Week 4 Flashcards
1
Q
Describe lactose intolerance
A
There is a deficiency in the brush border lactase enzyme resulting in undigested lactose
2
Q
What happens to the lactose that is left over in lactose intolerance?
A
There is an increase in SCFA and hydrogen gas which is formed into acetate, butrate, and propionate which causes water to remain in the lumen giving the patient osmotic diarrhea. The methane and H+ gas is fermented and creates flatulence
3
Q
______ ________ is the result of a deficiency in the pancreatic enzymes, specifically the lack of trypsinogen
A
Chronic pancreatitis
4
Q
If there is an absence of trypsin, what is this called and what happens to all of the other pancreatic enzymes?
A
Congenital trypsin absence All the pancreatic enzymes are gone
5
Q
_______ is the defect in transport (SLC3A1) or absence of dibasic AA transporter (SLC7A9) which does not allow cysteine, lysine, arginine, or ornithine to be absorbed in the proximal tubule
A
Cystinuria
6
Q
What is Hartnup disease?
A
An issue with the neutral amino acid transporter
7
Q
What are some of the symptoms of Hartnup disease?
A
diarrhea, mood changes, neurological problems, red scaly rash, photosensitivity, short stature, high neutral amino acids in the urine
8
Q
Describe cystic fibrosis
A
There is a deficiency in the Cl channels on the apical membrane of duct cells, which result in decreased HCO3 secretion
9
Q
Describe a gluten allergy
A
Your body creates Abs against a component of gluten, which causes the destruction of small intestine villi and hyperplasia of the intestinal crypts. causes abdominal pain, constipation, diarrhea, weight loss, vomiting, nausea, and steatorrhea
10
Q
_______ is the impaired absorption of lipids, which causes the fat to be excreted in the poop
A
Steatorrhea
11
Q
______ ______ is the failure to secrete proper amounts of pancreatic enzymes
A
Pancreatic insufficiency
12
Q
_______ ______ ________ is due to a gastrin secreting tumor of the pancreas that increases the H+ secretion from the gastric parietal cells causing a lot of acid to be present in the duodenum
A
Zollinger Ellison syndrome
13
Q
Pancreatitis is when the pancreatic enzymes, specifically trypsin is activated and ______ the pancreas
A
self digests
14
Q
What are some factors that can cause deficits in bile salts?
A
Ileal resection SIBO
15
Q
Describe what happens in SIBO
A
the bacteria deconjugate the bile salts and impairs micelle formation which leads to the bacterial overgrowth in the intestinal mucosa.
16
Q
A pt presents with abdominal pain, distention, gas, and diarrhea. The patient describes the diarrhea as “very greasy and slick”. You do a breath test and detect excess methane and H+. What is your diagnosis?
A
SIBO
17
Q
If there is a vitamin B12 deficiency, what is likely to occur?
A
Pernicious anemia or possibly microcytic or megaloblastic anemias
18
Q
________ ________ is a common cause of pernicious anemia where there is chronic inflammation of the stomach mucosa, which leads to the loss of parietal cells
A
Atrophic gastritis
19
Q
______ _______ ______ ______ is a common cause of pernicious anemia and is when the immune system attacked the intrinsic factor protein or the gastric parietal cells themselves
A
Autoimmune metaplastic atrophic gastritis
20
Q
What are surgical procedures that can impeded the absorption of B12?
A
Gastrectomy- no parietal cells Gastric bypass-no space for absorption
21
Q
What does cholera do to the Cl secretion and how?
A
It increases it by increasing the cAMP which causes secretion of Na and H2O causing massive secretory diarrhea
22
Q
An infant is brought to the pediatrician by his parents because they are concerned about the of his skin and general behavior changes. They report that he has seemed more tired and weak with his arms just flopping down by his side instead of him reaching for his toys. The parents are known to be first cousins. What is likely the diagnosis?
A
Crigler Najjar
23
Q
In Crigler Najjar, what is the form of bilirubin that is in excess?
A
Unconjugated
24
Q
In Crigler Najjar, there will be unconjugated hyperbilirubinemia, but there will be low levels of hepatic ______ _______
A
bilirubin glucose
25
Differentiate between Crigler Najjar type 1 and type 2
Type 1 is the complete inactivation or absence of UGT1A1 Type 2 is a mutation in the UGT1A1 coding region
26
UGT1A1 also metabolizes ______ \_\_\_\_\_\_\_ drugs
anti-cancer
27
What are the symptoms that are seen in Crigler Najjar syndrome?
Neonatal jaundice Sepsis Hypotonia Kernicterus jaundice oculomotor palsy
28
Describe kernicterus
There is an increased bilirubin deposition in the brain with poor development and mental function can lead to mental retardation and deafness
29
What are treatments of Cigar Najjar syndrome?
