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What are the two types of gastric adenocarcinomas?
- Intestinal type: ulcerative lesions
- Diffuse type: discrete mass.
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Which of these two types of gastric adenocarnicoma can result in a krukenberg's tumor?
Diffuse type - Krukenberg is gastric metastasis to ovaries with signet ring histology.
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A primary gastric lymphoma that metastasizes to the umbilicus presents with what sign?
Sister Mary Joseph's sign.
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How do you definitively diagnose gastric cancer?
Biopsy.
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What other sign is associated with Gastric cancer?
Acanthosis Nigricans.
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Which gastric cancer carries the best prognosis, worst?
- Primary Gastric Lymphoma: 40-60% 5 year
- Adenocarcinoma: 10-20% 5 year
- MALT lymphoma treated with antibiotics.
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What is the hallmark of Sjogren's syndrome?
Lymphocytic infiltration of exocrine glands.
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What drug is used to treat sjogren's?
Pilocarpine (M3 agonist).
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What is a zenker's diverticulum?
Pulsion (false) pharyngoesophageal divertuculum.
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What is an epiphrenic diverticula?
Pulsion diverticulum in the distal esophagus.
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What is the best diagnostic technique for an esophageal diverticulum?
Barium swallow.
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How do you treat esophageal varices?
Somatostatin or octreotide.
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What is required for diagnosis of achalasia?
aperistalsis.
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What triad is indicative of GERD?
Eosinophils, basal zone hyperplasia, elongation of lamina propria papillae.
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What are the two types of chronic gastritis?
- A: Fundus and body of stomach - secondary to pernicious anemia
- B: Antral predominant - secondary to H. pylori.
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What does the Schilling test measure?
Vitamin B12 levels.
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What is Menetrier's disease?
- Hyperplasia of mucus-secreting cells leading to rugal hypertrophy hypoproteinemia
- atrophy of parietal cells resulting in achlorydia.
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How is acid secretion affected with gastric ulcers?
Basal and nocturnal acid secretion normal to decreased.
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How is acid secretion affected with duodenal ulcers?
Basal and nocturnal acid secretion typically increased.
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What is/causes whipple's disease?
Malabsorptive syndrome due to T. whippelii (gram positive).
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What is a pathohistologic finding of Whipple's disease?
- PAS positive macrophages with pale, foamy cytoplasm
- Best visualized with electron microscopy.
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What is the drug of choice to treat whipple's disease?
Trimethoprim-sulfamethoxazole (Tmp-smx) for 1-2 years.
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How can you differentiate a congenital and acquired diverticula?
- Congenital: involves full thickness of segment (true)
- Acquired: mucosal herniation through muscular layer (false).
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What can tropical sprue cause, how is it treated?
Folate deficiency, tetracycline for 6 months.
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What is a Meckel's scan?
IV injection of technetium-99 - taken up by ectopic gastric tissue.
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What is both diagnostic and therapeutic for diverticulosis?
Mesenteric angiography: vasoconstriction and artificial blood clot formation can be induced.
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What is "left-sided appendecitis"?
Diverticulitis: LLQ pain, guarding, rebound tenderness, leukocytosis, fecal leukocytes, fever.
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What is anasarca?
Generelized (whole body) edema.
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What two diagnostic techniques are contraindicated with diverticulitis?
Colonoscopy, barium enema -- increased risk of perforation with acute infection.
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Where are intussusceptions most common?
Ileocecal junction of children.
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What are four secondary causes of intussesception?
Intestinal lymphoma, Meckel's diverticulum, vascular deformations, intestinal polyps.
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What is the classic triad of intussesception?
Pain, sausage shaped mass, currant jelly stools.
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What is both diagnostic and therapeutic for intussusception?
Air and barium enemas.
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What technique can be used to visualize intussusception, what is seen?
Abdominal ultrasound -- bull's-eye or coiled-spring pattern.
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What characterizes hirschsprung's disease, where does it always affect, what genetic mutation is commonly involved?
- Absence of ganglion cells (both plexi)
- Anus and may progress proximally
- RET proto-oncogene
- Associated with Down's syndrome.
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What are some extraintestinal manifestations of Crohn's disease?
Migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis, immunologic disorders.
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What are some extraintestinal manifestations of Ulcerative Colitis?
- Pyoderma gangrenosum, PSC.
- What is sulfasalazine?
- Precursor to 5-ASA, which acts as a local anti-inflammatory in the colon
- Hydrolized into active form by colonic flora.
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What is used to diagnose C. difficile infection (pseudomembranous colitis)?
Stool sample for A and B toxins.
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What is contraindicated in the treatment of pseudomembranous colitis?
Antidiarrheal (loperamide) - Allow toxins to build up in colon.
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What are the two most common pathogens in infectious colitis?
Entameoba histolytica, Vibrio cholerae.
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What is the most common type of benign polyp?
Hyperplastic polyp - benign.
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What are three types of adenomatous polyps?
- Tubular: most common
- Villous: highest rate of malignant conversion
- Tubulovillous: mixture of the two.
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A mutation in what gene causes Familial Adenomatous Polyposis (FAP)?
APC (Adenomatous Polyposis coli) - Autosomal dominant.
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What is Turcot's syndrome?
Autosomal recessive disorder causes colonic polyps and tumor of CNS.
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What is the mutation in Hereditary nonpolyposis colorectal cancer (HNPCC)?
- Autosomal dominant
- DNA mismatch repair gene (hMLH1 or h MSH2).
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What is Peutz-Jegher's syndrome?
- Autosomal dominant
- Combination of hamartomatous colon polyps and mucocutaneous hyperpigmented lesions on lips, hands, genitals.
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