GI - entire block 3 answers

[wcb22]

don't look 'till you finish the exam. it's tempting to look, but it will offset your real % if you see answers to the other questions, good luck.











88(E) CORRECT. She has a mucosa-associated lymphoid tissue lymphoma (MALToma) of the stomach, a condition that appears to be associated with H. pylori. Even though the lymphoid population has all the features of a malignancy, treating the H. pylori seems to remove the driving force behind the lesion.
89(C) CORRECT. The decreased attenuation results from the accumulation of material with lipid density. The transaminases are only mildly elevated. These findings are characteristic for a fatty liver. In the absence of a history of alcholism, the diagnosis becomes non-alcholic steatohepatitis, a condition that may appear in persons with type II diabetes mellitus, and it can go on to fibrosis or resolve.
90(E) Match on 90. The top differential diagnosis is biliary atresia (for which surgery must be considered). However, most cases of neonatal hepatitis resolve without further problems.
91(B) Match with 91. Such globules are classic for AAT deficiency, which over time may act like a chronic hepatitis and some patients may have cirrhosis. Many patients will get a panlobular emphysema.
92(E) Match on 92. CMV hepatitis is the most common form of hepatitis in liver transplant recipients.
93(D) Match with 93. Hepatitis D can be a superinfection of hepatitis B. The delta agent must have genetic information provided by hepatitis B virus. Thus, if you are immunized against hepatitis B, you will not get D. --- I think this is a bad question, not clear enough.
94(D) Match on 94. Staph aureus grows in the food and generates an enterotoxin that causes a very explosive diarrhea several hours after ingestion.
95(B) Match with 95. Poultry products that are poorly prepared may be the source for Salmonella food poisoning.
96(B) Match on 96. The transmural inflammation of Crohn's disease predisposes to fistula formation.
97(E) Match with 97. Salmonella typhi typically involves the Peyer's patches of the ileum.
98(B) Match on 98. Adenomatous polyps are seen with Gardner's syndrome, which can be considered a form of familial polyposis with extraintestinal manifestations.
99(C) Match with 99. Mucocutaneous pigmenation with hamartomatous polyps, mostly in the small intestine, are characteristic for Peutz-Jehgers syndrome.
100(A) Match on 100. The obstruction to bile outflow leads to a marked progressive jaundice.
101(C) Match with 101. These are features of cystic fibrosis.
102(C) Match on 102. The elevated amylase points to acute pancreatitis. A complication of acute pancreatitis is pseudocyst formation.
103(D) Match with 103. Cystadenoma of the appendix can generate mucin production that distends the appendix. Rupture of a mucocele can lead to a condition known as pseudomyxoma peritonei.
104(B) Match on 104&105. Elevation of amylase and lipase are most characteristic for acute pancreatic injury. Hypercalcemia may also lead to pancreatitis.
105(B) Match on 104&105. Elevation of amylase and lipase are most characteristic for acute pancreatic injury. Hypercalcemia may also lead to pancreatitis.
106(E) Match on 106. This is a clinically defined entity with no pathologic findings. It is made worse by stress.
107(C) Match with 107. Rotavirus usually produces a mild self-limited diarrheal illness in older children and adults. It can be more severe in very young children and infants.
108(E) Match with 108. Extrahepatic biliary obstruction leads to unconjugated (direct) hyperbilirubinemia.
109(D) Match on 109. Acute hepatitis leads to hepatocellular necrosis with an increase in transaminases.
110(E) Match on 110. Chronic viral hepatitis predisposes to hepatocellular carcinoma, with or without cirrhosis.
111(B) Match with 111. Hepatic adenomas are rare, but may be seen in women using oral contraceptives.
112(A) Match on 112. Over 80% of IV drug users become infected with viral hepatitis, though most infections are subclinical.
113(E) Match with 113. This feature is often seen in association with inflammatory bowel disease.
114(E) CORRECT. The most likely etiology is chronic alcoholism. A failing cirrhotic liver has many complications, but hemoperitoneum is more typically a possible complication of hepatocellular carcinoma.
115(D) CORRECT. Previous surgery leads to adhesions that are the most common cause for bowel obstruction in developed nations.
116(B) CORRECT. Atrophic gastritis, whether of the autoimmune or environmental type, increases the risk for gastric adenocarcinoma.
117(E) CORRECT. Secretion of insulin by beta cells in the adenoma could produce the symptoms described.
118(A) CORRECT. The accumulation of iron in many tissues leads to organ dysfunction, particularly in heart, liver, and endocrine systems.
119(C) CORRECT. Pancreatitis is treated medically (though a pseudocyst may be drained).
120(A) CORRECT. About 20% of persons have one or more stones, and most of them stay in the gallbladder and cause little or no problems. A 2 cm stone cannot pass, and a rounded appearance suggests there were no other stones.
121(A) CORRECT. About 20% of persons have one or more stones, and most of them stay in the gallbladder and cause little or no problems. A 2 cm stone cannot pass, and a rounded appearance suggests there were no other stones.
122(B) CORRECT. The increased indirect hyperbilirubinemia is typical for increased bilirubin production from hemolysis.
123(B) CORRECT. At least half of patients infected with hepatitis C go on to chronic hepatitis. It is usually acquired by a parenteral route of infection. Testing for HCV antibody has eliminated many, but not all, cases of transfusion-associated hepatitis from HCV. An antigen test is not yet available.
124(A) CORRECT. GI tract involvement is seen in about half of patients with polyarteritis nodosa. The periappendicitis here suggests a diagnosis other than a routine acute appendicitis.
125(A) CORRECT. These are the classic findings for acute cholecystitis with cholelithiasis. Most persons who have gallstones remain asymptomatic.
126(B) CORRECT. He has an acute gastritis. Anything which injuries the gastric mucosal barrier to back diffusion of acid and pepsin will predispose to this condition.