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Step 1 DIT > 9. GI > Flashcards

9. GI Flashcards

1
Q

What is the most common location of salivary gland tumors?

A

parotid gland

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2
Q

What is the most common salivary gland tumor? What is the histological appearance of this tumor?

A 
pleomorphic adenoma (benign) 
--> composed of both epithelial and mesenchymal type cells
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3
Q

What is the 2nd most common benign salivary gland tumor?

A 
Warthin tumor 
(benign cystic tumor where you have double layer of columnar epithelium around the cyst; looks like lymphoid tissue)
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4
Q

What is the most common malignant salivary gland tumor (the 2nd most common tumor overall of the salivary gland)?

A

Mucoepidermoid carcinoma

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5
Q

What medication is often used in the treatment of allergic rhinitis, nasal polyps, and eustachian tube dysfunction?

A

intranasal steroids

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6
Q

What are the names of the diverticula found in the esophagus based on their anatomical locations? (3)

A
  • Zenker: immediately above UES
  • Traction: mid
  • Epiphrenic: immediately above LES
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7
Q

What upper GI problem is associated with biopsy of a patient with esophagitis reveals large, pink, intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus?

A

HSV esophagitis

punched out ulcers

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8
Q

What upper GI problem is associated with biopsy of a patient with esophagitis revealing enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo?

A

CMV esophagitis

linear ulcers

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9
Q

What upper GI problem is associated with an esophageal biopsy revealing a lack of ganglion cells b/w the inner and outer muscular layers?

A

achalasia

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10
Q

What upper GI problem is associated with protrusion of the mucosa in the upper esophagus

A

plummer-vinson (esophageal webs)

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11
Q

What upper GI problem is associated with outpouching of the esophagus found just above the LES?

A

epiphrenic diverticulum

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12
Q

What upper GI problem is associated with goblet cells in the distal esophagus

A

Barrett esophagus

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13
Q

What upper GI problem is associated with a PAS stain on a biopsy from a pt with esophagitis revealing hyphate organisms?

A

Candida esophagitis (white pseudomembrane)

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14
Q

What upper GI problem is associated with esophageal pouch found in the upper esophagus

A

Zenker diverticulum

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15
Q

What disorder is characterized by an excess of gastrin? What is the treatment?

A

Zollinger Ellison syndrome

Tx: PPI +/- octreotide

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16
Q

What receptors found on gastric parietal cells regulate acid secretion? (5)

A
  • H2 receptor (most important)
  • CCKb receptor (directly stim by gastrin)
  • M3 receptor (directly stim by vagus)
  • Prostaglandin receptor (inhibitory)
  • somatostatin receptor (inhibitory)
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17
Q

What happens to serum pH at the time of gastric acid secretion?

A

serum pH rises slightly (alkaline)

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18
Q

Which antacid can cause diarrhea?

A

magnesium hydroxide

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19
Q

Which antacid can cause constipation?

A

aluminum hydroxide

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20
Q

Which antacid can cause hypercalcemia?

A

calcium bicarb

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21
Q

Which antacids can cause hypokalemia?

A

all of them

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22
Q

A patient taking NSAIDs develops anemia, has pain with eating, and is positive on occult blood test. What drug would most directly address the mechanism behind this patient’s current problem?

A

Misoprostol (PGE2 analog)

–> b/c NSAIDs are blocking prostaglandin production

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23
Q

Where is Virchow’s node located?

A

left supraclavicular lymph node (can indicate gastric cancer)

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24
Q

What important secretory products are secreted from G cells?

A

gastrin

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25
Q

What important secretory products are secreted from I cells?

A

CCK

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26
Q

What important secretory products are secreted from S cells?

A

secretin

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27
Q

What important secretory products are secreted from D cells?

A

somatostatin

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28
Q

What important secretory products are secreted from gastric parietal cells?

A

gastric acid, intrinsic factor

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29
Q

What GI ligament contains the portal triad and may be compressed to control bleeding?

A

hepatoduodenal

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30
Q

What GI ligament attaches the spleen to the posterior abdominal wall?

A

splenorenal

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31
Q

What GI ligament attaches the spleen to the stomach?

A

gastrosplenic

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32
Q

What is the MoA of metoclopramide?

A
  • antagonist @ D2 receptor
  • serotonin agonist

increases contractility in GI tract

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33
Q

What serum antibodies are associated with celiac disease?

A
  • anti-gliadin

- anti-tissue transglutaminase

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34
Q

What is the tx for celiac sprue?

A

gluten-free diet

35
Q

What organism is associated with Whipple disease?

A

Tropheryma whipplei

36
Q

What pathology of the small intestine is associated with small intestinal mucosa laden with distended macrophages in the lamina propria?

A

Whipple disease

37
Q

What pathology of the small intestine is associated with defect in chylomicron exportation?

A

Abetalipoproteinemia

38
Q

What pathology of the small intestine is associated with cramping associated with milk products?

A

lactase deficiency

39
Q

What intestinal disorder is common in the NICU to premature babies that receive oral feeds too soon?

A

Necrotizing enterocolitis

40
Q

What are the classic symptoms of carcinoid syndrome? (4)

A

Bronchospasm
Flushing
Diarrhea
Right-sided heart murmur

41
Q

What is the fundamental problem in Hirschsprung disease?

A
  • neural crest cells fail to migrate to the colon

- missing enteric ganglia/nerve plexuses

42
Q

What is the most abundant bacteria in the colon of most individuals?

A

Bacteroides fragilis

43
Q

Which pathological lesions of the colon are considered precursors to malignancy? which colon pathology has the most malignant potential?

A
  • adenomatous polyps

- villous adenomas have highest malignant potential

44
Q

What gene mutations are commonly seen in the development of colorectal cancer?

