Pharmacology and Gastroenterology Quiz

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Questions and Answers

Which drug is primarily associated with sulfonamide hypersensitivity as a side effect?

Sulfapyridine

Aspirin

Mesalamine

Sulfasalazine (correct)

What is the most common subtype of adenomatous polyp?

Villous

Tubular (correct)

Sessile

Pedunculated

What does the term 'sessile' refer to in the context of polyps?

A broad base attachment to the colon (correct)

A type of histology classification

A stalked attachment to the colon

Pre-cancerous growth of tissue

What is the immediate test indicated after identifying Bovis endocarditis?

Colonoscopy Signup and view all the answers

Which of the following is true regarding 5-aminosalicylic acid (5-ASA)?

Modified 5-ASA compounds can resist absorption. Signup and view all the answers

What is the primary clinical symptom associated with high serotonin levels in carcinoid syndrome?

Flushing Signup and view all the answers

What is the primary screening method for detecting large polyps that may cause bleeding?

Fecal occult blood testing Signup and view all the answers

Which type of polyp is characterized by having long projections extending from its surface?

Villous Signup and view all the answers

In patients with established disease, how does the level of Carcinoembryonic Antigen (CEA) correlate?

Directly with disease burden Signup and view all the answers

Which of the following treatments is used to alleviate flushing and diarrhea in carcinoid syndrome?

Octreotide Signup and view all the answers

Which of the following side effects is associated with sulfasalazine and is reversible upon drug cessation?

Oligospermia in men Signup and view all the answers

Which type of adenomatous polyp is most likely to have malignant potential?

Villous Signup and view all the answers

What is the metabolite of serotonin that appears in the urine of patients with carcinoid syndrome?

5-Hydroxyindoleacetic acid Signup and view all the answers

Which of the following statements is true regarding serotonin's metabolism?

Serotonin inactivated by lungs prevents left-sided heart symptoms Signup and view all the answers

What percentage of tryptophan is normally converted to serotonin?

1% Signup and view all the answers

What condition is associated with a deficiency in tryptophan due to altered metabolism in carcinoid syndrome?

Pellagra Signup and view all the answers

What is the primary role of the APC gene in colon cancer progression?

Prevents accumulation of β-catenin. Signup and view all the answers

Which step in the adenoma-carcinoma sequence directly leads to the formation of adenoma polyps?

K-RAS mutation. Signup and view all the answers

What characterizes Familial Adenomatous Polyposis regarding its genetic mutation?

Mutation of the APC gene on chromosome 5q. Signup and view all the answers

Which of the following is NOT associated with Gardner’s Syndrome?

Loss of p53 tumor suppressor gene. Signup and view all the answers

What is the significance of congenital hypertrophy of the retinal pigment epithelium in relation to polyposis?

It is an indicator of Gardner’s syndrome when seen with polyposis. Signup and view all the answers

What is the typical progression timeline for colon cancer due to the adenoma-carcinoma sequence?

10-40 years. Signup and view all the answers

Which of the following disorders is characterized by multiple extra-colonic manifestations?

Gardner’s Syndrome. Signup and view all the answers

What happens with the loss of the p53 tumor suppressor gene in colon cancer progression?

Tumor cell growth is promoted. Signup and view all the answers

What is the main cause of 'nutmeg liver'?

Chronic liver edema Signup and view all the answers

What significant consequence can result from aspirin use in children with viral infections?

Rapid acute liver failure Signup and view all the answers

Which condition is most commonly associated with autoimmune hepatitis?

Women in their 40s and 50s Signup and view all the answers

What is the primary treatment for acetaminophen overdose?

N-acetylcysteine Signup and view all the answers

Which laboratory finding is often seen in patients with hepatitis?

Very high AST/ALT levels Signup and view all the answers

Which complication is likely due to elevated estrogen levels in liver disease?

Gynecomastia in men Signup and view all the answers

What characterizes the liver during cirrhosis?

Fibrosis and nodular replacement of tissue Signup and view all the answers

What type of liver injury is associated with hypoperfusion?