Plasmapharesis
Phototherapy
Phenobarbital
UGT1A1 Inducer
Liver transplant
30
A 24-year-old third-year medical student is two weeks into her first surgery rotation when her senior resident tells her that her eyes look a little yellow. She experienced her first needle stick injury in the operating room just one week earlier and begins to worry about hepatitis. Other than rarely having the time to eat at work, she has no other complaints or symptoms. What is likely the diagnosis?
Gilbert's syndrome
31
Gilberts syndrome is a hereditary _______ hyperbilirubinemia
unconjugated
32
Where is the defect in the UGT1A1 gene in Gilberts syndrome?
Gene promoter
33
Where are the defects in the UGT1A1 gene in Type 1 and type 2 Crigler Najjar syndrome
Type 1 is a mutation in the open reading frame Type 2 is the coding region of the gene
34
What inheritance is typically seen in Gilbert's disease?
Gene promoter for UGT1A1
35
What does the gene mutation in Gilberts syndrome cause? Which enzyme has an issue?
Decreased UDP glucuronyl transferase activity due to lower expression of the wild type enzyme decreased bilirubin uptake
36
Most of the patients with Gilberts syndrome are asymptomatic, but if they do have symptoms what will the symptoms be?
Mild jaundice Associated with fasting, stress, infection, alcohol intake
37
Gilberts syndrome is uncinjugated hyperbilirubinemia without any evidence of _______ or \_\_\_\_\_\_\_
hepatitis or hemolysis
38
If you were wanting to test a patient for Gilberts disease, what test would you use?
Fasting test and Rifampin tests
39
Describe the Rifampin test
Unconjugated bilirubin rises after a dose of Rifampin in patients with gilbert syndrome, the rise in bilirubin will be present for a linger time
40
What medications from people with Gilberts syndrome avoid?
Irinotecan
41
A 22-year-old motorcycle accident victim with unknown past medical history is brought into the ED with severe head injuries. He is stabilized and brought to the surgical ICU where he is deemed to be brain dead by both the intensivist and neurosurgery staff. The organ transplant team is contacted and determine that he is an eligible kidney donor. However, he is not eligible for liver donation. Upon entering the abdomen during harvest, the team notices that his liver is black. What is likely the diagnosis?
Dubin-Johnson syndrome
42
Dubin Johnson is a mutation in ______ and Rotors syndrome is a mutation in ______ and \_\_\_\_\_\_\_\_
MRP2 OATP1B1 and OAT1B3
43
In Dubin Johnson and Rotors syndrome, there is a ________ hyperbilirubinemia
conjugated
44
In _____ \_\_\_\_\_\_\_ ______ the liver is grossly black because of the impaired excretion of epinephrine metabolites
Dubin Johnson syndrome
45
Describe the liver in Rotors syndrome
She's normale
46
What are some common lab findings in Dubin Johnson and Rotors syndrome?
May have direct (conjugated) hyperbilirubinemia coproporphyrin III: coproporphyrin ratio is 1:3 to 1:4
47
What are the total urine coproporphyrin levels in Rotors syndrome and DJS?
Rotors will have elevated coproporphyrin levels and are NORMAL in DJS
48
Impaired UDP-Glucuronosyl Transferase (UGT1A1) activity is observed in all of the following except:
A. Breast Milk Jaundice
B. Physiological Jaundice of the newborn
C. Crigler Najjar Syndrome
D. Dubin-Johnson Syndrome
D
49
A patient presents to her physician for unsteady gate, forgetfulness, and recent episodes of Turret-like spells where she will fling one arm out and above her head seemingly unprovoked. On physical exam, the neurologist notices that her irises appear multicolored with concentric rings around the periphery. He is concerned for a metabolic disease and orders several laboratory and radiologic studies. What is likely the diagnosis?
Wilsons disease
50
Describe Wilsons disease?
Free copper accumulation in many tissues because of a mutation in the ATP7B:
Copper cannot enter circulation because it cannot bind to ceruloplasmin free radicals that can damage tissues
51
Where does the copper accumulation typically occur in patients with Wilsons disease?
Liver
Brain
Cornea
joints
52
What is the defect in Wilsons disease?
There is a transmembrane P-type ATPase is encoded by the ATP7B gene that pumps copper into the bile and plasma
If this is defective, it is not able to pump the copper as it needs to and she builds up
53
What are common neurological symptoms that present in a patient that has Wilsons disease?
