Chapter 18 - GI tract

Question 1

Paraneoplastic syndroms producing PTHrp and so hypercalcemia

Answer 1

1. SCC of the lung

2. SCC of the esophagus

Question 2

Which type of ulcers are associated with MEN I?

Answer 2

Duodenal

Question 3

Mumps: possible presentations

Answer 3

1. Bilateral inflamed parotid glands
2. Orchitis
3. Pancreatitis
4. Aseptic meningitis

Question 4

Microb in sialadenitis

Answer 4

S. aureus

Question 5

DDx: glossitis

Answer 5

1. Scarlet fever (S. pyogenes)
2. EBV-associated hairy leukoplakia
3. Long standing iron deficiency
4. vitB12/folate deficiency
5. Scurvy (vitC def)
6. Pellagra (vitB3 def)

Question 6

Other findings that a patient with DM may present

Answer 6

1. Candidiasis
2. Autonomic neuropathy-> gastroparesis
3. Anal pruritus
4. Cataracts
5. Malignant external otitis

Question 7

Behcet s. may be precipitated by which 2 infections?

Answer 7

1. HSV or

2. Parvovirus

Question 8

Behcet s. is due to … small vessel vasculitis

Answer 8

Immune complex

Question 9

DDx: Macroglossia

Answer 9

1. Severe hypothyroidism: myxedema
2. Down s.
3. Acromegaly
4. Systemic amyloidosis
5. Mucosal neuromas (MEN IIb)

Question 10

Causes of erythroplakia/leukoplakia

Answer 10

1. Chronic irritation (dentures)
2. Tobacco
3. Alcohol
4. HPV

Question 11

Major risk factor for SCC of the oral cavity

Answer 11

HPV

Question 12

In Sjogren s., … glands and … glands are affected

Answer 12

1. Minor salivary

2. Lacrimal

Question 13

Patient presents with asthma at the age of 45. This is the first onset of asthma. He mentions no familial history of asthma. DIAGNOSIS NOW

Answer 13

Think of GERD!

Question 14

DDx: dysphagia for solids only

Answer 14

Think of obstructive lesion.

1. Esophageal CA
2. Esophageal web (eg. Plummer Vinson)
3. Stricture (eg. due to GERD-> ulceration-> stricture)

Question 15

DDx: dysphagia for solids and liquids

Answer 15

Think of motility disorder.

1. Achalasia
2. Progressed esophageal CA
3. Smooth muscle dysmotility (eg. dermatomyositis, myasthenia gravis, stroke)
4. Systemic sclerosis
5. CREST s.

Question 16

VATER (VACTERL) syndrome. Please tell me what each letter stands for.

Answer 16

V: Vertebral abnormalities
A: Anorectal (usually anal atresia)
C: Cardiac abnormalities
TE: Tracheoesophageal fistula
R: Renal disease & absent Radius
L: Limb abnormalities

Question 17

Location of Zenker diverticulum and area of weakness.

Answer 17

It is located in the upper esophagus, above the upper esophageal sphincter (UES), at the junction of the esophagus and pharynx.
The area of weakness is the cricopharyngeus muscle.

Question 18

DDx: Early satiety

Answer 18

1. Gastric ca (esp diffuse type)

2. Gastroparesis

Question 19

Way of transmission of H. pylori

Answer 19

1. Fecal-oral

2. Oral-oral

Question 20

H pylori attaches to … receptors on mucosal cells of stomach

Answer 20

Blood group O

Question 21

Which artery usually bleeds in a gastric ulcer?

Answer 21

Left gastric

Question 22

Which artery usually bleeds in a posterior duodenal ulcer?

Answer 22

Gastroduodenal artery

Question 23

Blood group A people are likely to have … ulcer

Answer 23

Gastric

Question 24

Blood group O people are likely to have … ulcer

Answer 24

Duodenal

Question 25

MEN I is associated with ... ulcers

Answer 25

duodenal

Question 26

PUD with diarrhea, with no history of H pylori or NSAIDS is indicative of ...

Answer 26

ZE syndrome

Question 27

In gastric ulcers, BAO and MAO are ...

Answer 27

Normal to decreased

Question 28

Which is the 2nd MC site of gastric adenoCA of intestinal type?

Answer 28

Cardia | first: lesser curvature

Question 29

Why colon is black during chronic use of laxatives?

Answer 29

Bowel is black because of an icrease in submucosal macrophages with lipofuscin pigment

Question 30

Type for stool osmotic gap

Answer 30

SOG= 300 - 2x(random stool Na + random stool K)

Question 31

MCC of adult gastroenteritis?

Answer 31

Nirovurus (Norwalk)

Question 32

MCC of childhood diarrhea?

Answer 32

Rotavirus

Question 33

Patient with an infection of 2 wks, now presents with bradycardia, neutropenia and splenomegaly. He has diarrhea. What is his infection?

Answer 33

S. typhi

Question 34

Why ZE syndrome can present with malabsorption?

Answer 34

Because excess acid interferes with pancreatic enzyme activity

Question 35

Dermatitis herpetoformis in...

Answer 35

Celiac d

Question 36

Associations of celiac d

Answer 36

1. Dermatitis herpetoformis 2. Hashimoto 3. PBC 4. DM type 1 5. IgA def 6. Down s 7. Turner s

Question 37

Other findings in celiac d

Answer 37

Osteoporosis, arthritis, seizures, depression, delayed puberty, miscarriages, infertility, small bowel ca, T-cell lymphoma(EATL)

Question 38

Infectious esophagitis. Tell me everything you know about it.

Answer 38

Usually complication of AIDS. Pathogens: HSV, CMV, Candida. Presents as odynophagia.

Question 39

Chagas disease. 2 effects in GI tract

Answer 39

1. Achalasia | 2. Hirsprung d.

Question 40

DDx: heartburn

Answer 40

1. GERD 2. Hiatal hernia (sliding) 3. Achalasia 4. ZE syndrome

Question 41

Diagnosis: patient with dysphagia for solids and liquids, frequent hiccups and difficulty belching.

Answer 41

Achalasia

Question 42

What other disease except RA, targets the synovium of the joints?

Answer 42

Whipple d. !

Question 43

"Thumbprint sign" on radiograph

Answer 43

Acute ischemia of small bowel or ischemic colitis. This sign is due to edema in bowel wall

Question 44

Associations of sigmoid colon diverticular disease

Answer 44

Marfan s Ehlers-Danlos s APKD

Question 45

Which is the most common IBD?

Answer 45

UC

Question 46

Which is the MC site of carcinoid tumor?

Answer 46

``` Vermiform appendix (40%) . Usually too small ( ```

Question 47

Which is the MC primary site of carcinoid tumor that gives carcinoid syndrome?

Answer 47

Terminal ileum

Question 48

DDx: facial telangiectasia

Answer 48

1. Osler-Rendu-Weber 2. Carcinoid s 3. Cirrhosis (spider angiomata)

Question 49

In FAP, what type of polyps are present?

Answer 49

Tubular

Question 50

2 primary pathogens in acute appendicitis

Answer 50

1. E coli (MC) | 2. Bacteroides fragilis

Question 51

Αιτια λοιμωδους κολιτιδας (dysentery)

Answer 51

Campylobacter Shigella E coli Entamoeba histolytica (κ.α.)