Ischemic hepatitis Signup and view all the answers

What is a common outcome of the presence of abnormal α1-antitrypsin (AAT) in the liver?

Cirrhosis and liver fibrosis Signup and view all the answers

Which is a potential cause of capillary fluid shifts in liver disease?

Decreased colloid osmotic pressure due to low albumin Signup and view all the answers

What types of tumors are most commonly associated with polyposis in the brain?

Medulloblastomas and gliomas Signup and view all the answers

What characterizes a stable microsatellite?

It has the same length across all individuals Signup and view all the answers

What is the primary mechanism that leads to colon cancer in Lynch Syndrome?

Microsatellite instability due to DNA mismatch repair enzyme mutations Signup and view all the answers

What is a common consequence of portal hypertension?

Caput medusa Signup and view all the answers

Which of the following is the most common non-colon malignancy associated with Lynch Syndrome?

Endometrial cancer Signup and view all the answers

Which of the following is associated with a Serum Ascites Albumin Gradient (SAAG) greater than 1.1 g/dL?

Portal hypertension Signup and view all the answers

What is indicated by microsatellite instability in tumor cells?

Dysfunction of mismatch repair enzymes Signup and view all the answers

What happens to plasma albumin levels in patients with cirrhosis?

They decrease Signup and view all the answers

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

Liver Signup and view all the answers

What symptom is more commonly associated with right-sided colon cancer?

Iron-deficiency anemia Signup and view all the answers

Which physical exam finding is indicative of portal hypertension in the abdomen?

Caput medusa Signup and view all the answers

Which veins are primarily engorged as a consequence of portal hypertension leading to esophageal varices?

Left gastric vein Signup and view all the answers

What is one of the risks associated with routine aspirin therapy?

Increased risk of ulcers and bleeding Signup and view all the answers

At what age is a colonoscopy typically recommended to begin screening for colorectal cancer?

50 years Signup and view all the answers

What is the effect of low plasma aldosterone levels in patients with cirrhosis?

Increased fluid retention Signup and view all the answers

Which of the following is a classic symptom of left-sided colon cancer?

Blood streaked stool Signup and view all the answers

Which feature distinguishes Crohn's disease from Ulcerative Colitis?

Presence of granulomas Signup and view all the answers

What does 'creeping fat' indicate in the context of Crohn's disease?

Transmural inflammation Signup and view all the answers

Which of the following is NOT a common extra-intestinal feature of Crohn's disease?

Peptic ulcer disease Signup and view all the answers

Which condition is characterized by non-caseating granulomas and transmural inflammation?

Crohn's disease Signup and view all the answers

What is the primary mechanism by which portal hypertension leads to ascites?

Decreased oncotic pressure and increased hydrostatic pressure Signup and view all the answers

What is the relationship between sodium retention and portal hypertension?

Increased sodium retention due to aldosterone Signup and view all the answers

Which of the following laboratory findings would likely indicate portal hypertension?

Low platelet count Signup and view all the answers

Which procedure is commonly used to confirm the diagnosis of ascites?