Parkinson like symptoms
Hemiballismus: flailing ballistic undesired limb movements
Dementia
54
The parkinson like symptoms in wilsons disease is secondary to copper deposits in the \_\_\_\_\_\_\_
putamen
55
The Hemiballismus like symptoms in wilsons disease is secondary to copper deposits in the \_\_\_\_\_\_\_\_\_
subthalamic nucleus
56
The dementia like symptoms in wilsons disease is secondary to copper deposits in the \_\_\_\_\_\_\_\_\_
cerebral cortex
57
Explain what will likely be seen in the physical examination in a patient with Wilsons disease
Cirrhosis of the liver
Kayser-Fleischer rings in the eye
58
A patient comes into the clinic and you run lab work. You find that there is a decreased serum copper, increased serum non-ceruloplasmin bound copper, increased urine free copper, and evidence of hemolytic anemia. What is likely going on with the patient?
Wilsons disease
59
List some of the treatments that can be used for wilsons disease?
Copper chelating agents: penicillamine,
tridentine Ammonium tetrathiomolybdate: facilitates urinary excretion of copper
Zinc: competes with copper for absorption in the gut with the same transporter (ATPB7)
60
Wilsons disease leads to risk factors for \_\_\_\_\_\_, \_\_\_\_\_\_\_\_, and \_\_\_\_\_\_\_\_
Hepatitis, Cirrhosis, and hepatocellular carcinoma (HCC)
61
Hemachromatosis is the accumulation of _______ in the liver, heart, pancreas and skin
Iron
62
What are the symptoms of Hemachromatosis?
Cirrhosis
heart failure
DM
bronzed skin
malabsorption
63
If there is a prehepatic portal HTN, what is likely present?
Portal vein thrombosis
64
If there is an intrahepatic portal hypertension, what is likely the cause?
Liver cirrhosis from HH or wilsons
65
If there is post hepatic portal hypertsnsion, what is likely the cause?
Thrombosis in the hepatic vein and IVC
66
This can be the result of a GALT deficiency, galactokinase deficiency, fructokinase deficiency, and a aldolase B deficiency
Galactosemia
67
Describe classic galactosemia
GALT is deficient
Pt will have cataracts, hepatomegaly, jaundice, and failure to thrive
68
Describe what would happen in the fructokinase deficiency?
Fructosuria: high concentration of fructose in the urine
69
Describe what would happen in the event of an aldolase B deficiency?
There is a hereditary fructose intolerance because the aldolase is not able to cleave fructose 1 phosphate into DHAP and G3P There is damage to the liver and kidney
70
In an aldolase B deficiency, which lab values will be low?
Phosphurus and glucose
71
A ______ \_\_\_\_\_\_\_\_ deficiency is an autosomal recessive that conflicts with the conversion of OXA to PEP
PEP carboxykinase deficiency
72
If there is an inability of OXA to convert to PEP, what can result?
acidemia
hypoglycemia
Loss of muscle tone
Liver enlargement
Failure to thrive
73
\_\_\_\_\_ _______ disease is an autosomal recessive disease that is due to a G6Pase deficiency where glucose is not able to get into the blood
Von Gierke disease
74
What are common symptoms of Von Gierke disease?
Fasting hypoglycemia
Lactic acidosis
Hepatomegaly
Hyperlipidemia
75
A 4 day old female child with yellow skin and eyes . The baby was born at term by a normal vaginal delivery. Pregnancy was uncomplicated; there were no risk factors for sepsis and no history of maternal alcohol or drug use. The baby is breast fed and has been nursing every 2 hours, about 10 minutes at each breast. The bilirubin level is 15 mg (unconjugated) , the hematocrit is 45% and the combs test is negative. Which of the following is the most likely diagnosis?
A. Congenital biliary atresia
B. Isoimmune hemolytic disease
C. Crigler-Najjar syndrome
D. Breast milk jaundice
E. Breast feeding jaundice
E
76
A 14-year-old Caucasian male patient found to have low serum copper, high urine copper, and low serum ceruloplasmin is placed on penicillamine for management of his genetic disorder. Which of the following is LEAST consistent with this patient's clinical picture?
A. Kinky, easily breakable hair
B. Cirrhosis
C. Hemiballismus
D.Corneal deposits
E. Parkinson-like symptoms
A. kinky easily breakable hair
77
An infant who was healthy at birth is brought to your office for her first office visit at the age of 6 weeks. You notice that the infant is jaundiced and that there is bilirubin staining of the wet diaper. Which one of the following diagnoses is most consistent with these findings?
a. Physiologic jaundice of the newborn
b. Hemolysis secondary to Rh incompatibility
c. Crigler-Najjar syndrome
d. Gilbert's syndrome
e. Biliary atresia
e
78
\_\_\_\_\_\_\_\_\_\_ is in the peripheral tissue and converts testosterone to DHT
5 (alpha) reductase
79
What is the rate limiting step in the biosynthetic pathway of androgens?
