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GI II > Week 2 (Exam 1) > Flashcards

Week 2 (Exam 1) Flashcards

1
Q

What gene mutation is responsible for intracellular lipid accumulation found in Abetalipoproteinemia?

A

MTP

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2
Q

What is the agent of choice in treating Trichinella?

A

Albendazole with steroids

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3
Q

What is the agent of choice for treating adult tapeworm?

A

Praziquantel

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4
Q

What TNF-a Inhibitor is IgG1k chimeric antibody?

A

Infliximab

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5
Q

What are the indications for Secukinumab and Ustekinumab?

A

Moderate to Severe UC and CD

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6
Q

A patient shows thumb-printing on abdominal X-ray. Where do you expect this finding to occur?

A

Splenic flexure: this is ischemic colitis

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7
Q

What histological findings are associated with Salmonella?

A 
Enlarged Peyer Patches in the Terminal Ilium
Typhoid Nodules (of MO) on the liver, marrow, LN
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8
Q

Triad of Diarrhea, Wheight loss, and Arthralgia. What is the morphologic hallmark of this disease?

A

Dense accumulation of distended and foamy macrophages in the small intestinal LP. This is Whipple Disease (also causes cardiac issues and CNS)

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9
Q

What is a mucinous tumor of the appendix most likely to cause?

A

Pseudomyxoma Peritonei

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10
Q

What class of drug is Ciprofloxacin?

A

Fluoroquinolone

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11
Q

What happens to salmonella in the ABSENCE of commensal bacteroides?

A

Salmonella Flagellin binds TLR5, transcribes NF-kB

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12
Q

What happens to salmonella in the PRESENCE of commensal bacteroides?

A

PPAR in induced, and pro inflammatory NF-kB is attenuated

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13
Q

What is Natalizumab?

A

a-4 intern inhibitor used to treat Crohn’s

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14
Q

What is the only indication for using Alvimopan?

A

Speeding up GI recovery after a bowel resection surgery with primary anastomosis (prevents post-op ileus)

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15
Q

What are the 5-ASA drugs?

A 
sulfaSALAzine
meSALAmine (not converted to 5-ASA)
olSALAzine
balSALAzide
(used to treat ulcerative colitis)
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16
Q

Where does Yersinia preferentially affect?

A

Ilium, Appendix, Right Colon

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17
Q

Which Benzimidazole is only used cutaneously?

A

Thiabendazole

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18
Q

What Osmotic Agent Laxative is also used in severe liver disease patients (hyperammonemia)?

A

Lactulose (change in pH traps ammonia in GI)

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19
Q

What is Vedolizumab?

A

a-4 Integrin Inhibitor used to treat UC and Crohn’s

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20
Q

What is the maintenance dosing of Adalimumab?

A

SQ every 2 weeks

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21
Q

How does Magnesium and Phosphate work as a laxative?

A

They are hyperosmolar and retain water in the GI tract

saline agents

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22
Q

What is the major risk associated with taking Alvimopan?

A

MI (can’t take more than 15 doses)

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23
Q

What are the three functions of Glycerin?

A

Irritant
Osmotic
Lubricant

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24
Q

What 4 things can you suggest as Bulk-Forming / Hydrophilic Colloidal Agents?

A

Fiber / Bran
Spyllium (Metamucil)
Carboxy-/MethylCellulose
Calcium Polycarbophil

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25
Q

What is the agent of choice for Ascaris Lumbricoides / Roundworm?

A

Albendazole

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26
Q

What infection puts you at a higher risk for colon cancer?

A

Strep Bovis aka Strep Gallolyticus

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27
Q

What laxative would you suspect in a patient with dark or reddish urine?

A

Senna

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28
Q

Why do we block IL-12 and 23?

A

It prevents T cell differentiation by binding P40-subunit

Inhibits pro-inflammatory IFN-y, TNF-a, IL-17, etc

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29
Q

What kind of cancers occur above and below the pectinate line?

