Test 3 Flashcards
(178 cards)
1
Q
What’s the mechanism of action of scopolamine?
A
anticholinergic; muscarinic antagonist
2
Q
Porcelain gallbladders are seen on X-ray b/c of Calcium deposits in the wall of the gallbladder. Why must they be removed?
A
they are at an increased risk of developing cholangiocarcinoma
3
Q
What will Carcinoid tumors stain positive for?
A
chromogranin, synaptophysin Small intestine carcinoids will also stain + for argentaffin
4
Q
Where does Hep B replicate?
A
can do intranuclear and cytoplasmic replication
5
Q
What tumor marker is associated with pancreatic adenocarcinoma?
A
CA 19-9
6
Q
What are some example of osmotic agents?
A
-sodium phosphate -Magnesium salts -lactulose -polyethylene glycol
7
Q
What are the two primary bile acids the liver produces?
A
cholic acid and chenodeoxycholic acid
8
Q
What is choledocolithiasis?
A
gallstones in the common bile duct
9
Q
What are the side effects of hydrophillic colloids?
A
may increase bloating and gas
10
Q
Visceral pain is conveyed through ____.
A
C fibers
11
Q
Guaiac based tests test for presence of _____ activity.
A
peroxidase activity does not test for presence of iron
12
Q
What are the main risk factors worldwide for cholangiocarcinoma?
A
Hep B Hep C cirrhosis of any etiology obesity diabetes mellitus
13
Q
What’s the most appropriate imaging modality for a pregnant woman with suspected appendicitis?
A
ultrasound (trying to avoid CT radiation)
14
Q
Which hereditary syndromes are associated with signifiant increase in lifetime risk of pancreatic cancer?
A
-Peutz jeghers (STK11) -p16 (FAMMM) - hereditary pancreatitis (PRSS1)
15
Q
Describe serous cystic neoplasms of the pancreas.
A
multi cystic mass filled with thin straw colored liquid
16
Q
What may be the only antibody or antigen detectable during the window period of Hep B infection?
A
anti-HBc (Hep B core antibody)
17
Q
What’s the most appropriate imaging modality for suspected pancreatitis?
A
CT
18
Q
What are some examples of neurokinin receptor antagonists?
A
Aprepitant Fosaprepitant Netupitant Rolapitant
19
Q
List the 2 pharmacological agents to treat IBS.
A
alosetron and nortriptyline
20
Q
What are the genetics associated with GISTs?
A
-75-80% of GISTs have a GAIN OF FUNCTION mutation in the oncogene c-kit -Other GIST mutations include activation of PDGFRA gene (8%)
21
Q
What are the side effects of metoclopramide?
A
–Significant extrapyramidal effects –Irreversible tardive dyskinesia associated with higher dosing (black box warning!)
22
Q
What is a palpable gall bladder a sign for? What’s the name of this sign?
A
classic sign of pancreatic cancer; called Courvoisier’s sign
23
Q
Treatment for carcinoid tumors?
A
-surgery -somatostatin analogue (Octreotide)
24
Q
Vaccinations against Hep C have failed b/c of Hep C’s antigenic variability in it’s envelope. What about the virus gives it this antigenic variability?
A
there is no 3’-5’ exonuclease activity (proofreading) in the viral RNA polymerase
25
Brown gallstones would signal an \_\_\_\_.
infection
26
What are some examples of opioids used to treat diarrhea?
Loperamide and diphenoxylate
27
What does the Charcot triad of cholangitis include?
jaundice, fever, RUQ pain (Duarte has leukocytosis and not jaundice in his Charcot's for acute cholecystitis)
28
What are some risk factors for pigment gallstones?
-chronic hemolysis -Gilbert's -cirrhosis - pernicious anemia -cystic fibrosis -ileal disease, resection or bypass (where bile salts get reabsorbed) -chronic biliary infection/infestation
29
Hep B virus reactivation would be more common in which cancer patients: those with solid tumors or those with hematologic malignancies?
hematologic malignancies
30
What causes Zollinger-Ellison syndrome?
a gastrin secreting carcinoid tumor in the pancreas of abdomen
31
Intraductal Papillary Mucinous Neoplasms of the pancreas -IPMN- have a strong predilection for which patient population?
males
32
What kinds of drugs are used to treat Hep C infections?