Conversion of cholesterol to pregenolone
80
\_\_\_\_\_\_\_\_\_ is the lack of descent of the testicles
Cryptorchidisim
81
At puberty, what does testosterone do to the body?
Increased muscle mass
pubertal growth spurt
closure of the epiphyseal plate
growth of the penis and seminal vesicles
deepening of the voice
spermatogenesis
libido
82
What are the actions of DHT?
differentiation of external male genitalia
Male hair distribution
sebaceous gland activity
growth of the prostate
83
Which hormone is responsible for male pattern baldness
DHT so if you give 5 (alpha) reductase inhibitors can be given
84
An 84 year old man comes into the clinic and is complaining of urinary urgency, peeing more at night, feeling like he still has to void urine even after he pees, and increased dribbling after going to the bathroom. What is likely the diagnosis?
Benign prostatic hyperplasia
85
True or false: The concentrations of DHT are increased in the prostatic tissue in men with BPH than those without
False: The concentrations of DHT in prostatic tissue are not higher in men with BPH than in those without BPH
86
Describe the parasympathetic stimulation of the penis during an erection
1. NO activates guanylyl cyclase which increases cGMP and decreased intracellular calcium and causes the relaxation of smooth muscle 2. Vasodilation allows blood flow causing the engirgement 3. enlarged tissue reduces venous drainage 4. somatic stimulation increases contraction of muscles at the base of the penis
87
There is a destruction in the internal sphincter of the bladder following a prostatectomy, what will likely result in the event of ejaculation?
retrograde ejaculation
88
\_\_\_\_\_\_\_ _______ isa genetic disorder that occurs when GnRH neurons fail to migrate into the hypothalamus
Kallmans syndrome
89
What are some symptoms of Kallmans syndrome
Delayed puberty and impaired small hypogonadotrophic hypogonadism males\>females
90
At puberty, a male seems to have increased levels of gonadotrophin but the testicular growth and spermatogenesis. Androgens are low and there is presence of primary hypogonadism. The male has an extra X chromosome
Klinefelter syndrome
91
In Klinefelter syndrome the _______ \_\_\_\_\_\_\_ are largely destroyed and cause infertility
seminiferous tubules
92
What things is a 5(alpha) inhibitor used to treat?
male pattern baldness BPH
93
True or False: As men age, gonadal sensitivity to LH decreases and androgen production drops
True
94
What happens to testosterone with age?
It decreases. there is decreased bone formation, muscle mass, facial hair growth, appetite, and libido
95
What are some of the causes of male impotence?
1. nerve damage to the prostatic nerve plexus
2. Atherosclerosis
3. T2DM
4. Spinal cord injury
5. Hormonal disorders
6. Psychological disorders
96
An ________ is a surgical incision between vagina and anus to prevent perineal tear during delivery.
Episiotomy
97
What is the most common type of episiotomy?
A medio-lateral incision: scissors through the posterior vaginal wall, bulbospongious muscle, superficial transverse perineum and skin and fascia
98
What are the types of urinary incontinence?
Overflow
Stress
Urge
99
In an ________ type of incontinence, there is a urethral blockage and the bladder is unable to empty properly
Overflow
100
In a _____ type of urinary incontinence, the pelvic floor is relaxed or there is increased abdominal pressure
Stress
101
In a _______ type of incontinence, there is bladder oversensitivity from infection or neurological damage
urge
102
What is a common cause of stress incontinence in men?
After prostate gland removal
103
What is the common cause of urge incontinence in men?
Overactive bladder
104
What is the common cause of an overflow incontinence?
Blocked urethra
105
What are some common causes of stress incontinence?
Pregnancy
Age
Obesity
Chronic cough
Genetics
106
If there is a weak pelvic floor, what is likely to happen?
Urinary stress incontinence
107
What is a common pelvic floor injury during childbirth?
Pubococcygeus
108
\_\_\_\_\_\_\_\_ is the most common male birth defect after cryptorchidism (0.5% of all births in US). Due to failure of urethral folds to close properly. Various degrees.
Hypospadias
109
\_\_\_\_\_\_\_\_ is rare with incidence of 1:40,000 to 120,000. Cause is unknown but may be due to improper ventral body closure or formation of too large of a cloacal membrane to be covered when it ruptures.
Epispadias
110
What do cells express in the absence of the SRY gene?
WNT4 and FOXL2
111
FOXL2 continually suppresses any \_\_\_\_\_\_expression thereby maintaining female gonad differentiation (by continually suppressing Sertoli cell and Leydig cell differentiation).
