer 24

INR

Question 25

50yo Cauc with normal labs, no GI symptoms, no history of colon cancer should be started with preventive care (colonoscopies) when?

Answer 25

start at age 50, so now

Question 26

most common precursor lesion to colon cancer?

Answer 26

adenomatous polp

Question 27

Highest risk factors for colorectal cancer are?

Answer 27

family history and age > 50

Question 28

2nd most common cause of cancer death in US?

Answer 28

Colon cancer, second to lungs

Question 29

60yo with 15lb weight loss, no meds, CT shows diffusely thickened gastric wall, and stomach doesnt distend, w/ diffuse gastric adenocarcinoma. Diagnosis?

Answer 29

Linitis plastica

Question 30

60yo w/ 25lb weight loss, pain w/ eating, nausea from pain, past PUD history, did not take antibiotics, on PPI, has anemia. Diagnosis?

Answer 30

gastric ulcer that progressed to adenocarcinoma

Question 31

55yo male with dysphagia, 30lb weight loss, and long standing reflux. What is precursor syndrome called? What does it lead to?

Answer 31

Barrett’s esophagus –> adenocarcinoma so endoscope for biopsy

Question 32

55yo AA male smokes and drinks 1 pt of vodka/day with 25lb weight loss and dysphagia that started with solids and progressed to fluids. Also odynephagia (painful swallow) and anemia. Diagnosis?

Answer 32

Squamous cell carcinoma of esophagus

Question 33

How do patients w/ cholangitis present?

Answer 33

triad of pain, jaundice and fever

Question 34

What can cause pigment stones?

Answer 34

hemolysis

Question 35

Fat malabsorption can be caused by?

Answer 35

bacterial overgrowth, chronic pancreatitis, and ileal resection

Question 36

In patients w/ malabsorption, most frequent nutrient uptake affected is?

Answer 36

fats/lipids

Question 37

Most frequent GI lymphoma is?

Answer 37

non-hodgkin (B-cell) lymphoma

Question 38

Most frequent gastric carcinoid develops in patients with high levels of?

Answer 38

gastrin

Question 39

most frequent problem in patients with hematoschezia is?

Answer 39

diverticular bleeding

Question 40

Most frequent areas affected by ischemic colitis are?

Answer 40

splenic flexure and rectosigmoid (watershed areas)

Question 41

Acute mesenteric ischemia presentation is most likely to include?

Answer 41

severe abdominal pain