A

Above: Adenocarcinoma
Below: Squmous Cell Carcinoma

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30
Q

What is the MOA of pre-colonoscopy bowel prep?

A

GI stimulant / irritant

This is Sodium Picosulfate (with magnesium oxide / anyhdrous citric acid converted to magnesium citrate)

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31
Q

What is the dosing of Tofacitinib?

A

PO BID

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32
Q

What is the composition of mesalamine?

A

single 5-ASA

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33
Q

How does Cystic Fibrosis present?

A 
Chronic lung disease
Male Infertility
Exocrine Fibrosis and atrophy, Squamous Metaplasia
Avitaminosis A
Meconium Ileus
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34
Q

All colorectal cancers should undergo testing to look for what kind of mutations?

A

DNA mismatch repair genes (MLH1/2, MSH6/2)

This is for Lynch Syndrome / HNPCC

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35
Q

What are the indications of Golimumab?

A

Moderate to severe CD

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36
Q

What are the potential side effects of Alostetron?

A

Black Box for Ischemic Colitis

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37
Q

What are the indications for Vedolizumab?

A

Moderate to Severe CD and UC

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38
Q

What is the major side effects of Natalizumab, and what are its 3 main risk factors?

A

Progressive Multifocal Leukoencephalopathy:

Treatment longer than 2 years, prior immunosuppression, anti-JC virus Abs

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39
Q

What does commensal bacteria use to suppress pathobionts?

A

Treg Cells

IL-10

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40
Q

IBD is characterized by bacterial components crossing the epithelial barrier through weakened tight junctions. Which specific aberrant responses are mainly associated with which disease?

A

Disruption of Barrier is mainly UC
Dysfunction of Microbe Sensing is mainly CD
Both have changes in immunoregulation

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41
Q

How do you diagnose Microvillus Inclusion Disease?

A

CD10 Immunohistochemistry

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42
Q

What is the bacterial composition found in IBD compared to normal?

A

Normal: Mostly Bateroidetes, some Fimicutes
CD: Mostly Firmicutes, some Actinobacteria
UC: Evenly Firmicutes, Proteobacteria, and Bacteroidetes

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43
Q

How does Loperamide work?

A

Treats diarrhea by opioid-like action

No analgesia or dependence

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44
Q

A patient has IBS-D (diarrhea-predominant subtype IBS). What does the recommended drug target?

A

Mu and Kappa agonist, Delta antagonist (less secretions)

This is Eluxadoline

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45
Q

What is the dosing for Ustekinumab?

A

SQ every 8 weeks

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46
Q

What TNF-a inhibitor is a recombinant Fab fragment?

A

Certolizumab

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47
Q

What is the major contraindication in treating Shigella after it is diagnosed via Stool culture?

A

Antidiarrheals: Prolongs symptoms. Give Abx instead

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48
Q

What are the Antihelmintics?

A 
Benzimidazoles (Al-/Me-/Thia-bendazole)
Ivermectin
Nitazoxanide
Praxiquantel
Pyrantel Pamoate
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49
Q

How do you treat and prevent HNPCC?

A

Subtotal Colectomy with Ileorectal Anastomosis

Prohylactic Hyeterectomy and Oophorectomy for women at age 40 or once they’re done having kids

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50
Q

What TNF-a Inhibitor is IgG1k monoclonal antibody?

A

Golimumab

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51
Q

What is the structure of Ustekinumab?

A

Fully Human IgG1k mab

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52
Q

What are the positive lab findings in IBD?

A

Crohn’s is ASCA+

UC is pANCA+

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53
Q

What gene causes a deficiency in brush-border assembly?

A

MYO5B (this is microvillus inclusion disease)

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54
Q

What should be avoided when treating moderate to severe UC with JAK inhibitors?

A

Biologics or immunosuppressants

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55
Q

What are the indications of Infliximab?

A

Moderate to severe CD

Severe UC

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56
Q

How do you treat Shigella?

