Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step 1 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Retroperitoneal structures (10)

A

SAD PUCKER. Suprarenal gland, Aorta and ivc, Duodenum (2-4th parts), Pancreas (except tail), Ureters, Colon (desc and asc), Kidneys, Esophagus (lower 2/3), Rectum (upper 2/3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In the abdomen, where is the IVC relative to the aorta?

A

To the RIGHT of the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Falciform ligament

A

Contains ligamentum teres. Derviative of fetal umbilical vein. Connects liver to abdominal wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hepatoduodenal ligament

A

CONTAINS PORTAL TRIAD. Connects greater and lesser sacs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Gastrohepatic ligament

A

Contains gastric arteries. May cut to access lesser sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Gastrocolic ligament

A

Contains gastroepiploic arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Gastrosplenic ligament

A

Contains short gastric arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Splenorenal ligament

A

Contains splenic artery and vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Histology of normal esophagus

A

Nonkeratinized stratified squamous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the arterial supply of the spleen and how does it differ from the other organs it shares arterial supply with?

A

Only mesodermal organ supplied by the celiac (all the other organs are foregut derivatives)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Arterial supply of upper lesser curavture of stomach and lower lesser curvature respectively

A

Upper - left gastric artery, lower right gastric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What structure is NOT contained in the femoral sheath

A

The femoral nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which type of inguinal hernia can form a hydrocele?

A

Indirect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which type of inguinal hernia is covered by all 3 layers of spermatic fascia?

A

Indirect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What abdominal hernias are especially common in men and which in women?

A

Indirect inguinal - all males, direct inguinal - older men, femoral - women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the leading cause of bowel incarceration?

A

Femoral hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Give the location of manufacture of all GI hormones (8)

A

Gastrin - G cells (antrum), CCK - I cells (duod, jej), Secretin - S cells (duod), Somatostatin - D cells (pancr, GI mucosa), GIP - K cells (duod, jej), VIP - Parasympathetic ganglia, NO - everywhere, Motilin - Small intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Main effects of gastrin

A

Inc gastric acid secretion, inc growth of gastric mucosa, inc gastric motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Main effects of CCK

A

Inc pancreatic secretion, inc gallbladder contraction, dec gastric emptying, inc sphincter of Oddi relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Main effects of secretin

A

Inc pancreatic bicarb secretion, dec gastric acid secretion, inc bile secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Main effects of somatostatin

A

Dec gastric acid and pepsinogen secretion, Dec pancreatic and SI fluid secretion, Dec gallbladder contraction, Dec insulin and glucagon release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Main effects of GIP release

A

Dec gastric acid secretion, inc insulin release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Main effects of VIP release

A

Inc intestinal water and electrolyte secretion, inc relaxation of intestinal SM and sphincters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Main effects of motilin secretion

A

Production of MMCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Stimulators of gastrin secretion

A

Phenylalanine and tryptophan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Where are VIPomas and what is the main symptom?

A

They are non-a non-b pancreatic islet tumors that secrete VIP and create copious diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Give the source of each of the GI secretory products (4)

A

IF - parietal cells (stomach), Gastric acid - parietal cells (stomach), Pepsin - chief cells (stomach), Bicarb - mucosal cells (stomach, duod, salivary glands, pancr) and Brunners glands (duod)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What stimulates gastric acid secretion and what inhibits it?

A

Stimulators - histamine, ACh, gastrin. Inhibitors - Somatostatin, GIP, prostaglandin, secretin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Does high salivary flow rate produce hypo, iso, or hypertonic saliva?

A

Isotonic. Normal saliva is hypotonic, but with high flow rate there isnt enough to reabsorb everything

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What cells mediate the effect of gastrin in increasing acid secretion?

A

ECL cells (this method is more important than direct stimulation of parietal cells by gastrin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What NT does the vagus nerve use to stimulate parietal cells and G cells respectively?

A

Parietal - ACh, G cells - GRP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What linkages are hydrolyzed by amylase?

A

Alpha-1,4 linkages (yielding disaccharides such as maltose and alpha limit dextrins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are glucose, galactose, and fructose taken up by enterocytes and transported to blood respectively by?