SOX9
112
How are the duct systems formed in females?
Absence of Sertoli cells, there is no AMH so the paramesonephric ducts are retained In the absence of Leydig cells, the mesonephric duct system is lost; remnants are found in the epoophoron and paraoophoron near the ovary
113
\_\_\_\_\_\_ is the term for a double uterus
Didelphys
114
\_\_\_\_\_ _______ is when there are two bodies (uteruses) and one cervix
Bicornate uterus
115
If a patient has inadequate conversion of androstenedione to testosterone, what is likely the genotype and phenotype of the patient?
The genotype is XY but the phenotype is female other than testicle formation
116
A patient comes in with the following symptoms and characteristics:
a. They have testes but no spermatogenesis; testosterone levels may be elevated due to a lack of negative feedback.
b. At puberty, the testosterone is metabolized to estradiol initiating female secondary sexual characteristics.
c. They produce AMH so the paramesonephric system is suppressed, resulting in the absence of a uterus or uterine tubes, and the vagina is short and ends blindly; exhibit amenorrhea.
d. Testis usually found in inguinal or labial regions increasing the risk of tumor formation in the gonads. 25-35% develop malignancies before age 50 without treatment.
What is likely going on?
An androgen insensitivity syndrome
117
Describe the genitalia changes in a 5 (alpha) reductase deficiency
Autosomal recessive disorder Normal testis and duct system develops as there is AMH and testosterone. However there is underdeveloped male external genitalia, the degree of which depends on level of deficiency of DHT but they can exhibit an external female phenotype.
118
Retention of paramesonephric ducts so individual has uterus and uterine tubes along with male ducts and external genitalia is secondary to a mutation in the ______ receptor
AMH
119
Describe adrenal hypoplasia
Mutations in genes involved in adrenocortical steroid biosynthesis such as deficiency in 21-hydroxlase (90% of time) leading to excess ACTH production (due to lack of negative feedback). Excess ACTH causes adrenal hyperplasia and excessive production of androgens. They have ovaries. Female external genitalia is masculinization and depending on androgen levels, they can exhibit fusion of labioscrotal swellings and an enlarged clitoris with what may look like hypospadias.
120
If there is a translocation of a piece of a Y chromosome onto an X chromosome, what likely results?
Ovotesticular disorders
121
Describe the phenotype of an ovotesticular disorder
Have ovaries and testicles ambiguous genitalia uterus is present
122
many older men experience an enlargement of the posterior middle portion of the prostate (\_\_\_\_\_\_\_ ________ \_\_\_\_\_\_\_\_), which narrows the prostatic urethra.
Benign prostatic hypertrophy
123
In the event of a metastatic prostate tumor, where could the tumor spread to via the lymph?
Spine
Liver
Lungs
124
Intraperitoneal abdominopelvic viscera, or aspects of visceral structures that are in contact with the peritoneum, are _______ to the pelvic pain line.
superior
125
Subperitoneal pelvic viscera or portions of viscera are ______ to the pelvic pain line.
inferior
126
Describe the nerve pathway of abdominopelvic organs that are superior to the pelvic pain line
Use the sympathetics to retrograde and ascending into the sympathetic plexuses
127
Describe the nerve pathway of the organs that are inferior to the pelvic line
Use parasympathetic fibers
128
Describe an epidural block
The anesthetic agent is administered into the epidural space at the L3-L4 vertebral level. The anesthetic agent bathes the spinal nerve roots, including the pain fibers from the uterine cervix, superior vagina, and pudendal nerve. The entire birth canal, pelvic floor, and majority of the perineum are anesthetized.
The pain fibers from the uterine body are not affected, so the mother is aware of her uterine contractions.
129
Describe the blocking of the pudendal nerve
Provides anesthesia over the S2-S4 dermatomes (the majority of the perineum) and the inferior 1/4 of the vagina. The pudendal nerve block does not block pain from the superior birth canal, so the mother is able to feel uterine contractions.
130
This is the term that is used to describe white clay colored stools. What causes this?
Acholic stools
Absence of secretion of bile into the GI tract
131
\_\_\_\_\_ ______ is any serious acute intraabdominal condition (for example, appendicitis) attended by pain, tenderness, and muscular rigidity and for which emergency surgery must be considered.
acute abdomen
132
\_\_\_\_\_\_\_ is a profound and marked state of constitutional disorder; general ill health and malnutrition.
cachexia
133
\_\_\_\_\_\_ _______ \_\_\_\_\_\_\_ denotes blood congealed and separated within gastric contents that takes the form of coffee grounds when in contact with acidic environment.
Coffee ground emesis
134
What is colic?
