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Review Flashcards

1
Q
A

A

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2
Q
A

A) ascending colon

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3
Q
A

C) lesser omentum

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4
Q
A

A) common hepatic

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5
Q

An incision or deep laceration along which of the following will disrupt innervation to the rectus abdominis muscle?

a) medial arcuate ligament
b) arcuate line
c) linea semilunaris
d) linea alba
e) lateral arcuate ligament

A

c) linea semilunaris

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6
Q
A

C) increased sympathetic activity resulting in increased blood flow to skeletal muscle, shunting blood away from the GI tract

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7
Q
A

A) cephalic phase

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8
Q
A

C) dental caries

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9
Q

Which of the following is NOT a function of acid in the stomach?

a) facilitates hydrolysis of pepsinogen to pepsin
b) creates pH environment optimal for pepsin to function
c) stimulates secretion of amylase
d) denatures proteins
e) has anti-microbial activity

A

c) stimulates secretion of amylase

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10
Q

Which of the following is a consequence of taking PPIs?

a) decreased histamine release from ECL cells
b) increased histamine release from ECL cells
c) decreased gastrin secretion
d) decreased gastrin secretion
e) no change in gastrin and histamine levels

A

d) increased gastrin secretion

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11
Q

Which one of the following inhibits gastrin release?

a) a large meal
b) thinking about eating delicious Halloween candy
c) a PPI like omeprazole
d) high gastric pH
e) low gastric pH

A

e) low gastric pH

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12
Q

Ingestion of a large fat meal causes which one of the following?

a) gallbladder relaxation
b) release of pancreatic enzymes
c) increased bicarbonate secretion by the pancreas
d) increased gastric emptying
e) sphincter of oddi contraction

A

b) release of pancreatic enzymes

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13
Q

You return from a trip with massive diarrhea. A secretory diarrhea is suspected. What is the likely mechanism of action for the diarrhea?

a) increased cyclic AMP activity
b) impaired secretion of Chloride at the apical membrane of enterocytes
c) decreased activity of the CFTR channels
d) destruction of enterocytes via an inflammatory process

A

a) increased cyclic AMP activity

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14
Q

Which of the following patterns of activity is active during the inter-digestive state?

a) slow waves
b) migrating motor complex
c) peristalsis
d) segmentation
e) haustration

A

b) migrating motor complex

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15
Q

Which of the following is most effective at moving intestinal contents aborally?

a) segmentation
b) peristalsis
c) haustration
d) migrating motor complex
e) gastric contractions

A

b) peristalsis

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16
Q

What is a function of the interstitial cells of Cajal?

a) electrical pacemakers for smooth muscle cells (slow waves)
b) cause relaxation of lower esophageal sphincter after bolus ingestion
c) stimulate contractions via action potentials
d) maintain patency of the ileocecal valve to prevent retrograde flow into the terminal ileum
e) cause relaxation of internal anal sphincter to aid in defecation

A

a) electrical pacemakers for smooth muscle cells (slow waves)

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17
Q
A

B) stomach

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18
Q
A

b) submucosa

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19
Q
A

B) eosinophilic esophagitis

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20
Q

Which of the following features favors a dysplastic process over a benign process when looking at a biopsy of the esophagus?

a) basal cell hyperplasia
b) intercellular edema between keratinocytes
c) lamina propria fibrosis
d) loss of cell polarity
e) presence of goblet cells

A

d) loss of cell polarity

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21
Q
A

A

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22
Q
A

E) transient relaxation of the lower esophageal sphincter

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23
Q
A

D) weight loss

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24
Q
A

c) findings of furrows on endoscopy

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25
Q
A

a) pill esophagitis due to starting bisphosphonates

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26
Q
A

A) esophageal biopsy

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27
Q
A

c) achalasia

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28
Q

Which one of the following is likely to improve symptoms of gastroparesis?

a) eating mostly solid, high fat meals
b) liquid diet and small meals
c) use of a gastric pacemaker
d) surgical vagotomy
e) use of atropine (ACh receptor blocker)

A

b) liquid diet and small meals

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29
Q

Which of the following is NOT a mucosal protective mechanism preventing the stomach from autodigesting?