A

Into enterocytes - Glucose and Galactose are SGLT1, Fructose is GLUT-5. Into blood - All are GLUT-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

D-xylose absorption test

A

Distinguishes GI mucosal damage from other causes of malabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is secretory IgA composed of?

A

Two IgA monomers, a J chain, and a secretory component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are bile acids conjugated to to make them soluble?

A

Glycine or taurine (the result of which is bile salts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Most common salivary gland tumor

A

Pleomorphic adenoma of parotid. Next most common is Warthins then mucoepidermoid carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Globus sensation

A

Feeling of lump in ones through with no other signs. Often triggered by strong emotion, benign.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Infectious cause of secondary achalasia

A

Chagas disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Causes of esophagitis

A

HSV-1 (punched out ulcers), CMV (linear ulcers), Candida (white pseudomembrane), chemical ingestion. Association with reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Risk factors for esophageal SCC and adenocarcinoma respectively

A

SCC - Alcohol, Achalasia, Cigarettes, Esophageal web, Esophagitis. Adenocarcinoma - Barretts, Diverticula (eg Zenkers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

In what part of the esophagus do you typically get SCC and adenocarcinoma respectively?

A

SCC - upper 2/3, adenocarcinoma - lower 1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What stain should you use to diagnose malabsorption and what does it stain for?

A

Sudan III stains for fecal fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Differences between celiac sprue and tropical sprue

A

Tropical is probably infectious, and it affects the whole small bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Infectious agent in Whipples disease

A

Tropheryma whippellii

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Arthralgias, cardiac and neurologic symptoms, PAS positive macrophages, gram positive bacteria

A

Whipples disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Who gets Whipples disease most often?

A

Older men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What part of the bowel is most affected by celiac sprue?

A

Distal duodenum or proximal jejunum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Two things looked for in lactose tolerance test

A

Reproduction of symptoms, and if glucose rises less than 20 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Histologic findings in celiac sprue

A

Blunting of villi, lymphocytes in the lamina propria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Association between celiac sprue and cancer

A

Moderately increased risk of T-cell lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Blood chemistry findings in celiac sprue

A

Vitamin D deficiency (dec Ca, dec PO4, inc PTH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Curlings ulcer

A

Decreased plasma volume (as in burns) leads to sloughing of gastric mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Cushings ulcer

A

Brain injury leads to increased vagal stimulation, inc ACh, increased H+ production, ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Types of chronic gastritis

A

Type A (fundus and body) - autoimmune, pernicious anemia. Type B (antrum) - H Pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Menetriers disease

A

Gastric hypertrophy with protein loss, parietal cell atrophy and increased mucous cells. Precancerous. Stomach looks like brain (many folds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Krunkenbergs tumor

A

Bilateral stomach mets to ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the difference between a gastric ulcer and a gastric erosion?

A

Erosion doesnt penetrate muscularis mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Triple therapy

A

Peptic ulcers. PPI, clarithromycin, amoxicillin (or metronidazole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Difference in appearance between a duodenal ulcer and carcinoma

A

Punched out margins unlike ulcer (ca is raised and irregular). Ulcer gives no increased risk of ca (unlike gastric ulcer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Extraintestinal manifestations of Crohns

A

Migratory polyarthritis, erythema nodosum, immunologic disorderes, kidney stones (reduced Ca-oxalate binding in intestine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Treatment for Crohns

A

Corticosteroids, infliximab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Which type of immunologic reaction mediates Crohns and UC respectively?

A

Crohns - Th1, UC - Th2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Extraintestinal manifestations of UC

A

Pyoderma gangrenosum, PSC, AS, Uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Treatment for UC

A

Sulfasalazine, 6-MP, Infliximab, Colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Complications of UC

A

Malnutrition, PSC, toxic megacolon, colorectal carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is a fecalith and what might it cause?

A

It is a fecal stone. Can lead to appendicitis in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Difference between a true and false diverticulum and which type is a Meckels?