A

Ciprofloxacin

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57
Q

How would you distinguish left sided vs right sided colon cancers?

A

Left: Rectal bleeding, ab/back pain, altered bowel habits
Right: Anemia, Bloody stool, weight loss, others

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58
Q

What is the maintenance dosing of Golimubab?

A

SQ every 4 weeks

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59
Q

What are the indication s for Linaclotide?

A

IBS-C

Chronic Idiopathic Constipation (CIC)

60
Q

What are the side effects of giving Eluxadilone for diarrhea?

A

Pancreatitis (especially w/o a gallbladder)

Getting high

61
Q

What is the MOA of Linaclotide?

A

Guanylate Cyclase C Agonist
Activates CFTR ion channel
Stimulates Cl-/HCO3- secretion

62
Q

What is the agent of choice in treating larval tapeworm Echinococcus Granulosus?

A

Albendazole and Praziquantel at the same time

63
Q

What is the maintenance dosing of Infliximab?

A

IV every 8 weeks

64
Q

How do you get Sterile Peritonitis?

A

Leakage of bile or pancreatic enzymes

65
Q

What TNF-a Inhibitor is a recombinant IgG1 monoclonal antibody?

A

Adalimumab

66
Q

What is the structure of Natalizumab?

A

Recombinant IgG4k monoclonal ab

a4b1 (VCAM-1) and a4b7 (MAdCAM-1)

67
Q

What does CARD15 recognize, and what is the result?

A

MDP (muramyl dipeptide): Peptidoglycan in bacteria

Triggers NF-kB

68
Q

What is the agent of choice for Giardia?

A

Metronidazole

69
Q

Which IL-12 / 23 inhibitor is used to treat Crohn’s?

A

Ustekinumab

70
Q

What is Polyethylene Glycol used for?

A

Large doses for Bowel Prep prior to scopes and stuff

Smaller doses are used as a laxative

71
Q

What is the agent of choice in treating Trichuris Trichiura / Whipworm?

A

Mebendazole

72
Q

What is the structure of Vedolizumab?

A

Humanized IgG1 Monoclonal antibody

a4b7 (MAdCAM-1)

73
Q

What would a mutation the FOXP3 gene cause?

A

Immune Dysregulation, Polyendocrinopathy, Enteropathy, X-linked. (IPEX)

74
Q

What is the agent of choice in treating Strongyloides Stercoralis / Threadworm?

A

Ivermectin

75
Q

What mutation is associated with Peutz-Jeghers Syndrome?

A

Serine Threonine Kinase 11

AD

76
Q

How do you treat C Diff?

A

At first? Vanco

First Recurrence? Fidaxomicin

77
Q

What is the composition of Balsalazide?

A

Inert carrier + 5-ASA

78
Q

A child has hypertrophy of the retinal pigment, detected at birth. What genes do you suspect to be involved in this disease?

A 
APC mutation (90%)
MUTYH mutation (8%)
This is Familial Adenomatous Polyposis
79
Q

What is the composition of sulfasalazine?

A

Sulfapyridine + 5-ASA

80
Q

What are the major stool softeners?

A

Docusate salts

Mineral Oil

81
Q

How do the 4 major macronutrients in your diet affect your gut microbiome?

A

High fat diet: Decreases Everything
High Protein and High Carb: Increases Everything
High Fiber: Increases everything but Proteobacteria

82
Q

What would you expect to find on blood smear of a patient who is completely deficient of Apolipoprotein B?

A

Acanthocytes

83
Q

What class of drug is Vanco?

A

Glycopeptide

84
Q

What is the mechanism of action you would use to treat non-infectious diarrhea in HIV/AIDS patients?

A

Cl- channel blocker (Crofelemer)

85
Q

What is expressed on Treg cells that makes it good at suppression?

A

CTLA-4 and IL-2R (deprives the IL-2)

86
Q

What is the maintenance dosing for Vedolizumab?

A

IV every 8 weeks

87
Q

What is the only indication for olsalazine?

