Kgi 250-300

Front 1

Q250. pathogenesis of chronic pancreatitis

Back 1

A250. continuing inflammation of pancreas, with fibrotic tissue replacing pancreatic parenchyma and alteration of pancreatic ducts --> irreversible destruction of pancreas

Front 2

Q251. most common cause of chronic pancreatitis

Back 2

A251. chronic alcoholism

Front 3

Q252. presentation of chronic pancreatitis

Back 3

A252. chronic epigastric pain + calcifications on plain abdominal films; steatorrhea, DM, and pancreatic calcifications

Front 4

Q253. serum and amylase levels in chronic pancreatitis

Back 4

A253. not elevated

Front 5

Q254. appearance of chronic pancreatitis on ct

Back 5

A254. calcifications and pseudocysts an be seen

Front 6

Q255. appearance of chronic pancreatitis on ERCP

Back 6

A255. chain of lakes appearance from areas of stricture and duct dilation throughout the pancreatic ducts

Front 7

Q256. complications of chronic pancreatitis

Back 7

A256. DM; narcotic addiction; malabsorption/steatorrhea; pseudocyst formation; pancreatic ductal dilation; b12 malabsorption; pancreatic carcinoma

Front 8

Q257. non surgical tx for chronic pancreatitis

Back 8

A257. narcotics for pain; NPO; pancreatic enzymes + h2 blockers; insulin; alcohol abstinence; frequent small low-fat meals

Front 9

Q258. surgical tx for chronic pancreatitis

Back 9

A258. pancreaticojejunostomy (drains the pancreatic ducts to decompress dilated ducts); pancreatic resection

Front 10

Q259. most common location for pancreatic cancer

Back 10

A259. pancreatic head

Front 11

Q260. risk factors for pancreatic cancer

Back 11

A260. cigarette smoking (most common); chronic pancreatitis; DM; heavy Etoh use; exposure to benzidine and b-naphthylamine

Front 12

Q261. purpose of h2 blockers + pancreatic enzymes in chronic pancreatitis

Back 12

A261. pancreatic enzymes inhibit CCK release and decrease pancreatic secretion after meals; h2 blockers inhibit gastric acid secretion, preventing degradation of pancreatic enzyme supplements by gastric acid

Front 13

Q262. test for dx pancreatic ca

Back 13

A262. CT; ERCP

Front 14

Q263. tumor markers for pancreatic ca

Back 14

A263. ca 19-9; CEA

Front 15

Q264. Definition: Gluten-induced enteropathy in susceptible persons affecting the small bowel

Back 15

A264. Celiac Sprue

Front 16

Q265. What HLA is Celiac sprue?; (2)

Back 16

A265. HLA DR3; HLA DQw2

Front 17

Q266. Dx: Malabsorption (diarrhea, bloating, abd pain, steatorrhea, weight loss), vitamin deficiency (high PT/INR, low iron and calcium), Rash

Back 17

A266. Celiac sprue

Front 18

Q267. Pathology Biopsy of small bowel: flattened intestinal villi, infiltration of lymphocytes, hyperplasia and lengthing of the intestinal crypts

Back 18

A267. Celiac sprue

Front 19

Q268. what does Antiendomysial Ab test?; What other test accompanies this one?; When is it performed?; What is the most accurate test for this Dx?

Back 19

A268. Confirms Dx of Celiac Sprue; (also Antigliadin Ab test); Performed: After a Sudan Black stain confirms Malabsorption; Most Accurate: Small Bowel Biopsy; (must be done to Dx the disease and to RULE OUT Lymphoma)

Front 20

Q269. Definition: A pruitic rash associated with Celiac sprue, responds to Tx of topical Sulfone, resolves with regression of disease

Back 20

A269. Dermatitis Herpetiformis

Front 21

Q270. Tx for Celiac sprue

Back 21

A270. All grains are eliminated from diet except Rice and Corn; (no wheat rye or barley)

Front 22

Q271. *Patient has chronic pale, greasy, malodorous diarrhea and no evidence of infection. Initial test?

Back 22

A271. Sudan Black stain

Front 23

Q272. Pathology Biopsy: mildly flattened intestinal villi with jejunal infiltration of monocytes

Back 23

A272. Tropical sprue

Front 24

Q273. Dx: malabsorption signs, megaloblastic anemia, decreased calcium, B-12, iron, folic acid, cholesterol, albumin and magnesium

Back 24

A273. Tropical sprue

Front 25

Q274. Tx for Tropical sprue; (2)

Back 25

A274. Vitamin B-12 and Folate supplements; Tetracycline (for a few months)

Front 26

Q275. Difference b/t Whipple's disease and Sprue

Back 26

A275. Whipple's has CNS involvement

Front 27

Q276. If there is the presence of a normal jejunal Biopsy, what malabsorption disease is ruled-out?