A

True - all 3 layers, False - only mucosa and submucosa. Meckels is true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Give the diverticulum type, location, and symptoms of a Zenker diverticulum

A

False. Junction of pharynx and esophagus. Halitosis, dysphagia, obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What tend to be the properties of colonic diverticula?

A

Pulsion (caused by herniation through a weak spot during a BM) and false (do not contain all 3 layers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Most common congenital anomaly of the GI tract

A

Meckels diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Complications of Meckels diverticulum

A

Melena, RLQ pain, Intussusception, Volvulus, Obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Rule of 2s for Meckels diverticulum

A

2 inches long, 2 ft from ileocecal valve, 2 percent of population, presents in first 2 years, 2 types of epithelia (gastric/pancreatic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Test of choice to diagnose Meckels diverticulum

A

Pertechnetate study for ectopic uptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What bowel abnormality can cause currant jelly stool in kids and what causes it?

A

Intussusception. Usually idiopathic, may be adenovirus or other viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What genetic disorder is associated with meconium ileus?

A

CF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What increases risk for necrotizing entercolitis in newborns?

A

Prematurity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Pain after eating and weight loss in elderly

A

Ischemic colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Angiodysplasia

A

Tortuous dilation of vessels and bleeding. Most often in cecum, terminal ileum, ascending colon. Older pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Most common non-neoplastic polyp in colon and most common location

A

Hyperplastic. Rectosigmoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Are juvenille polyps malignant?

A

Not if single. If part of Juvenile polyposis syndrome there is an increased risk of adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Peutz-Jeghers findings and genetics

A

AD. Multiple nonmalignant hamartomas in GI tract with hyperpigmented mouth, lips, hands, genitalia. Increased risk of CRC and other visceral malignancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Abdominal pain, distention, constipation, microcytic hypochromic anemia, mucous diarrhea, positive guaiac

A

Large (usually villous) polyps. May progress to adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

FAP genetics, which gene is mutated, what does this gene do and what chromosome is it on

A

AD. APC gene (intercellular adhesion) or chromosome 5q

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Gardners syndrome

A

FAP with osseous and soft tissue tumors, retinal hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Turcots syndrome

A

FAP with malignant CNS tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Genetics of HNPCC and where in the colon it hits

A

AD mutation of DNA mismatch repair genes. 80 percent progress to CRC. Proximal colon always involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Risk factors for CRC besides FAP and HNPCC

A

IBD, strep bovis, tobacco use, large villous adenomas, juvenile polyposis syndrome, Peutz-Jeghers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Most common location of CRC and the presentation of CRC in this area

A

Rectosigmoid. Presents with constipation, distention, nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What should iron deficiency anemia in males over 50 and postmenopausal females raise suspicion of?

A

Colorectal Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Barium Enema X-Ray findings in CRC

A

Apple core lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Sequence of mutations in chromosomal instability pathway to CRC

A

Loss of APC gene (decreased adhesion), K-RAS mutation (unregulated signal transduction), Loss of p53 (tumorigenesis). Adenomas have completed first 2 steps, carcinomas all 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Histologic appearance of carcinoid tumors

A

Minimal to no variation in shape and size of the cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What constitutes 50 percent of small bowel tumors?

A

Carcinoid tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Most common sites of carcinoid tumors

A

Appendix, ileum, rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Wheezing, right-sided heart murmur, diarrhea, flushing

A

Carcinoid syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What 3 findings in portal hypertension are due to altered estrogen metabolism (decrease of catabolism and increase in SHBG)?

A

Spider nevi, gynecomastia, testicular atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Etiologies of cirrhosis

A

Alcohol, viral hepatitis, biliary disease, hemochromatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Aminotransferases in alcoholic hepatitis

A

AST greater than ALT (often by 2 to 1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is Alk Phos a good marker for?

A

Obstructive liver disease (incl HCC), Bone disease, bile duct disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Besides acute pancreatitis, what is amylase a good marker for?