Paracentesis Signup and view all the answers

Study Notes

Esophageal Disorders

Gastroesophageal Reflux Disease (GERD) involves gastric juice refluxing into the esophagus.
GERD results from a malfunction of the lower esophageal sphincter, leading to a decrease in its tone.
The precise mechanism behind GERD isn't fully understood.
Reflux Esophagitis:
- Characterized by epithelial layer inflammation (erythema and edema) within the esophagus' mucosa.
- Erosions (loss of the epithelial layer) are evident features.
Histology of Reflux Esophagitis:
- Basal zone (epithelium) shows hyperplasia.
- Papillae of the lamina propria elongate.
- Increased eosinophils and neutrophils are present.
Pediatric GERD often presents with an immature lower esophageal sphincter, causing vomiting and crying.
GERD Risk Factors:
- Alcohol consumption.
- Smoking.
- Obesity.
- Fatty foods.
- Caffeine.
- Hiatal hernia.
GERD Symptoms:
- Heartburn (retrosternal "burning" sensation, often after meals or when lying down).
- Dysphagia (difficulty swallowing).
- Painful esophagitis.
- Respiratory symptoms (e.g., reflux into respiratory tract, adult-onset asthma, cough, dyspnea).
- Damage to tooth enamel.
GERD Treatment:
- Weight loss.
- Dietary modification (avoiding triggers like fatty foods, caffeine, chocolate, spicy foods, carbonated beverages, and peppermint).
- Refractory GERD: Nissen fundoplication (surgical procedure).
- Histamine (H2) blockers (e.g., famotidine, ranitidine, nizatidine, cimetidine).
- Proton pump inhibitors (e.g., omeprazole, pantoprazole, lansoprazole, esomeprazole).
Potential Consequences of GERD:
- Ulcers: acid destroys the mucosa.
- Fibrosis: tissue replacement with scar tissue.
- Strictures: constrictions that cause dysphagia (difficulty swallowing).
Ingestion of Lye:
- Alkali substances (sodium or potassium hydroxide) found in household cleaners.
- Rapid tissue damage (liquefactive necrosis) through the esophagus' mucosa, often requiring surgical repair.
- Usually neutralized in the stomach, allowing for recovery in most cases.
Barrett's Esophagus:
- A result of long-standing GERD.
- Metaplasia of the esophageal epithelium (turning into intestinal-like epithelium).
- Squamous epithelium changes to intestinal epithelium.
Barrett's Esophagus Diagnosis and Management:
- Endoscopy often performed for GERD patients.
- If Barrett's is seen, regular surveillance endoscopy is needed.
- Biopsy samples are essential to check for dysplasia and carcinoma.
Esophageal Cancer
- Squamous cell carcinoma or adenocarcinoma are types.
- Smoking increases the risk of both types.
- Often diagnosed late, resulting in advanced disease.
- "Progressive" dysphagia is a prevalent symptom.
- Commonly presents with other symptoms such as weight loss, hematemesis, etc.
Adenocarcinoma is most frequent in US.
- Usually arises from the lower one-third of the esophagus.
Additional forms of esophageal cancer, depending on location.
Esophageal Cancer Lymph Node Involvement:
- Upper esophagus: cervical lymph nodes.
- Middle esophagus: mediastinal and tracheobronchial nodes.
- Lower esophagus: celiac and gastric nodes.
Esophagitis (Infectious Causes):
- Candida: white membranes, pseudohyphae seen on biopsy
- HSV-1 (Herpes Simplex): often oral herpes, may affect esophagus, punched-out ulcers
- CMV (Cytomegalovirus): linear ulcers
- AIDS (CD4<50): linear ulcers
Eosinophilic Esophagitis:
- Allergic or immune-mediated reaction (unknown antigens).
- Esophageal dysfunctions (e.g., dysphagia).
- Predominant eosinophils observed on biopsy.
- Diagnosed by exclusion after ruling out other potential causes (e.g., GERD).
Achalasia:
- Inability to relax the lower esophageal sphincter.
- Due to a loss in Auerbach's plexus ganglion cells in the esophageal muscular layer.
- Often idiopathic.
Achalasia Symptoms:
- Dysphagia (solids and liquids).
- "Closed” lower esophageal sphincter (only for solids).
- Contrast obstruction (solids).
- Bad breath
- Accumulation of food in esophagus
Achalasia Diagnostic Testing:
- Esophagus dilation ("bird's beak") on barium swallow.
- Esophageal manometry to measure pressure changes during contraction.
Esophageal Varices:
- Dilated submucosal veins, often in the lower one-third of the esophagus.