Acute paroxysmal abdominal pain
135
What is the difference between dyspepsia and dysphagia?
Dyspepsia is postprandial epigastric discomfort (during or after eating) Dysphagia is difficulty in swallowing
136
\_\_\_\_\_\_\_ is the inflammation of the esophagus
Esophagitis
137
\_\_\_\_\_\_ is gas or air in the GI tract expelled through the anus
Flatus
138
\_\_\_\_\_\_\_ is inflammation of the stomach with distinctive histologic and endoscopic features
gastritis
139
\_\_\_\_\_\_\_ is the protective response in muscle resulting from pain or fear of movement, voluntary versus involuntary
guarding
140
If a patient is vomiting blood, it is called....
hematemesis
141
\_\_\_\_\_\_\_ is a dark stool consistent with broken down hemosiderin in the bowel, it is malodorous, sticky, and tarry
Melena
142
What is melon consistent with?
Upper GI bleed
143
\_\_\_\_\_\_\_\_ is the passage of bright red or maroon stools
hematochezia
144
If the word pneumo is in front of something, what does it mean?
that there is an abnormal presence of air or gas present The word following that will tell you where the air is.... mediastinum, peritoneum, etc
145
\_\_\_\_\_\_\_\_\_ is a stone from kidney making its way through ureter to bladder, urine analysis will show hematuria
ureterolithiasis
146
\_\_\_\_\_\_ ______ is a palpable mass, lymph node, in the left supraclavicular/sternoclavicular fossa
Virchow's node
147
An ______ is a local defect, or excavation, of the surface of an organ or tissue that is produced by the sloughing (shedding) of inflamed necrotic tissue
ulcer
148
Based on the picture, what is present?
Ascites and cavae medusa
149
What is present in this radiograph?
Pneumomediastinum
150
What is found in this radiograph
Air in the biliary tree
151
\_\_\_\_\_ ______ is secondary to distension, stretching or contraction of hollow organs. It is not localized
Visceral pain
152
What is somatic pain
Secondary to inflammation of the parietal peritoneum and is localized
153
What are several isceral afferent causes of nausea and vomiting?
Infection
Mechanical obstruction
Dysmotility
Peritoneal irritation
Hepatobilliary or pancreatic disorders
Topical GI irritatnts
Post-op
154
What are important questions to ask when a patient presents with nausea and vomiting?
Appearance of the vomit.... is there blood? coffee grounds? food? Feculuence?
How often does it happen
Is it projectile
155
What is Oropharyngeal dysphagia?
Trouble initiating swallowing
156
What are common causes of oropharyngeal dysphagia
NEurologic disorders- parkinsons
Muscular disorders
Metabolic disorders
Infectious disease
Structural disorders
Motility disorders
157
Why does esophageal commonly occur?
Mechanical obstruction
Motility disorder
158
\_\_\_\_\_\_\_ _______ is more sensitive for detecting subtle esophageal narrowing due to rings, achalasia, and proximal esophageal lesions
Barium study
159
When is an upper endoscopy needed? What is it used to diagnose?
Persistent heartburn
Dysphagia
odynophagia
structural abnormalities on a barium esophagography
160
What are the perks of an EGD?
Allows for direct visualization
Allows for a biopsy
can result in treatment and the dilation of structures
161
What is the function of a HIDA Scan?
Reveals the function of the gall bladder
162
What are the classic symptoms of GERD?
Heartburn and regurgitation and reflux
163
What is shown in these images?
GERD that is shown by endoscopy
164
What are treatments of GERD?
Lifestyle modification
Antacids
Surface agents
H2 blockers
proton pump inhibitors
165
\_\_\_\_\_\_ ______ \_\_\_\_\_\_\_ is the most common cause of UGI bleeding
Peptic ulcer disease
166
Where do gastric ulcers typically occur?
In the lesser curvature of the stomach
167
If a patient comes in complaining of sharp and burning epigastric pain that is worsened about 30 min after eating, what is likely happening?
A gastric ulcer
168
If a patient comes in with "gnawing" epigastric pain that is worsened about 3-5 hours after eating, what is likely happening?
A duodenal ulcer
169
Describe helicobacter pylori
Bacteria that have a urease producing organism: It is able to create a ring of protection around itself so that it is not borken down by the stomach acid
170
Risk factors of ______ \_\_\_\_\_\_\_\_ infection includes poverty, overcrowding, limited education, ethnicity, rural
H. pylori
171
What are the effects of H. pylori on the physiology of the GI system?
Increased gastric acid secretion
Gastric metaplasia
Immune response
Mucosal defense mechanisms
172
How do you test for H. pylori?