A

Mumps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Best lab markers of alcoholism

A

Inc GGT and Inc MCV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Findings in Reyes syndrome

A

Mitochondrial abnormalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What precipitates Reyes syndrome usually

A

Salicylates given during viral infection in kids (esp VZV and Influenza B)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Mechanism of Reyes syndrome

A

Aspirin metabolites inhibiting beta-oxidation by reversible inhibition of mitochondrial enzymes

106
Q

In what conditions is increased incidence of HCC seen?

A

Hep B, Hep C, Wilsons disease, hemochromatosis, A1-antitrypsin def, Alcoholic cirrhosis, Aflatoxin exposure

107
Q

Jaundice, tender hepatomegaly, ascites, polycythemia, hypoglycemia

A

HCC

108
Q

Marker for HCC and a common complication

A

A-FP and Budd-Chiari syndrome

109
Q

Most common benign liver tumor, who gets it, and management

A

Cavernous hemangioma. Typically age 30-50. DO NOT BIOPSY (it will bleed like crazy)

110
Q

Signs of congestive liver disease (ala RHF) without JVD

A

Budd-Chiari

111
Q

Causes of Budd-Chiari

A

Hypercoagulable states, polycythemia vera, pregnancy, HCC

112
Q

Genetics of A1-Antitrypsin deficiency

A

Co-dominant

113
Q

How might A1-Antitrypsin deficiency present in neonates

A

Jaundice, hepatitis, cholecystitis

114
Q

What is a synergistic risk factor with A1-Antitrypsin deficiency and what are they a risk for?

A

Smoking. Enormous risk for emphysema

115
Q

Neonatal jaundice is caused by less than normal levels of what enzyme?

A

UDP-glucoronyl transferase

116
Q

What is the deficiency in Gilbert and how does it present?

A

Mild deficiency of UDP-glucoronyl transferase or bilirubin uptake. Essentially asymptomatic (may have some jaundice after fasting or stress)

117
Q

Jaundice, kernicterus, inc unconjugated bilirubin in newborn

A

Crigler-Najjar type 1. Give plasmapheresis and phototerapy

118
Q

Difference in severity and treatment between Criggler-Najjar type 1 and 2

A

Type 2 less severe and respond to phenobarbital (inc liver enzyme synthesis)

119
Q

Defect and findings in Dubin-Johnson

A

Defective Organic Anion Transporting Polypeptide (OATP, cant excrete conjugated bilirubin from liver). Grossly black liver. Benign

120
Q

What is the defective process in Criggler-Najjar and Dubin-Johnson respectively?

A

Criggler-Najjar is conjugation. Dubin-Johnson is excretion

121
Q

Rotors syndrome

A

Similar to Dubin-Johnson (cant excrete conjugated bilirubin from liver) but milder and no black liver

122
Q

Primary sites of copper accumulation in Wilsons

A

Liver, brain, cornea, kidneys, joints

123
Q

Neurologic findings in Wilsons

A

Basal ganglia degeneration (Parkinsonian symptoms), Asterixis, Dementia, Dyskinesia, Dysarthria

124
Q

Bronze diabetes

A

Hemochromatosis

125
Q

Genetics of primary hemochromatosis

A

AR

126
Q

Treatment for hereditary hemochromatosis

A

Phlebotomy, deferoxamine

127
Q

Pruritis, jaundice, dark urine, light stools, hepatosplenomegaly

A

Biliary tract disease (SBC, PBC, or PSC)

128
Q

Which biliary tract disease is more common in men and which in women

A

Women - PBC, Men - PSC

129
Q

Histology of cholestasis

A

Deposition of bile pigment within hepatic parenchyma, green-brown plugs within dilated bile cannaliculi. Can cause malabsorption of ADEK (and thus osteomalacia among other things)

130
Q

What type of antibodies are associated with a biliary tract disease and which disease? Include antibody isotype

A

Anti-Mitochondrial Antibodies (including IgM) with PBC

131
Q

Gallstone risk factors

A

Female Fat Fertile Forty

132
Q

What is the intermediate step between gallbaldder hypomotility and gallstone formation?