-interferon alpha -ribavirin -protease inhibitors
33
List the main risk factors for hepatocellular carcinoma
Hep C, Hep B, alcohol, obesity, type 2 DM
34
The actions of substance P are mediated through the post-synaptic \_\_\_\_\_\_\_\_\_\_.
neurokinin receptor 1 (NK1)
35
In what type of cancer is the tumor marker CA 19-9 found?
pancreatic cancer
36
What clinical sign can be positive for a patient with cholecystitis? Describe it.
+Murphy sign. Patient will have inspiratory arrest when you are palpating their RUQ due to pain
37
list the secondary bile acids.
-Deoxycholic acid -Ursodeoxycholic acid -Lithocholic acid
38
Why does pancreatic cancer pain sometimes radiate to the back?
the cancer grows and encases the celiac plexus
39
What are some risk factors for cholesterol gallstones?
-obesity -cholesterol rich diet -genetics -rapid weight reduction (gastric bypass) -gallbladder hypomotility -pregnancy -drugs -primary biliary choliangitis (PBC)
40
\_\_\_\_\_ are the most common small intestine malignancy.
Carcinoid tumors
41
What causes a Mallory- Weiss tear?
forceful retching, vomiting, or even coughing (common in alcoholics and bulemics)
42
Which antibody, if found in a patient, is indicative of recovery from infection?
Anti-HBs (Hep B surface antibody)
43
What is Mirizzi syndrome?
gallstone in cystic duct/neck obstructs common bile duct
44
In the symptomatic phase of Hep B infection, antigens/antibodies will be in the blood?
HBsAg and HBeAg
45
What meds are used to treat Hep B?
Lamivudine, NRTIs (nucleoside reverse transcriptase inhibitors), or interferon alpha
46
What serological test is used to aid in the diagnosis of HCC?
AFP (alpha fetoprotein)
47
Black gall stones derive from increased \_\_\_\_\_\_.
conjugated bilirubin
48
What are the findings of ascending cholangitis ?
Charcot's triad (jaundice, fever, RUQ pain) + altered mental status + hypotension this is called Reynold's pentad
49
What's an example of stool softeners?
docusate salts
50
Which is more aggressive, gastric GIST or small intestine GIST?
small intestine GIST
51
When will HBeAg (Hep B envelope antigen) be seen?
in acute and chronic HBV infections; presence of HBeAg indicated high transmissability
52
90% of the time, hepatocellular carcinoma arises in the background of \_\_\_\_.
cirrhosis
53
What is pancreatitis (what's causing the -itis)?
auto digestion of the pancreas by pancreatic enzymes
54
What's the most common location of Intraductal Papillary Mucinous Neoplasms of the pancreas?
head of the pancreas
55
What's the only chemo approved for HCC? What does it target?
Sorafenib; targets VEGF
56
Describe how the DNA is packaged in Hep b.
DNA is double stranded circular
57
Dilation of the common bile duct beyond what measurement warrants further evaluation ?
8mm
58
Describe superinfection with Hep D.
Hep D infection after recent Hep B infection
59
What can successfully treat intussusception in most infants?
barium enema
60
What's a common source of Hep A infection in the developing world? How about the developed world?
developing= contaminated water developed= uncooked shellfish
61
What's the mechanism of action of Lubiprostone?
prostinoid chloride channel activator; Binds to EP4 receptors linked to adenylate cyclase activation which enhances Cl- conductance. Stimulates secretion of Cl- rich fluid that improves stool consistency and activates motility
62
What's the route of transmission for Hep A?
fecal-oral
63
Where are Mallory-Weiss tears typically found?
gastroesophageal junction
64
May present with abdominal distention with a pulsatile mass
AAA
65
What is a sign of increase infectivity in Hep B infection?
HBeAg (Hep B envelope antigen)
66
What are neurokinin receptor antagonists used for?
used as anti-emetics
67
The most common hepatic neoplasms are metastatic. From where do they most often metastasize from?
colon, lung, breast
68
What are cryoglobins?
serum proteins containing IgM that precipitate in cooler temps
69
What are the distinguishing features of Intraductal Papillary Mucinous Neoplasms of the pancreas from mucinous cystic neoplasms of the pancreas?
1) absence of ovarian stroma 2) involvement of a pancreatic duct
70
What are the 3 basic mechanisms of carcinogenesis in cirrhosis?
1) telomere shortening 2) altered hepatocyte proliferation 3) altered milieu conditions promoting tumor cell proliferating
71
What are the side effects of osmotic agents?
small changes in intravascular volume may cause problems in certain patients such as those with cardiovascular heart failure
72
What is linked to the treatment strategy for a patient with HCC?
the HCC staging
73
From which cells will GIST arise?
interstitial cells of cajal
74
What are some examples of hydrophilic colloids?