a) mucin presence prevents food from directly touching the epithelium
b) rich vasculature washes away acid that has back diffused to the lamina propria
c) epithelial regenerative capacity
d) continuous layer of epithelial cells forms a physical barrier
e) goblet cells provide a protective barrier from acid

A

e) goblet cells provide a protective barrier from acid

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30
Q

What does the following biopsy show?

a) acute hemorrhagic gastritis
b) H. pylori gastritis
c) gastric adenocarcinoma
d) autoimmune gastritis
e) CMV gastritis

A

A) acute hemorrhagic gastritis

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31
Q
A

C) autoimmune gastritis

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32
Q

Which of the following would you expect in a patient with autoimmune gastritis?

a) hyperchlorhydria and high gastrin
b) hypochlorhydria and high gastrin
c) hyperchlorhydria and low gastrin
d) hypochlorhydria and low gastrin

A

b) hypochlorhydria and high gastrin

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33
Q

Which of the following is true regarding Zollinger-Ellison syndrome?

a) characterized by diffuse foveolar hyperplasia
b) results in hypochlorhydria
c) caused by excessive secretion of TGF-alpha
d) can be seen in MEN syndrome 2
e) can present as non-healing ulcers

A

e) can present as non-healing ulcers

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34
Q

A 52 yo man with recurrent abdominal pain and endoscopy proven duodenal ulcer is treated with proton pump therapy (omeprazole 40 mg daily). His symptoms improve, but after reading Up to Date about acid peptic disorders his physician orders a fasting serum gastrin and vitamin levels. His gastrin is 200 pg/mL (normal 0-110 pg/mL) and his B12 is normal. Which one of the following is the most likely explanation for the elevated gastrin?

a) chronic PPI use
b) autoimmune gastritis
c) H. pylori infection
d) surreptitious use of non-steroidal anti-inflammatory agents (NSAIDs)
e) Zollinger-Ellison syndrome

A

a) chronic PPI use

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35
Q

Why are duodenal ulcers more likely in antral predominant H pylori gastritis?

a) more D cells than G cells are destroyed resulting in higher acid levels
b) more G cells than D cells are destroyed resulting in higher acid levels
c) both D and G cells are destroyed equally resulting in increased acid production
d) parietal cells, and D and G cells are destroyed resulting in atrophic gastritis which leads to ulcer formation

A

a) more D cells than G cells are destroyed resulting in higher acid levels

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36
Q

Which of the following is false regarding H pylori?

a) implicated in pathogenesis of gastric adenocarcinoma
b) implicated in pathogenesis of MALT lymphoma
c) is localized to the gastric epithelium
d) is a urease producer
e) inhibits prostaglandin synthesis

A

e) inhibits prostaglandin synthesis

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37
Q

A 19-year old male presents to his physician for diarrhea and fatigue. Further workup revealed iron-deficiency anemia and biopsies of the duodenum were obtained and appear consistent with a diagnosis of celiac disease. The patient is currently on a gluten-inclusive diet. Which of the foollowing would essentially rule out, or make very unlikely, a diagnosis of celiac disease?

a) the patient has no symptoms when he consumes gluten
b) the patient lacks IgA tissue transglutaminase antibody and IgA anti-gliadin antibody
c) the patient does not have HLA DQ2/DQ8 gene
d) the patient has normal total IgA levels

A

c) the patient does not have HLA DQ2/DQ8 gene

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38
Q

Which of the following would you expect to see in the biopsies of a patient with Whipple’s disease?

a) transmural inflammation with presence of granulomas
b) lamina propria with many macrophages containing bacilli that stain with periodic acid-Schiff reagent
c) branching bundles of smooth muscle derived from muscularis mucosae
d) marked (>20 eos/hpf) infiltration of eosinophils in the submucosa

A

b) lamina propria with many macrophages containing bacilli that stain with periodic acid-Schiff reagent

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39
Q
A

d) branching bundles of smooth muscle consistent with hamartomas in Peutz-Jeghers

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40
Q

Which of the following scenarios is consistent with fat malabsorption?

