Colon Cancer and Polyps Quiz

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Questions and Answers

What is a common side effect associated with sulfasalazine treatment?

Oligospermia in men (correct)

Thrombocytopenia

Skin rash

Hypertension

Which compound is less absorbed in the jejunum compared to sulfasalazine?

Acetylsalicylic acid

Mesalamine (correct)

5-ASA

Sulfapyridine

What type of polyp is characterized by a 'saw tooth' or serrated pattern?

Villous polyp

Pedunculated polyp

Tubular polyp

Benign polyp (correct)

Which subtype of adenomatous polyps is the most common?

Tubular polyp Signup and view all the answers

Which polyp type is often associated with a high risk of developing into colon cancer?

Villous polyp Signup and view all the answers

What is one of the practical uses of fecal occult blood testing?

Screening for large polyps Signup and view all the answers

Which of the following is NOT a classification of dysplastic polyps?

Sessile Signup and view all the answers

What is a significant characteristic of large polyps detected during screening colonoscopy?

Usually cause bleeding Signup and view all the answers

Which genetic mutation is the first step in the adenoma-carcinoma sequence of colon cancer?

APC mutation Signup and view all the answers

What is a characteristic feature of Familial Adenomatous Polyposis (FAP)?

A germline mutation of the APC gene Signup and view all the answers

What effect does the loss of the APC gene have on β-catenin levels?

Increases β-catenin levels Signup and view all the answers

What is the primary consequence of the K-RAS mutation in the adenoma-carcinoma sequence?

Aberrant cell signaling Signup and view all the answers

Which of the following conditions is associated with Gardner’s Syndrome?

Benign bone growths, particularly in the mandible Signup and view all the answers

Which mutation is a hallmark of advanced colorectal cancer?

DCC mutation Signup and view all the answers

What is a primary treatment for Familial Adenomatous Polyposis?

Colectomy Signup and view all the answers

Congenital Hypertrophy of the Retinal Pigment Epithelium is associated with which of the following?

Benign findings without symptoms Signup and view all the answers

What is the primary function of serotonin in relation to gastrointestinal motility?

Stimulates GI motility Signup and view all the answers

Which condition is primarily associated with elevated levels of carcinoembryonic antigen (CEA)?

Colon cancer Signup and view all the answers

What is the best next step in managing a patient with identified Bovis endocarditis?

Colonoscopy Signup and view all the answers

In patients with carcinoid syndrome, what percentage of tryptophan typically converts to serotonin?

Up to 70% Signup and view all the answers

What is the major diagnostic metabolite of serotonin found in urine for carcinoid syndrome?

5-Hydroxyindoleacetic acid Signup and view all the answers

What role does octreotide play in the treatment of carcinoid syndrome?

Inhibits release of bioactive amines Signup and view all the answers

Which of the following symptoms is not typically associated with carcinoid syndrome?

Weight loss Signup and view all the answers

What type of lesions are primarily caused by the fibrous deposits related to serotonin in carcinoid syndrome?

Tricuspid and pulmonic valve disease Signup and view all the answers

What condition can result from a walled-off infection of the liver in the US?

Bacteremia Signup and view all the answers

Which of the following antibodies are most commonly associated with autoimmune hepatitis?

Anti-smooth muscle antibodies (ASMA) Signup and view all the answers

What is the maximum recommended daily dose of acetaminophen to avoid overdose?

4 grams Signup and view all the answers

What is the primary mechanism by which N-acetylcysteine helps in acetaminophen overdose?

Replenishes glutathione Signup and view all the answers

What is the primary cause of hyperammonemia in end-stage liver disease?

Decreased ammonia conversion to urea Signup and view all the answers

Which condition is characterized by hepatomegaly and fatty changes in the liver due to aspirin use in children?

Reye syndrome Signup and view all the answers

In the pathogenesis of alpha-1 antitrypsin deficiency, where does the pathological accumulation of the protein occur?

Liver endoplasmic reticulum Signup and view all the answers

What is the hallmark clinical symptom indicating liver failure that involves elevated ammonia levels?

Asterixis Signup and view all the answers

Which imaging finding is associated with 'nutmeg liver' resulting from chronic liver congestion?

Cardiac cirrhosis Signup and view all the answers

Which treatment is considered the first-line for managing ammonia levels in patients with liver failure?

Lactulose Signup and view all the answers

What type of brain tumors are most commonly associated with familial adenomatous polyposis?

Medulloblastomas Signup and view all the answers

What is a characteristic feature of microsatellites?

They consist of repeated non-coding DNA segments. Signup and view all the answers

How does hereditary non-polyposis colorectal cancer typically arise?

Through inherited mutations of DNA mismatch repair enzymes. Signup and view all the answers

Which cancer is most commonly associated with hereditary non-polyposis colorectal cancer?