-Psyllium (Metamucil, Per Diem, and others) -Agar -Bran -Methylcellulose
75
What's the treatment for acute pancreatitis?
–Treatment involves pancreatic rest (arrest pancreas: do not eat) and supportive care
* Aggressive volume support
* Nutritional support
* Monitoring for infections and treating if present
76
What's the treatment for carcinoid tumors/syndrome?
If localization and resection is possible, DO IT. Octreotide (somatostatin analog) for symptomatic management
77
What's often used for making a HCC diagnosis (it's very sensitive and specific)?
MRI with IV contrast
78
What's the first step in management of patients with GI bleeds?
stabilize the patient.
* Intravascular volume replacement
* IV fluids
* Blood transfusion
* Correct coagulation/platelet problems
* Vasopressors if necessary
* Respiratory support if necessary
79
What does Hep D require to be infectious?
requires HBsAG (Hep B surface antigen)
80
What's the most appropriate imaging modality for suspected pneumoperitoneum?
xray with acute abdomen series (if postive, will see cresecent sign on right side)
81
Describe how type II mixed cryoglobulinemia causes membranoproliferative glomerulonephritis.
Immune complexes between core protein and IgG + rheumatoid factor Get trapped in glomeruli. Because of that, mesangial cells proliferate= Inflammation
82
Describe co-infection with Hep B and Hep D.
Hep B and Hep D infection at same time
83
What's Boerhaave's syndrome?
esophageal rupture
84
What's the classic triad of a symptomatic carcinoid tumor?
recurrent cutaneous flushing, asthmatic wheezing, diarrhea may also see tachycardia or R-sided cardiac valvular fibrosis
85
Describe the vaccine for HepA.
inactivated vaccine
86
What can some patients with cryoglobulinemia progress to?
B cell non-hodgkin lymphoma; if you treat the Hep C virus early enough in these patients, the lymphoma disappears
87
what are some meds used to reduce risk of gallstones (after a bariatric surgery for instance)?
ursodeoxycholic acid, statins, ezetimibe
88
Glucocorticoids are effective anti-emetics for ____ induced emesis.
chemo
89
What are the risk factors for gallstones (cholelithiasis)?
female, fat, fertile (pregnant), forty
90
What agent is given for opioid induced constipation?
Methylnaltrexone
91
Who usually have Solid pseudopapillary neoplasms of the pancreas ?
young women
92
Hep E has higher disease rates and higher mortality rates in which population?
pregnant women
93
What's the most common location of carcinoid tumors in the small intestine?
ileum
94
Brown gall stones derive from increased \_\_\_\_\_\_.
unconjugated bilirubin
95
What's the Carney triad (seen in young females)?
1. Gastric GIST 2. Paraganglioma 3. Pulmonary chondroma
96
What's the method of choice for diagnosing gall stones?
ultrasound
97
Subcapsular hepatocellular adenomas are at risk of what? Especially in what patient population?
rupture; especially in women of child bearing age/pregnant
98
What is given to babies within 12 hours of birth to prevent vertical transmission of Hep B?
Hep B immunoglobin and Hep B vaccination (Engerix)
99
In Which high risk group is screening for AAA's recommended?
older men with a history of smoking
100
Describe the immunoglobulin (antibody) response during the various phases of Hep B infection.
IgM in acute phase and 'window period'. IgG in chronic infections or resolved infections
101
What is used to help physicians make the most appropriate imaging or treatment decision for a specific clinical condition?
ACR appropriateness criteria
102
What's the most appropriate imaging modality for suspected diverticulitis case?
CT with contrast
103
What are the side effects of neurokinin receptor antagonists?
fatigue, dizziness, diarrhea
104
Meckel's diverticulum is formed from a remnant of the vitelline duct. What's another name for this duct?
omphalomesenteric duct
105
Carcinoid tumors are also known as \_\_\_\_.
neuroendocrine tumors
106
List the pro kinetic agents.
Prucalopride Lubiprostone
107
Hepatocellular carcinomas are very well vascularized. what process leads to this?
inflammation and hypoxia seen in cirrhosis results in the over expression of VEGF/FGF which stimulates neoangiogenesis
108
Ascending cholangitis is a gastrointestinal emergency. Immediate ____ for decompression of Common bile duct is needed (+ antibiotics and standard medical care).
ERCP
109
What 5 things are associated with hepatocellular adenoma ?