- Usually due to portal hypertension (often from cirrhosis).
- Can lead to upper gastrointestinal bleeding (variceal rupture).
- Frequently a cause of death from liver-related conditions
- Treated with emergent endoscopy for banding/ligation.
Malloy-Weiss Syndrome: damage to esophagus at gastroesophageal junction.
Boerhaave Syndrome: transmural rupture of esophagus due to severe/chronic vomiting or retching.
Esophageal Webs and Rings: tissue protrusion in esophagus, causing food obstruction
Schatzki Ring: Ring at the squamocolumnar junction frequently causes food obstruction
Plummer-Vinson Syndrome: Triad of iron deficiency anemia, beefy red tongue, and esophageal web, often in middle-aged and white females
Zenker's Diverticulum: Hernias of the pharynx/esophagus, often due to malfunctioning cricopharyngeal muscle.
Zenker's Diverticulum symptoms include dysphagia, as well as halitosis (bad breath) because of trapped food inside.
Video Swallowing Study: Diagnosis of esophageal and other swallowing issues
Liver Disease: General information on liver disease and conditions.
Liver Tests and Function: Details of different liver enzymes, including AST, ALT, alkaline phosphatase, and GGT
Alcoholic Liver Disease, three stages:
- Fatty liver disease
- Acute hepatitis
- Cirrhosis
Non-Alcoholic Fatty Liver Disease (NAFLD)
- Fatty infiltration of liver not due to alcohol
- NAFL (Fatty liver).
- NASH (Steatohepatitis) - fat and inflammation
Alcoholic Hepatitis
- Classically results from heavy, binge drinking on top of long history of alcohol consumption
- Symptoms may include fever, jaundice, and RUQ pain/tenderness
Mallory bodies are cytoplasmic inclusions found in cells of the liver
Budd-Chiari Syndrome
- Venous thrombosis of the hepatic veins
- Usually related to several other medical conditions
Right Heart Failure
- Rare event causing nutmeg liver with edema
- Mottled liver, like a nutmeg
- Common in association with Budd Chiari syndrome
Reyes Syndrome (rare): Liver failure/encephalopathy from viral infections (e.g., chickenpox) with aspirin use.
a1-antitrypsin Deficiency causes lung disease.
a1-antitrypsin Deficiency also causes cirrhosis.
Liver Abscess: infection in liver tissue.
Viral Hepatitis A, B, C, D, E: Infections characterized by elevated liver enzymes and jaundice. Severity may vary.
Autoimmune Hepatitis: Autoimmune diseases of liver and bile ducts
- More common in females in 40s, 50s
Anti-nuclear antibodies (ANAs).
Anti-smooth muscle antibodies (ASMA).
Tylenol Overdose: Acute liver failure due to acetaminophen overdose.
Shock Liver (Ischemic Hepatitis): Liver damage due to lack of blood perfusion caused by various causes
Cirrhosis: End-stage, irreversible liver disease due to chronic liver injury.
Characteristic features, like shrunken liver, are observed in this condition.
Clinical features include hyperammonemia (elevated ammonia levels), causing confusion and coma.
Treatment options include a low protein diet and the use of lactulose (a synthetic disaccharide) to lower colonic pH and reduce ammonia absorption, as well as addressing other associated conditions.
Clinical features include jaundice, hypoglycemia, coagulopathy/bleeding problems, and hypoalbuminemia.
Portal Hypertension: High pressure in portal vein due to obstructed flow, often caused by cirrhosis
- Blood flows → portal vein → liver → hepatic vein
Ascites and Edema: Conditions where excess fluid accumulates in peritoneal cavity due to underlying liver conditions
Venous Collaterals: Secondary blood vessels/veins develop to help blood flow by detour when main blood vessel is blocked or damaged, often seen in conditions such as portal hypertension.
Gastric Varices: Gastric varices are dilated veins located in the stomach, occurring frequently in patients with portal hypertension.
Caput Medusa: Observable engorgement of veins around the umbilical region
Internal Hemorrhoids: Dilated blood vessels near anus.
Hypersplenism: Spleen swells and consumes blood components (e.g., platelets)
- Engorgement of spleen can cause a decrease in platelets in portal hypertension
Portal Vein Thrombosis
- Usually from causes such as other medical conditions
- Splenomegaly and gastric varices can result
SAAG (Serum Ascites Albumin Gradient) is a helpful diagnostic tool for determining the causes of ascites (fluid in the abdominal cavity)
TIPS (Transjugular Intrahepatic Portosystemic Shunt) is a surgical procedure performed in portal hypertension cases.
- Creation of channel in liver to connect portal vein to hepatic vein to divert blood flow
Spontaneous Bacterial Peritonitis (SBP): Bacterial infections in ascitic fluid.
MELD Score: Scoring system to evaluate and predict mortality among individuals with chronic liver conditions
- Points system for bilirubin, creatinine, and INR are evaluated.
Child-Pugh classification
- Scoring system to evaluate and predict mortality among individuals with chronic liver conditions
- Points system for encephalopathy, ascites, bilirubin, albumin, and prothrombin time are evaluated.
Liver Biopsy is the gold standard for liver condition diagnosis
Stellate Cells are cells that are important to liver structure and function.
Liver Tumors: Descriptions of different liver tumors, including hepatocellular carcinoma (HCC) and types that are rarer
Aspergillus: A fungus that produces the toxin aflatoxin, which is associated with a rare type of liver cancer (HCC)
- Can contaminate foods like corn, soybeans, peanuts
Hepatocellular Carcinoma (HCC)
- Most common primary liver cancer.
- Often a consequence of chronic liver disease such as hepatitis B & C, alcoholic liver disease, Wilson’s disease, hemochromatosis, and α 1-antitrypsin
Hepatic Adenoma: Benign tumor of the liver.
- Often detected by chance.
- Associated with usage of certain drugs (e.g., oral contraceptives, anabolic steroids).
Hepatic Hemangioma: Benign tumor of the liver
- Most common benign liver tumor.
- Composed of vascular spaces often containing blood clots.
Hepatic Angiosarcoma: Rare, malignant liver tumor
- Often associated with certain toxic exposures (e.g., vinyl chloride, arsenic).
Metastasis to liver is a common finding in several types of cancers.
Wilson's Disease is an inherited disorder of copper metabolism in which copper can build up in the liver.
Clinical features including various neurological issues are associated with this disease
Hemochromatosis is a hereditary disease involving iron overload in the body which can also cause liver damage.
Gallstones: Stones can form in the gallbladder made of cholesterol and/or bilirubin
Cholelithiasis (gallstones) are solid masses that form within the gallbladder. -Components are bilirubin, bile salts, and cholesterol .
- If the balance of these components is upset, stones can form and precipitate
Several Conditions can cause acute cholecystitis such as gallstone disease.
Choledocolithiasis involves obstructing stones in the common bile duct
- Clinical features like Jaundice might be present
Chronic Cholecystitis
- Chronic inflammation of the gallbladder.
- Can cause a porcelain gallbladder.
Acalculous cholecystitis results from ischemia or inflammation of gallbladder without gallstones.
AIDS Cholangiopathy
- Rare disorder of biliary tree seen in individuals with end-stage HIV disease (infection or disorder in biliary tract).
Ascending cholangitis : Infection of biliary tree through ascending infection
- Charcot's triad (fever, right upper quadrant pain, jaundice)
ERCP (Endoscopic retrograde cholangiopancreatography) is an imaging procedure used in biliary tree assessments
Gallstone Ileus result from the perforation of a gallstone through the biliary tract wall
- Causes intestinal obstruction
Gallstone Pancreatitis is a condition in which gallstones cause acute inflammation in the pancreas.
Gallbladder Carcinoma: Adenocarcinoma resulting from chronic inflammation processes
- Rare malignancy involving gall bladder.
Biliary Atresia : Biliary atresia occurs when the bile ducts of the liver do not develop properly or become blocked.
In neonates, and key findings include jaundice, dark urine, and pale stool
Biliary Cirrhosis is an older term for liver damage due to chronic biliary obstructions involving several conditions
Primary Biliary Cirrhosis (PBC) is a chronic, cholestatic liver disease
- Autoimmune response targeting the interlobular biliary ducts
Clinical features include itching (pruritus), fatigue, and ultimately cirrhosis.
Primary Sclerosing Cholangitis (PSC)