A

Biliary sludge (cholesterol, calcium bilirubinate, mucous)

133
Q

Gallstone colors

A

Black - hemolysis associated, Brown - infection associated

134
Q

Gallstone ileus

A

A gallstone obstructing the ileocecal valve. Occurs secondary to a fistula between gallbladder and SI (will see air in biliary tree)

135
Q

Autodigestion of what enzyme is especially important in acute pancreatitis?

A

Trypsin

136
Q

Causes of acute pancreatitis

A

GET SMASHED. Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia/Hypertriglyceridemia (over 1000), ERCP, Drugs (eg sulfa drugs)

137
Q

Epigastric pain radiating to back, anorexia, nausea

A

Acute pancreatitis

138
Q

Complications of acute pancreatitis

A

DIC, ARDS, diffuse fat necrosis, hypocalcemia, pseudocyst formation, hemorrhage, infection, multi-organ failure

139
Q

Pseudocyst

A

Fluid rich in enzymes and inflammatory debris walled off by granulation tissue and fibrosis (seen in acute pancreatitis)

140
Q

Porcelain gallbladder

A

Bluish, brittle, calcium ladden gallbladder wall from chronic cholecystitis. 11 to 33 percent will develop gallbladder carcinoma. Recommend cholecystecomy

141
Q

Primary associations of chronic pancreatitis

A

Alcoholism and smoking

142
Q

Risk factors for pancreatic adenocarcinoma

A

Smoking (BUT NOT ALCOHOL), chronic pancreatitis, age over 50, jewish or AA male

143
Q

Abdominal pain radiating to back, weight loss, migratory thrombophlebitis, obstructive jaundice with palpable gallbladder

A

Pancreatic adenocarcinoma

144
Q

Cimetidine, ranitidine, famotidine, nizatidine

A

H2 blockers. Decreased acid secretion. PUD, gastritis, mild GERD

145
Q

Cimetidine and ranitidine side effects

A

Cimetidine - P450 inhibition, antiandrogenic (gynecomastia, impotence, etc), confusion, dizziness, headaches, cross placenta. Both - dec renal creatinine excretion

146
Q

Omeprazole and lansoprazole

A

Proton pump inhibitors. Use in PUD, GERD, Z-E syndrome

147
Q

Bismuth, sucralfate

A

Physically protect ulcer base and allow bicarb secretion to restablish pH. Use in ulcer healing and travelers diarrhea

148
Q

Misoprostol

A

PGE1 analog. Protects gastric mucosa. Use in NSAID induced PUD, maintenance of PDA, induction of labor. DO NOT GIVE IN PREGNANCY

149
Q

Octreotide

A

Somatostatin analog. Use in variceal bleeds, acromegaly, VIPoma, carcinoid

150
Q

Over use of aluminum hydroxide (an antacid) can cause what problems?

A

Constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures

151
Q

Overuse of magnesium hydroxide (an antacid) can cause what problems?

A

Diarrhea, hyporeflexia, hypotension, cardiac arrest

152
Q

Overuse of calcium carbonate (an antacid) can cause what problems?

A

Hypercalcemia, rebound acid increase

153
Q

Overuse of antacids can cause what electrolyte abnormality?

A

Hypokalemia

154
Q

Osmotic laxiatives

A

Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose. Use in constipation also hepatic encephalopathy (lactulose)

155
Q

Infliximab

A

Antibody to TNF-a. Use in Crohns and RA

156
Q

Sulfasalazine

A

Sulfapyridine (antibacterial) with 5-ASA (anti-inflammatory). Use in UC and Crohns

157
Q

Ondansetron

A

5-HT3 antagonist, antiemetic.

158
Q

Precipitants of hepatic encephalopathy

A

GI bleeds (eg hematemsis), hypovolemia, hypokalemia, metabolic acidosis, hypoxia, sedative usage, hypoglycemia, infection

159
Q

Metoclopramide

A

D2 receptor antagonist. Inc resting tone, contractility, LES tone, motility. Use for gastroparesis. May cause parkinsonism

160
Q

Are systemic symptoms (fever, lymphadenopathy) a component of primary HSV, recurrent HSV, or both?

