Gi-3

Front 1

According to Mayo Review book, how much fat malabsorption will be needed for the test to work? How about Sudan stain?

Back 1

1. Need >100g/day on high fat diet for test to work.
2. Sudan stain needs 20g/day

Front 2

What is a good "Rule out" test for Celiac? Why?

Back 2

DQ2 and DQ8 which only occur in 20% of patients therefore it is a good rule out test.

Front 3

Which type of Marsh classification of Celiac is irreversible and found in patient who don't respond to treatmet also with T-cell lymphoma?

Back 3

Type 4

Front 4

What is the biggest problem with USA patient with celiac not responding to dietary treatment?

Back 4

Contamination from gluten.

Front 5

What are 3 other things to look for in patient who did not respond to dietary treatment in patient with Celiac.

Back 5

1. Look for refractory sprue (need steroid)
2. Look for pancreatic enzyme insufficency
3. Look for microscopic colitis.

Front 6

Refractory Celiac sprue may have high risk for 3 other problems.

Celiac disease also put people in high risk for what two other type of cancers?

Back 6

1. Ulcerative jejunitis, collagenous sprue, T-cell lymphoma.
2. esophageal and oropharyngeal cancer.

Front 7

What are the 3 stages of chronic tropical spure?

Back 7

1. fatigue, malaise, abdominal pain, diarrhea.
2. GI complaints such as dyspepsia, diarrhea, malabsorptive deficiencies.
3. macrocytic anemia and pancytopenia.

Front 8

What are the 3 treatment for tropical sprue?

Back 8

1. Folic acid 5mg/day for 1 year
2. Vitamin B12
3. tetracycline 250mg QID for 6 months.

Front 9

Whipple disease is predominately male vs. female? What age?

Back 9

Male (9:1) develop in 40-50s

Front 10

What the 7 symptoms of Whipple disease?

Back 10

1. Endocarditis
2. Embolic GN
3. Neurological problems
4. rhematologic problems
5. pancytopenia
6. Fever
7. CHF

Front 11

What are the treatment for Whipples?

Back 11

1. Bactrim
2. PCN
3. Ceftriaxone
4. Tetracycline
5. PCN + streptomycin

Front 12

Patient develops diarrhea with ingestion of mushroom. He was also found to have a congenital enzyme deficiency.

Back 12

Trehalase deficiency

Front 13

Where does small bowel primary adenocarcinoma usually present?

Back 13

Ileum

Front 14

What is the primary presentation for intestinal lymphangiectasia?

Back 14

1. hypoproteinemia, edema, lymphocytopenia

Front 15

What 4 syndromes/diseases is primary intestinal lymphangiectasia associate with?

Back 15

Noonan syndrome
Charcot-Marie-Tooth
Turner's
hypobetalipoproteinemia

Front 16

How is diagnosis of lymphangiectasis made?

Back 16

Decrease on all plasma protein, lymphocytopenia, and increase alpha 1 anti-trypsin in stool showing protein losing enteropathy

Front 17

How does fat malabsorption occur in bacterial overgrowth?

Back 17

de-conjugation of conjugated bile salt leads to poor formation of micelles.

Front 18

52 year old with abnormal LFT after swimmed in a natural lake. He developed fever, conjunctival suffusion, muscle tenderness, rigors, diarrhea, cough and found to have T101.9, but normal pusle, abnormal LFT, hyponatremia, CK=1000. diagnosis? tx?

Back 18

Weil syndrome, leptosprosis

dx with ELISA, serological test

Tx with doxycycline

Front 19

59 year old patient with rhematoid arthritis, developed chronic diarrhea, flaky stool, nasuea, bloating, 20lb weight lost.

ROS showed LE swelling, orthopnea, swelling and tingling of his extremities.

Exam showed S3gallop, no evidence of chronic liver disease, but presence of peripheral neuropathy.

ALKP elevated,
carotene is 8
low albumin
ALT/AST min elevated

Diagnosis? How do you confirm it?

Back 19

Amylodosis. dx with fat pad or rectal biopsy

Front 20

What is the rate limiting step in hepatic transport of bile acid from the blood into bile?

Back 20

Canalicular secretion

Slesienger

Front 21

In those with ragweed allergy, what food will trigger attacks?

Back 21

Melons and bananas.


Slesienger

Front 22

When planning for curative surgery in patient with cholangiocarcinoma, what is the most improtant information that is needed to plan for surgical resection?

Back 22

Tumor location.

Slesienger

Front 23

Is there any data to suggest difference in efficacy and safety of precholecystectomy ERCP compare to open common bile duct exploration or lap. exloration of cbd?

Back 23

No

Slesienger

Front 24

What is the most important determinant of crystal formation in human gallbladder?

Back 24

degreee of cholesterol saturation

Slesienger

Front 25

What is the rate of gallstone recurrence after lithotripsy in 1st year? 5th year?

Back 25

1st year: 6-7%
5th year: 31-44%

Slesienger

Front 26

Has Urso shown in study to slow down progression of liver disease and increase survival in PBC patients?

Back 26

Yes

Slesienger

Front 27

Which three proteins are useful in monitoring short term changes in nutritional status?

Back 27

prealbumin, transferrin, retinal binding protein all have short half lives than albumin therefore it is useful

Slesienger

Front 28

Which cancer is associated with the greatest increase in obesity related relative risk?

Back 28

pancreatic cancer

Front 29

Which type of SOD benefit from PD manometery before sphincterotomy?

Back 29

3, since it has normal LFT and normal duct size.

Front 30

In infants, where do most of spontaneous perforation of biliry tract occur?

Back 30

junction of the cystic and common duct.

Slesienger

Front 31

What is the typical findings seen on liver biopsy for patients with Alagille's syndrome?

Back 31

A paucity of interlobular bile ducts.

Slesienger

Front 32

What is the difference in patients with acute hydrop vs. acute cholecystitis?

What are two conditions (children) associated with acute hydrop?

Back 32

Absence of gallbladder inflammation.

Kawasaki and Henoch-schonlein purpura

Slesienger

Front 33

How does following medications affect the sphincter of Oddi?

1. Morphine?
2. Meperidine?
3. Calcium channel blocker?
4. Midazolam?

Back 33

1. increase pressure
2. No effect
3. Decrease pressure
4. lower pressure.

Slesienger

Front 34

How much bile is secreted by liver each day?