A

Maintenance of remission of UC

88
Q

What causes a granulomatous reaction from release of Keratins?

A

Ruptured Dermoid Cyst

89
Q

What drug combines with atropine to reduce the likelihood of abuse?

A

Diphenoxylate

90
Q

What class of drug are Fidaxomicin and Azithromycin?

A

Macrolide

91
Q

What is the role of Helminths in IBD?

A

Prevalence is inversely related

92
Q

What is the composition of olsaalazine?

A

2 molecules of 5-ASA

93
Q

What are the possible side effects of Crofelemer?

A

Abdominal Distension
Elevated Liver Enzymes
Repiratory and Urinary Infections

94
Q

What is the MOA of Lubiprostone?

A

PGE-1 Derivative: Activates GI Cl-Channels (ClC-2)

Increases Intestinal Fluid Secretions

95
Q

What other conditions is Tofacitinib used for?

A

Psoriatic and Rheumatoid Arthritis

96
Q

How do 5-ASA (-sala-) agents work?

A

Inhibit prostaglandins and leukotrienes via COX and LIPOX pathways
Reduces PMN and Macrophage Chemotaxis, NF-kB

97
Q

What are the two disorders that can be characterized as IBD?

A

UC and Crohn’s

98
Q

How do you get Acute Hemorrhagic Pancreatitis?

A

Leakage of pancreatic enzymes

Fat Necrosis

99
Q

What are. the agents of choice for Entamoeba Histolytica?

A

Metronidazole followed by Paromomycin

100
Q

What are the radiological identifiers of IBD?

A

Crohn’s has a String Sign and Cobblestoning

UC has “lead pipe colon”

101
Q

Alostetron is obviously a Serotonin blocker. What is it used for?

A

Really bad IBS-D that isn’t responsive to other therapies (women)

102
Q

What are the indications for Natalizumab?

A

Moderate to severe CD

do not take with immunosuppressants like TNF-a agents

103
Q

What are the side effects of Diphenoxylate?

A

Anticholinergic

104
Q

How do you treat Salmonella?

A

Ciprofloxacin

105
Q

What part of the GI tract is more likely to be spared in Crohn’s Disease?

A

Rectum

106
Q

What is the agent of choice for Cryptosporidium?

A

Nitazoxanide

107
Q

What is the only indication for Balsalazide?

A

Active Disease (UC)

108
Q

What is the agent of choice for treating Cyclospora Cayetanesis?

A

TMP-SMX

Ciprofloxacin for sulfa-allergies

109
Q

What mutation is associated with hamartomatous polyps and lipomas throughout the GI tract and Cerebellum?

A

PTEN (Cowden)

110
Q

What auto-antibodies can you expect to find in Celiac Disease?

A

IgA Tissue Transglutaminase (tTG)

IgG Anti-Gliadin

111
Q

What are the TNF-a inhibitors used to treat Crohn’s?

A

adalimuMAB*
certoilzuMAB
inflixiMAB*

112
Q

What is the maintenance dosing of Certolizumab?

A

SW every 4 weeks

113
Q

How do a-4 Integrin inhibitors work?

A

Limits Integrin-associated Cell adhesion and migration

114
Q

What tropism of Shigella causes the ulcerations and stuff like you’d see in Crohn?

A

M Cells

115
Q

What three patient groups are at higher risk for reactive arthritis from Campylobacter infectioins?

A

Those with HLA B-27, Guillain-Barre, and Erythema Nodosum

116
Q

How would you differentiate Celiac Disease and IPEX by infiltrate?

A

IPEX shows neutrophils infiltrating gut mucosa, celiac doesnt

117
Q

What are the cytokines associated with Crohn’s?

A

DC and MO making IL-12/6/23
Activates Th1: secretes IL-2, IFN-y, and TNF
Activates Th17: secretes IL-17

118
Q

What is the significance of SCFA’s in the digestive tract?

A

They induce Tregs, reduce inflammation
Induce IgA and mucus secretion
Barrier integrity and pathogen prevention

119
Q

What is the maintenance dosing for Natalizumab?

A

IV every 4 weeks

120
Q

Where is the IBD susceptibility locus?

A

IBD-1 is found on Chr 16, containing the CARD15 aka NOD2 Gene ex[ressed mainly in Macrophages and DCs

121
Q

Who is at greater risk for sepsis and death resulting from a Yersinia infection?

A

Those with more non-heme Iron.

122
Q

What is the agent of choice in treating Enterobius Vermicularis / Pinworm?

A

Mebendazole

123
Q

What mediates outside-to-inside signaling in IBD?

A

tmTNF

124
Q

What infection leads to the Stacked Brick morphology in epithelial cells?

A

EAEC (enteroaggregative E Coli)

125
Q

Which forms of diarrhea go away with fasting and which persist?

A

Persists: Secretory and Exudative
Relieved: Osmotic and Malabsorptive

126
Q

What must happen to Castor oil for it to stimulate peristalsis?

A

Must be hydrolyzed into Ricinoleic Acid

127
Q

What are the indications for Lubiprostone?

A

IBS-C
CIC
Opioid-Induced Constipation (OIC)

128
Q

What are the major side effects of Secukinumab / Ustekinumab?

A

Infections (screen for Tb first)

129
Q

What does giving TNF-a do?

A

Increases surface adhesion molecules for leukocyte adhesion

130
Q

What are the indications of Adalimumab?

A

moderate to severe UC and CD

131
Q

What is the agent of choice for Ancylostoma / Hookworm?

A

Albendazole

132
Q

What are the three major complications of Shigellosis?

A

Toxic Megacolon
HUS
Reactive Arthropathy

133
Q

What are the cytokines associated with UC?

A

TH2 and NK making IL-4 (Th2), IL-5, and IL-13 (TH2 and NK)

134
Q

What infection can cause gallstones and a chronic carrier state?

A

Gallbladder colonization with Salmonella

135
Q

What are the TNF-a inhibitors that are used to treat UC?

A

adalimuMAB*
golimuMAB
inflixiMAB*

136
Q

What are the three consequences of NOD2 mutations that lead to Crohn’s?

A

Defective Macrophage Function
Defective Epithelial Cell Responses
Defective APC Conditioning

137
Q

What antibodies would you expect to see in IPEX?

A

Enterocytes, Goblet Cells, Parietal, Islet Cells

138
Q

What do Treg cells use to suppress TH17 (Crohn’s) cells?

A

Retinoic Acid

139
Q

What are the three mu-opioid antagonists you can use to treat constipation?

A

Methylnaltrexone
Naloxegol
Alvimopan

140
Q

What is the agent of choice to treat Schistosoma?

A

Praziquantel with steroids

141
Q

What mutation is associated with Familial Juvenile Polyposis?

A

AD MADH4 and BMPR1A

142
Q

What 4 things does the microbiota use to induce host tolerance to commensal bacteria?

A

MAMPs
Polysaccharide (PSA) Signaling
SCFA production
Intestinal Alkaline Phosphatase (IAP)

143
Q

A patient has back and abdominal pain relating to IgG4. What elevated lab values would you expect to find?

A

Elevate Erythrocyte Sedimentation
Elevated CRP
This is Idiopathic Retroperitoneal Fibrosis

144
Q

What do Segmented Filamentous Bacteria do?

A

(Bacteroides Fragilis and Clostridium)
Induce Tregs in the Lamina Propria
Basal Level Activation Th17 Cells for Epithelial integrity

145
Q

What is Tofacitinib?

A

JAK kinase inhibitor used to treat UC

146
Q

There are two Antimuscarinic agents you can use to treat abdominal pain. What are they?

A

Hyoscyamine

Dicyclomine

147
Q

How do you treat Campylobacter?

A

Ciprofloxacin

GI II (4 decks)

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