a) pale, clay-colored stools
b) greasy, floaty stools
c) bloody stools
d) melenic (black) stools
e) normal stools

A

b) greasy, floaty stools

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41
Q

A 19 yo female with cystic fibrosis presents with progressive weight loss and diarrhea. Her stool tends to float, and she needs to flush the toilet multiple times to clear the toilet bowl. You send stool studies including a fecal elastase and 72-hour stool collection on a high fat diet. What set of labs fit best with the person’s presenting clinical picture?

a) fecal elastase 50, fecal fat 23 g/day
b) fecal elastase 50, fecal fat 6 g/day
c) fecal elastase 500, fecal fat 6 g/day
d) fecal elastase 500, fecal fat 23 g/day

A

a) fecal elastase 50, fecal fat 23 g/day

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42
Q

A 25 yo female presents to your clinic with post-prandial diarrhea and bloating. She reports a remote history of ileocecectomy for complicated appendicitis. She appears well nourished and her exam is normal. Which of the following is true?

a) she is at risk for iron deficiency because iron is absorbed in the terminal ileum
b) she is at risk for B12 deficiency because B12 is absorbed in the terminal ileum
c) she is at risk for short gut syndrome because of her prior surgery
d) she is at risk for pancreatic insufficiency and should be started on pancreatic enzyme replacement therapy

A

b) she is at risk for B12 deficiency because B12 is absorbed in the terminal ileum

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43
Q

What gets absorbed in the duodenum?

A

heavy metals (iron, copper, magnesium, calcium, etc.)

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44
Q

What gets absorbed in the jejunum?

A

heavy metals, monosaccharides, small peptides, amino acids, start of lipids

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45
Q

What gets absorbed in the ileum?

A

lipids, vitamins (including fat soluble - A, D, E, K), folate

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46
Q

What is absorbed in the terminal ileum?

A

vitamin B12, bile salts, fat

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47
Q

What is absorbed in the colon?

A

short chain fatty acids, water

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48
Q

A 23 year old vegetarian patient with celiac disease presents to review her gluten free diet. Her celiac serologies have normalized since being gluten free, and her diarrhea has resolved, but she now complains of paresthesias, fatigue, and memory impairment. Which of the following vitamin deficiencies do you suspect?

a) vitamin A deficiency
b) vitamin D deficiency
c) vitamin B12 deficiency
d) zinc deficiency
e) selenium deficiency

A

c) vitamin B12 deficiency

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49
Q

A 25 yo F presents to your clinic at 14 weeks pregnant without previously having received any prenatal care. She has not been taking prenatal vitamins and she consumes 2-3 alcoholic drinks daily. Whihc of the following problems with the fetus would you most be concerned about?

a) neural tube defects
b) rickets
c) blindness
d) cardiomegaly

A

a) neural tube defects

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50
Q

Which of the following is true regarding amylase?

a) it breaks up terminal alpha 1,4 bonds
b) it breaks up internal alpha 1,4 bonds
c) it breaks up terminal alpha 1,6 bonds
d) it breaks up internal alpha 1,6 bonds
e) it breaks 1,4 bonds

A

b) it breaks up internal alpha 1,4 bonds

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51
Q

Which of the following transporters is responsible for active absorption of glucose via the brush border?

a) SGLUT-1
b) GLUT-1
c) GLUT-2
d) GLUT-3
e) GLUT-4
f) GLUT-5

A

a) SGLUT-1

GLUT-2 and GLUT5 are also in gut, but do not actively absorb glucose

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52
Q

Which of the following is not unique to the Gut Associated Lymphoid Tissue (GALT)?

a) microfold cells
b) preferential production of secretory IgA
c) paneth cells
d) pathways to promote tolerance to oral antigens
e) dendritic cells

A

e) dendritic cells

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53
Q

A 23 yo female with history of unexplained diarrhea, bloating, and iron deficiency anemia presents to your clinic. You are concerned that she has celiac disease. Which of the following tests are diagnostic?