A

Primary only

161
Q

Esophageal biopsy from an HIV patient shows multinucleated cell with multiple intranuclear inclusions

A

Herpes esophagitis

162
Q

What causes hairy leukoplakia and where is it seen?

A

Lateral border of tongue, due to EBV infection

163
Q

Causes of exudative tonsilitis

A

Viral (70 percent) - adenovirus, EBV. Group A beta hemolytic strep (30 percent)

164
Q

White plaque-like lesion that wont come off when you scrape it

A

Leukoplakia. Biopsy it

165
Q

Where is the first place you see hyperpigmentation in Addisons?

A

Buccal mucosa

166
Q

Why doesnt mumps orchitis cause infertility?

A

Because it is unilateral

167
Q

What part of the esophagus would MG affect and why?

A

Upper 1/3 (because its skeletal muscle). Middle 1/3 is a mix, Lower 1/3 is smooth (affected by Scleroderma)

168
Q

Finding during pregnancy in which a TE fistula has occurred

A

Polyhydramnios

169
Q

Area of weakness in a Zenkers diverticulum

A

Cricopharyngeous muscle

170
Q

What hormone in the ganglion cells of the LES act to relax the LES?

A

VIP. Ablation (eg to treat achalsia) will reduce VIP levels

171
Q

Romanas sign

A

Swelling of the eye. Associated with Chagas disease

172
Q

Where in the abdomen would you feel a knot on exam in the case of congenital pyloric stenosis

A

RUQ

173
Q

Difference in results between urease test and H pylori Ab test

A

Urease test indicates CURRENT infection, Ab test indicates an H pylori infection currently or any time in the past (permanent positive)

174
Q

Where are most gastric ulcers and gastric cancers respectively

A

Both are in the lesser curvature of the pylorus and antrum (think right gastric artery distribution)

175
Q

Most common cause of stomach cancer

A

H pylori

176
Q

What malignancy do duodenal ulcers put you at risk for?

A

Trick question. NONE. Duodenal ulcers are never malignant

177
Q

Melena means a GI bleed above what point, and what makes it black?

A

Above ligament of trietz (duod-jej junction). Acid converts Hb to hematin (black)

178
Q

Rhinitis plastica

A

A type of gastric adenocarcinoma. Signet ring cells invade stomach wall. Weight loss, epigastric distress, gastroparesis

179
Q

How does a Krukenberg tumor get to the ovary?

A

Hematogenous spread (not seeding)

180
Q

Differential for signet ring cells in ovary

A

Krunkenberg tumor. There is no primary signet ring cell tumor in the ovary

181
Q

List ethnically associated cancers (4)

A

NPC - China, Stomach cancer and HTLV-1 - Japan, Burkitts Lymphoma - Africa

182
Q

What other cancers (besides gastric adenocarcinoma) likes to met to Virchows node?

A

Pancreatic and cervical cancer

183
Q

Causes of bile salt deficiency (5)

A

Liver disease, Obstruction of bile flow, Bacterial overgrowth, Termineal ileal disease (eg Crohns), Cholestyramine

184
Q

How does the causal agent of Whipple disease show up on Gram stain?

A

It doesnt. It is gram positive but doesnt show on gram stain. You have to use EM to see it (cannot be cultured)

185
Q

What infection causes symptoms similar to Whipple disease in AIDS patients

A

MAI

186
Q

Two main causes of secretory diarrhea and what the toxin of each targets

A

Vibrio cholerae (works via cAMP) and ETEC (works via guanylate cyclase)

187
Q

Two most common causes of invasive diarrhea in the US

A

Campylobacter jejuni followed by shigella

188
Q

C difficile causes pseudomembranes. What are two other organisms that can cause pseudomembranes in the GI tract?

A

Campylobacter and Shigella

189
Q

Most common cause of diarrhea due to a parasite in the US

A

Giardia

190
Q

Most common cause of diarrhea in AIDS patients

A

Cryptosporidium parvi

191
Q

Treatment for Giardia

A

Metronidazole

192
Q

Test of choice if you suspect C dif

A

Toxin assay of stool

193
Q

Treatment for C dif

A

Metronidazole

194
Q

What does colicky pain indicate

A

Small bowel obstruction (in bile duct obstruction you get crampy pain)

195
Q

Most common cause of small bowel obstruction

A

Adhesions from previous surgeries

196
Q

Weight lifter with a bowel obstruction and no history of surgery

A

Indirect inguinal hernia

197
Q

Difference in presentation between small bowel infarct and ischemic ulcer in the splenic flexure?

