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USMLE S1 > Gastroenterology and GI Surgery > Flashcards

Gastroenterology and GI Surgery Flashcards

1
Q

radiologic finding of UC

A

lead pipe sign loss of haustra

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2
Q

HCV principle serological marker?

A

HCV-RNA

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3
Q

chronic gastritis divided into two subtypes

A
  1. chronic autoimmune gastritis (assoc pernicious anaemia and intestinal type gastric adenoma)
  2. chronic H. pylori gastritis
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4
Q

clinical features of haemochromatosis? (5)

A
  1. cirrhosis
  2. diabetes mellitus
  3. bronzed skin
  4. dilated cardiomyopathy and arrhythmia
  5. male gonadal atrophy
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5
Q

cellular mediator of Crohn’s disease?

A

Th1 cells

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6
Q

which HxV is particularly worrying in pregnancy? sequelae?

A

HEV fulminant hepatitis leading to liver failure and massive necrosis

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7
Q

complications of acute pancreatitis?

A

shock

pancreatic pseudocyst

pancreatic abscess

DIC and ARDS

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8
Q

pathoG - bilateral inflamed parotid glands

A

Mumps virus infection

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9
Q

pain following meal and weight loss in a smoker with hypertension?

A

ischaemic colitis - atherosclerosis of SMA

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10
Q

define tropical sprue

A

damage to the small bowel villi due to some unknown infectious agent resulting in malabsorption

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11
Q

GvHD pathogenesis of liver disease?

A

allografted T cells migrate into host tissues lymphocyte infiltration of intrahepatic bile ducts, recognition of host MHC I, granuloma formation intrahepatic biliary sclerosis, rise in Alk Phos, similar to PBC

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12
Q

RFs for colonic diverticula

A

constipation, straining low fibre diet

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13
Q

what bugs causes oesophagitis?

A

candida CMV HSV usually in the setting of HIV/AIDS, immunosuppression

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14
Q

diagnostic test for the major complication of UC?

A

AXR for toxic megacolon

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15
Q

2 consequences of a posterior duodenal ulcer

A
  1. penetration of the gastroduodenal artery causing severe haemorrhage
  2. acute pancreatitis
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16
Q

gross appearance of Crohn’s bowel? (3)

A

cobblestone mucosa, creeping fat and stricture

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17
Q

mechanism of lactulose in hepatic encephalopathy why not another laxative?

A

intraluminal conversion of lactulose (disaccharide) to acidic breakdown products converts ammonia to ammonium ions which cannot be absorbed. also decreases gut transit time. others do not acidify the stool

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18
Q

role of secretin in the GI tract

A

sitmulates pancreas in response to fat and acid arriving in duodenum

decreases gastrin production from gastric G cells and increases pancreatic juice (in.c bicarbonate) excretion from the pancreas.

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19
Q

peak age of CRC?

A

60-70

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20
Q

which HxV… travellers

A

HAV

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21
Q

how does newborn phototherapy work to reduce unconj bilirubin levels?

A

makes UCB water soluble so it can be excreted in the urine - it DOES NOT conjugate the UCB

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22
Q

failure of fusion of the facial prominences results in what condition?

A

cleft lip and palate

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23
Q

CA oesophagus upper 1/3rd spreads to which LNs?

A

cervical nodes

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24
Q

half life of albumin?

A

about 20 days

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25
Q

CRC serum tumour marker?

A

CEA only useful for assessing response to treatment, not for screening tool

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26
Q

Polyhydramnios drooling child vomit on first feed these findings suggest which pathology?

A

EA with TEF

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27
Q

Peutz-Jeghers syndrome genetic inheritance?

A

autosomal dominant

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28
Q

GvHD affects which three tissues primarily?

A

skin liver GI tract

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29
Q

Meckel’s diverticulum - rule of 2s (4)

A

2% of population

2 inches long within

2 feet of ileocaecal valve

presents in first 2 years of life

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30
Q

linear, shallow ulcerations in the lower oesophagus on gross morphology histology shows enlarged cells with intranuclear inclusion bodies where else can this disease affect?

A

CMV oesophagitis pneumonitis or colitis

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31
Q

6 features of colitis-associated carcinoma (epidem, gross, molecular, site affected, bonus)

A
  1. younger
  2. non-polypoid dysplasia
  3. histo: signet ring morphology, mucinous
  4. early p53 mutation
  5. proximal colon
  6. multifocal
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32
Q

what is the mechanism of cell damage in haemochromatosis?

A

Fe2+ generates oxygen free radicals via the Fenton reaction

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33
Q

why is a pancreatic pseudocyst not a real cyst? how long following acute pancreatitis does the pseudocyst take to “mature”?