Normal values: IgA (70-400), ttg IgA (0-19), ttg IgG (<40)

a) ttg IgA 3, total IgA 34
b) ttg IgA 3, total IgA 150
c) ttg IgG 3, total IgA 150
d) ttg IgG 98, total IgA 34

A

d) ttg IgG 98, total IgA 34

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54
Q

What is the correct relationship between bioavailability and first pass metabolism?

a) a drug with low first pass metabolism will have low bioavailability
b) a drug with high first pass metabolism will have low bioavailability
c) a drug with high first pass metabolism will have high bioavailability
d) the relationship between the two is variable depending on the drug

A

b) a drug with high first pass metabolism will have low bioavailability

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55
Q

You are taking care of a cirrhotic patient who has grade I encephalopathy and recently underwent a paracentesis. The patient is complaining of severe pain at the site of paracentesis. Aside from ordering a CT scan, the nurse on the floor pages you pleading for an order for oral morphine to calm the patient’s pain. What is your response, and which of the following statements is true regarding the pharmacokinetics of oral morphine?

a) yes, give him oral morphine - as long as it’s not given IV its bioavailability will be low so it won’t have any detrimental effects
b) yes, give him oral morphine - it’s a high extraction drug so the liver will effectively clear it resulting in lower bioavailability
c) no, oral morphine is a high extraction drug so its clearance will be affected in a cirrhotic liver, resulting in higher bioavailability
d) no, oral morphine is a low extraction drug so its clearance will be affected in a cirrhotic liver, resulting in higher bioavailability

A

c) no, oral morphine is a high extraction drug so its clearance will be affected in a cirrhotic liver, resulting in higher bioavailability

56
Q

Thermic effect of food (TEF) makes up what percentage of the components of energy expenditure?

a) 85%
b) 65%
c) 25%
d) 10%
e) 2%

A

d) 10%

57
Q

A 25 yo F with anorexia nervosa presents to your clinic. Her BMI is 15 and she severely restricts her caloric intake. Which of the following hormones would you expect to be elevated in the fasting state?

a) insulin
b) leptin
c) ghrelin
d) gastrin

A

c) ghrelin

58
Q

Which of the following is not a mechanism by which obesity is pathological?

a) decrease in adipokines
b) increased mechanical burden
c) increased abdominal pressure
d) cardiovascular burden
e) increased respiratory burden

A

a) decrease in adipokines

59
Q

A 50 yo F comes to see you after undergoing liposuction which resulted in a reduction in her waist circumference. She is upset that her diabetes and hypertension have not improved. Why might this be?

a) she needs to have more subcutaneous fat removed
b) she has developed insulin resistance, which is not reversible
c) amount of visceral adipose tissue has not changed
d) her adipokine levels have increased

A

c) amount of visceral adipose tissue has not changed

60
Q

Which of the following is false regarding visceral fat?

a) can be estimated by measuring waist circumference
b) decreases insulin resistance
c) results in increased inflammatory cells
d) results in increased adipokines and cytokines
e) is metabolically worse than subcutaneous fat

A

b) decreases insulin resistance

61
Q

Which of the following weight changes is NOT normal?

a) 5-10% of birth weight loss in first few days of life
b) daily weight gain of 20-30 g in the first three months
c) double birth weight at 8 months
d) triple birth weight at 12 months
e) average 1 year old is 10 kg

A

c) double birth weight at 8 months

birth weight should double at 3-4 months

62
Q

Where is this in the GI tract?

A

esophagus or anus

squamous mucosa

63
Q

Where is this in the GI tract?

A

stomach

stratified/columnar mucosa

64
Q

Where in the GI tract is this?

A

small bowel

villi, goblet cells

65
Q

Where in the GI tract is this?

A

colon/appendix

glands, goblet cells

66
Q

What are major associations with tracheoesophageal fistulas?

A

VATERL

Vertebral

Anal anomalies

Cardiac

TE (tracheoesophageal fistula)

Renal anomalies

Limb anomalies

67
Q

What type of vomiting is associated with pyloric stenosis?

A

non-bilious projectile vomiting

68
Q

What syndrome is associated with pyloric stenosis?