Back 34

500-600mL


Slesienger

Front 35

1. Is periductal concentric fibrosis (the classic appearance in PSC) frequently seen in PSC?

2. How do you define a dominant stricture in PSC?

3. How often do you seen dominant stricture in PSC?

4. Is there benefit in treating patient's dominant stricture in terms of survival benefit? If so, how much?

Back 35

1. Rarely

2. stenosis diameter of <=1.5mm in extrahepatic duct and <=1mm in hepatic duct

3. 45-58%

4. Yes, 83% vs. 65% base on Mayo risk score in 5 year survival.


AASLD 2010 recommendations

Front 36

1. Which is more frequently associated with PSC. UC or CD?

2. What is the difference in IBD patients with PSC vs. those who doesn't?

3. How should you screen CRC in patient with IBD and PSC?

4. Which side of the colon tend to be involved in CRC in patient with IBD/PSC?

5. Is there any recommendation in terms of using Urso for CRC prevention in patient with IBD/PSC?

Back 36

1. UC

2. They are more extensive. Patient with IBD with PSC has more severe IBD then those who doesn't.

3. They are at higher risk of CRC and should start screening colonoscopy at 1-2 year interval starting at the time of PSC diagnosis.

4. Right side

5. No

AASLD 2010 recommendations

Front 37

1. Does patient with PSC have higher risk for developing gallbladder cancer? If so, what is the recommended surviellence and treatment?

2. Is duration of PSC a risk factor for developing cholangiocarcinoma?

3. What are two problems using CA19-9 for surviellence in patient with PSC?

4. Is Urso recommended in treatment of adult PSC?

Back 37

1. Yes, Q1 year U/S and if there is polyp found, should have it removed despite polyp <1cm

2. May not be

3. they are elevated in setting of cholangitis and 7% of population doesn't have lewis antigen.

4. No


AASLD 2010 recommendations

Front 38

Which study validate the use of Certolizumab pegol in induce remission and maintaining a response? How was it done and its result?

Back 38

PRECISE-1 and 2

PRECISE-1
662 mod/severe CD (CDAI 220-450) tx with 400mg at week 0,2,4 and q4 week through week 24. At week 6, 37% in tx vs. 26% in placebo had response (CDAI drop >100)

in PRECISE-2 (maintanence)
668 adult with CD (CDAI 220-450) got open label induction with 400mg at week 0,2,4 and at 6, those with responsive were assigned to maintenance (400+ patients) therapy with 400mg Q4 week and placebo until week 24.

Overall intent to treat analysis, clinical response rate were 62.8% and 36.2% for treatment group at week 26.

Front 39

1. What is the dosage for IFX?

2. What is the dosage for Adalimumab

3. What is the dosage for certolizumab pegol?

Back 39

1. 5mg/kg at 0,2,6, then Q8week

2. Humira, 40mg SC every 2 week

3. 400mg sc every 4 weeks

Front 40

How does Natalizumab work in IBD?

What is the study that prove it works? What is the result?
What was the "troubling finding"

What is the problem?

Back 40

It is a recombinant humanized IgG4 monoclonal antibody to alpha 4 integrin that block adhesion and subsequent leukocyte migration into the gut.

ENACT-1 and 2
No stat significant difference between tx and placebo until the pos hoc analysis showed that greater response and remission for tx group with increase CRP. In maintanence, 61% vs. 28% in placebo.

Problem was that it was voluntarily withdrawn due to development of multifocal leukoencephalopathy (PML) in 1800 patients. Risk was estimated to 1 out of 1000.

Front 41

34 year old gentleman with a snapping uvula. Patient has been haivng globus sensation and occasional dysphagia. what is the diagnosis?
Treatment? and what is the danger possible complication?

Back 41

Fibrovascular polyp of the esophagus often near the UES/cricoid.

Can be removed endoscopically, if <2cm. Often has pentrating vessel.

Can lead to asphyxiation therefore it can be lifte threatening.

Front 42

78 year old lady with history of ischemic heart disease, renovascular disease and repair of an abdominal aortic aneurysm. She was found to have elevated ESR and 80% eosinophils. Colonoscopy revealed multiple small raised focal nodules in colon. Biopsy revealed intra-arteriolar needle shaped clefts within the specimens. What is the diagnosis. What is the pathognomonic finding?

Back 42

Cholesterol embolization to the GI tract.

pathognomonic finding is the needle shaped cleft on mucosal biopsy which shows the previous cholesterol crystal now gone from the specimen after leaving their foot print.

Front 43

1. Which side is the most common side for pleural effusion in patients with Boerhaave's syndrome.

2. What is the significance of developing new pruritic seborrheic keratoses?

Back 43

1. Left side effusion.

2. GI malignancy.

Front 44

HIV patient with fever, diarrhea, B12 deficiency. Biopsy showed small dark particle near the surface of the epithelium. What is the diagnosis?

Back 44

Cryptosporidiosis.

Front 45

60 year old present with new onset DM, anorexia, weight loss and diarrhea. She developed a rash begins under the folds of her breast or buttock and then spread becomes raised, blisters, and crust over. The rash disappear then comes back. On exam, there was evidence of erythematous lesions in her groin, thighs, and buttock along with glossitis, dystrophic nails and angular stomatitis? What is the problem?

Back 45

glucagoma.

The erythematous skin lesion is necrolytic migratory erythema.

Front 46

38 year old with nausea, vomiting and hematemesis. She was found to have "pebbly papules" on his neck, antecubital fossae and axillae. They appears to coalesce into plaques in several area. There xanthelasma on his eyelids. Also history of angioid streaks. What is the diagnosis?

Back 46

GI bleed +plucked chicken skin = pseudoxanthoma elasticum (AR)

Front 47

What is the definition of the Modified Milwaukee Classification of SOD?

Back 47

SOD1: pain, abnormal LFT/pancreatic enzyme on 2 occasions + dilated ducts

SOD2: pain + either abnormal enzymes or dilated duct

SOD3: pain alone.

Front 48

1. What is the rate limiting step in INR?

2. What 2 problems can lack of selenium do?

Back 48

1. factor 7

2. cardiomyopathy, myositis

Front 49

1. what is the only criterion of malnutrition that has proved to offer predictive value?

2. What is a common element that is missing in TPN?

3. What can cause woren fracture rate which is related to TPN

4. what two element in excessive in TPN can lead to cholestatic liver disease?

Back 49

1. unintentional weight lost.

2. Selenium

3. Aluminum toxicity

4. copper/manganese

Front 50

What are the 6 risk factors for bone disease in patient taking chronic TPN?

Back 50

1. large sodium and amino acid load

2. hyperinsulinemia from large dextrose load

3. cycling TPN

4. aluminum contamination

5. high phosphate load

6. heparin added to the bag

Front 51

What is the pathophysiology of re-feeding syndrome

Back 51

when high glucose and volume feeding started suddenly in malnourished patient result in sudden shift of electrolytes from extracellular space to intracellular space lead to gross electrolyte abnormalities and can lead to retention of free water and cause CHF, anasarca.