Urea breath test
Fecal antigen test
detection of Abs in serum
Upper endoscopy with gastric biopsy
173
What are the differences in stool in an upper and lower GI blood?
Upper GI bleed has a melena appearnce
Lower has hematochezia
174
What ligament is the defining factor between an upper and a lower GI bleed?
Ligament of Treitz: between the duodenum and jejunum
175
If there is a gall stone obstruction in the neck of the gallbladder or the cystic duct, what is this called
Cholecystitis
176
If there is a stone that is stuck in the common bile duct, what is this called?
Choledocholithiasis
177
In _______ \_\_\_\_\_\_\_\_ the biliary tree gets inflamed and infected typically from a stone in the common bile duct. Air is present in the biliary tree
Ascending cholangitis
178
Why does gallstone pancreatitis happen?
A gallstone gets stuck in the pancreatic duct and causes an elevation int he LFTs and pancreatic enzymes
179
What is diverticulitis?
When the patient has diverticulosis (holes that are present in the colon that get infected because of food getting trapped there
180
\_\_\_\_\_\_\_ _______ is the impaired relaxation of the lower esophageal sphincter, because there is a loss of nitroc oxide producing inhibitory eurons of the myenteric plexus
Primary achalasia
181
The parasite, Trypanosoma cruzi, causes esophageal dysfunction and periorbital swelling .
Chagas disease
182
Describe Zollinger Ellison syndrome
gastrinoma in the duodenum or pancreas
increases fasting gastrin level and positive secretin stimulation test
183
What is the sympathetic level of the appendix?
T12
184
What is the sympathetic level of the esophagus
T2-T8
185
What is the sympathetic level of the stomach
T5-T9
186
What is the sympathetic level of the liver
T6-T9
187
What is the sympathetic level of the gallbladder
T6-T9
188
What is the sympathetic level of the small intestine
T5-T9
T9-T12
189
What is the sympathetic level of the colon
T9-L2
190
What is the sympathetic level of the pancreas
T5-T11
191
What dietary aspects can cause black or red stools?
Eating black licorice, blueberries, blood sausage, or taking iron pills, activated charcoal, or bismuth medicines like Pepto- Bismol, can also cause black stools.
Beets and foods with red coloring can sometimes make stools appear reddish
192
A 67 YEAR OLD POSTMENOPAUSAL FEMALE PRESENTS WITH CONCERNS OF PERIUMBILICAL ABDOMINAL PAIN. SHE IS HAVING NAUSEA AND VOMITING ASSOCIATED WITH IT. SHE HAS HAD MULTIPLE ABDOMINAL SURGERIES IN THE PAST. SHE IS NOT TAKING ANY PRESCRIBED OR OTC MEDICATIONS. SHE HAS NOT HAD A BOWEL MOVEMENT AND ISN’T PASSING FLATUS IN OVER 24 HOURS. WHICH OF THE FOLLOWING IS THE MOST LIKELY ETIOLOGY OF HER SYMPTOMS?
* A. Pregnancy
* B. Small intestinal obstruction
* C. Hepatitis A virus
* D. Motion sickness
* E. Chemotherapy medications
B
193
WHICH OF THE FOLLOWING DIAGNOSES COULD PRESENT AS OROPHARYNGEAL DYSPHAGIA?
A. Parkinson’s disease
B. Schatzki ring
C. Esophageal cancer
D. Achalasia
E. Scleroderma
B
194
What is present in the following radiograph?
Zenkers diverticulum
195
MR. SIMECKA IS A 45 YO MALE THAT PRESENTS WITH CONCERNS OF PROGRESSIVE DYSPHAGIA AND NOCTURNAL REGURGITATION. HE HAS DIFFICULTY SWALLOWING BOTH SOLIDS AND LIQUIDS. HE FREQUENTLY TRAVELS TO CENTRAL AMERICA. IMAGING IS PERFORMED AND IS SHOWN. PERIPHERAL BLOOD SMEAR REVEALS TRYPANOSOMA CRUZI. WHICH OF THE FOLLOWING BEST DESCRIBES HIS DYSPHAGIA?
A. Esophageal dysphagia: Mechanical obstruction
B. Esophageal dysphagia: Motility disorder
C. Oropharyngeal dysphagia: Neurologic disorder
D. Oropharyngeal dysphagia: Metabolic disorder
E. Oropharyngeal dysphagia: Structural disorder
B
196
MRS. BURNS HAS SIMILAR SYMPTOMS AS MR. SIMECKA BUT WITHOUT ANY TRAVEL HISTORY. HER DOCTOR ORDERS ESOPHAGEAL MANOMETRY WHICH DEFINITIVELY DIAGNOSES HER WITH PRIMARY ACHALASIA. THE REPORT READS: ABNORMAL ESOPHAGEAL PERISTALSIS AND FAILURE OF THE LES TO RELAX UPON SWALLOWING. WHICH OF THE FOLLOWING IS THE PATHOPHYSIOLOGY OF THIS DISORDER?
