Unit 3 - Formative 2 D4 Thursday

Front 1

Which type of acute gastric ulcer is most common in individuals with shock, sepsis or severe trauma?

Back 1

Stress ulcers

Front 2

Which type of acute gastric ulcer is most commonly associated with severe burns or trauma?

Back 2

Curling ulcer; occur in the proximal duodenum

Front 3

Which type of acute gastric, esophageal, or duodenal ulcer is most commonly associated with intracranial disease?

Back 3

Cushing ulcer; carry a high incidence of perforation

Front 4

Upon gastric biopsy, you note spiral shaped organisms concentrated within the superficial mucus overlying epithelial cells in the surface and neck regions. What is this organism?

Back 4

H. pylori; most common cause of chronic gastritis

Front 5

What are some characteristics of autoimmune gastritis?

Back 5

Located in the body of the stomach; inflammatory infiltrate lymphcytes and macrophages; acid production is decreased so gastrin production is increased; antibodies to parietal cells/their products are found; patients often also have other autoimmune diseases going on

Front 6

While treating a patient with a Meckel diverticulum, you note a round to oval, sharply punched out defect in the adjacent mucosa. Diagnosis?

Back 6

Peptic Ulcer; pretty much always associated with chronic gastritis

Front 7

Which disease is characterized by uncontrolled release of gastrin by a tumor which results in massive acid production?

Back 7

Zollinger-Ellison Syndrome; multiple peptic ulcerations in the stomach and duodenum

Front 8

Is a peptic ulcer more likely to occur in the stomach or the proximal duodenum?

Back 8

Proximal duodenum

Front 9

If a patient presents with free air under the diaphragm and epigastric pain, what has probably happened?

Back 9

Acute gastric perforation

Front 10

How is the risk of adenocarcinoma in gastric adenomas related to the size of the lesion?

Back 10

Increased lesion size = increased risk of malignancy

Front 11

Which disease is characterized by large fixed mucosal polyps arising in the stomach proximal to an old gastroenterostomy.

Back 11

Gastritis cystica

Front 12

A gastric biopsy reveals a doubling of oxyntic (parietal) mucosal thickness along with multiple peptic ulcers. Likely diagnosis?

Back 12

Zollinger Ellison Syndrome; increased secretion of gastric by tumors = lots of acid

Front 13

A biopsy reveals enlargement of rugal folds. There is no inflammation.

Back 13

Menetrier's Disease; caused by excessive secretion of transforming growth factor a (TGF-alpha)

Front 14

A patient presents with a well differentiated neuroendocrine tumor in the tracheobronchial tree and lungs.

Back 14

Carninoids; clinical features are determined by what hormones are produced

Front 15

A patient presents with epigastric pain, nausea, vomiting, GI bleeding. Labs are notable for c-KIT. Diagnosis?

Back 15

Gastro-intestinal stromal tumors

Front 16

A 70 year old male is a survivor of a massive fire in his residential complex. He has 40% burns. He complains of epigastric pain, nausea, vomiting, and two episodes of hematemesis. Dx?

Back 16

Curling Ulcer

Front 17

A 70 yo F has a massive stroke. She complains of epigastric pain, nausea, vomiting, and two episodes of hematemesis. Dx?

Back 17

Cushings Ulcer

Front 18

A 42 yo man presents with a recent history of abdominal pain, distension and nausea. Urea breath testing for H. pylori is positive. Dx?

Back 18

Chronic gastritis

Front 19

A 70-year old male presents with history of epigastric pain, nausea, vomiting and two episodes of hematemesis. He is on NSAIDS for chronic degenerative arthritis. Physical examination is remarkable for tachycardia and conjunctival pallor .

Back 19

Acute gastritis

Front 20

70-year-old woman presents with a 2-month history of increasing fatigue, difficulty with ambulation, and memory deficits. Family history is notable for autoimmune disease. Laboratory evaluation is remarkable for a macrocytic anemia, a markedly reduced serum vitamin B12, and presence of antiparietal cell antibodies.

Back 20

Chronic Auto-Immune Gastritis

Front 21

A 40-year-old man presents to his primary care physician with a 2-month history of intermittent upper abdominal pain. He describes the pain as a dull, gnawing ache. The pain sometimes wakes him at night, is relieved by food and drinking milk, and is helped partially by ranitidine. He had a similar but milder episode about 5 years ago, which was treated with omeprazole. Physical examination reveals a fit, apparently healthy man in no distress. The only abnormal finding is mild epigastric tenderness on palpation of the abdomen.

Back 21

Gastric Ulcer

Front 22

A 54-yo male presents with severe epigastric pain, nausea, bloating, abdominal fullness since last several months. OTC drugs are not beneficial. His primary care physician prescribes proton pump inhibitors. After 6 weeks on PPI, the symptoms have not resolved. Subsequent endoscopy reveals multiple punched out lesions in fundus of the stomach, and in duodenum.

Back 22

Zollinger Ellison Syndrome; caused by gastrin secreting tumors

Front 23

A 70yo male presents with recurrent, intractable watery diarrhea, cloikyabdominal pain, , flushing and wheezing. A colonoscopy revealed a mass in stomach (biopsy shown). Additionally, a chest CT revealed pulmonary infiltrates.

Back 23

Carcinoid

Front 24

Which GI disease microscopically shows whorled texture?

Back 24

Gastrointestinal Stromal Tumor

Front 25

What are two histological markers of stomach tissue?

Back 25

Columnar epithelium and gastric glands

Front 26

What type of cell are gastric polyps derived from?

Back 26

foveolar cells

Front 27

Which organism will typically show a green-metallic growth on EMB plates?

Back 27

E. coli; strong lactose fermenter/lactose positive

Front 28

Kligler's Iron Agar shows red at the top with yellow at the bottom

Back 28

Shigella

Front 29

Kligler's Iron Agar shows red at the top with BLACK on the bottom.

Back 29

Salmonella

Front 30

Klignler's Iron Agar shows an all yellow tube which has a layer of gas at the bottom.

Back 30

E. coli

Front 31

Which organism is being looked for with a urease test?

Back 31

Urease-positive genus Proteus

Acid changes tube from orange -> yellow
Urease + Nh3 changes tube from orange -> pink/red

Front 32

Which two enteric bacteria produce citrate and can thus be used in simmons citrate media?

Back 32

Enterobacter aerogenes and Salmonella enterica

Control tube = green in color
Citrase Positive tube = blue

Front 33

Which two organisms produce a black precipitate in SIM medium?

Back 33

Salmonella and Citrobacter; both produces hydrogen sulfide which reacts with sodium thiosulfate to produce the black precipitate

Front 34

Which orgainsm produces indole in SIM medium?

Back 34

E. coli; indol reacts with Kovac's reagent to produce a red color in the medium

Front 35

What is the COFFEe pneumonic for?

Back 35

enterobacteriacae

Capsular (K antigen related to virulence of bug)
O anigen (polysaccharide of endotoxin)
Flagellar antigen (H antigen) found in all motile species
Ferment glucose
Enterobacteriaceae