A

Small bowel infarction will have DIFFUSE abdominal pain. Ischemic colitis will point to specific area (splenic flexure). Both will have bloody diarrhea

198
Q

Two most common causes of hematochezia in old people

A

Diverticulosis followed by angiodysplasia

199
Q

Hematemesis, pain in RLQ, melena

A

Meckels diverticulum. Combination of melena and hematemsis rules out UC and Crohns

200
Q

Persistence of what structures leads to feces and urine respectively draining out the umbilicus?

A

Feces - Vitelline duct, Urine - Uracus

201
Q

Most common location for cancer, polyps, and diverticula respectively in GI tract

A

Sigmoid colon (for all 3)

202
Q

Which way (relative to the lumen) do polyps and diverticula respectively go?

A

Polyps into the lumen, Diverticula out

203
Q

What do they call left sided appendicitis

A

Diverticulitis

204
Q

Most common type of fistulas in diverticulitis

A

Colovesicle fistula

205
Q

Which part of the distal GI tract does each IBD prefer?

A

Crohns prefers the anus, UC prefers the rectum

206
Q

Colicky pain in the RLQ in a young person

A

Crohns

207
Q

String sign, apthus (linear) ulcers, and cobblestoning

A

Crohns

208
Q

What is the rule for the hematologic complications of hemorrhoids

A

Internal hemorrhoids bleed, external hemorrhoids thrombose

209
Q

Most common cause in children and adults respectively of something red sticking out the butt

A

Child - juvenile polyp, Adult - prolapsed internal hemorrhoid

210
Q

Most common location for a carcinoid tumor

A

Tip of the appendix

211
Q

Why do appendiceal carcinoid tumors never cause carcinoid syndrome?

A

Because they cant be more than 2 cm, which is the length required to metastasize (which is required for carcinoid syndrome)

212
Q

Most common location of the original tumor in carcinoid syndrome

A

Terminal ileum

213
Q

Marker for carcinoid tumor

A

Urinary 5-HIAA

214
Q

What vitamin deficiency can you get in carcinoid syndrome and why?

A

Pellagra, because you are using all your tryptophan to make serotonin instead of niacin

215
Q

Most common cause of colon cancer and reason why

A

Lack of fiber in diet, higher exposure to lipocolic acid

216
Q

Give the general class of diseases that cause unconjugated, intermediate, and conjugated hyperbilirubinemia respectively

A

Unconjugated - hemolytic anemias (also Criggler-Najjar and newborn jaundice), Intermediate - Hepatitis (including alcoholic), Conjugated - Bile obstruction

217
Q

What proportion of bilirubin being conjugated qualifies an intermediate hyperbilirubinemia

A

20-50 percent. Below 20 is unconjugated, Above 50 is conjugated hyperbilirubinemia

218
Q

What causes light stools with dark (tea colored) urine?

A

Conjugated hyperbilirubinemia secondary to bile obstruction

219
Q

Test of choice for Gilberts syndrome

A

24 hour fasting test

220
Q

Why is AST more elevated than ALT in alcoholic hepatitis?

A

Because AST is present in hepatocyte mitochondria (ALT is in cytosol) and alcohol is a mitochondrial poison

221
Q

What liver enzymes signal bile obstruction?

A

Alk Phos and GGT

222
Q

Best tests for severity of liver damage

A

Albumin and PT

223
Q

Most common viral hepatitis

A

A, followed by B, followed by C, followed by D, followed by E

224
Q

Only protective hepatitis antibodies

A

Anti-HAV (IgG), Anti-HBs, Anti-HEV

225
Q

First marker of Hep B

A

HBsAg

226
Q

Only Hep B elements that are infective

A

HBeAg and HBV DNA

227
Q

First Ab produced in Hep B infection

A

Anti-HBc IgM

228
Q

Most common outcome of Hep B infection

A

Recovery (90 percent). In HIV most common outcome is chronic disease

229
Q

First and last things to go away in clearing a Hep B infection

A

First to go away is HBeAg and HBV DNA. Last is HBsAg

230
Q

What combination of Hepatitis antigen results is not possible based on the progression of the disease?