A

Turner Syndrome (trisomy 18)

69
Q

What imaging findings are associated with duodenal atresia? Jejunal atresia?

A

duodenal: “double bubble” sign

Jejunal: “triple bubble” sign, apple-peel atresia

70
Q

What type of vomit is associated with intestinal atresia?

A

bilious vomit

71
Q

What syndrome is associated with duodenal atresia?

A

trisomy 21

72
Q

What is the cause of Hirschprung’s disease?

A

failure of neural crest migration leading to lack of ganglion cells in the distal colon/rectum

73
Q

What is the difference between gastroschisis and omphalocele?

A

gastroschisis: lateral wall defect leading to uncovered organs
omphalocele: umbilical ring defect leading to organs covered by peritoneum

74
Q

What genetic changes contribute to colonic adenocarcinoma?

A

APC + KRAS + DCCC + P53

75
Q

What is this?

A

mallory-weiss tear of the esophagus

76
Q

What is this?

A

celiac disease

77
Q

What is the genetic cause of lynch syndrome?

A

mutations of mismatch repair proteins

78
Q

What is the genetic cause of famial adenomatous polyposis?

A

autosomal dominant mutation of the APC gene

79
Q

What cancers are associated with Peutz-Jegher Syndrome?

A

colorectal cancer, breast cancer, pancreatic cancer, sex-cord tumors

80
Q

What are the major symptoms of vitamin A deficiency?

A

eye/vision symptoms

81
Q

What are the major symptoms of vitamin A toxicity?

A

headache, intracranial pressure, bone pain

82
Q

What are the major symptoms of vitamin D deficiency?

A

rickets, osteomalacia

83
Q

What are the major symptoms of vitamin E deficiency?

A

degenerated posterior spine columns

84
Q

What are the major symptoms of vitamin K deficiency?

A

bleeding (affects clotting factors)

85
Q

What are the major symptoms of vitamin B1 (thiamine) deficiency?

A

beri beri dry (polyneuropathy), wet (dilated, edema)

wernicke-korsakoff syndrome (from alcohol)

86
Q

What are the major symptoms of vitamin B2 (riboflavin) deficiency?

A

cheilosis, glossitis, dermatitis

87
Q

What are the major symptoms of vitamin B3 (niacin) deficiency?

A

pellagra: 4 Ds –> dermatitis, diarrhea, dementia, death

88
Q

What are the major symptoms of vitamin B6 (pyridoxine) deficiency?

A

coenzyme problems leading to normocytic anemia

89
Q

What are the major symptoms of vitamin B12 deficiency?

A

posterior column spinal cord degeneration

megaloblastic anemia

90
Q

What are the major symptoms of folate deficiency?

A

megaloblastic anemia

91
Q

What are the major symptoms of vitamin C deficiency?

A

scurvy, collagen defects

92
Q

What are the major symptoms of zinc deficiency?

A

cheilitis, rash, poor night vision

93
Q
A

c) preterm delivery

94
Q
A

B) hirschprung disease

95
Q
A

E) trypansoma cruzi

chagas disease

96
Q
A

E) vomiting

aggressive vomiting leads to mallory-weiss tears

97
Q
A

A) adenocarcinoma

associated with barret’s esophagus

98
Q
A

A) aspirin

NSAID associated ulcers

99
Q
A

E) signet ring adenocarcinoma

100
Q
A

C) neural crest

neuroendocrine cells are derived from the neural crest

101
Q
A

D) ischemic colitis

102
Q
A

E) villous blunting and flattening

103
Q
A

B) enterocutaneous fistula

104
Q
A

B) adenocarcinoma

105
Q
A

C) pericolic abscess

diverticulitis

106
Q
A

C) lynch syndrome

107
Q
A

D) hemorrhoids

108
Q
A

E) Niacin

pellagra

109
Q
A

E) thiamine

110
Q
A

C) zone 3

111
Q
A

D) macrovesicular steatosis

all of the others are seen with inflammatory changes

112
Q
A

B) cirrhosis due to alpha-1 anti-trypsin deficiency

113
Q
A

B) chronic hepatitis C viral infection

periportal inflammation

114
Q
A

D) herpes virus

this is only an acute disease process, so it would not cause dysplastic changes

115
Q

A 49 year old woman presents with worsening fatigue, jaundice, and pruritis. Serum alkaline phosphatase levels are increased, and serum aminotransferase levels are within normal liimits. Her blood work is positive for anti-mitochondrial antibodies. A liver biopsy shows granulomatous inflammation and bile duct injury in the portal tracts. What is the MOST likely diagnosis?