A

not lined by epithelium but instead by fibrosis and granulation tissue 4 - 6 weeks, mature = formation of fibrous capsule

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34
Q

mouldy food associated with which cancer? how?

A

HCC mould = aflatoxin = G:C –> T:A muation in p53 = HCC

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35
Q

lymphatic drainage from above the pectinate line

A

internal iliac LNs

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36
Q

what is removed in the whipple procedure? (3)

A
  1. head and neck of pancreas
  2. proximal duodenum
  3. gallbladder
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37
Q

how does Shigella invade the GI mucosa?

A

through endocytosis into the microfold (M) cells of the ileal Peyer patches

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38
Q

what are the AXR findings of oesophageal atresia?

A

gasless abdomen

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39
Q

3 associations with H pylori infection

A
  1. ulceration
  2. gastric adenocarcinoma
  3. MALT lymphoma
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40
Q

how is IBD related to gall stone formation?

A

occurs in Crohn’s disease when the terminal ileum is preferentially affected. This decreases bile acid absorption, leading to bile acid wasting. Phosphatidylcholine levels decreased. Cholesterol:bile acid ratio increases. Cholesterol stones precipitate

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41
Q

flattening of vili, crypt hyperplasia, increased intraepithelial lymphocytes on small bowel biopsy

A

Coeliac disease

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42
Q

2 complications of volvulus

A
  1. obstruction
  2. infarction (haemorrhagic)
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43
Q

on endoscopy a large, irregular ulcer with heaped up margins… what pathology?

A

intestinal type gastric CA

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44
Q

RFs for intestinal type gastric CA (3)

A
  1. intestinal metaplasia (chronic gastrites)
  2. nitrosamines in smoked foods
  3. blood type A
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45
Q

the layers of the gut wall from in to out? name the associated nerve plexus (when applicable)

A

mucosa submucosa (Meissner) muscularis externa (Auerbach, or Myenteric nerve plexus) serosa

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46
Q

a Mallory body is found where? what do they contain?

A

hepatocytes of alcoholic hepatitis contain damaged intermediate cytokeratin filaments

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47
Q

most common cause of delayed gastric emptying

A

uncontrolled DM

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48
Q

two mechanisms that prevent trypsin from autodigesting the pancreas

A
  1. SPINK1 - direct trypsin inhibitor
  2. trypsin auto-peptidase activity - cleaves itself. loss of auto-regulation by mutation at the cleavage site is responsible for hereditary pancreatitis
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49
Q

why is the left heart spared in carcinoid heart disease?

A

MAO present in the lung 5-HT coming from IVC so must pass through lung to get to left heart

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50
Q

procedure for secretin test for ZE syndrome

what is diagnostic?

A

administer secretin and monitor gastrin levels usually this causes a decrease in the production of gastrin but in gastrin-producing adenoma it will moderately increase gastrin production

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51
Q

clinical finding associated with metastatic liver cancer?

A

nodular enlarged liver on palpation of abdomen

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52
Q

hyperplastic polyps - benign or malignant? where do they commonly arrise?

A

benign rectosigmoid colon

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53
Q

3 factors contributing to development of cholelithiasis?

A
  1. supersaturation with cholesterol or bilirubin
  2. decreased production of bile salts or phospholipids
  3. stasis
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54
Q

obstruction of appendix in children? in adults?

A

kids - lymphoid hyperplasia adults - faecalith

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55
Q

how does a GI bleed lead to increased systemic nitrogen load?

A

haemoglobin bled into the lumen of GI broken down to aa’s –> ammonia –> portal circulation –> overwhelms liver

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56
Q

in the liver: microvesicular steatosis, fat vacuoles in cytoplasm.

EM findings - swelling and decreased number of mitochondria and glycogen depletion

suggests what pathology?

A

Reye syndrome

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57
Q

microbe causing sialadenitis

A

staph aureus

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58
Q

PBC is associated with which other conditions? (6)

A
  1. Sjögren
  2. Reynaud disease
  3. scleroderma
  4. thyroid (AI), Graves’ and Hashimoto.
  5. Celiac disease
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59
Q

what is Sister Mary Joseph nodule? association?

A

periumbilical metastasis intestinal type gastric CA

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60
Q

ulcer distal to the duodenal bulb suggests which pathology?

A

ZE syndrome

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61
Q

Rx Wilson disease

A

D-penicillamine (Cu-chelating agent)

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62
Q

zone 2, intermediate, of liver lobule is affected preferentially in which pathology?

