Liver
This blood test marker is particularly elevated in cases of HCC and is often used for monitoring disease progression.
What is alpha-fetaprotein (AFP)?
A 47-year-old woman complains of tremors, weight loss, and heat intolerance. On exam, she has exophthalmos and a diffusely enlarged thyroid. Labs show undetectable TSH and elevated T3 and T4. What is the most likely diagnosis, and what is the underlying mechanism?
What is Graves’ disease, caused by thyroid-stimulating immunoglobulins stimulating the TSH receptor?
___________ is defined as the outpouching of all three layers of the bowel wall that arises due to failure of the vitelline duct to involute.
What is Meckel Diverticulum?
This congenital defect results in a connection between the esophagus and trachea.
What is Tracheoesophageal Fistula?
A 58-year-old woman with hypertension started a new medication but has developed a persistent dry cough. This symptom is linked to the drug's inhibition of bradykinin breakdown. Which medication is she likely taking?
What is lisinopril?
These two serum markers help distinguish between alcohol liver disease and non-alcoholic fatty liver disease. Include how.
What are AST and ALT? High AST:ALT ratio suggests alcohol as the cause of injury.
A 26-year-old man presents with fatigue, nausea, and salt cravings. He has hyperpigmentation on his gums and knuckles. Labs reveal hyponatremia, hyperkalemia, and a low morning cortisol level with elevated ACTH. What is the diagnosis?
What is Addison’s disease (primary adrenal insufficiency)?
This radiologic finding, known as “string sign”, is characteristic of this type of inflammatory bowel disease?
What is Crohn’s disease?
A 50-year-old man with a long history of gastroesophageal reflux disease (GERD) undergoes an endoscopy, which reveals a change in the lining of the distal esophagus. Biopsy shows intestinal metaplasia with the presence of goblet cells. What is the likely diagnosis?
What is Barrett Esophagus?
This drug, used in the treatment of Crohn's disease, is a prodrug that requires conversion to 6-mercaptopurine in the body. It acts by inhibiting DNA synthesis in lymphocytes, reducing immune response.
What is azathioprine?
This syndrome, marked by hepatic vein thrombosis, presents with abdominal pain, hepatomegaly, and ascites and is often associated with hypercoagulable states.
What is Budd-Chiari syndrome?
A newborn girl is noted to have ambiguous genitalia. Laboratory results show hyponatremia, hyperkalemia, and elevated 17-hydroxyprogesterone. Which enzyme deficiency is most likely responsible for her condition?
A) 11β-hydroxylase
B) 21-hydroxylase
C) 17α-hydroxylase
D) 3β-hydroxysteroid dehydrogenase
E) 18-hydroxylase
What is B) 21-hydroxylase?
What GI pathology is caused by an autosomal recessive deficiency of apolipoprotein B-48 and B-100?
What is Abetalipoproteinemia?
Achalasia causes disordered esophageal motility by damaging this type of cell (bonus: where are these cells located?)
What are ganglion cells in the myenteric plexus?
This combination medication, used in the treatment of chronic Hepatitis C, targets viral replication by inhibiting both NS5A and NS5B proteins, leading to sustained virologic response in many patients.
What is Harvoni (ledipasvir/sofosbuvir)?
This liver disease is characterized by progressive bile duct destruction, anti-mitochondrial antibodies, and is often associated with autoimmune conditions.
What is primary biliary cholangitis?
A 35-year-old woman with a history of hyperparathyroidism is found to have a pancreatic tumor. Genetic testing reveals a mutation in the MEN1 gene. Which of the following additional findings is most likely in this patient?
A) Medullary thyroid carcinoma
B) Pheochromocytoma
C) Pituitary adenoma
D) Parathyroid carcinoma
E) Adrenal hyperplasia
What is C) Pituitary adenoma?
A 22-year-old man with a family history of colon cancer undergoes a screening colonoscopy, which reveals hundreds of adenomatous polyps throughout the colon. Genetic testing reveals a mutation in the APC gene. Which of the following is the primary treatment to prevent colorectal cancer in this patient?
A) Regular endoscopic surveillance
B) High-fiber diet
C) Total colectomy
D) NSAID therapy
E) Radiation therapy
What is C) Total colectomy?
A 45-year-old man presents with dysphagia that initially occurred only with solids but has progressed to include both solids and liquids. Barium swallow shows a "bird-beak" appearance at the lower esophagus. What is the most likely diagnosis?
What is Achalasia?
A 65-year-old man with liver cirrhosis presents with confusion and elevated ammonia levels. He’s prescribed a medication that works by trapping ammonia in his gut to lower blood levels. What medication is he receiving, and what is the primary mechanism?
What is lactulose, which acidifies the colon to convert ammonia to ammonium?
This enzyme, elevated in cases of bile duct obstruction, is particularly useful in differentiating between hepatic and bone sources of increased alkaline phosphatase.
What is gamma-glutamyl transferase (GGT)?
A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. Her thyroid is diffusely enlarged and non-tender on examination. Laboratory results reveal elevated TSH and low T4. Anti-thyroid peroxidase antibodies are present. Which of the following histologic findings is most likely in her thyroid gland?
A) Granulomas with multinucleated giant cells
B) Lymphoid aggregates with germinal centers
C) Hurthle cell hyperplasia
D) Amyloid deposition
E) Diffuse fibrosis
What is B) Lymphoid aggregates with germinal centers?
A 40-year-old female presents with chronic diarrhea, bloating, and weight loss. Laboratory studies show anti-tissue transglutaminase (anti-tTG) antibodies. Which of the following histologic findings on small intestine biopsy would be most consistent with this condition?
A) Villous atrophy and crypt hyperplasia
B) Increased eosinophils in the lamina propria
C) Pseudopolyps in the mucosa
D) Non-caseating granulomas
E) Cobblestone appearance of the mucosa
What is A) Villous atrophy and crypt hyperplasia?
A 28-year-old male presents with hematemesis following a night of heavy drinking. Endoscopy shows linear mucosal tears at the gastroesophageal junction. What is the most likely diagnosis?
What is Mallory-Weiss tear?
A 70-year-old man with hepatic encephalopathy is given an antibiotic to reduce ammonia-producing gut bacteria. He reports improved mental clarity after a few days on the medication, which is also sometimes used off-label for IBS. Which antibiotic is this?
What is rifaximin?