a) alcoholic hepatitis
b) primary biliary cholangitis
c) primary sclerosing cholangitis
d) acute hepatitis B viral infection
e) autoimmune hepatitis

A

b) primary biliary cholangitis

associated with older women, anti-mitochondrial antibodies, and disease of the small ducts in the portal tracts

116
Q

Which of the following infections can result in chronic hepatitis?

a) hepatitis A
b) hepatitis B
c) hepatitis E
d) herpes virus
e) ebstein-barr virus

A

b) hepatitis B

117
Q

Which of the following scenarios represents immunity to hep B via vaccination?

a) HBsAg (-), total anti-HBc (-), HBsAb (-)
b) HBsAg (-), total anti-HBc (+), HBsAb (+)
c) HBsAg (-), total anti-HBc (-), HBsAb (+)
d) HBsAg (+), total anti-HBc (+), HBsAb (-)
e) HBsAg (-), total anti-HBc (+), HBsAb (-)

A

c) HBsAg (-), total anti-HBc (-), HBsAb (+)
* A represents somebody who has never had it and has not had a vaccine*
* B represents somebody with natural immunity*
* D represents somebody with chronic infection*
* E could be a bunch of stuff*

118
Q

32 yo patient with chronic HBV infection is found to have total bilirubin 3x the upper limit of normal (ULN), ALT is 4x ULN. HBV DNA viral load is very low. You suspect super-infection with Hepatitis D. Which of the following is true?

a) presence of HDV results in lower morbidity and mortality than HBV infection alone
b) superinfection is seen with acute HBV
c) presence of HBsAg is necessary for HDV viability, regardless of HBV viral load amount
d) new treatments now result in high cure rates
e) curing both viruses should yield an HB serology pattern of HBsAg (-), HBcAb (-), and HBsAb (+)

A

c) presence of HBsAg is necessary for HDV viability, regardless of HBV viral load amount

119
Q

50 yo patient with HCV cirrhosis is admitted to the hospital with recurrent confusion, increasing ascites, and acute kidney injury. Which of the following is the best next step?

a) large volume paracentesis (> 6 L)
b) CT head to rule out stroke
c) empiric antibiotic treatment
d) diagnostic paracentesis
e) administration of diuretics

A

d) diagnostic paracentesis

120
Q

65 yo patient with alcohol cirrhosis is recently diagnosed with HCC based on imaging findings on MRI. Which of the following is true?

a) the diagnosis of HCC in the absence of hepatic decompensation or systemic symptoms is atypical, and thus other etiologies should be considered
b) the diagnosis of HCC is usually determined through biopsy, so a biopsy is needed for diagnosis
c) the diagnosis of HCC requires both imaging studies with contrast and blood test alpha fetal protein
d) the diagnosis of HCC requires careful measurement of size and number of tumors to determine appropriate treatment
e) the diagnosis of HCC is based on enhancing in the venous phase on imaging

A

d) the diagnosis of HCC requires careful measurement of size and number of tumors to determine appropriate treatment

121
Q

Which of the following is not a component of bile?

a) bile salts
b) bilirubin
c) phospholipids
d) cholesterol
e) lipase

A

e) lipase

122
Q

What percentage of bile acids are recycled in each cycle of enterohepatic circulation?

a) 5%
b) 20%
c) 50%
d) 75%
e) 95%

A

e) 95%

123
Q

What is the difference between bile salts and bile acids?

a) bile acids are conjugated to form bile salts
b) bile acids are made from cholesterol and bile salts are not
c) bile acids are made in the liver and bile salts are made in the intestine
d) bile salts are more potent detergents

A

a) bile acids are conjugated to form bile salts

124
Q

Why does ursodeoxycholic acid help in patients with cholestasis?