- Chronic cholestatic liver disease.
- Associated with ulcerative colitis.
- Characterized by inflammatory involvement and strictures.
Cholangiocarcinoma is a rare cancer arising from the bile duct epithelium.
- Key risk factors are primary sclerosing cholangitis and chronic inflammatory bowel disease (IBD)
Gastritis is an inflammation of the stomach mucosa
- Symptoms: nausea, vomiting, loss of appetite, abdominal pain
- Acute gastritis is usually caused by too much acid or loss of protection to the stomach lining
- Chronic gastritis: Lymphocytes, macroph ages, H. pylori infection, autoimmune response
Pernicious Anemia is a chronic condition often resulting from autoimmune gastritis wherein the stomach's intrinsic factor isn't secreted in sufficient amounts.
Peptic Ulcer Disease: Sores or ulcers in the lining of the stomach and/or duodenum (upper small intestine).
- H. pylori infection, NSAIDs use, smoking are risk factors.
Duodenal ulcers frequently lead to complications such as bleeding problems.
Bruhners Gland Hypertrophy is an increase in thickness of glands of the duodenum (part of small intestine)
- Protects the duodenum from excess acidity by producing alkaline fluids.
Complications of ulcers include perforation and upper GI bleeding.
Stress ulcers are ulcers that develop in the stomach due to conditions such as shock, sepsis or trauma situations.
- Prophylactic therapy with proton pump inhibitors (PPIs) is frequently administered.
Gastric Carcinoma: A rare cancer frequently developing through complications of chronic gastritis and ulcers
- 2 major subtypes: Intestinal and diffuse tumors .
Hypertrophic Gastropathy; Rare disorders that cause enlargment of the rugal folds (folds or wrinkles of tissue in inner lining of stomach).
Caused by hyperplasia (not inflammatory conditions)
Menetrier's Disease: A rare disorder involving hyperplasia of stomach mucous cells (excessive secretions).
Frequently occurs with protein loss ("protein-losing enteropathy")
Malabsorption: Impaired nutrient intake due to abnormalities within the gut.
Symptoms: diarrhea, weight loss, vitamin/mineral deficiencies
Common presentation symptoms include steatorrhea, fatty, and foul-smelling stools.
Celiac Sprue (Celiac Disease): Autoimmune response triggering destruction of the villi lining small intestine when exposed to gluten
Key conditions include bloating, flatulence, or chronic diarrhea, loss of several essential nutrients
Whipple's Disease: Rare infection of small intestine, causing malabsorption
- Common in European, white males, with average age of 49.
- Four cardinal features: diarrhea, abdominal pain, weight loss, and joint pains.
- Microscopic analysis shows PAS-positive foamy macrophages.
- Treated with antibiotics
Lactose Intolerance: A common condition where the small intestine loses or has insufficient production of the enzyme lactase, necessary for digesting milk products.
- Symptoms frequently following lactose ingestion with diarrhea, abdominal pain, or bloating
Pancreatic Insufficiency is a condition commonly seen in cystic fibrosis and chronic pancreatitis (inflammation of pancreas)
Features include fat malabsorption and steatorrhea, resulting from the loss of essential pancreatic enzymes
Bacterial Overgrowth occurs when excessive bacteria are present, causing fermentation /inflammation/ and malnutrition /malabsorption
Acute Pancreatitis: Acute inflammation of the pancreas.
Common causes: gallstones, alcohol
Rare causes: idiopathic, trauma, infections, toxins, autoimmune diseases, and certain medical conditions
Complications of acute pancreatitis include DIC (disseminated intravascular coagulation), ARDS, pseudocysts, abscess, fat necrosis, hypocalcemia, and multi-organ failure.
Diagnostic tools such as CT scans and elevations in serum amylase and lipase levels are used.
Ranson's criteria are used for assessing the severity of acute pancreatitis.
Several conditions are included along with treatment options and complications

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Test your knowledge on pharmaceutics and gastroenterology with this quiz. It covers topics such as drug hypersensitivity, polyps, and treatments for carcinoid syndrome. Perfect for students and professionals in the medical field.