Front 52

How do you prevent refeeding syndrome? 4 things you can do.

Back 52

1. Use parenteral thiamine 100mg QD x 3 days.
2. slow initiation of feed
3. minimize dextrose
4. replete electrolytes.

Front 53

What amount of CD4 count and viral load is a risk factor for HIV related infection and malignancy?

Back 53

CD4<200
Viral load >10,000

Front 54

What are some 4 common side effects of nucleoside reverse transcriptase inhibitors?

Back 54

n/v/d
hepatic steatosis
lactic acidosis
pancreatitis.

Front 55

Which non-nucleoside RT inhibitor is most liver toxic?

Back 55

Nevirapine

Front 56

What 3 side effects can be associated with HIV protease inhibitor?

Back 56

1. n/v/d
2. abnormal LFT
3. pancreatitis

Front 57

1. What percentage of patient with candidasis esophagus will have thrush?

2. How do you treat it?

3. Is primary prophylaxis in HIV patient recommended?

Back 57

1. 2/3

2. 200mg then 100mg of diflucan for 2-3 weeks

3. No

Front 58

1. Up to what % of patient with CMV esophagitis will have retinitis?

2. Where do you biopsy the esophagus for CMV?

Back 58

1. 15%

2. BASE of ulcer due to involvement of vessels and endothelium

Front 59

Where should you biopsy the ulcer for herpes virus?

Back 59

The edge because it affect the epithelial cells.

Front 60

What can you use to treat idiopathic esophageal ulcers? (2)

Back 60

steroids, thalidomide

Front 61

Is HIV gastropathy common?

Back 61

1. No

Front 62

1. How is microspordia transmitted?

2. Which sites can E. intestinalis affects (3).

3. What is the treatment?

4. Where do you identify them? (2)

5. Where can E. Bieneusi infect? (2)

6. What is the stain you use to identify microspordia?

Back 62

1. fecal oral via zoonosis

2. small bowel, kideny and lung

3. Albendazole

4. identified in lamina propria or urine sediment.

5. small bowel and biliary tree

6. modified trichome stain

Front 63

1. How is isospora transmitted?

2. Is it intracellular or extracelluar?

3. Which stain is used to identify them?

4. How do you treat it?

5. Where is commonly endemic? (3)

Back 63

1. fecal/oral

2. intracellular

3. acid fast stain show oocysts and charcot leyden crystal

4. treat with bactrium

5. Haiti, Africia and developing country.

Front 64

Which stain do you use to identify cyclospora? How do you treat it?

Back 64

acid fast stool stain

bactrium

Front 65

1. Is Giardia infection more severe in HIV patient?

2. What do you use to treat it?

Back 65

1. No

2. Flagyl

Front 66

At what CD4 count is primary prophylaxis recommended for HIV patient to avoid mycobacterium?

Back 66

<50

Front 67

Can you diagnose CMV colitis with just sigmoidoscopy? why or why not?

Back 67

No, 18% can involve ONLY the right colon, therefore need colonoscopy.

Front 68

1. What is the most common cause of diarrhea in young children worldwide?

2. which part of the body does it affect?

Back 68

Rotavirus

affect small bowel.

Front 69

Paitent with progressive dysphagia with wweight lost. He also noted dramatic thickening of skin on both hands, sole about the same time his dysphagia begin. He was noted to have keratoderma on both hands and feet. What is the diagnosis and what is the gi association? How do you perform surviellence for these patients?

Back 69

Tylosis

autosomal dominant disease with 95% of patient developing cancer by age 70.

Associated with oral leukoplakia and squamous cell carcinoma of the esophagus. Screen for esophageal cancer at age 30 at Q1-3 years interval.

Front 70

Patient with dyspepsia had EGD with biopsy which showed corkscrew foveolar hyperplasia with lack of ocyntic gland mucosa. What is the diagnosis?

Back 70

Menetrier's disease.

Front 71

What two possible cause of Menetrier's disease has been recently identified?

What are the two treatment for Menetrier's?

Is Menetrier's pre-malignant?

Back 71

1. CMV and H. Pylori

2. tx h. pylori and anti-epidermal growth factor receptor (cetuximab)

3. Yes, associated with gastric lymphoma and primary stomach CA.

Front 72

60 year old recently admitted for arterial dissection leading to stroke was found to have abnormal LFT. Liver biopsy showed PAS positive diatase resistant globules. what is the diagnosis?

Back 72

Alpha 1 antitrypsin deficiency.

Front 73

1. What is the typical definition for short bowel syndrome?

2. Is it important to maintain the small bowel-colonic continuity? why?

3. When should anastomosis NOT attempt in patient with short bowel?

Back 73

1. Less then 200cm of small intestine.

2. Yes, to allow colon to become a energy absorptive organ

3. If there is <60cm of residual intestine and <20% of the colon remain due to high risk of perianal skin breakdown due to severe diarrhea.

Front 74

1. In patient with short bowel syndrome, what is the recommended kcal/kg for TPN?

2. How much protein should be added?

3. How about fluid of TPN?

Back 74

1. 20-30kcal/kg/day base on ideal body weight

2. 1-1.5g/kg/day of protein.

3. 1kcal/mL of TPN should be okay. unless there is CHF or renal insufficiency.

Front 75

In patient with chronic TPN, which two type of patients should be started on chronic anticoagulation therapy?

Back 75

Patient with history of mesenteric ischemia and hx of catheter thrombosis.

Front 76

Since developing short bowel syndrome, patient has been haivng large amount of fluid lost. Despite having short bowel syndrome, what is another mechanism that induce fluid loss? How do you treat this?

Back 76

gastric hypersecretion in the initial 6 months. Tx with PPI.

Front 77

In patient with short bowel syndrome what are 3 things they should beware of when they take PO?

Back 77

1. Eat 1.5 to 3x of normal caloric intake

2. In patient with colon continuity, a Low oxalate (lower kidney stone), high complex carbohydrate with soluble fiber diet should be perscribed

3. Encourage oral hydration with isotonic (sodium concentration of at least 90 mEq/L)

Front 78

1. How much fecal energy loss can be saved with colonic carbohydrate salvage?

2. What type of vitamin and 2 elements should be supplemented in patient with short bowel syndrome?

Back 78

1. 1000kcal/day.

2. TPN dependent: Zn, selenium, fat soluable vitamin.

Front 79

What are 3 drugs that can be consider to treat high output failure in patient with short bowel syndrome?

Back 79

1. Loperamide or diphenoxylate (up to 16mg/day)

2. codeine/tincture of opium

3. octreotide 100mcg/SC/BID

Front 80

1. At what level of serum glucose should be maintained in patient getting TPN?

2. In patient with TPN, what should be reduced in patient with renal dysfunction?

Back 80

1. 165

2. protein(amino acids) should be reduced.

Front 81

What are 2 ways to decrease liver dysfunction in patient with chronic TPN?

Back 81

1. avoid dextrose overfeeding

2. use <2.5g/kg/day lipids. If possible <1.5g/kg/day.

Front 82

What are 4 major viruses that can cuase diarrhea in patients?

Back 82

1. Rotavirus
2. Caliciviruses
3. Astrovirus
4. Enteric adenovirus

Front 83

1. What is the incubation period for Campylobacter?

2. What is the recurrent infection rate?

3. What are 3 major possible complications arise form Campylobacter infection?

4. What do you treat it with?

Back 83

1. 1-4 days lasting up to 1 week

2. 25%

3. Hemolytic uremic syndrome, reactive arthritis (HLAB27) and guillain Barre syndrome

4. Treat with Erythromycin or quinolone.

Front 84

1. Is Typhoid fever Zoonosis? If not, where can you get it?

2. What are 4 clinical signs to look for in Typhoid fever?

3. What is the inbuation period for typhoid fever?

Back 84

1. Exist only in human

2. bardycardia, hepatosplenomegaly, lymphadenopathy, and macular rash

3. 7-14 days.

Front 85

1. Why does Shigella have low infective dose?

2. What type of complications can cause children?

3. Which specie is the "bad" shigella and what 3 complications can it cause and why?

Back 85

1. resistant to stomach acid

2. It can cause seizure and other neurological symptoms in children.

3. S. Dysenteriae can cause HUS, toxic megacolon and reactive arthritis in patient with HLAB27 due to production of shiga toxin.

Front 86

What 2 type of patients generally may accquire problem from EAEC?

Back 86

HIV/infant

Front 87

Which vibrio infection is acquired through wound contamination by infected sea water?

Back 87

V. Vulnificus.

Front 88

Can Yersinia infection lead to arthritis and rash?

Back 88

Yes

Front 89

1. What is the incubation period for Giardia?

2. How do you treat it?

Back 89

1. 1-2 weeks.

2. flagyl 250TID for 5-7 days.

Front 90

1. What is the most common parasitic diarrhea cause in the world?

2. When does symptoms typically start after ingestion?

3. Is this organism invasive?

4. How do you treat it?

Back 90

1. Entamoeba histolytica

2. 1-3 weeks

3. Yes, can lead to higher risk for perforation

4. Flagyl + diloxanide/paromomycin or iodoquinol due to cyst resistance to flagyl.

Front 91

What are 3 per-formed toxin that can cause diarrhea. How quick can you have symptoms? Which can be fatal?

Back 91

1. Staph toxin (2-6 hrs)
2. C. perfringens (8-24hrs)
3. B. Ceres (2-6hrs)

C. perfringens can lead to fatal enteritis necroticans in tropics.

Front 92

Patient present with symptoms of dyspepsia despite being on PPI. Patient was then had EGD which showed erythema and nodular mucosa. Biopsy showed CD8+ t cells in the antrum and oxyntic mucosa with >25lymphocytes/100 epithelial cells. What is the treatment, suspected cause and what disease is it usually associate with it?

Back 92

Lymphocytic gastritis

tx the H. Pylori, but usually it goes away by it self.

Associated with celiac disease.

Front 93

What are the 3 major branch of SMA and what part of the intestine does each supply?

What is consider a "major emboli" vs. minor emboli in patient with acute mesenteric ischemia?

Back 93

Middle colic supply transverse colon
Rigth colic supply ascending colon
Ileocolic artery supply TI/ascending

Major emboli lode above the take off of the ileocolic artery. Those lodge beyond ileocolic artery are minor emboli.

Front 94

42 year old post bone marrow transplant POD 2 weeks ago, present with jaundice, abnormal LFT, ascites and hepatomegaly with thrombocytopenia. Ultrasound with doppler showed patent hepatic vein and no evidence of cholecystitis. She has no fever nor is she on TPN. What is the diagnosis?

How is this disease different then GVHD?

Back 94

VOD

Usually occurs within 21 days of transplant as oppose to GVHD which usually occurs within 21 days.

Front 95

What is type
I, II, III, IV, V of choledochal cysts? Which one has the highest potential of cancer?

Back 95

1. diffuse enlargement of CBD
2. cyst are diverticula of the CBD
3. cyst are dilation of the intraduodenal portion of the CBD
4. multiple intra-extrahepatic bile duct cysts
5. diffuse intrahepatic cyst (Caroli's)

Type 1-2 has highest risk for cancer.

Front 96

What is the typical presentation of choledochal cysts?

What is the treatment for type 1,2 and 3 choledochal cysts?

Back 96

1. jaundice, abdominal pain and palpable abdominal mass. Pancreatitis as well.

2. 1-2 surgery, 3 can try with sphincterotomy.

Front 97

Does schistosomiasis typically have normal LFT or close to normal LFT? What is the treatment?

Back 97

1. Yes

2. Tx with praziquantel.

Front 98

1. Patient present with GI bleed after liver biopsy. The first diagnosis should come to mind is? What is the treatment?

2. What is the chance of GI bleed when there is BILIOUS aspirate in NG lavage?

Back 98

1. hemobilia, treat with anigogram.

2. <5% chance.

Front 99

21 year old lady with off and on abdominal pain since 9 years ago. previous imaging study showed "nodular" colon which is seen off and on. Barium study also suggest ?stricture, but patient reports no B-type symptoms. Colonoscopy reveal nodule during pain episodes, but again disappeared after pain resolved. What is the diagnossi?

Back 99

Endometriosis. Can present with "strictuere like" due to swelling of serosa, but normal luminal appearance due to no invasion of the lumen.

Front 100

30 year old present with epigastric pain, nausea, early satiety who underwent an EGD which showed an abnormal second portion of duodenum without mucosal abnormalities. CT showed a enlarged pancreas without any focal mass. He remember that he had "problems" as a youngest and remember the doctor told his parent that he had "double bubble" sign on x-ray. What is the diagnosis and the next step in diagnosis. What is the treatment?

Back 100

Annular pancreas

next step is ERCP to look for a ductal ring.

Treatment is surgery.

Front 101

1. At what temperature does cryoglobulin precipitate out of solution?

2. What are the two treatment solution?

3. What typically cause the skin palpable purpuric lesions?

4. What are 2 other common lab work seen with cryoglobulin?

Back 101

1. 37 degree C.

2. plasmaphresis and treat the underlying hepatitis C.

3. leukocytoclastic vasculitis.

4. RF and low C4 level.

Front 102

59 year old woman has family history of polyps was found to have small papules on hands, feet and face. There is "cobblestoning" on her tongue. Colonoscopy showed numerous polyps throughout the colon with histology showing hamartomatous polyp.