a) it enters the enterohepatic circulation decreasing the overall production of bile acids
b) it enters the enterohepatic circulation increasing the overall production of bile acids
c) it’s hydrophobic and thus causes less liver damage than hydrophilic bile acids
d) it causes increased fecal excretion of bile acids

A

a) it enters the enterohepatic circulation decreasing the overall production of bile acids

125
Q

Which of the following is not true regarding bilirubin and it’s physiology?

a) it’s conjugated by UDP-GT
b) it’s a breakdown product of heme
c) UDP-GT activity is gestation related
d) bilirubin levels peak at 4-5 days after birth
e) excess bilirubin results in jaundice

A

c) UDP-GT activity is gestation related

it is birth related, not gestation related

126
Q

Which of the following is true of bilirubin?

a) it involves glucuronidation by glucuronyltransferase
b) it changes bilirubin from a hydrophilic to a hydrophobic form
c) it forms the indirect fraction of bilirubin
d) it occurs in the small intestine
e) it creates the insoluble form of bilirubin

A

a) it involves glucuronidation by glucuronyltransferase

127
Q
A

C

cholecstitis

128
Q

Which of the following disorders is characterized by a complete absence of UDP-GT?

a) Gilbert’s syndrome
b) Crigler-Najjar syndrome type I
c) Crigler-Najjar syndrome type II
d) dubin johnson syndrome
e) alagille syndrome

A

b) Crigler-Najjar syndrome type I

type II is less severe

129
Q

Which of the following findings would you expect to find in a liver biopsy of a child with cystic fibrosis?

a) reduced interlobular bile ducts
b) concentric periductal fibrosis (“onion skin”)
c) florid duct lesions
d) mucin in the bile ducts
e) hepatocytes with PAS+, diastase resistant inclusions

A

d) mucin in the bile ducts

130
Q
A

c) dysregulation of trypsin

acute pancreatitis

131
Q

For past 7 months, a 79 yo woman has had vague abdominal pain. Yesterday, she experienced acute chest pain with dyspnea. Chest and abdominal CT shows pulmonary embolus and 9 cm mass in the body of pancreas. Lab studies show elevation in CEA and CA19-9. A mutation involving which of the following genes is most likely implicated in the development of this mass?

a) APC
b) CFTR
c) K-Ras

D) SPINK1

A

c) K-Ras

main gene implicated in pancreatic cancer

132
Q

Which of the following is not a cause of acute pancreatitis?

a) tobacco use
b) alcohol use
c) autoimmune
d) post ERCP
e) pancreatic cancer
f) PRSS1 gene mutation
g) KRAS mutation

A

g) KRAS mutation

133
Q

A 50 yo patient presents with acute onset abdominal pain and elevated lipase and amylase (3x ULN). Which of the following is the most appropriate next step?

a) obtain gallbladder ultrasound
b) obtain CT scan of pancreas
c) proceed to ERCP
d) obtaiin MRCP of pancreas
e) start IV antibiotics

A

a) obtain gallbladder ultrasound

assess for gallbladder stones or bile duct stones

134
Q

A patient that you previously saw for acute uncomplicated pancreatitis gets a repeat scan 8 weeks later showing a large cyst in the pancreas. The patient has no symptoms. Which of the following is the most likely etiology of the cyst:

a) pseudocyst
b) walled off necrosis
c) acute necrosis
d) mucinous cystic neoplasm
e) intraductal papillary mucinous neoplasm
f) serous crystadenoma

A

a) pseudocyst

135
Q

Which of the following is a cause of inflammatory diarrhea?

a) vibrio cholerae
b) clostridium perfringes
c) rotavirus
d) cryptosporidium
e) salmonella enterica

A

e) salmonella enterica

136
Q

A 24 yo medical student presents with acute onset diarrhea and vomiting after eating leftover fried rice. Which is the most likely pathogen?

a) clostridium perfringes
b) cryptosporidium
c) bacillus cereus
d) rotavirus
e) staphylococcus aureus

A

c) bacillus cereus

GI (10 decks)

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