Answer and Explanation 4

4.    The correct answer is D.  Cowden's Syndrome in not a risk factor for colon cancer.  They will frequently have multiple hamartomas but not colon cancer.  Gardner's Syndrome is a genetic disorder that has a 100% chance of developing colon cancer.  Having a personal history of breast, ovarian, or uterine cancer is a risk factor for developing colon cancer.  Ulcerative colitis and Crohns Disease are both risk factors for the development of colon cancer.

Question 4

4.  Which of the following has not been identified as a risk factor for colon cancer?

A.  Gardner's Syndrome
B.  Personal history of breast, ovarian, or uterine cancer,
C.  Ulcerative Colitis or Crohns Disease
D.  Cowden's Syndrome

Answer and Explanation 3

3.  The correct answer is C.  Crohns disease can cause bloody diarrhea and frequently does.  It affects anywhere from the mouth to the anus.  Patients with Crohns Disease sometimes need surgery when abscess occur or fistulas occur from it being transmural.  It most commonly affects the terminal ileum.  It is also important to remember that is surgery is not curative for Crohns disease but is with Ulcerative Colitis.

Question 3

3.  Which of the following is not a characteristic of Crohns Disease?

A.  Occurs anywhere from the mouth to the anus

B.  Is a disorder that is typically transmural

C.  Cannot cause bloody diarrhea

D.  Most commonly affects the terminal ileum

Answer and Explanation 2

2.  The correct answer is B.  This patient has a clinical picture consistent with Zollinger Ellison Syndrome.  Somatostatin Receptor Scintigraphy is the single best imaging test for identifying this.  CLO testing is a biopsy test done during endoscopy to screen for H. Pylori and this would not be helpful because the patient is H. Pylori negative.  Prostaglandin levels have no correlation with the development of ulcers.  Cyclic AMP has nothing to do with the development of ulcers.  The only "cure" for Zollinger Ellison syndrome is if a gastrin secreting tumor can be found and be surgically removed.

Question 2

2.   Your patient is a 33 year old male who was underwent an extensive workup for epigastric abdominal pain.  He has an upper endoscopy that has revealed numerous ulcers in the stomach as well as in the duodenum.  He does not use alcohol nor does he use NSAIDS.  He has tested negative for H. Pylori.  He is currently on maximal therapy including Proton Pump inhibitors and Carafate.  What would be the natural next step in terms of workup for this patient.

A. Obtain a CLO test on the patient

B. Obtain somatostatin receptor scintigraphy

C.  Obtain Prostaglandin Levels

D.  Obtain Cyclic AMP Levels

Answer and Explanation 1

1.  The correct answer is B intrinsic factor.  This type of anemia, pernicious anemia, is caused by the lack of intrinsic factor being secreted by the parietal cells of the stomach.  If a patient is lacking in intrinsic factor the Vitamin B12 should ideally be administered parenterally.   Another common nutritional deficiency that manifests itself as a macrocytic anemia is folic acid.  This is common in patients that have had gastric bypass and who are pregnant.  A common microcytic hypochromic anemia is iron deficiency anemia.  Gastrin helps with digestion and regulate pH and is also produced by the parietal cells.  HCO3 also helps in regulation of the pH of the stomach.  Cycylooxygenase helps with prostaglandin synthesis.  This pathway is impaired with NSAID use.