What is the diagnosis?
What are the bumps
How is it inherited?

Back 102

Cowden's disease
bumps are trichilemmomas
The "bumps" can coalesce in the buccal mucosa and leads to cobblestone like pattern.
Inherited AD with PTEN mutation.

Front 103

60 year old man with fever, weight lost, costovertebral angle tenderness, and microscopic hematuria with HIGH ALKP, but normal LFT and GGT. What is the diagnosis?

Back 103

renal cell carcinoma

Front 104

Patient present with flushing with alcohol ingestion, intermittent hypotension, abdominal pain and found to have hepatosplenomegaly and signs of malabsorption and Darier's sign

He has normal LFT except elevated GGT and ALKP. What is the diagnosis? What is Darier's sign?

Back 104

mastocytosis
diffuse mastocyte infiltrate the liver leading to rising ALKP and GGT

Darier's sign is urticaria with scratching.

Front 105

What are the two condition that has "angioid streak in eyes"

Which condition has elevated ALKP?

Back 105

pseudoxanthsma elesticum (abnormal deposite of collagen) which lead to GI bleed.

Pagets disesae

Front 106

46 year old with AIDS developed jaundice and progressive weight loss along with fever and abdominal pain. On exam, he has cutaneous papules on his hands marked by central umbilication. CT showed LAD and large liver.

What is the diagnosis?
Treatment?
What would a liver biopsy show?
What two conditions are associated with this condition?

Back 106

Peliosi hepatitis from Bartonella henselae
Biopsy of the liver would show blood filled cystic spaces throughout the parenchyma.

Treat with erythromycin 2grams daily.

Two most common assocation is steroid use and HIV. Other include (vitamin A, hydroxyurea, oral contraceptives etc...)

Front 107

1. Diarrhea after milk, lunch meat, cheese think?

2. Bloody diarrhea after eating undercooked beef think?

3. Diarrhea while on cruise ship think?

4. Diarrhea in cirrhotic patient leading to sepsis and death, think?

Back 107

1. Listeria

2. EHEC

3. Norwalk virus

4. Vibrio Vulinficus.

Front 108

What would happen if a patient is taking AZA and allopurinol at the same time?

Back 108

It may cause toxic build up due to shunting of metabolite to 6TG and 6MMP pathway. Allopurinol block the XO pathway.

Front 109

1. Which race does Whipple disesae typically affect?

2. How do you differentiate Whipple and MAC?

Back 109

1. white

2. acid fast stain. Both is PAS+ foamy macrophages.

Front 110

What medication is suspected of causing a nurisng home patient with dementia who was being treated for severe constipation. Patient aspirated the medication and rapidly developed severe pneumonia and dies

Back 110

Mineral oil induced lipid pneumonia.

Front 111

Patient developed bloody diarrhea after using a short course of high dose therapy for ankle sprain.

Back 111

NSAID induced colitis.

Front 112

A young woman develops acute sharpt right upper quadrant pain after taking this medication. CT showed hemoperitoneum. What medication can lead to this?

Back 112

estrogen induced hepatic adenoma causing rupture and hemoperitoneum.

Front 113

Cirrhotic patient developed severe abdominal pain after taking diuretics.

Back 113

Lasix incuded pancreatitis.

Front 114

What are 7 common drugs that is known to cause pill esophagitis?

Back 114

1. Alendronate
2. ASA
3. Doxy
4. Indomethacin
5. Iron
6. Potassium
7. Quinidine

Front 115

What are 5 common drugs that can cause MACROvesicular steatosis?

Back 115

1. Acetaminophen
2. Cisplatin
3. Corticosteroid
4. MTX
5. Tamoxifen

Front 116

What are 9 drugs that can lead to ischemic colitis?

Back 116

1. Alosetron
2. Carboplatin
3. Cocaine
4. Digitalis
5. Diuretics
6. Estrogen
7. NSAIDs
8. Tegaserod
9. Paclitaxel

Front 117

12 drugs that can cause pancreatitis?

Back 117

1. AZA
2. 6MP
3. Lasix
4. Sulfasalazine
5. Cimetidine
6. Estrogen
7. Flagyl
8. Pentamidine
9. Salicylate
10.Sulindac
11.Tetracycline
12.Valproic acid

Front 118

At cecal size would you start to worry about perforation for Ogilvie's? What is a medication that you can possibly use? What are its side effect?

Back 118

10-12cm is the cut off
Use Neostigmine
Side effect include bronchocontriction, cramping, hypersalivation, diaphoresis, bradycardia.

Front 119

1. What is a Balthazar's sign? what does it typically indicate?

Back 119

1. air in the gallbladder, indicate a direct communication btwn gallbladder and the bowel vs. gas forming orgainism.

Front 120

HIV patient present with urgency, tenesmus, bloody diarrhea and paresthesias in a "saddle" distribution?

Back 120

HSV procitis. Virus is neurotropic and attachs the S2-S4 leads to saddle paresthesia.

Front 121

HIV patient with fever, watery diarrhea, cholecystitis and terminal ileitis?

Back 121

cryptosporidium

Front 122

HIV patient with abdominal pain, bloody diarrhea and colonic ulcer showed "owl's eye" inclusion body.

Back 122

CMV

Front 123

1. HIV patient with diarrhea after coming back from developemental country. stool showed Charcot-Leyden crystals.


2. "Trophozites with ingested RBC"

Back 123

1. Isospora.

2. E. histolytica

Front 124

24 year old with sudden onset of severe abdominal pain located in the LLQ. Vitals are stable and lab revealed no significant findings.

CT showeda normal cecum, appendix and no diverticula. However in the anti-mesenteric border of the sigmoid colon, there is a focal oval area of fat with inflammatory stranding and a linear central attenuating line through the inflammed fat. What is the diagnosis?

Back 124

Epiploic appendagitis.

Front 125

18 year old Armenian developed severe abdominal pain after exercising. He has had family history of "abdominal pain" and has experienced similar pain before.

T=100.8, R=110
diffuse TTP around the abdomen and there is a patch of tender erythematous skin along his right ankle and dorsum of this foot. WBC is 15 and ESR is 68. CT is negative. What is the diagnosis?

What are the ethnicity consider high risk for this disease (7)

What is the treatment?

Back 125

FMF.

Arabs, Turks, Greek, Italians, Armenians, Sephardic Jews, North Africans.

Colchicine

Front 126

How do you differentiate adult Hirschprung's from pelvic dyssynergia?

Back 126

Hirshprung's there is a lack of relaxation of the interal sphincter with balloon inflation. In pelvic dyssynergia, the problem is contraction of the external anal sphincter upon attempted balloon expulsion.