Endometrial cancer Signup and view all the answers

What is the primary benefit of aspirin therapy in colorectal cancer prevention?

It reduces the risk of colorectal cancer by 20-40%. Signup and view all the answers

What is a common symptom of right-sided colon cancer?

Iron-deficiency anemia Signup and view all the answers

At what age is a colonoscopy generally recommended?

50 years Signup and view all the answers

What specifically does microsatellite instability indicate in cancer cells?

Dysfunction of mismatch repair enzymes. Signup and view all the answers

Which gene is frequently mutated in advanced colorectal cancers?

DCC Signup and view all the answers

What is the most common site for metastasis in colorectal cancer?

Liver Signup and view all the answers

What leads to the development of ascites in patients with cirrhosis?

Low albumin and portal hypertension Signup and view all the answers

Which of the following physical exam findings is associated with portal hypertension?

Caput medusa Signup and view all the answers

What does a Serum Ascites Albumin Gradient (SAAG) greater than 1.1 g/dL indicate?

Portal hypertension Signup and view all the answers

Which factor is mainly responsible for vasodilation in the setting of portal hypertension?

Elevated nitric oxide levels Signup and view all the answers

Which gastrointestinal manifestation is commonly seen in patients with portal hypertension?

Esophageal varices Signup and view all the answers

What is the primary clinical consequence of splenic engorgement in portal hypertension?

Thrombocytopenia Signup and view all the answers

In Crohn’s disease, where is transmural granulomatous inflammation most commonly located?

Terminal ileum Signup and view all the answers

What distinguishes ulcerative colitis from Crohn’s disease histologically?

Granulomas Signup and view all the answers

What is a potential complication associated with the involvement of the colon in Crohn’s disease?

Fistula formation Signup and view all the answers

Which of the following is not a common extra-intestinal manifestation of Crohn’s disease?

Cholecystitis Signup and view all the answers

What is the recommended monitoring for patients with Crohn's when the colon is involved?

Surveillance colonoscopy Signup and view all the answers

During the treatment of ulcerative colitis (UC), which medication is considered to improve outcomes?

Infliximab Signup and view all the answers

Which antibody is associated with inflammatory bowel disease (IBD) and can be elevated in patients with Crohn's disease?

Anti-saccharomyces cerevisiae antibodies (ASCA) Signup and view all the answers

What is often the result of nutritional deficiencies in Crohn’s disease?