Back 27

A276. Tropical sprue

Front 28

Q277. Dx: 54-yo farmer who has been suffering with diarrhea, weight loss, and arthralgias for the past few months is brought in by his wife for memory deficits that have been occurring for the past 3 weeks.

Back 28

A277. Whipple's disease

Front 29

Q278. Definition: devastatingly profound malabsorption syndrome due to destruction of the intestinal lamina due to a gram- negative rod of the Actinomyces genus

Back 29

A278. Whipple's Disease

Front 30

Q279. Dx: arthralgia, abdominal pain, malabsorption, fever, inc skin pigment, uveitis, confusion, CNS palsies, nystagmus, heart failure

Back 30

A279. Whipple's Disease

Front 31

Q280. *Most accurate test for Whipple's Disease; Other test?

Back 31

A280. Most accurate: PAS positive macrophages in the lamina propria;; other: PCR of peripheral blood for T. whippelii (Actinomyces strain)

Front 32

Q281. Antibiotics Tx of Whipple's Disease; (2 steps)

Back 32

A281. 1. initial course of Ceftriaxone; 2. TMP-SMZ and Tetracycline for 1 year

Front 33

Q282. Definition: Albumin lost to the GI lumen in excess

Back 33

A282. Protein-losing Enteropathy

Front 34

Q283. Dx: Diarrhea, edema, steatorrhea, low albumin

Back 34

A283. Protein-losing Enteropathy

Front 35

Q284. Dx test for Protein-losing Enteropathy

Back 35

A284. Alpha-1-Antitrypsin comparison in serum vs stool

Front 36

Q285. Similar look to gastric cancer on barium study

Back 36

A285. Menetrier's Disease

Front 37

Q286. Definition: Protein-losing enteropathy that causes mucosal thickening due to hyperplasia of glandular cells replacing chief and parietal cells leading to enlarged, tortuous rugae

Back 37

A286. Menetrier's Disease

Front 38

Q287. Dx: epigastric pain, diarrhea, edema, steatorrhea, decreased gastric acid secretion, low albumin

Back 38

A287. Menetrier's Disease

Front 39

Q288. Dx Tests for Menetrier's Disease; (2)

Back 39

A288. Endoscopy with deep mucosal Biopsy; Barium swallow will reveal large gastric folds

Front 40

Q289. Rx Tx for Menetrier's Disease; (2 plus MOA of each specific to this)

Back 40

A289. Anticholinergics (reduce width of tight junctions b/t gastric mucosal cells); H-2 Blockers (reduce protein loss)

Front 41

Q290. Definition: Stool frequency < 3 times per week

Back 41

A290. Constipation

Front 42

Q291. Etiology of Constipation; (6)*

Back 42

A291. OLD MD Farts:; Obstruction;; Low thyroid(hypothyroidism);; Disturbed colonic motility;; Medications;; DM;; Fluid and fiber intake is low

Front 43

Q292. what amount should you increase your fiber to, if your are constipated?

Back 43

A292. 30 g/day

Front 44

Q293. Definition: Neuroendocrine tumor arising from ectodermal stem cells in the gut

Back 44

A293. Carcinoid Tumor

Front 45

Q294. MC place of a Carcinoid tumor

Back 45

A294. 90% in Ileum; (most in appendix)

Front 46

Q295. What neurotransmitters and hormones does the Carcinoid tumor secrete?; (3)

Back 46

A295. Serotonin;; Bradykinin;; Histamine

Front 47

Q296. MC places of mets with Carcinoid tumor; (2: in order of frequency)

Back 47

A296. Liver;; Lung

Front 48

Q297. Etiology of Carcinoid tumor; (2)

Back 48

A297. Most are Idiopathic;; part of MEN-1

Front 49

Q298. Classic triad of Carcinoid tumor and reason for each sign. (3) other signs

Back 49

A298. 1. Flushing, Hypotension - Bradykinin; 2. Diarrhea - Serotonin; 3. Rt-sided Valvular heart Disease - Serotonin other:; Wheezing (histamine);; Bowel obstruction;; Appendicitis

Front 50

Q299. Dx test for Carcinoid tumor; (2)

Back 50

A299. 1. > 10mg/24 hour 5-HIAA; 2. elevated serum and urine 5-HT

Front 51

Q300. Tx for Carcinoid tumor; (3)

Back 51

A300. Surgical excision;; Radiation therapy;; Antihormonal therapy