Front 127

Subepithelial mass in the stomach which stain positive actin, but negative c-kit. What is the diagnosis?

Back 127

leiomyoma

Front 128

1.5cm subepitheilail mass found in the stomach. EUS showed hypoechoic 4th layer tumor with biopsy + for actin and vimentin but c-kit negative.

Back 128

Glomus tumor

Front 129

Several subepithelial mass found in the stomach in patient with prior Billroth II for PUD. GAstrin was found to be elevated but negative stimulation test. EUS showed lesion starts in MM and SM layer.

Back 129

Carcinoid

Front 130

A 2cm subepithelial mass found in the stomach during EGD and EUS showed a hypoechoic 4th layer lesion biopys showed + S-100

Back 130

Schwannoma

Front 131

What are the 3 types of carcinoids?

Which type is consider more benign?

Back 131

type I: associated with hypergastrinemia from chronic atrophic gastritis, most common

type II: associated with ZES

type III: sporadic

Type 1 and 2.

Front 132

1. What is the genetic mutatioin that cause FAP? Which chromosome does it come from?

2. What does this mutation do that leads to abnromal growth?

3. Are there >1 mutation in patient with FAP?

Back 132

1. APC gene on chromosome 5q

2. Mutated gene result in a a defective complex of glycogen kinase APC and axin which is unable to bind or phosphorylate beta-catenin, preventing its degradation leading to activation of Wnt signal pathway leads to cell growth.

3. Yes, >825 different mutation.

Front 133

When should you start offering colonoscopy for patients once they were found to be carrier of FAP gene?

Back 133

Screen at age of 10 for those at risk for classic FAP and 18 for AFAP

Front 134

What is another mutation which was thought to explain those who is negative for FAP yet have phenotypical trait of FAP? When do they usually present and how does it pass on genetically (AR vs. AD?)
Which chromosome it is on and what does this gene do?

Back 134

MYH associated polyposis which is AR, typically present between 45-60 years of age.

Chromosome 1p and it is a base excision repair gene.

Front 135

1. How is juvenile polyposis inheritated.

2. How is it diagnosed using the 3 criteria?

3. When is the average age of diagnosis?

4. Which 2 gene mutation is thought to be responsible for JP?

Back 135

1. AD

2. >5 juvenile polyps in the colorectum, juvenile polyps throughout the GI tract, any number of juvenile polyps in a person with a known family history of JP

3. 18.5

4. SMAD4 (mother against decapentaplegic homolog 4) on chromosome 18q or BMPR1A on chromosome 10.

Front 136

1. How is Peutz-Jeghers syndrome inherited? What is the estimate incidence?

2. What is the typical clinically course presentation of PJS?

3. Are PJS Polyps usually adenomatous always?

Back 136

1. AD, 1/120,000

2. Commonly characterized by repeated surgery from complications resulting from small bowel polyps such as intussusception, bleeding, obstructive symptoms.

3. No, but can present with adenomatous changes.

Front 137

How do you differentiate MCN from IPMN base on histology?

What are some exceptions in this histology?

Referrence?

Back 137

MCN have ovarian stromal cells which can stain for estrogen and progesterone receptors.

It maybe possible that postmenopausal women and men with MCN may fail to demonstrate ovarian type stroma and therefore, MCN is VERY rare in male and uncommon in post menopausal women

Sendai Tanaka 2004

Front 138

1. Which two population rarely or uncommonly have mucineous cystic neoplasm?

2. What does the ovarian stromal cells look like?

Back 138

1. Male (lack of ovarian stromal cells) and post menopausal women.

2. They have oval nuclei and spindle cellshape.

Front 139

What are some difference between MCN and IPMN clinically?

Back 139

1. MCN thought to be arise from the pancreatic rest vs. IPMN from the duct
2. MCN usually solitary and don't recur after resection.

Front 140

What are three findings that suggest malignancy in patient with IPMN?

Back 140

1. Presence of symptoms.
2. MPD>15mm
3. Mural nodules

Sugiyama

Front 141

1. What is the current recommendation for main duct IPMN and mixed variant?

2. What is the recommendations treatment for MCN?

Referrence

Back 141

1. Surgery

2. Surgery

Sendai recommendations.

Front 142

What is the malignancy rate for branch duct IPMN? How about frequency of invasive CA? Referrence?

Back 142

Malignancy: 6-46% mean 25%

Invasive carcinoma 0-31% mean of 15%

Sendai, Tanaka 2004

Front 143

What are the two situation where a limited pancreatectomy is recommended treatment for IPMN and MCN?

Back 143

Branch duct IPMN with ?in-situ CA and MCN.

Front 144

What is the suggested method of management in patient with multi-focal branch IPMN in a poor surgical candidiate?

Back 144

Reasonable to resect dominant lesion and obsever the rest.

Front 145

What are the three indication for surgical treatment in patient with branch duct IPMN?

Back 145

1. >3cm
2. + Mural nodules
3. Symptomatic

Front 146

1. Does negative surgical margin for IPMN indicate free surgical margin?

2. Is further resection needed if you see IPM adenoma? Atypia? or CIS on frozen section? How about PanIN-1 or 2?

Back 146

1. No, IPMN can have skip lesions.

2. Adenoma and atypia generally no. CIS = yes
PanIN-1 or 2=no

Front 147

How should branch duct IPMN be followed in patient who did not have surgery?

Referrence?

Back 147

<1cm = yearly follow up with imaging

1-3cm= EUS and MRCP or ERCP. If high risk stigmata was found then need resection. If not, then MR/CT (1-2cm 6-12months, 2-3cm 3-6 months)

>3cm needs resection.

Sendai Tanaka 2004

Front 148

How should patient with MCN followed after resection? How about malignant MCN?

Referrence?

Back 148

1. No need to follow if not malignant

2. If malignant then need Q6 months imaging.

Sendai Tanaka 2004

Front 149

How should patient with IPMN follow after surgery?

Do CEA and CA19-9 have any utility?

Referrence?

Back 149

1. Yearly imaging with CT/MRI if no malignant feature

2. If malignant features, Q6 months follow up

Sendai, Tanaka 2004

NO

Front 150

What is the risk of main duct IPMN developing high grade dysplasia or invasive carcinoma within 5 year?

How about Branch duct?

Reference?

Back 150

63% for Main duct
15% for branch duct.

Sahani 2009

Front 151

What are some predictors for IPMN with invasive carcinoma at preoperative CT? (6 things)

Referrence?

Back 151

1. Involvement of main duct
2. dilation >1cm of the main PD
3. diffuse or multifocal involvement
4. presence of large mural nodule or solid mass
5. large size of the mass
6. calcified intraluminal contents or obstruction of cbd.