A

HBeAg positive and HBsAg negative (surface arrives first and leaves last)

231
Q

Only thing present in the window period of Hep B

A

HBcAb (IgM)

232
Q

When is the Hep B window period and are you infective during this time?

A

5-6 months. Not infective

233
Q

Only Hep B marker in vaccinated persons

A

HBsAb

234
Q

What do individuals who had a Hep B infection (and recovered) have that those who were vaccinated dont?

A

HBcAb

235
Q

What organism excysts in the cecum and can cause right lobe liver abscesses?

A

Entamoeba histolytica (also flask-shaped ulcers and bloody diarrhea)

236
Q

Treatment for entamoeba histolytica

A

Metronidazole

237
Q

Only amoeba that can phagocytose RBCs

A

Entamoeba histolytica

238
Q

What is the most serious complication of sheep herders disease?

A

Rupture of the cysts leading to fluid in the abdominal cavity and anaphylactic shock

239
Q

What type of host is the patient in sheep herders disease and t. solium infection respectively?

A

Sheep herders - intermediate (dog is definitive), T. solium - can be intermediate or definitive

240
Q

What organs do T. solium larvae particularly target?

A

Eye and brain (cysticercosis)

241
Q

Ito cell

A

Stores Vitamin A in the liver. Makes fibrous tissue and collagen in alcoholic hepatitis

242
Q

Histology of PBC

A

Granulomatous destruction of bile duct in the portal triad

243
Q

Treatment for intrahepatic cholestasis associated with pregnancy

A

None. Delivery of the baby will take care of this

244
Q

Two drugs that cause intrahepatic cholestasis

A

OCPs and anabolic steroids

245
Q

Two drugs that predispose to hepatic adenoma

A

OCPs and anabolic steroids

246
Q

Complication of hepatic adenoma

A

If it ruptures it can kill you (inraperitoneal hemorrhage like crazy)

247
Q

Chorea, dementia, and cirrhosis

A

Wilsons

248
Q

Treatment for Wilsons

A

Penicillinamine

249
Q

3 times when gynecomastia is normal for men

A

Newborn, puberty, elderly

250
Q

Is gynecomastia unilateral or bilateral?

A

Can be either

251
Q

Hand abnormalities in alcoholic cirrhosis

A

Palmar erythema (hyperestrinism) and dupuytrens contractures

252
Q

Infectious complication of ascites

A

Spontaneous peritonitis due to e coli

253
Q

You have a child and an adult respectively with ascites and spontaneous peritonitis. What is the organism?

A

Child - strep pneumo. Adult - e coli

254
Q

What ectopic hormones can HCC produce?

A

Epo (polycythemia) and IGF (hypoglycemia)

255
Q

What is a common way in which HCC is found?

A

Patient with long term cirrhosis begins to lose weight and ascites gets worse. Blood found on peritoneal tap.

256
Q

You find cannoball metastases in the liver. Where is the most likely primary site of the cancer?

A

Smoker - Lungs, Nonsmoker - Colon

257
Q

For what abdominal organ is ultrasound not the imaging test of choice?

A

Pancreas (overlying bowel makes it tough to see)

258
Q

What chromosome is CFTR on?

A

7

259
Q

Most common cause of death in CF?

A

Psuedomonas aeruginosa

260
Q

When would a pancreatic pseudocyst likely show up?

A

About 10 days after an episode of acute pancreatitis

261
Q

Sentinel sign

A

Sign of acute pancreatitis with inflammation. Duodenum next to pancreas stops peristalsing right in the area of the inflammation

262
Q

Gray-Turner sign

A

Flank hemorrhage usually due to hemorrhagic pancreatitis

Step 1 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions