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Question 1

Colorectal cancer

Answer 1

most all arise from adenomas
liver is most common site of distant spread
most common cause of large bowel obstruction in adults

Question 2

Colorectal staging

Answer 2

Duke's staging
A- muscularis mucosa only (90% 5 yr)
B- past muscularis mucosa, no nodes (70%)
C- positive regional nodes (40%)
D- distant mets (5%)

Question 3

Colorectal cancer risk factors

Answer 3

age (>50)
Adenomatous polyps (villous)
Prior CRC
Inflammatory bowel disease (UC > Chron's)
Family hx
Dietary
Polyposis syndromes

Question 4

Familial adenomatous polyposis

Answer 4

autosomal dominant
colon always involved, duodenum (90%)
CRC risk 100% by 20’s-30’s
prophylactic colectomy

Question 5

Gardner’s syndrome

Answer 5

Polyps + osteomas, dental abnormalities, benign soft tissue tumors, desmoid tumors, sebaceous cysts
CRC risk 100% by 40

Question 6

Turcot’s syndrome

Answer 6

autosomal recessive

polyps + neuro tumor (medulloblastoma, glioblastoma multiforme)

Question 7

Peutz-Jaghers

Answer 7

single or multiple hamartomas throughout GI tract
pigmented spots around lips, oral mucusa, face
intussusception or GI bleeding may occur

Question 8

Familial juvenile polyposis coli

Answer 8

presents in childhood, small risk CRC

Question 9

Hereditary non-polyposis CRC

Answer 9

Lynch syndrome I- early onset CRC, absent multiple polyposis

Lynch synd II- as above + other cancers

Question 10

Diverticulosis

Answer 10

caused by increased intraluminal pressure
most commonly in sigmoid colon
LLQ discomfort, bloating, constipation/diarrhea

Dx: barium enema
Complications: painless rectal bleeding (40%)

Question 11

Diverticulitis

Answer 11

impacted feces in diverticulum
fever, LLQ pain, leukocytosis

Dx: CT scan with contrast
Tx: initial- IV abx, bowel rest, iV fluids
Multiple episodes- surgery

Question 12

Abx with frequent association to pseudomembranous colitis

Answer 12

clindamycin
ampicillin
cephalosporins

Question 13

Child’s classification

Answer 13

A- no ascites, bili < 2, no enceph, good nutrition, albu > 3.5
B- controlled ascites, bili 2-2.5, minimal enecph, good nutrition, albu 3-3.5
C- uncontrolled ascites, billi >3, sever enceph, poor nutrition, albu < 3

Question 14

Wilson’s disease

Answer 14

deficiency of ceruloplasmin, can’t excrete copper

Tx: D-penicillamine, chelating agent

Question 15

asymptomatic elevation of LFTs

Answer 15

Autoimmune hepatitis
hep B
hep C
Drugs or toxins
Ethanol
Fatty liver (triglyceridemia)
Growths (tumors)
Hemodynamic disorders (CHF)
Iron (hemochromatosis), copper (wilsons), AAT deficiency

Question 16

Boa’s sign

Answer 16

referred right subscapular pain of biliary colic

Question 17

Charcot’s triad

Answer 17

RUQ pain
jaundice
fever

cholangitis- only in 50-70% pts

Question 18

Reynolds’ pentad

Answer 18

Charcot’s triad + septic shock and altered mental status

Question 19

antimitochondrial antibodies (AMAs)

Answer 19

positive in 90-95% of primary biliary cirrhosis

98% specificity

Question 20

Ranson’s criteria

Answer 20

Assess acute pancreatitis

Glucose > 200
Age > 55
LDH > 350
AST > 250
WBC > 16,000

Question 21

Small bowel obstruction

Answer 21

Dehydration is key
Intestinal distention causes reflex vomiting, increased secretions proximal to obs, decreased absorption -> hypochloremia, hypokalemia, metabolic alkalosis

Question 22

Extraintestinal manifestations of IBD

Answer 22

Eye- Episcleritis, Anterior uveitis
Skin- Erythema nodosum (CD), Pyoderma gangrenosum (UC)
Arthritis- Migratory monoarticular arthritis, Ankylosing spondylitis, Sacroiliitis
Thromboembolic-hypercoagulable
Idiopathic thrombocytopenic purpura
Osteoporosis
Gallstones (CD, ileal involvement)
Sclerosing cholangitis (UC)

Question 23

Sulfasalazine

Answer 23

main treatment for IBD (UC, CD)

Mesalamine (5-ASA) is active component (metabolite from intestinal bacteria breakdown)