1. oral contraceptive pills (estrogen) 2. obesity 3. glycogen storage disease 4. MODY 5. McCune Albright syndrome
110
What are the side effects of the antihistamine and anticholinergics used to treat motion sickness?
sedation, dry mouth, confusion, cycloplegia and urinary retention
111
What's the best diagnostic modality for diagnosing cavernous hemangiomas?
MRI with IV contrast (will show peripheral enhancement: starts filling from outside to inside)
112
What's the most appropriate imaging modality for a kid with suspected appendicitis?
ultrasound (trying to avoid CT radiation in a kiddo)
113
mucinous cystic neoplasms of the pancreas have a very strong predilection for which patient population?
95% in women
114
Describe Grey-Turner's sign.
Ecchymoses of the flanks, caused by **retroperitoneal** hemorrhage.
not exclusive to pancreatitis
115
What's Methylnaltrexone's Mechanism of action?
a μ-opioid receptor antagonist that only acts in the periphery and does not cross the blood brain barrier so it does NOT influence the analgesia produced by the drug in the CNS.
116
Somatoparietal pain is conveyed through _____ fibers.
A-delta fibers
117
What will patients with Hep A acute hepatitis be positive for on serology?
anti-Hep A IgM
118
What's the first detectable antibody in someone with Hep B infection?
anti-HBc (Hep B core antibody)
119
How is Hep B transmitted
sex, IV drug use, needle sticks, blood transfusions
120
What are the different pathophysiology mechanisms behind acute cholecystitis ?
-Mechanical: increased pressure causes ischemia -Chemical: lysolecithin irritates and causes inflammation. Lysolecithin derives from action of phospholipase on lecithin in bile -Bacterial: present in 50-85% of patients ---E. coli, Klebsiella spp., Sterptococcus spp., Clostridium spp.
121
What are some examples of anti-emetics that work as dopamine receptor antagonists?
Prochlorperazine Chlorpromazine Droperidol Metoclopramide
122
Where are cystic fibrosis related small intestine adenocarcinomas usually found?
ileum
123
Describe the lining of serous cystic neoplasms of the pancreas.
lined by glycogen rich cuboidal cells
124
Pigment stones are more frequent in \_\_\_\_.
Asians
125
When will HBsAg (Hep B surface antigen) be seen?
In acute HBV infection and in chronic HBV infection
126
Mutations in which genes can cause pancreatitis ?
PRSS1 or SPINK1
127
describe cullen's sign.
Ecchymoses of the periumbilical area, caused by **intraperitoneal** hemorrhage.
128
What's the treatment for gastrointestinal stromal tumors (GIST)
Complete surgical resection If metastatic imatinib (tyrosine kinase inhibitor -TKI) is effective if KIT or PDGFRA are mutated. HOWEVER, secondary mutations lead to resistance need for another TKI
129
Where do most small intestine adenocarcinomas occur?
duodenum
130
What's the most common biliary malignancy?
cholangiocarcinoma
131
What's the most common cause of intussusception in an adult?
a tumor
132
What are the most common mutations for Intraductal Papillary Mucinous Neoplasms of the pancreas?
GNAS, KRAS, TP53, SMAD4, RNF 43
133
What's found in Heyde's syndrome?
aortic stenosis + bleeding of GI vascular malformation
134
What's the difference between imaging of cholangiocarcinoma and HCC?
cholangiocarcinoma does not have arterial enhancement. Will instead be evident by dilation and strictures of the bile ducts on imaging
135
What's the most common location of mucinous cystic neoplasms of the pancreas?
tail of the pancreas
136
What are some cannabinoids side effects?
Euphoria, vertigo, xerostomia (dry mouth), hypotension, dysphoria
137
Which has the worse prognosis: co-infection of HepB and Hep D or superinfection with Hep D??
superinfection with Hep D (HepD infection soon after infection with Hep B) has the worse prognosis
138
What's the mechanism of action of prucalopride?
5-HT4 receptor agonist; enhances coordinated contraction resulting in improved GI motility
139
What's the most common mutation of serous cystic neoplasms of the pancreas?
inactivation of VHL
140
Whats the side effect of Bisacodyl?
with long term use, the colon can become atonic, and non-functional
141
Describe Solid pseudopapillary neoplasms of the pancreas .
large, well circumscribed with solid and cystic components. filled with hemorrhagic debris.
142
What's the most appropriate imaging modality for an adult with suspected appendicitis?