A

yellow fever

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63
Q

pathoG linitis plastica

A

diffuse type gastric CA

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64
Q

extrusion of the abdominal contents through the abdominal folds; not covered by peritoneum or amnion this usually occurs where, relative to umbilicus?

A

gastroschisis typically to the right of umbilicus

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65
Q

cause of death in Crigler-Najjar syndrome?

A

Kernicterus

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66
Q

which enzyme catalyzes the rate limiting step of bile acid synthesis?

A

cholesterol 7alpha-hydroxylase

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67
Q

nutritional consequence of SIBO what goes up? what goes down?

A

up: Vitamin K, folate
down: Iron, B12, fat-soluble vitamins

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68
Q

a cystic tumour with lymphocytes and germinal centres of the parotid gland is called…

A

Warthin tumour

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69
Q

bowel sounds in the lower lung field suggests? complication?

A

paraoesophageal hernia left lung hypoplasia

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70
Q

a persistent herniation of abdominal contents into the umbilical cord is…

A

omphalocele

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71
Q

Barret’s oesophagus predisposes to which cancer?

A

oesophageal adenocarcinoma

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72
Q

two molecular pathways for the development of CRC? which is more common on which side of the bowel?

A
  1. adenoma-carcinoma development (left)
  2. microsatellite instability (Right)
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73
Q

high LES pressure on manometry suggests?

A

achalasia

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74
Q

where is the viral reservoir in latent oral herpes?

what is the virus?

A

trigeminal nerve root ganglion

HSV-1 (typically)

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75
Q

which gall stone is radiolucent?

A

cholesterol

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76
Q

anal fissure usually occurs where anatomically?

A

posterior - as this area is poorly perfused distal to the dentate(/pectinate) line

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77
Q

left versus right sided CRC features?

A

Left - napkin ring, decreased stool calibre, left sides pain, blood streaked stool

Right - raised lesion, IDA, non-specific pain

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78
Q

Peutz-Jeghers syndrome what/where are the skin lesions?

A

hyperpigmented macules oral mucosa, lips and genital skin

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79
Q

crypt abscess with neutrophils

A

UC

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80
Q

Behçet syndrome consists of a triad …

A
  1. aphthous ulcers
  2. genital ulcers
  3. uveitis
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81
Q

name the lateral, medial and inferior borders of Hesselbach’s triange

A

lateral - inferior epigastric artery

medial - lateral border of rectus abdominis

inferior - inguinal ligament

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82
Q

membranous GN is best associated with this HxV?

A

HBV

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83
Q

APC - adenomatous polyposis coli gene ocogene or tumour suppressor? Locus?

A

tumour supressor Chr 5

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84
Q

associated GI condition with Coeliac

A

small bowel carcinoma T cell lymphoma (enteropathy-associated T cell Lymphoma EATL)

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85
Q

in which secenario is HDV infection most dangerous?

A

superinfection on preexisting HBV, c/o co-infection with HBV

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86
Q

Leser-Trélat sign what is it? association?

A

solar keratosis eruption all over skin

gastric CA

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87
Q

which HxV is a DNA virus?

A

HBV

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88
Q

which liver tumour is associated with OCP use?

A

hepatic adenoma

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89
Q

what is damaged in Dubin-Jonhson syndrome?

A

conjugated bilirubin transport protein - cannot enter the bile cannaliculus

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90
Q

duodenal atresia clinical features? 2 symptoms, 1 radiological finding

A
  1. polyhydramnios
  2. bilious vomit
  3. double-bubble sign
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91
Q

derm association with coeliac disease? pathogenesis?

A

dermatitis herpetiformis IgA deposition at the tips of the dermal papillae, leading to vesicular blistering (herpetiform)

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92
Q

which HxVs predispose to HCC?

A

HBV, HCV, HDV

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93
Q

hirschprung disease association?

A

Down’s syndrome neural crest cell migration failure

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94
Q

pathogenesis of intussusception, what gives rise to the leading edge in children? In adults?

A

kids - lymphoid hyperplasia (many Peyer’s patches in TI) adults - tumour

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95
Q

which cell type mediates tissue damage in Coeliac disease?

A

Helper T cells Deaminated gliadin presented by APCs to Th cells

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96
Q

causes of pancreatitis

A

GET SMASHED

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97
Q

what is Sudan III stain? what does it test for? what is normal?

A

stool sample stain, most sensitive assay for generalised malabsorption unabsorbed dietary fats no fat in the stool at all

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98
Q

which colonic adenoma is most likely to undergo malignant change?

A

villous adenoma (villous is the “villain”)

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99
Q

UC complications acute or chronic

A

A: toxic megacolon

C: carcinoma

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100
Q

parenteral transmission of which HxV? (parturition, IVDU, sexual intercourse, transfusion)

A

HBV, HCV

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101
Q

cellular mediator of UC?

A

Th2 cells

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102
Q

which is the most common tracheoesophageal abnormality?

A

EA with TEF (OA with TOF)

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103
Q

chronic gastritis involving the body and the fundus suggests which pathology?

A

chronic autoimmune gastritis

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104
Q

granular eosinophilic ‘ground glass’ appearance - which HxV?

A

HBV

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105
Q

Peutz-Jeghers syndrome - risk of which CA (3)?

A

breast, CRC and GYN CA

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106
Q

most proximal portion of bowel affected in UC?

A

caecum can only affect large bowel!

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107
Q

zone 1, periportal, of liver lobule is affected preferentially in which pathologies?

A

viral hepatitis and ingested toxins (cocaine, halothane)

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108
Q

neurotoxic action of ammonia

A

decreases:

  • aa transport across BBB
  • glucose metabolism
  • proper NT metabolism; overall more GABA and less glutamate
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109
Q

aetiology - newborn jaundice (physiologic)

A

transiently low UGT activity inherently, will increase in activity over time on their own

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110
Q

2 infective agents predisposing to gall stone formation? which type of gall stone is produced?

A
  1. ascaris infection (roundworm)
  2. clonorchis sinensis - China, Vietnam and Korea.. “Chinese liver fluke”
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111
Q

which HxV has faecal-oral transmission?

112
Q

stimulation of parietal cells to produce acid (3)

A

enterochromafin cells produce histamine works on H2 receptor vagus nerve ACh gastrin from chief cells

113
Q

chronic gastritis involving the antrum of the stomach suggests which pathology?

114
Q

FAP with malignant CNS tumour (medulloblastoma or glioma) is called…

A

Turcot syndrome

115
Q

3 screening tests used to identify CRC

A

colonoscopy/flexi sigi faecal occult blood faecal immunochemical testing CT colonography

116
Q

Rigler’s triad, suggestive of gallstone illeus is what?

A

evidence of SBO air/gas in the biliary tree gallstone at the ileocaecal valve

117
Q

HNPCC preferentially affects which area of bowel?

A

proximal colon

118
Q

causes of chronic pancreatitis? (2)

A

adult - alcoholism kids - cystic fibrosis

119
Q

which HxV… contaminated water or undercooked seafood

120
Q

major RFs for HCC?

A
  1. chronic hepatitis
  2. cirrhosis (of any cause)
  3. afltatoxin derived from aspergillus
121
Q

primary tumour marker for HCC?

A

alpha-fetoprotein

122
Q

most common cause of death in cirrhotic patients?

A

ruptured oesophageal varyx

123
Q

Rokitansky-Aschoff sinus - herniation of gallbladder mucosa into the muscular wall … suggests which pathology?

A

chronic cholecystitis

124
Q

most common site of bowel angiodysplasia?

A

caecum and right colon due to high wall tensions

125
Q

what marks the development into chronic pancreatitis from recurrent acute pancreatitis?

A

pancreatic insufficiency - fat soluble vitamin deficiency (A,E,D,K) - steatorrhoea

126
Q

gross and histologic examination of bowel mucosa for primary lactase deficiency?

127
Q

risk factors for acute gastritis (6)

A
  1. severe burn (Curling ulcer) and subsequent hypovolaemia, hypoperfusion
  2. NSAIDs (PGE2 inhibition)
  3. alcohol
  4. chemotherapy
  5. increased ICP (Cushing ulcer) - increased vagal stimulation, increase ACh
  6. Shock
128
Q

radiologic finding of Crohn’s

A

string sign

129
Q

Gilbert syndrome inheritance?

130
Q

how does portal hypertension (NOT liver failure) alter platelet function?

A

spenomegaly, hypertrophy, increased splenic sequestration, decreased circulating Plts

131
Q

essential mixed cryoglobulinaemia …which HxV?

132
Q

most likely type of CA from distal oesophagus

A

adenocarcinoma

133
Q

bowel histopath - lymphoid aggregates with granuloma

A

Crohn’s disease

134
Q

complications of Crohn’s disease (4)

A
  1. malabsorbtion
  2. calcium oxalate stones
  3. fistula
  4. carcinoma (only with colon involvement)
135
Q

HLA subtypes associated with Coeliac disease

A

HLA DQ2 and DQ8

136
Q

duodenal atresia is associated with which condition?

A

Down’s syndrome

137
Q

on biopsy, 3 factors increasing carcinoma risk in a polyp?

A
  1. size >2cm
  2. sessile growth (c/o pedunculated)
  3. villous histology (‘the villain’ of CRC)
138
Q

diverticulosis complications - immediate, acute, chronic

A

I - haematochezia A - diverticulitis C - fistula

139
Q

HNPCC - genetic mechanism?

A

mutation in DNA mismatch repair enzymes

140
Q

RFs for bilirubin stone formation?

A
  1. extravascular haemolysis
  2. biliary tract infection
141
Q

failure to pass an NG tube into stomach at birth suggests which pathology?

A

oesophageal atresia

142
Q

associated disease causing achalasia? why?

A

Chagas disease, infection with trypanosoma cruzi damage to the myenteric plexus of the oesophagus, cannot coordinate peristalsis or relax the lower oesophageal sphincter

143
Q

what small bowel infarction is seen in hypotension?

A

mucosal infacrtion mucosa (inner layer) is furthest from the blood supply, greatest diffusion distance

144
Q

adult onset asthma suggests what disease?

145
Q

duodenal atresia - association?

A

Down’s syndrome

146
Q

Strep bovis endocarditis - association?

A

CRC must follow up with colonoscopy, FOB & tumour markers

147
Q

antibody present with PBC?

148
Q

intestinal biopsy: foamy macrophages laden with PAS +ve granules in the lamina propria suggests which pathology? common tissues affected? (4)

A

Whipple’s disease. small intestine, joints, CNS, heart

149
Q

signet ring cells that diffusely infiltrate the gastric wall… what pathology?

A

diffuse type gastric CA

150
Q

what happens to serum Ca in acute pancreatitis

A

hypocalcaemia saponification consumes Ca from serum in fat necrosis. Sign of poor prognosis

151
Q

which HxV is most likely to lead to chronic hepatitis? which has a 20% chance?

A

HCV 20% = HBV

152
Q

GP setting - 42 y/o man had a father die of CRC aged 57. When should he start screening, and which test?

A

colonoscopy from 47 years old (or 10 years before relative developed CA)

153
Q

chronic sequela of biliary atresia?

154
Q

periductal fibrosis with onion-skin appearance?

155
Q

biopsy of colonic polyp shows: high grade dysplasia, long glands with villi-like projections from the surface. Gross - velvety, cauliflower-like appearance

A

villous adenoma

156
Q

5 risk factors of pancreatic CA?

A
  1. chronic pancreatitis (duration dependent)
  2. smoking
  3. age
  4. diabetes mellitus (duration dependent)
  5. genetic predisposition (hereditary pancreatitis, HNPCC, FAP, MEN syndromes)
157
Q

consequence of anterior duodenal artery

A

perforation into the anterior abdominal cavity, causing pneumoperitoneum

158
Q

2 features of vitamin E deficiency

A
  1. haemolytic anaemia
  2. peripheral myoneuropathy - oxidative damage to long nerve cells and high oxidative stress erythrocytes
159
Q

most common type of stone?

A

cholesterol stone (90%)

160
Q

other than CB, in bile duct obstruction what else leaks into the blood?

A
  1. cholesterol (xanthoma)
  2. bile salts (pruritus)
161
Q

tumour marker for pancreatic CA?

162
Q

gene mutations associated with Lynch (HNPCC) syndrome?

A

MSH2, MSH6 MLH1 PMS2

163
Q

pathoG - hypertrophy of Brunner glands

A

peptic ulcer disease - duodenal ulcer

164
Q

association with UC

A

PSC positive pANCA (microscopic polyangiitis, Churg-Strauss…)

165
Q

macrovesicular steatosis - which HxV?

166
Q

FAP natural history of disease?

A

development of 100s to 1000s of polyps develop CA before age 40. must have prophylactic colectomy with ileorectal anastomosis or proctocolectomy

167
Q

pathogenesis of foetor hepaticus

A

portal hypertension portosystemic shunting allows passage of thiol toxins through the lungs into the breath

168
Q

main cellular mediator of PBC?

A

T lymphocytes

169
Q

key finding in Dubin-Johnson syndrome on gross histology?

A

pitch black liver

170
Q

a white plaque discolouration on the inside of the mouth that cannot be scraped away - what is this? associated condition?

A

leukoplakia oral SCC

171
Q

foamy macrophages in the lamina propria suggests..?

A

whipple’s disease

172
Q

2 associations with oesophageal web?

A
  1. plummer vinson syndrome (IDA)
  2. oesophageal SCC
173
Q

a white deposit on the tongue easily scraped away with tongue depressor - what is this? associated condition?

A

oral candidiasis immunocompromised state

174
Q

4 steps in the adenoma-carcinoma sequence (molecular progression from normal colonic mucosa to adenomatous polyp to CA)

A
  1. APC inactivation (Two-hits) - increase risk of developing polyp)
  2. K-ras mutation leads to polyp developing
  3. p53 oncogene mutation AND
  4. increase COX expression –> carcinoma
175
Q

coffee bean sign suggests what pathology?

A

sigmoid colon volvulus common in the elderly

176
Q

CA oesophagus middle 1/3rd spreads to which LNs?

A

mediastinal or tracheobronchial

177
Q

air or stool in the urine suggests?

A

diverticulosis with colovesicular fistula formation

178
Q

Acute HBV hepatitis clinical features?

A
  1. fever/fatigue/jaundice/transaminitis (as all others)
  2. joint pain
  3. urticarial widespread rash
179
Q

association with Crohn’s

A

ARTHRITIS (Ank Spond, sacroilitis, migratory polyarthritis)

derm: erythema nodosum, pyoderma gangrenosum
ocular: uveitis

180
Q

what is a porcelain gall bladder? which pathology? increases risk of which cancer?

A

shrunken, hard gall bladder due to chronic inflammation, fibrosis and calcification chronic cholecystitis gallbladder adenocarcinoma

181
Q

the portal triad consists of? contained within which structure?

A

hepatic artery proper hepatic portal vein common bile duct hepatoduodenal ligament

182
Q

air in the mediastinum and subcutaneous emphysema suggests? association?

A

Boerhaave syndrome

Mallory-Weiss syndrome

183
Q

parietal cells make what in the stomach?

A

acid intrinsic factor

184
Q

in hepatic fibrosis and portal hypertension, where do varices form?

A

oesophagus umbilicus (caput medusae)

Rectum (anorectal varices)

185
Q

3 groups of clinical features from cirrhosis

A
  1. decreased toxin clearance
  2. portal HTN
  3. decreased synthetic funciton
186
Q

embryonic origin of Meckel’s diverticulum

A

failure of vitelline duct to involute COMPLETELY

187
Q

clinical features of abetalipoproteinaemia (2)

A

malabsorption (cannot make chylomicrons) absent LDL or VLDL in plasma

188
Q

FAP with desmoid tumours of the retroperitoneum and osteoma, hypertrophy of retinal pigment epithelium and impacted teeth is called…

A

Gardner syndrome

189
Q

what is Krukenburg tumour? Association?

A

bilateral ovarian metastasis diffuse type gastric CA

190
Q

CA oesophagus lower 1/3rd spreads to which LNs?

A

celiac and gastric

191
Q

Wilson disease gene mutation

A

ATP7B gene (ATP-dependent copper transporter)

192
Q

polyarteritis nodosa & aplastic anaemia …which HxV?

193
Q

molecular mechanism of cell damage in Wilson disease?

A

Copper deposition in target tissues, hydroxyl-free radical production

194
Q

first enzyme activated in acute pancreatitis?

A

trypsin –> activates all other enzymes

195
Q

a rough, shaggy, white patch of discolouration on the lateral aspect of the tongue - what is this? associated condition?

A

hairy cell leukoplakia immunocompromise & subsequent infection wtih EBV, causing squamous mucosa hyperplasia (not pre-malignant)

196
Q

FAP muation?

A

APC on chromosome 5

197
Q

primary haemochromatosis gene mutation?

A

HFE, usually C282Y (cystine -> tyrosine)

198
Q

biopsy of colonic polyp shows: small, pedunculated polyp of dysplastic cells forming tube-shaped glands

A

tubular adenoma

199
Q

HNPCC - risk of which CA (3)?

A

CRC ovarian endometrial

200
Q

2 types of necrosis in acute pancreatitis

A
  1. liquefactive necrosis
  2. fat necrosis (saponification of peripancreatic fat)
201
Q

What is present in the duodenum that activated pancreatic enzymes? which enzyme is activated first?

A

duodenal brush border expression of enteropeptidase(/enterokinase) activates trypsin from trypsinogen

202
Q

2 complications of GORD

A
  1. ulceration with stricture
  2. Barret oesophagus
203
Q

most common oesophageal cancer in the world?

A

squamous cell carcinoma

204
Q

sickle cell disease predisposes to which biliary condition?

A

bilirubin gall stones

205
Q

most and least common sites of involvement in Crohn’s disease

A

most - terminal ileum least - rectum

206
Q

why is AST > ALT in alcoholic liver damage?