Front 152

1. How often is pancreas divisum seen?

2. How does pancreas divisum form?

3. How does the accessory duct form? what % of patients?

Back 152

1. about 10%

2. In second week of fetal development, the ventral bud arises with the hepatobiliary system and will form the posteroinferior aspect of the head of the pancreas as it rotates to fuse with the dorsal bud which form the rest of the gland. When the dorsal duct remains and drains the majority of the pancreas via the minor papilla, and the shor tventral duct drains the inferior portion of the head via the major papilla

3. In about 30% of the people he portion of the dorsal duct nearest the minor papilla doesn't regress and forms the accessory duct.

Front 153

1. What is the other name for the dorsal duct?

2. What about the ventral?

Back 153

1. Wirsung

2. Santorini's

Front 154

1. What are 3 major type of patient categories for pancreatic divisum?

2. What are two ways to facilitate cannulation of the minor pancreatic duct?

Back 154

1. patient with acute pancreatitis, chronic pancreatitis and patient with pancreatic pain.

2. spray methylene blue and IV secretin (0.25-1Unit)

Front 155

1. Does secretin improves non-invasive imaging for pancreatic divisum? How or why not?

Back 155

1. It doens't, it may matter infact increase false positive as it can make the duct more "plum"

Front 156

Is papillary dilation of the minor duct a good way of treating pancreatic divisum induced pancreatitis? why or why not?

Back 156

No, increase risk for traumatic pancreatitis and largely abandoned.

Front 157

1. How do you perform a minor duct papillotomy? which direction do you cut?

2. What is the down side of prolong pancreatic stenting for patient with divisum? what is the evidence? Why do they think this happen?

Back 157

1. 10-12 o'clock.

2. Kozarek in 1990 reports ductal changes in 72% of patients who underwent serial stent exchange for pancreatic divisum. They think it is due to the duration of the stent placement.

Front 158

Which population of the patients with pancreatic divisum had the most benefit in long term follow up after endoscopic treatment?

Back 158

Patient with acute recurrent pancreatitis had the most effect. patient with pain and chronic pancreatitis only had 20-50% improvement.

Front 159

What is the metabolic pathway of AZA and 6MP?

What level of 6-TG do you want to keep at? What is the toxic level?

Back 159

AZA -> 6mp

6MP + TPMT = 6MMP (hepatotoxicity)

6MP -> 6-TG(active metabolite) leads to myleosuppression

6MP + XO = 6TU


6TG=235 and level above 450 can lead to myleosuppression.

Front 160

17 year old recent immigrant from Mexico present with dysphagia for solid and liquid. She had swelling around her left eye prior to the symptom onset. She leved in a thatched roof hut in Mexico. What causes it?

Back 160

Chaga disease.

Trypanosoma cruzi which is spred by reduviid bug which defecat in your eyes whiel you sleep.

Front 161

72 year old man with 50pack year smoking history present with "overnight" dysphagia with new onset constipation. He also noted hoarse voice.

what is the cause and what is the pathophysiology?

Back 161

paraneoplastic syndrome from lung cancer

An epitope on small cell cancer mimics an epitope on the myenteric plexus and forms anti-Hu antibody against the epitope and affixes itself along the myenteric plexus throughout the GI tract leads to paralysis of esophagus, gastroparesis, colonic inertia and peudo-obstruction.

Front 162

What is the difference between nutcracker esophagus and DES?

How can you tell clinically?


How do you diagnosed DES?

Back 162

DES has nonpropagating esophageal contractions and nutcracker esophagus has propagating esophageal contraction.

You can tell because patient with nutcracker can still swallow, but patient with DES can't due to nonpropragating contraction.

>30mmHg pressure wave amplitude is found >20% of wet swallow.

Front 163

50 year old woman presnt with progressive dysphagia for solids and liquids. She has difficult standing from a seating position and describe a violaceous rash like a shawl at the nape of her neck?

Back 163

Dermatomyositis.

Front 164

50 year old man present with progressive worsen weakness and atrophy of his lower extremity musculature along with worsen dysphagia for solid and liquids. He had polio at age of 15. What is the cause?

Back 164

Post polio dysphagia which can occur even 40 years after polio. Usually had polio of the bulbar region but NOT necessary to develop dysphagia symptoms

Front 165

32 year old woman with worsen dysphagia, first solid, then both. She had megaduodenum on small bowel x-ray and has had recurrent SBBO?

Back 165

systemic sclerosis

Front 166

72 year old with long standing dysphagia to solids but not liquid. No weight lost or other symptoms. Barium swallow showed normal motility pattern and transit of barium column to the stomach. However, there was a shelf impinging on the barium column at the level of UES. What is the cause?

Is EGD indicated?

What type of conditions is this associated with?

Treatment?

Back 166

Crycopharyngeus bar

No EGD is needed for diagnosis.

Associated with neurodegenerative conditions such as stroke, ALS, MS, myasthenia gravis, etc...
Treat with dilation for mild and surgical myotomy for severe.

Front 167

Why when people vomit, their HCO3 goes up and K goes down?

Back 167

vomit leads to lost of H and the compensated HCO3 normally used to neutralize the HCL would then be absorbed and increase the serum HCO3. Increase HCO3 in serum leads kidney to increase H+ uptake due to alkalosis and subsequent potassium dumping by the kidney.

Front 168

22 year old Arabian man who recently travel to US developed LE edema, abdominal pain and worsen diarrhea. patient has fever of 101, LAD and stool is positive for fat with low serum carotene. Serum is positive for alpha chain paraproteinemia.

EGD showed cobblestoning of the mucosa of the duodenum. Biopsy showed dense lymphoplasmacytic infiltrate of small intestine

Diagnosis?
What is the key lab finding in this case?
What is it associated with?

Back 168

Immunoproliferative small intestinal disease (IPSID) subtype of gastric lymphoma.

Almost exclusively from middle East Men

Assocaited with C. jejuni

alpha heavy chain paraproteinemia)

Front 169

Patient with history of diverticulitis with ileostomy started to have bloody stool from the rectum, but not the ileostomy. What is the diagnosis and treatment?

Back 169

Diversion colitis improve with short chain fatty acid enema.

Front 170

32 year old woman on oral contraceptive undergoes an abdominal CT to evaluate for abdominal pain. CT showed a 5cm mass with a central scar with fibrous appearing septae radiating from the scar like spokes of a wheel. This lesion is hypodense in the noncontrast phase and hyperdense during the hepatic arterial phase. Follow up nuclear sulfur colloid liver scan reveals marked uptake of the tracer. What is the diagnosis? Does it need to be removed?

Back 170

Focal nodular hyperplasia.

No need to be removed.

Front 171

When is a hepatic adenoma recommended for surgical resection?

Back 171

when it is >5cm

Front 172

65 year old man with essential thrombocytosis found to have isolated elevated ALKP. He then had CT which showed multiple hypodense nodules in the righ tlobe. Biopsy showed regenerative nodules clustered around the portal triad without fibrosis. What is the diagnosis? What is it associated with?

Back 172

Non-regenerative hyperplasia.

associated with drugs: hypercoagulable state, myleoproliferative state, lymphoproliferative disorder, AZA, chemo (cyclophosphamide, busulfan, bleomycin).

Front 173

1. How often is VIPoma malignant at time of diagnosis and how much % have metastatic disease?

2. What are three major symptoms of VIPoma?

3. Which organ is VIPoma mostly found?

4. Which part of this organ is VIPoma mostly found?

Back 173

1. 75% malignant and 50% have met.

2. pancreatic cholera, hyperglycemia and hypokalemia

3. 90% in pancreas, non-beta pancreatic islet cell.

4. >75% are in the body or tail

Front 174

1. What do you use to diagnose VIPoma?

2. Waht is the 3 treatments for VIPoma?

Back 174

1. serum VIP level and imaging study

2. octreotide, if no response, can try steroid. surgery and chemo (streptozocin and doxorubicin) + embolization if met.

Front 175

1. Where are glucagonoma usually located in the pancrease?

2. How often do they have metastic disease on diagnosis?

3. What is the cause of necrolytic migratory erythema in patient with glucagonoma?

4. What other symptoms are present other then necrolytic migratory erythema (7)

Back 175

1. head of pancreas

2. >75% have mets.

3. Hypoaminoacidemia

4. glossitis, stomatitis, dystrophic nails, hair thinning, DM, increase thromboembolic disease and diarrhea.

Front 176

1. How do you diagnose glucagonoma?

2. What is the treatment of glucagonoma?

3. why is surgery risky?

Back 176

1. >1000pg/L glucagon

2. TX with nutrional support, octreotide, embolization, chemo.

3. Surgery can be risky due to hypercatabolic effect of glucagon.

Front 177

1. whre are somatostatinoma usually locate at? (2)

2. Where does it produce more symptoms

3. How often are their met at time of diagnosis?

4. What are 4 other conditions that can mimic somatostainomas?

5. What are three major symptoms?

Back 177

1. 60% in pancreas, 40% in duodenum/jejunum

2. Pancreatic tumor produces more symptoms

3. 85% have met.

4. small cell lung ca, medullary thyroid cancer, pheochromocytoma and paragangliomas can mimic somatostatinoma.

5. DM, gallbladder disease, steatorrhea.

Front 178

1. What are the 3 major treatment of somatostainomas?

2. How are the tumor most commonly discovered?

Back 178

1. octreotide MAYBE helpful, correction of nutrional deficiency, chemo maybe helpful in patient with mets but no clear benefit

2. Incidental discovered

Front 179

68-year-old man is sent to you for formal evaluation by an ENT physician regarding dysphagia. Five years ago, the patient noticed visual changes and was eventually diagnosed with bilateral ptosis requiring surgery. One year ago, he noticed occasional dysphagia to solids and liquids. His symptoms have progressed over the last 6 months, and he has suffered a documented unintentional weight loss of 70 pounds. His local physician performed an upper endoscopy which was reported as normal. A barium swallow revealed impaired clearance of the pharyngeal bolus, incomplete upper esophageal sphincter (UES) relaxation, and mild aspiration.

Back 179

Oculopharyngeal muscular dystrophy

Front 180

A 24-year-old male patient reports swelling of his tongue and lips when he eats certain fruits. Recently, he has also noted a feeling that his throat is tightening and he has some difficulty breathing. He has been treated for allergies to pollens in the past which has helped his respiratory symptoms. What is the most likely cause of his current symptoms?

Back 180

Oral allergy syndrome

Front 181

1. What is Olestra vs. Orlistat?

2. Calcium is absorbed where?

3. Three reasons for IBD to cause osteoporosis?

Back 181

1. Olestra is a sucrose polyester which is a fat subsitute which can lead to gas, bloating, pain. Orlistat is a drug that inhibit gastric/pancreatic lipase.

2. Duodenum

3. malabsorption, bone wasting from steroids and inflammatory cytokines stimulate osteoclast activity lead to bone remodeling.

Front 182

What are 7 complications related to weight lost surgery?

Back 182

1. marginal ulcer
2. bypassing duodenum lead to malabsorption of iron, calcium, copper
3. malabsorption of fat soluable vitamins
4. water soluble vitamin deficiency
5. protein-calorie malnutrion
6. Dumping syndrome
7. decrease bone mineral density.

Front 183

1. What maybe the "perfer" fuel for colonocytes?

2. What are 4 nutrional related skin lesion?

3. Folate deficiency is associated with what type of CA?

Back 183

1. Butyrate.

2. Pellagra (niacin), essential fatty acid deficiency, Zinc and vitamin C.

3. Colon

Front 184

1. When does diversion colitis typically present after the initial diversion procedure?

2. When does it typically get better after re-anastomosis?

3. What is the Behcet's triad?

Back 184

1. 3-36 months post surgery.

2. 2-3 weeks

3. oral ulcer, genital ulcer and uveitis.

Front 185

1. Which nerve innervate external anal sphincter?

2. Which nerve inneratve puborectalis muscle?

3. Most of the resting pressure in the anal canal is dervied from which muscle?

Back 185

1. S2

2. S3 and S4

3. Internal anal sphincter.

Front 186

Patient with internal anal sphincter weakness will have
High, low or normal on manometric study?

1. resting pressure
2. squeeze pressure?
3. puborectalis muscle pressure?
4. Sensation?
5. Compliance?

Back 186

1. low resting
2. normal
3. normal
4. Normal
5. Normal.

Front 187

Patient with external anal sphincter trauma will have
High, low or normal on manometric study?

1. resting pressure
2. squeeze pressure?
3. puborectalis muscle pressure?
4. Sensation?
5. Compliance?

Back 187

1. Normal
2. Low
3. Normal
4. Normal
5. Normal

Front 188

Patient with peripheral neurogenic cause will have
High, low or normal on manometric study?

1. resting pressure
2. squeeze pressure?
3. puborectalis muscle pressure?
4. Sensation?
5. Compliance?

Back 188

1. Normal resting
2. Low squeeze
3. Low
4. Normal
5. Normal

Front 189

Patient with central neurogenic cause will have
High, low or normal on manometric study?

1. resting pressure
2. squeeze pressure?
3. puborectalis muscle pressure?
4. Sensation?
5. Compliance?

Back 189

1. Normal
2. Low
3. Low
4. Low
5. Normal.