A. Mucosal barrier breakdown from a cytotoxin producing motile flagellated microaerophilic urease producing gram-negative rod
B. Decreased gastric acid secretion leading to a loss of protective mucosal barrier
C. Loss of nitric oxide-producing inhibitory neurons in the myenteric plexus
D. Gastrin producing tumor
E. Abnormally weak or relaxed LES allowing gastric contents into the esophagus
C
197
A 25 YEAR OLD MALE DIAGNOSED WITH A HISTORY OF A PITUITARY NEOPLASM PRESENTS WITH CONSTIPATION, WEIGHT LOSS, STEATORRHEA, NAUSEA, AND EPIGASTRIC PAIN. LAB SHOWS ELEVATED CALCIUM LEVEL AND ON CT IMAGING THERE IS A 1 CM TUMOR IN THE PANCREAS. WHICH OF THE FOLLOWING WOULD DEFINITIVELY DIAGNOSE THE SUSPECTED DIAGNOSIS?
* A. Normal fasting gastrin level
* B. Fecal stool antigen for H. Pylori
* C. Positive urea breath test
* D. Positive secretin stimulation test
* E. Peripheral blood smear showing trypanosoma cruzi
D
198
MS. KUNADI IS AN 18 YO FEMALE WHO PRESENTS WITH SEVERE ABDOMINAL PAIN FOR THE LAST 6 HOURS. SHE HAS ASSOCIATED NAUSEA BUT DENIES VOMITING. SHE HAS A FEVER OF 101F. HER WBC COUNT ON CBC IS ELEVATED. ON PHYSICAL EXAM SHE HAS PAIN IN THE RLQ WHEN THE LLQ IS PALPATED. GIVEN THESE FINDINGS, WHICH OF THE FOLLOWING WOULD YOU DOCUMENT?
A. Murphy sign present
B. Tenderness at McBurney’s point
C. Rovsing’s sign present
D. Tenderness over costovertebral angles
C
199
MR. PEREZ IS A 35 YEAR OLD MALE IMMIGRANT FROM RURAL GUATEMALA WHO PRESENTS WITH A 6 MONTH HISTORY OF DYSPEPSIA AND EPIGASTRIC ABDOMINAL PAIN. ON CBC HE IS FOUND TO HAVE A MICROCYTIC ANEMIA. EGD IS PERFORMED AND THE PICTURE ATTACHED IS FOUND AND BIOPSIED. BIOPSY REPORT REVEALS MALT LYMPHOMA. WHICH OF THE FOLLOWING IS THE MOST LIKELY UNDERLYING CAUSE OF HIS PRESENTATION?
A. Zollinger Ellison Syndrome
B. Multiple Endocrine Neoplasia Type 1
C. Chagas disease
D. Helicobacter pylori infection
E. Zenker’s diverticulum
D
200
201
MRS. MARTINEZ IS A POSTMENOPAUSAL 56 YO FEMALE THAT PRESENTS WITH CONCERNS OF DYSPEPSIA AND EPIGASTRIC ABDOMINAL PAIN FOR THE LAST 3 MONTHS. SHE HAS NOTICED THAT HER SYMPTOMS HAVE GRADUALLY WORSENED. INITIALLY EATING WILL HELP HER SYMPTOMS BUT ABOUT 3.5 HOURS AFTER EATING HER PAIN WORSENS AND SHE DESCRIBES IT AS A GNAWING FEELING. SHE DENIES PMH. SHE DENIES ANY MEDICATIONS (RX/OTC). SHE DENIES ALCOHOL, TOBACCO, OR RECREATIONAL DRUG USE. WHICH OF THE FOLLOWING DIAGNOSTIC STUDIES WOULD BE THE MOST HELPFUL IN DETERMINING HER SUSPECTED DIAGNOSIS?
A. Colonoscopy
B. Urea breath test
C. Pregnancy test
D. Barium esophagram
E. Secretin stimulation test
B. Urea breath test
202
WHICH OF THE FOLLOWING WOULD ALLOW YOU TO VISUALIZE THE BILIARY TREE AND PROVIDE INTERVENTION (TREATMENT)?
A. Endoscopic retrograde cholangiopancreatography
B. Magnetic resonance cholangiopancreatography
C. Kidney-ureter-bladder X-ray
D. Colonoscopy
E. Esophagoduodenoscopy
A.
203