A
  1. loss of APC gene –> KRAS mutation –> loss of tumor suppressor genes (p53, DCC)
  2. dysfunction of DNA mismatch repair enzymes (Lynch)
45
Q

What is the treatment for diverticulitis?

A
  • metronidazole with

- fluoroquinolone or TMP-SMX

46
Q

Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- skip lesions

A

crohn’s

47
Q

Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- loss of haustra

A

UC

48
Q

Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- fistulas

A

Crohn’s

49
Q

Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- increased risk of colorectal cancer

A

both (but UC > crohn’s)

50
Q

Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- noncaseating granulomas

A

crohn’s

51
Q

Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- associated with primary sclerosing cholangitis

A

UC

52
Q

Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- associated with ankylosing spondylitis

A

both

53
Q

Which hormones stimulate pancreatic secretion? (3)

A
  • CCK
  • Secretin (=> bicarb secretion)
  • ACh (vagus nerve; technically not hormone)
54
Q

What enzyme catalyzes the rate-limiting step in carbohydrate digestion?

A

oligosaccharide hydrolases (ex. sucrase) found @ intestinal brush border

55
Q

What are the typical presentation of a pt with pancreatic insufficiency?

A
  • diarrhea
  • steatorrhea
  • malabsorption
  • wt loss
  • deficiency of fat-soluble vitamins (A, D, E, K)
56
Q

What is the treatment for pancreatic insufficiency?

A
  • limit fat intake
  • pancreatic enzyme supplements
  • fat-soluble vitamin supp.
57
Q

From which embryonic germ layer is the liver derived?

A

endoderm

58
Q

What 3 structures make up a portal triad?

A
  1. branch of hepatic artery
  2. branch of portal vein
  3. bile ductule
59
Q

Where is the portal triad located relative to the flow of arterial blood and the flow of bile?

A

blood flows away from triad

bile flows towards triad

60
Q

What enzyme is responsible for the conjugation of bilirubin?

A

UDP-glucoronyl transferase

61
Q

Which hereditary hyperbilirubinemia matches mildly decreased UDP-GT?

A

Gilbert

62
Q

Which hereditary hyperbilirubinemia matches completely absent UDP-GT?

A

Crigler Najjar type 1

63
Q

Which hereditary hyperbilirubinemia matches grossly black liver?

A

Dubin-Johnson

64
Q

Which hereditary hyperbilirubinemia responds to phenobarbital?

A

CN type 2

65
Q

Which hereditary hyperbilirubinemia matches treatment that includes plasmapheresis and phototherapy?

A

CN type 1

66
Q

Which hereditary hyperbilirubinemia is asymptomatic unless under physical stress (ex. alcohol, infection)?

A

gilbert

67
Q

What cocktail of medication is commonly taken by pts suffering from severe cirrhosis?

A
  • diuretics
  • beta blockers
  • vit K
  • lactulose
68
Q

What conditions are associated with Budd-Chiari syndrome? (3)

A
  • occlusion of IVC, hepatic veins

- associated with polycythemia vera, pregnancy, HCC

69
Q

What is the mechanism by which aspirin can cause Reye syndrome?

A
  • aspirin metabolites inhibit mitochondrial enzymes

- decreased beta-oxidation

70
Q

A young man presents with ataxia and tremors. He has brown pigmentation in a ring around the periphery of his cornea. What treatment should he receive?

A

penicillamine

71
Q

What is the underlying problem in Wilson disease?

A

impaired copper excretion into bile

- copper accumulation

72
Q

What is the classic triad of symptoms in hemochromatosis?

A

Bronze diabetes

  • diabetes
  • bronzing of skin
  • cirrhosis
73
Q

What lab tests are used to diagnose hemochromatosis?

A
  • elevated ferritin, transferritin saturation, serum iron

- decreased TIBC

74
Q

What is the treatment for hemochromatosis?

A
  • repeated phlebotomy

- also can chelate with deferoxamine

75
Q

Which hep viruses are transmitted through the fecal/oral route?

A

Hep A, Hep E

76
Q

Which antibodies can be used to help make the diagnosis of autoimmune hepatitis type 1?

A

ANA, anti-smooth muscle ab

77
Q

Which antibodies can be used to help make the diagnosis of autoimmune hepatitis type 2?

A
  • anti-liver-kidney microsomal ab

- anti-liver cytosol ab

78
Q

Identify the hepatitis B status based on serologic markers

  • Hep BsAg neg
  • Hep BsAb positive
  • Hep BcAb positive
A

recovered

79
Q

Identify the hepatitis B status based on serologic markers

  • Hep BsAg neg
  • Hep BsAb neg
  • Hep BcAb positive
A

window

80
Q

Identify the hepatitis B status based on serologic markers

  • Hep BsAg pos
  • Hep BsAb neg
  • Hep BcAb positive IgM
A

acute

81
Q

Identify the hepatitis B status based on serologic markers

  • Hep BsAg pos
  • Hep BsAb neg
  • Hep BcAb positive IgG
A

chronic

82
Q

Identify the hepatitis B status based on serologic markers

  • Hep BsAg neg
  • Hep BsAb positive
  • Hep BcAb neg
A

immunized

83
Q

What is the fate of bilirubin after its conjugated and secreted into the GI tract?

A
  • bacteria in the colon converts it to UROBILINOGEN
  • -> most excreted in stool as STERCOBILIN
  • -> some reabsorbed and recycled into bile
  • —–> tiny amt excreted in urine as UROBILIN
84
Q

What is the diff. between primary biliary cirrhosis and primary sclerosing cholangitis?

A

PBC:

  • autoimmune disease
  • (+)ANA
  • middle-age women

PSC:

  • (+)pANCA
  • men over 40
  • associated with ulcerative colitis and cholangiocarcinoma

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