CT with contrast
143
how does hepatocellular carcinoma spread?
hematogenously
144
What's the most appropriate imaging modality for small bowel obstruction?
xray with acute abdomen series
145
Acute appendicitis results from obstruction of the lumen of the appendix, usually with a \_\_\_\_\_\_\_.
fecalith
146
What lab value do you need to make sure to get for small intestine carcinoid tumor diagnosis?
5-HIAA level in a 24h urine sample; Carcinoid tumor makes 5-HT→5-HT metabolized to 5-hydroxyindoleacetic acid (5-HIAA) in liver→5-HIAA excreted in urine
147
What's the most common location of serous cystic neoplasms of the pancreas?
tail of the pancreas
148
Increased levels of ____ would help you make the diagnosis of hepatocellular carcinoma.
alpha fetoprotein
149
What's the second most common primary malignancy of the liver?
cholangiocarcinoma
150
The most common cause of small bowel obstruction is \_\_\_\_.
intraabdominal adhesions (scar tissue) from prior surgeries
151
What are the causes of acute pancreatitis? Use the mnemonic.
GET SMASHED Gallstones Ethanol Trauma (typically a car crash) Steroids Mumps Autoimmune disease Scorpion sting Hyper- calcemia/triglyceridemia ERCP (invasive test to look at bile ducts, pancreatic ducts) Drugs (e.g. sulfa drugs, NRTIs, protease inhibitors)
152
Describe the ultrasound findings of cavernous hemangiomas.
Homogenous hyperechoic mass with sharp margins
153
What are the most common mutations for mucinous cystic neoplasms of the pancreas?
KRAS, TP53, RNF4
154
Describe the appearance of focal nodular hyperplasias.
Central scar with fibrous septa radiating from it, with large dystrophic arteries in the center and the hyperplastic rxn of hepatocytes in between the fibrous septae
155
What's important to know about treatment of extra hepatic manifestations (like cryoglobulinemia vasculitis)?
you need to treat the virus and stop B cell expansion
156
what is bisacodyl?
a stimulant laxative
157
What causes the right sided heart disease in patients with carcinoid syndrome?
5-HT (serotonin) mediated fibrosis in endocardium
158
When will HBsAB (Hep B surface antibody) be seen?
in resolved cases of HBV infection and in immunized individuals
159
What are the most common benign hepatic tumors?
cavernous hemangiomas
160
What's the one stupid protein derived from viral RNA translation that Duarte said to know?
NS5b; it encodes for RNA dependent RNA polymerase
161
What's the first marker of infection in Hep B?
HBsAg (Hep B surface antigen)
162
What are some examples of glucocorticoids used to treat chemo-induced emesis?
dexamethasone methylprednisolone
163
What are the manifestations of type II mixed cryoglobulinemia?
palpable purpura, ulcers, raynaud's, membranoproliferative glomerulonephritis, arthralgias, neuropathy
164
Why is the treatment of porcelain gallbladder (calcified gallbladder due to chronic cholecystitis) prophylactic cholecystectomy?
high rates of it becoming gallbladder carcinoma
165
What's the scan of choice for diagnosing pancreatic cancer?
CT scan with contrast
166
What's the most appropriate imaging modality for cholecystitis?
ultrasound
167
What are the 3 views required for an acute abdomen series xray?
1. erect PA chest
2. supine abdomen
3. erect abdomen
168
A person immunized against Hep B will only be positive for which antibody or antigen?
anti-HBs (Hep B surface antibody)
169
What's the mechanism of action of the "-setron" antiemetic drugs?
block 5-HT3 receptors on the chemoreceptor trigger zone really only used for post chemo, radiation, surgery induced vomiting
170
What is the most common primary malignancy of the liver?
hepatocellular carcinoma
171
What's the most common mesenchymal tumor w/in the abdomen?
GIST
172
What are the most common mutations found in Solid pseudopapillary neoplasms of the pancreas ?
Wnt hyperactivation by activating mutation of TNNB1 (beta catenin)
173
What does HIDA stand for and what is it used for?
Hepatobiliary iminodiacetic acid scan; used to look for bladder problems (gall bladder won't fill with dye if there is a stone or stricture blocking cystic duct)
174
which pain is transmitted faster: somatoparietal or visceral?
somatoparietal; it is conveyed through myelinated fibers
175
What is the most common blood borne infection the US?
Hep C
176
Describe hydrophillic colloids
Indigestible plant products and dietary fiber supplements. --Are often the first line reagents that are used to treat chronic constipation
177
What are some examples of cannabinoid meds?
dronabinaol nabilone
178
What are pigmented gallstones composed of?
calcium bilirubinate (less than 20% is cholesterol)