Bone fragility Signup and view all the answers

Study Notes

Esophageal Disorders

Esophageal disorders encompass a range of conditions affecting the esophagus, the tube connecting the mouth to the stomach.
Gastroesophageal Reflux Disease (GERD) is characterized by gastric juice flowing back into the esophagus. This is linked to a weakened lower esophageal sphincter (LES) and decreased LES tone.
Reflux Esophagitis involves inflammation of the esophageal lining (epithelial layer) and mucosa and can lead damage and erosions (loss of the epithelial layer).
Histopathology in reflux esophagitis may display basal zone epithelial hyperplasia, elongated papillae in the lamina propria, and an increase in eosinophils and neutrophils.
Pediatric GERD presents with symptoms like vomiting or crying frequently. This is due to an immature lower esophageal sphincter (LES) in infants.
Alcohol, smoking, obesity, fatty foods, and caffeine are identified as risk factors for GERD
Symptoms of GERD include heartburn, retrosternal burning, dysphagia, and painful esophagitis, often worsening when lying down. Reflux may also enter the respiratory tract, potentially causing asthma in adults. Tooth enamel damage can also be a consequence of GERD.
Weight loss and dietary modification are treatments. Refractory cases may necessitate Nissen fundoplication surgery.
Medical therapies include histamine (H2) blockers such as famotidine, ranitidine, and others, and proton pump inhibitors like omeprazole, pantoprazole, Lansoprazole, andesomeprazole.
Long-standing GERD may contribute to ulcers, fibrosis, and strictures leading to dysphagia.
Lye ingestion can precipitate serious esophageal damage, potentially leading to strictures.
Barrett's Esophagus results from long-standing GERD, leading to metaplasia of the esophageal lining, transforming from squamous epithelium to intestinal epithelium.
Regular endoscopy and biopsies are crucial for surveillance.
Esophageal cancer often arises from squamous cell or adenocarcinoma.
Increased risk in smokers and manifesting with advanced disease/metastasis often late.
Patients sometimes experience progressive dysphagia, starting with solids and progressing to liquids as the tumor grows. Additional symptoms include weight loss and hematemesis.
Adenocarcinoma is more common in the US.
Squamous cell cancer is often discovered in the mid to upper esophagus, and can originate from conditions that harm the upper esophagus (e.g., food/alcohol).
Zenker's diverticulum and esophageal webs can impair food passage and result in esophageal discomfort.
Lymph nodes critical in esophageal cancer diagnosis and treatment include cervical (neck), mediastinal (chest), tracheobronchial (chest) nodes and celiac/gastric nodes (abdomen).
Infectious esophagitis can be caused by Candida (white membranes, pseudohyphae), HSV-1 (oral herpes, punched-out ulcers), CMV, or AIDS (linear ulcers).
Eosinophilic esophagitis is an allergic/immune-mediated condition characterized by eosinophil-predominant inflammation in the esophagus. Diagnosing it involves ruling out other causes like GERD.
Achalasia is an esophageal motility disorder causing failure to relax the lower esophageal sphincter (LES). It's often idiopathic, or linked to Chagas disease.
Symptoms of achalasia include difficulty swallowing (dysphagia) with solids and liquids, closed LES, contrast obstruction (solids), bad breath, and food accumulation in the esophagus.
Diagnosis involves esophageal dilation on barium swallow and esophageal manometry.
Esophageal varices are dilated veins in the esophagus, often caused by portal hypertension related to cirrhosis.
Malloy-Weiss syndrome relates to esophageal mucosal damage at the gastroesophageal junction, frequently resulting from prolonged vomiting or alcohol abuse - characterized by painful hematemesis (vomited blood).
Boerhaave syndrome is characterized by a tear in the esophageal wall, frequently after severe vomiting or retching characterized by air in the mediastinum on chest X-rays, subcutaneous emphysema of the neck, and pain.
Schatzki's ring, a fibrous ring at the gastroesophageal junction, can cause dysphagia, particularly for solid foods.
Plummer-Vinson syndrome is a rare condition involving iron deficiency anemia, a beefy red tongue, and an esophageal web.
Zenker's diverticulum is a pouch that forms in the pharynx leading to difficulty swallowing (dysphagia) or bad breath (halitosis), commonly occurring at the junction of the esophagus and pharynx.
Liver disease encompasses conditions like alcoholic fatty liver disease, acute hepatitis, cirrhosis, non-alcoholic fatty liver disease (NAFLD), and related issues like Budd-Chiari syndrome or right heart failure, impacting the liver's normal function.
Liver tests include measures of liver enzymes like aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT), along with synthetic tests for albumin, PT/PTT, and glucose levels.
Alcoholic liver disease presents in three stages: fatty liver, hepatitis, and cirrhosis. NAFLD, similarly, can progress to cirrhosis.
Budd-Chiari syndrome involves hepatic vein thrombosis, causing symptoms like abdominal pain, ascites (fluid buildup in the abdomen), and hepatomegaly (liver enlargement).
Right heart failure can result in a nutmeg liver appearance, marked by a mottled pattern due to congestion.
Reye's syndrome is a severe childhood disease from viral infection (especially chicken pox) that is linked to aspirin use. This condition may cause liver damage and encephalopathy.
a1-antitrypsin deficiency leads to abnormal accumulation of the protein in the liver and lungs, contributing to conditions like emphysema (lungs) and cirrhosis (liver).
Liver abscesses are walled-off infections that may be caused by bacteria or protozoa (Entamoeba histolytica) or helminths (Echinococcus).
Viruses like hepatitis (A, B, C, D, E) can cause hepatitis, an inflammatory condition of the liver, potentially leading to further complications. Autoimmune hepatitis is an immune-system driven disease affecting the liver.
Tylenol overdose causes acute liver failure (hepatic necrosis) due to the formation of a toxic metabolite, NAPQI. Activated charcoal and N-acetylcysteine are crucial treatments for such cases.
Shock liver, an ischemic type of hepatitis, is characterized by diffuse liver injury from hypoperfusion commonly seen in ICU patients with shock of various causes.
Cirrhosis is an irreversible, end-stage liver disease resulting from various chronic diseases or conditions like hepatitis or alcohol abuse and non-alcoholic fatty liver disease.
Cirrhosis manifests with symptoms such as shrunken liver, formation of nodular tissue replacing liver tissue, smoother surface of the liver replaced by nodules. Other clinical features include elevated ammonia, leading to confusion and coma (hyperammonemia), jaundice, hypoglycemia, coagulopathy related to loss of clotting factors resulting in elevated PT/PTT, and hypoalbuminemia.
Treatment for hyperammonemia usually involves a low-protein diet and a synthetic disaccharide (lactulose) to lower colonic pH and trap ammonia.
Portal hypertension, a consequence of liver damage, leads to high pressure in portal veins, and elevated levels of estrogen. This can result in conditions like esophageal/gastric varices, spleen enlargement, ascites and edema, which can result from high pressure that forces fluid into the space between the visceral layers.
Venous collaterals develop as an effect of portal hypertension, abnormal connections between portal and systemic veins. Caput medusa is a key finding in portal hypertension, where dilated veins are visible around the umbilicus.
Hypersplenism from portal hypertension is identified by splenic enlargement and results in low platelet counts.
Portal vein thrombosis presents with acute abdominal pain and splenomegaly (a palpable or enlarged spleen); it's often an unusual cause of portal hypertension.
Ascites is fluid accumulation in the peritoneal cavity, often associated with lower albumin levels and portal hypertension arising from disorders such as cirrhosis. SAAG is a helpful diagnostic test that measures serum albumin minus ascites albumin.
Common treatments for ascites include sodium restriction, diuretics (like spironolactone), large-volume paracentesis (fluid removal), or a transjugular intrahepatic portosystemic shunt (TIPS) procedure.
Spontaneous bacterial peritonitis is an infection of the ascitic fluid (fluid in the abdominal cavity), often caused by bacteria (like E. coli or Klebsiella).
MELD score and Child-Pugh classification are important in evaluating chronic liver disease, helping predict mortality in these patients.
In cases of cirrhosis or other chronic liver diseases, a liver biopsy remains the gold standard in diagnosing various liver pathology. Various other imaging studies and clinical assessments are helpful, including physical examination or imaging studies (e.g., CT or MRI scans).
Stellate cells, perisinusoidal cells in the liver, contribute to fibrosis in liver disease through the production of TGF-β.
Hepatocellular carcinoma frequently arises as a consequence of chronic liver disease, impacting organs such as the liver, but also in other locations potentially with metastasis.
Aspergillus is a fungus that contaminates grains and can produce aflatoxins, which are linked to the development of hepatocellular carcinoma (HCC), a significant cancer of liver cells. Chronic exposure to aflatoxins from improperly stored food can pose an increased risk in non-industrialized countries with locally grown foodstuffs.
Hepatic adenoma, a benign liver tumor most often found in young women and usually discovered incidentally, is frequently associated with oral contraceptive or anabolic steroid usage.
Hepatic hemangioma and angiosarcoma are other possible benign and malignant liver cell tumors.
Liver tumors such as metastatic colon cancer tumors can occur as a site of secondary cancer spread.
Various types of gastric disorders affect the stomach. Gastritis describes inflammation of the stomach lining (mucosa), potentially due to acid damage (acute) or chronic inflammation (often from autoimmune causes or H. pylori infections). Symptoms of gastritis include dyspepsia (digestive discomfort), nausea and vomiting, and epigastric discomfort.
NSAIDs (non-steroidal anti-inflammatory drugs) or chemotherapy can induce acute gastritis.
Chronic gastritis, often categorized as type A or type B (linked respectively most often to autoimmune situations or H. pylori infections).
Autoimmune gastritis, a type of chronic gastritis, frequently leads to pernicious anemia.
H. Pylori infections commonly cause chronic gastritis, and may lead to ulcers and increased risk of malignancies like MALT lymphoma.
Peptic ulcer disease often includes gastric ulcers or duodenal ulcers. Duodenal ulcers are frequently related to H. pylori in the antrum of the stomach leading to an increase in gastrin release. Gastric (or stomach) ulcers are usually fewer in number and more likely to be associated with NSAID use or other stomach abnormalities such as tumors.
Curling's ulcers are lesions in the stomach lining that often develop in burn patients due to stress of the injury with dehydration.
Cushing's ulcers typically result from increased intracranial pressure causing vagal stimulation and excess gastric acid production.
Stress ulcers, related to shock, sepsis, or trauma, arise due to loss of the defensive mucous/bicarbonate barrier.
Stress ulcers are treated with prophylactic therapy with proton pump inhibitors (e.g. Pantoprazole, Omeprazole).
Intestinal disorders can manifest as malabsorption (failure to absorb nutrients), diarrhea (e.g., watery), or other symptoms that impair digestion. Celiac disease is an autoimmune response to gluten and may involve destruction of the villi in the small intestine, causing malabsorption and diarrhea.
Tropical sprue from unknown infectious agent, most often found in warm, tropical climates. The small intestine may be affected; diarrhea is a key characteristic. There is often a striking difference between the affected intestinal part's location compared to celiac disease, which usually impacts the duodenum.
Whipple's disease is a systemic infection involving small intestine, causing malabsorption.
Lactose intolerance, due to a decline in lactase activity (either from decline with aging or from secondary mucosal harm), makes the digesting of lactose compounds difficult, potentially causing symptoms like stomachaches, bloating, and diarrhea.
Other important intestinal conditions may include acute appendicitis, diverticular disease, intussusception, volvulus, or bowel obstruction arising from several causes (e.g., adhesions, hernias, or cancer).
Intestinal conditions including celiac disease or tropical sprue, Whipple's disease or Crohn's disease may lead to malabsorption, and cause significant problems if untreated.

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Test your knowledge on colon cancer, polyps, and their characteristics. This quiz covers common treatments, risks associated with different polyp types, genetic mutations, and practical applications of testing. Ideal for medical students and healthcare professionals.