Gastrointestinal and Endocrine Conditions Quiz

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Questions and Answers

What is the tumor marker associated with medullary thyroid cancer?

Alpha-fetoprotein

Calcitonin (correct)

Carcinoembryonic antigen

Thyroglobulin

What is a classic histopathological finding in papillary thyroid cancer?

Giant cells

Trivially increased fibroblasts

Keratohyalin granules

Psammoma bodies (correct)

Which lung cancer type is primarily associated with hypercalcemia due to parathyroid hormone-related peptide (PTHrP)?

Squamous cell carcinoma (correct)

Large cell carcinoma

Adenocarcinoma

Small cell lung cancer

What is the next best step in managing a patient with significant pleural effusion and a suspected malignancy?

Thoracentesis with cytology Signup and view all the answers

What is the characteristic 'coffee bean sign' indicative of?

Sigmoid volvulus Signup and view all the answers

In which condition would you expect to see low levels of orexin/hypocretin in the cerebrospinal fluid (CSF)?

Narcolepsy Signup and view all the answers

What is the next best step in the management of a patient with suspected subarachnoid hemorrhage and xanthochromia?

Non-contrast head CT Signup and view all the answers

What finding on MRI is characteristic of herpes encephalitis?

Hyperintense signaling in the temporal regions Signup and view all the answers

What condition is suggested by a kid with mild RLQ pain and guaiac positive stool?

Meckel's diverticulum Signup and view all the answers

Which diagnostic test is used for confirming Meckel's diverticulum?

Tech-99/Pertechnetate scan Signup and view all the answers

A patient with a history of ulcerative colitis presenting with severe abdominal pain and distention of the transverse colon is likely suffering from what condition?

Toxic megacolon Signup and view all the answers

What is the next best step in managing a patient with toxic megacolon?

Emergency laparotomy Signup and view all the answers

What is the most common cause of hypothyroidism in the United States?

Hashimoto's thyroiditis Signup and view all the answers

In a patient with an enlarged thyroid and profound weight loss at the age of 80, which type of cancer is most likely?

Anaplastic thyroid cancer Signup and view all the answers

What is the most likely diagnosis for a patient with recurrent abdominal pain and multiple kidney stones alongside an enlarging thyroid?

Medullary thyroid cancer Signup and view all the answers

What imaging finding is associated with cecal volvulus?

Coffee bean sign with head toward LUQ Signup and view all the answers

What lung cancer type is most commonly associated with hypercalcemia due to parathyroid-related peptide?

Squamous cell carcinoma Signup and view all the answers

Which condition is characterized by low levels of orexin/hypocretin in the cerebrospinal fluid?

Narcolepsy Signup and view all the answers

What is the treatment option for a patient with cataplexy in narcolepsy?

Sodium oxybate Signup and view all the answers

Which of the following findings is a common associated feature of Herpes encephalitis?

Increased protein in CSF Signup and view all the answers

What laboratory finding is characteristic of Creutzfeldt-Jakob disease (CJD)?

Elevated 14-3-3 protein levels Signup and view all the answers

In the scenario of a patient with weight loss, cough, and dullness to percussion in the lungs, what is the first step in management?

Thoracentesis with cytology Signup and view all the answers

Study Notes

Gastrointestinal Conditions

Meckel's Diverticulum: Associated with RLQ pain, guaiac-positive stool, and failure of the vitelline duct obliteration. Diagnosis via technetium-99m pertechnetate scan. Resection is the treatment.
Small Bowel Obstruction: Patients with Crohn's disease can develop this due to strictures. N/V and lack of bowel movements are symptoms.
Toxic Megacolon: A serious complication of ulcerative colitis (UC) marked by severe abdominal pain, distended transverse colon. Exploratory laparotomy (ex lap) is the next best step. Other causes include C. diff and Chagas disease.
Screening Colonoscopies: High-risk individuals, like those with UC or combined UC/PSC, need screening colonoscopies, eight years post-diagnosis, and every 1-2 years following that.

Endocrine Conditions

Hypothyroidism (Hashimoto's): The most common cause of hypothyroidism in the US, characterized by antibodies against thyroid peroxidase. Hashimoto's is often accompanied by fatigue, low mood, bradycardia, and carpal tunnel syndrome.
Hypothyroidism (Other Causes): Other causes include De Quervain's thyroiditis (painful, tender thyroid, recent viral URI; decreased uptake), factitious hyperthyroidism (low TSH, low uptake, low thyroglobulin), Grave's disease (autoantibodies against TSH receptor; increased uptake), struma ovarii (elevated T3/T4, low TSH, decreased uptake), toxic adenoma (one hot spot), and multinodular goiter (multiple hotspots).
Thyroid Cancer:
- Papillary Thyroid Cancer: Common, characterized by psammoma bodies and orphan Annie eye nuclei.
- Follicular Thyroid Cancer: Spreads hematogenously.
- Anaplastic Thyroid Cancer: Associated with profound weight loss and a growing thyroid in elderly patients.
- Medullary Thyroid Cancer: Associated with multiple kidney stones, recurring abdominal pain, and enlarging thyroid. MEN2A and hypercalcemia are connected. Calcitonin is a tumor marker that can cause prolonged QT interval. Congo red stain shows apple-green birefringence from amyloid.
- Reidel's Thyroiditis: Fibrosis of the thyroid, often rock-hard. Associated with IgG4-related disease, autoimmune pancreatitis, retroperitoneal fibrosis (causing bilateral hydronephrosis), and autoimmune gallbladder disease.

Oncology Review

Lung Cancer: Adenocarcinoma is the most common type. Squamous cell carcinoma presents with keratin pearls and hypercalcemia (PTHrP). Small cell lung cancer shows SIADH, Lambert-Eaton syndrome, and Cushing's. It's often already metastatic on diagnosis.
Lung Cancer Complications: SVC syndrome (radiation), Pancoast tumor (Horner's syndrome), and hypertrophic pulmonary osteopathy (imaging).

Neurological Conditions

Horner's Syndrome: Partial Horner's syndrome (ptosis and miosis) is associated with cluster headaches.
Subarachnoid Hemorrhage (SAH): Xanthochromia (yellowing of CSF). Key feature is sudden onset, often mimicking meningitis. Noncontrast head CT is the first step, followed by LP. Nimodipine is given to prevent ischemic stroke.
Herpes Encephalitis/Meningitis: Marked by hyperintense signaling in temporal regions on MRI. IV acyclovir is crucial if the patient is admitted.
Creutzfeldt-Jakob Disease (CJD): Characterized by memory loss, myoclonus, and proprioception loss over 6 weeks. Elevated protein 14-3-3 is a marker.
Narcolepsy: Low levels of orexin/hypocretin in the CSF. Diagnostic and therapeutic options include sleep studies, scheduled naps, stimulants (e.g., modafinil), and sodium oxybate (for cataplexy).

Surgical Conditions

Sigmoid/Cecal Volvulus: N/V and the "coffee bean" sign on imaging. Sigmoid volvulus has the sign oriented toward the RUQ; cecal volvulus toward the LUQ.
Pleural Effusion with Lung Cancer: Heavy smoker, weight loss, dullness to percussion, decreased breath sounds, large pleural effusion, and lung coin lesion warrant thoracentesis with cytology to check for malignancy (stage 4 cancer).

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Description

Test your knowledge on various gastrointestinal and endocrine conditions. This quiz covers key topics such as Meckel's diverticulum, small bowel obstruction, toxic megacolon, and hypothyroidism. It's designed for medical students and healthcare professionals to assess their understanding of these critical conditions.