Week 7 Flashcards
What is the pathophysiology underlying lactase deficiency (aka lactose intolerance)?
A. Allergic reaction to lactose, the sugar found in milk
B. Decrease of lactase enzyme in the brush border cells that occurs with age
B. Decrease of lactase enzyme in the brush border cells that occurs with age
Which ethnic background has the highest rate of lactase deficiency?
A. Asians B. American Indians C. African Americans D. Latinos E. Caucasians
A. Asians
Which of the following symptoms is NOT associated with lactase deficiency?
a. Bloating
b. Flatulence
c. Weight loss
d. Abdominal cramps
e. Diarrhea
c. Weight loss
Conditions like celiac where there is malabsorption may be associated with weight loss.
What type of diarrhea occurs with lactase deficiency?
A. Osmotic
B. Secretory
C. Bloody
A. Osmotic
Diarrhea stops when lactase deficient person stops eating.
What type of diarrhea occurs with inflammatory bowel disease?
A. Osmotic
B. Secretory
C. Bloody
B. Secretory
This is when intestinal crypt cells secrete too much water and diarrhea does NOT stop when the patient fasts.
2 conditions that make up IBD: Crohne’s and Ulcerative Colitis
If you suspect a patient may have lactose intolerance which of the following tests would be appropriate to recommend?
a. hydrogen breath test
b. abdominal ultrasound
c. lactase blood test
a. hydrogen breath test
Time consuming test so in real life just do an avoidance diet and see what happens to Sx.
True or False. If a patient is lactose intolerant they must avoid all dairy products.
a. True
b. False
b. False
Because lactase deficient person may not be 100% deficient
True or false. Both lactase deficiency and
celiac disease patients may present with complaint of bloating, foul smelling stools, and watery diarrhea.
a. true
b. false
a. true
DDX Sx: weight loss associated celiac patients
What causes Celiac Disease?
A. Allergic reaction to gliadin
B. Autoimmune reaction to gliadin
C. Deficiency in the enzyme that breaks down gliadin
B. Autoimmune reaction to gliadin
Your own body attacks itself in response to consumed gliadin.
Which of the following grains does NOT contain the protein gluten?
A. Wheat
B. Rye
C. Rice
D. Barley
C. Rice
If a tissue biopsy of the duodenal mucosa is taken from a patient with celiac disease, what is the expected finding?
A. Thickened mucosa lining & villi
B. Atrophy of the mucosal villi
B. Atrophy of the mucosal villi
Which of the following skin conditions is pathognomonic for celiac disease?
A. Pyoderma gangrenosum
B. Dermatitis herpetiformis
C. Erythema nodosum
B. Dermatitis herpetiformis
Which of the following best describes the classic presentation of dermatitis herpetiformis?
a. papulovesicular rash
b. bluish skin discoloration
c. painful ulcerations
a. papulovesicular rash
Bluish skin discoloration usually associated with erythema nodosum on the shins. Painful ulcerations are associated with pyoderma gangrenosum. These two are associated with inflammatory bowel disease (UC and Crohns).
Patients with celiac disease typically report:
a. acute onset of diarrhea
b. chronic diarrhea
b. chronic diarrhea
Which of the following is a common associated lab abnormality in celiac disease?
a. low sodium
b. low hemoglobin = anemia
c. leukocytosis
b. low hemoglobin = anemia
They have anemia because mucosal lining is atrophied and they can’t absorbed iron, b12, folate very well.
Leukocytosis is increased WBC in blood but celiac is AI happening in the gut. So WBC is not really elevated in the blood.
Which of the following is an appropriate next step if you have a high suspicion that a patient has celiac disease?
a. advise them to decrease gluten in their diet
b. emergency GI referral for mucosal biopsy
c. draw blood to check anti-TTG antibody level
c. draw blood to check anti-TTG antibody level
TTG = Tissue transglutaminase. These are antibodies, present in people with AI aka self attacking self.
Which of the following is NOT associated with dysentery?
a. Salmonella
b. Norovirus
c. Shigella
d. E Coli
b. Norovirus
Dysentery = bloody diarrhea.
Campylobacter completes the list of things associated with dysentery.
Norovirus causes watery diarrhea (not bloody) and is the MC reason people get gasteroenteritis. Self resolves 24-48 hours.
With which of the following would a patient be most likely to report tenesmus?
a. Norovirus
b. S Aureus
c. Campylobacter
d. C diff
c. Campylobacter
Tenesmus = urge to have bowel movement even when colon is empty. Remember that tenesmus = dysentery.
Campylobacter is 1 of 4 viral infections that could cause dysentery. And people with dysentery report tenesmus.
What is Tenesmus?
urge to have bowel movement even when colon is empty
A patient presents with nausea, watery diarrhea, low grade fever, and abdominal cramping since yesterday. What is the most likely cause?
a. Metformin
b. PPI
c. Norovirus
d. Enterohemorrhagic E Coli
c. Norovirus
Meds unlikely to cause fever. So think inflammatory process like a virus. Enterohemorrhagic E.coli means gut bleed, so you’d have bloody diarrhea. Norovirus is the self limiting watery diarrhea virus.
Which of the following is a potential cause of hemolytic uremic syndrome?
a. Norovirus
b. S Aureus
c. E Coli
c. E Coli
Can cause dysentery. Can be severe.
S. Aureus is food poisoning.
Diarrhea that occurs after stopping antibiotics
is most likely due to?
a. Metformin
b. Campylobacter
c. Antibiotics
d. C difficile
d. C. Difficile
Opportunistic pathogen, meaning its present and causes no Sx until the good flora are wiped out as antibiotics do.
With which of the following should you feel safe recommending OTC anti-diarrheal medication?
a. viral gastroenteritis
b. dysentery
a. viral gastroenteritis
OTC Txmt agents include fiber supplements, osmotic laxatives, enema or suppository (glycerine).