A

AST held within mitochondria and acetaldehyde is a mitochondrial poison

207
Q

a mobile, painless, well circumscribed mass at the angle of the jaw cause for concern?

A

pleomorphic adenoma from parotid gland no - likely benign, though high rate of recurrence

Rx surgical resection

208
Q

time cut off between acute and chronic hepatitis?

209
Q

which is worse? leukoplakia or erythroplakia?

A

erythroplakia due to highly vascularised giving red colour. more predictive of dysplasia

210
Q

Classic antibodies for coeliac disease?

A

IgA vs endomysium, tTG or gliadin higher proportion of IgA deficiency so must also test for IgG

211
Q

most affected area(s) of the small bowel?

A

jejunum (folate def) ileum (B12 def) c/o coeliac

212
Q

acute cholecystitis 2ary gall stone… most common pathogen?

213
Q

most common nidus of H Pylori infection?

A

prepyloric antrum of stomach

214
Q

which clotting study best used to follow natural history of cirrhosis?

A

PT following enzyme function of liver epoxide reductase (target of warfarin)

215
Q

complications of chronic pancreatitis (2)

A
  1. 2ary type 1 DM
  2. pancreatic carcinoma arising from pancreatic ducts
216
Q

most affected area of bowel on Coeliac disease?

217
Q

most likely type of CA in proximal 2/3rds of oesophagus

A

squamous cell carcinoma

218
Q

in cirrhosis, which is the key cel mediating fibrosis? which cytokine is implicated?

A

stellate cell TGF-beta

219
Q

zone 3, pericentral vein, of liver lobule is preferentially affected in which pathologies?

A

alcoholic hepatitis ischaemia metabolic toxins (as contains P450 system)

220
Q

through which GI layer must an EROSION pass in order to be called an ULCER?

A

muscularis mucosa (just below the mucosal layer, above the submucosa)

221
Q

membranoproliferative GN is best associated with which HxV?

222
Q

annular pancreas complication?

A

duodenal obstruction

223
Q

OCP use association with which GI cancer?

A

hepatic adenoma benign - will regress upon cessation of drug

224
Q

Mumps complications (3)

A
  1. orchitis and subsequent sterility (only teenagers)
  2. pancreatitis (amylase is not an indicator with mumps infection b/c salivary glands also release it)
  3. aseptic meningitis
225
Q

FBC finding of hypersplenism?

A

anaemia thrombocytopenia

226
Q

lymphatic drainage from below the pectinate line

A

superficial inguinal LNs

228
Q

failure of ventral wall rostral fold closure leads to what?

A

ectopia cordis (sternal defects)

229
Q

failure of ventral wall lateral fold closure leads to what?

A

omphalocele, gastroschisis

230
Q

ventral wall caudal fold closure leads to what?

A

bladder exstrophy

231
Q

double bubble sign suggests what?

associated with what congenital condition?

A

duodenal atresia

Down’s syndrome

232
Q

what is the pathogenesis of jejunal/ileal atresia?

A

disruption of mesenteric vessels, ischaemic necrosis, segmental resorbtion

233
Q

pyloric stenosis associated with in utero exposure to what drug?

A

macrolide antibiotics

234
Q

what segment of developing gut is the pancreas from?

235
Q

retoperitoneal structures

A

Suprarenal (adrenal)

Aorta and IVC

Duodenum (2nd & 4th parts)

Pancreas (except tail)

Ureters

Colon (ascending and descending)

Kidneys

Esophagus (thoracic)

Rectum

236
Q

falciform ligament

connects and contains?

A

liver to ant abdominal wall

ligamentum teres hepatis

237
Q

hepatoduodenal

connects and contains

A

liver to duodenum

portal triad: proper hepatic artery, hepatic portal vein, common bile duct

(red, green, blue)

238
Q

gastrohepatic

connects and contains

A

liver to lesser curvature of stomach

gastric ateries

239
Q

gastrocolic ligament

connects and contains

A

greater curvature of stomach to transverse colon

gastroepiploic arteries

240
Q

gastrosplenic ligament

connects and contains

A

greater curvature of stomach to spleen

short gastrics, left gastroepiploic artery

241
Q

splenorenal artery

connects and contains

A

spleen to posterior peritoneum

splenic artery and vein; tail of pancreas

242
Q

where do you find Brunner glands and what do they do?

A

duodenum; submucosa

bicarb secretion

243
Q

what are Peyer patches and where do you find them?

A

lymphoid aggregates/tissue in the lamina propria/submucosa

ileum

244
Q

who gets superior mesenteric artery syndrome and why?

A

low BMI/malnutrition

less adipose tissue between SMA and 3rd horizontal portion of duodenum

245
Q

spleen arises from what germ layer?

246
Q

draw the coeliac trunk

247
Q

what is the portosystemic anastamosis affected in caput medusae?

A

paraumbilical veins (become distended)

shunt blood back to small epigastric veins

248
Q

what is the portosystemic anastamosis affected in anorectal varyx?

A

superior rectal (proximal to dentate line)

shunts blood to middle and inferior rectal veins

249
Q

what anal cancer do you get above the dentate line?

A

adenocarcinoma

250
Q

what anal cancer do you get below the dentate line?

A

squamous cell carcinoma

251
Q

arterial supply above and below the dentate line

A

above - superior rectal from IMA

below - inferior rectal from pudendal

252
Q

what nerve gives perianal sensation below the dentate line (i.e. affected in external haemorrhoids)

A

inferior rectal, branch of pudendal n.

253
Q

what are the layers of the spermatic cord?

what are the linings of the abdominal wall that they correspond to?

A
  • internal spermatic fascia - transversalis fascia
  • cremaster - internal oblique
  • external spermatic fascia - aponeurosis of external oblique
254
Q

what is the anatomic space through which a direct inguinal hernia protrudes?

what are the borders?

A

Hesselbach triangle

lateral - inferior epigastric vessels

medial - lateral wall of rectus abdominis

inferior - inginal ligament

255
Q

meconium discharge from umbilicus soon after birth is suggestive of …

A

persistent vitelline duct

256
Q

pathoG

99mTc-pertechnetate scan showing collection in the right lower quadrant

A

Meckel diverticulum

257
Q

the ventral pancratic duct gives rise to what normally?

A

uncinate process, main pacreatic duct, portion of head of pancreas

258
Q

venous drainage of internal haemorrhoids

A

superior and middle rectal vein

inferior mesenteric vein and internal iliac respectively

259
Q

venous drainage of external haemorrhoids

A

inferior rectal vein

internal pudendal, internal iliac vein

260
Q

what are the layers of GI wall present in Meckel’s diverticulum?

A

True diverticulum so it contains all of the layers

mucosa, submucosa, muscularis and serosa

261
Q

gastric varices isolated to the fundus of the stomach suggests what?

A

splenic vein thrombosis

2ary to pancreatitis, pancreatic CA or other abdominal tumours

262
Q

what structure separates the duodenum from the jejunum?

A

ligament of Treiz

264
Q

gastrin

function and secretion site

A

increase gastric H+ secretion

G cells of gastric antrum and duodenum

265
Q

somatostatin

function and site of secretion

A

decrease secretion of all other gut hormones

D cells of pancreatic islets and gut mucosa

266
Q

cholecystokinin

function and site of secretion

A

gall bladder motilityl, secretion of pancreatic enzymes, HCO3- secretion

I cells of small intestine

267
Q

secretin

function and site of secretion

A

increase HCO3- production from duodenum and pancreas, pancreatic enzyme release, decrease gastric H+ secretion

S cells of duodenum

268
Q

GIP

function and site of secretion

A

stimulate insulin release, decrease gastric H+ secretion

K cells of small intestine

269
Q

motilin

function and site of secretion

A

increase gut motility

M cells of small intestine

270
Q

what is the GI effect of erythromycin and what is the mechanism?

A

diarrhoea

activation of the motilin receptor in the stomach and duodenum

271
Q

what are P450 inducers?

A

NEURO: carbamazepine, barbs, phenytoin, modafinil, St John’s Wort

ID: rifampin, griseofulvin

Immuno: cyclophosphamide

272
Q

what are P450 inhibitors?

A

ID: isoniazid, ritonavir, fluoroquinolones, azole antifungals, clarithromycin

cardio: amiodarone
gastro: cimetidine (histamine antagonist for PUD)
other: grapefruit juice

273
Q

what is the acetylcholine receptor present on parietal cells that controls gastric acid secretion? stimulation of this results in what?

A

M3

stimulation = gasric acid release

274
Q

what is cimetidie?

what is the main limitation of this drug?

A

treatment for GORD/GERD - zantac

inhibitor of H2 receptor. effective in preventing gastric acid release in response to gastrin/histamine release, but no effect on vagal gastric acid secretion which is mediated through M3 receptors

275
Q

what is diphenoxylate?

A

opioid anti-diarrhoeal

binds mu-opioid receptors, decreases GI motility

276
Q

what enzyme is inhibited by fibrate antitriglyceridaemic drugs that promotes formation of gall stones?

A

cholesterol 7-alpha hydroxylase

USMLE S1 (16 decks)

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