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USMLE STEP 1 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

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USMLE® Step 1 flashcards
1
Q

The most common cause of acute abdomen

A

appendicitis

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2
Q

Appendicitis- causes

A

1) lymphoid hyperplasia (children)

2) fecaliths (adult)

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3
Q

Appendicitis- presentation

A

periumbilical pain migrating to RLQ pain, nausea, guarding, rebound tenderness, periappendiceal abscess (complication)

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4
Q

Ulcerative colitis- distribution of inflammation

A

Ulceration in the mucosa and submucosa, usually extending contiguously from the rectum. May go up to cecum.

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5
Q

Ulcerative colitis- presentation

A

Bloody diarrhea, LLQ pain

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6
Q

Ulcerative colitis- histology

A

Crypt abscesses with neutrophils

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7
Q

Ulcerative colitis- gross and radiological findings

A

Pseudopolyps, loss of haustra (“lead pipe” appearance on imaging)

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8
Q

Ulcerative colitis- complications

A

Toxic megacolon, carcinoma

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9
Q

Ulcerative colitis- associated disorders

A

primary sclerosing choleangitis, p-ANCA positivity

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10
Q

Crohn’s disease- distribution of inflammation

A

full thickness from mouth to anus, often with skip/patchy distribution. Often involves ileum; rarely involves rectum.

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11
Q

Crohn’s disease- presentation

A

non-bloody diarrhea, RLQ pain

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12
Q

Crohn’s disease- histology

A

lymphoid aggregates, non-caseating granulomas

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13
Q

Crohn’s disease- gross and radiological findings

A

cobblestone mucosa, creeping fat, strictures (string-sign with barium)

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14
Q

Crohn’s disease- complications

A

malabsorption, vitamin D and B12 deficiency, calcium oxalate nephrolithiasis, fistulas, cancer

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15
Q

Crohn’s disease- associated disorders

A

ankylosing spondylitis, sacroiliitis, migratory polyarthritis, erythema nodosum, uveitis

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16
Q

Duodenal atresia- etiology

A

failure of canalization in the duodenum

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17
Q

Duodenal atresia- association

A

Down Syndrome

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18
Q

Duodenal atresia- presentation

A

polyhydramnios, bilious emesis, “double-bubble” sign

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19
Q

Meckel diverticulum- etiology

A

failure of vitelline duct to invaginate

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20
Q

Meckel diverticulum- presentation

A

Symptoms: Often asymptomatic, or bleeding, volvulus, intussusception, or obstruction during first 2 years of life.
Clinical: stool-like feeling in area of umbilicus. 2 inches long in the small bowel within 2 feet of the ileocecal valve.

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21
Q

Volvulus- etiology

A

Twisting of bowel along its mesentery, leading to obstruction and infarction

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22
Q

Volvulus- location

A

Sigmoid in elderly; cecum in young adults

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23
Q

Intussusception sign

A

Currant jelly stool (due to infarction)

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24
Q

Intussusception causes

A

Lymphoid hyperplasia in children (e.g. virus); tumor in adults

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25
Q

Transmural small bowel infarction- causes

A

Embolism/thrombosis of superior mesenteric artery or thrombosis of superior mesenteric vein

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26
Q

Mucosal small bowel infarction- causes

A

Marked hypotension

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27
Q

Small bowel infarction- presentation

A

Abdominal pain, bloody diarrhea, decreased bowel sounds

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28
Q

Causes of lactose intolerance

A

Congenital (rare), aging, post-infectious (transient)

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29
Q

Test to rule out celiac

A

(Negative for) HLA-DQ2 and HLA-DQ8

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30
Q

Celiac- laboratory testing

A

IgA to tTG, gliadin, endomysium. If IgA is low (common in celiac), check IgG.

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31
Q

Celiac- histology findings

A

Flattening of villi, hyperplasia of crypts, and intraepithelial lymphocytes. Mostly in the duodenum.

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32
Q

Celiac- complications

A

Small bowel carcinoma, enteropathy-associated T cell lymphoma (EATL)

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33
Q

Tropical sprue- key differences with celiac sprue

A

Caused by an unknown organism, follows infectious diarrhea, primarily affects jejunum and ileum (rather than duodenum), and responds to antibiotics

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34
Q

Whipple disease-etiology

A

Systemic tissue damage. Tropheryma whipplei bacteria are incorporated into macrophages in the lamina propria. These macrophages compress the lacteals and cause fat malabsorption.

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35
Q

Whipple disease- locations outside of GI system

A

synovium, cardiac valves, lymph nodes, CNS

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36
Q

Abetalipoproteinemia- inheritance and etiology

A

autosomal recessive deficiency of apolipoproteins B-48 and B-100. B-48 is needed to make chylomicrons, leading to fat malabsorption. B-100 is needed to make VLDL and LDL, so these are absent.

37
Q

Carcinoid tumor- cell type

A

neuroendocrine cells

38
Q

Carcinoid tumor- stain

A

chromogranin, synaptophysin, cytokeratin

39
Q

Carcinoid tumor- most common GI location

A

small bowel

40
Q

Why isn’t there carcinoid syndrome if it is confined to the small intestine?

A

5-HT is metabolized to by 5-HIAA by MAO in the liver after going through portal circulation.

41
Q

Carcinoid syndrome- symptoms

A

Bronchospasm, diarrhea, flushing

42
Q

Carcinoid syndrome- aggravating factors

A

Emotional stress and alcohol

43
Q

Carcinoid syndrome- cardiac effects and tumor location if these are present

A

Fibrosis, deposition of collagen within valves of right heart. Tricuspid regurgitation, pulmonary stenosis. Left side unaffected due to MAO in lungs. Tumor located in liver (hepatic vein drains to IVC).

44
Q

Rovsing’s sign and significance

A

Pushing on left side of abdomen hurts right side of abdomen; appendicitis (severe)

45
Q

McBurney’s point and significance

A

2/3 laterally on imaginary line from umbilicus to ASIS; appendicitis

46
Q

Murphy’s sign significance

A

Gallbladder (or liver) inflammation

47
Q

Hinchey stages and their use

A

Diverticulitis.

1) small abscess
2) large abscess
3) gaseous release outside colon wall
4) fecal discharge outside colon wall

48
Q

Diverticulitis- antibiotic combinations

A

1) metronidazole + quinolone
2) metronidazole + 3rd generation cephalosporin
3) Beta-lactam + beta-lactamase inhibitor (Augmentin)

49
Q

Paralytic ileus causes

A

iatrogenic/surgery, narcotics, calcium channel blockers, hypokalemia

50
Q

Inflammatory pseudopolyps- histology

A

granulation tissue, inflammatory infiltrate

51
Q

Hamartomatous polyps- histology

A

“arborizing” smooth muscle divides glands and crypts

52
Q

Juvenile/retention polyps- histology

A

cystic glands, stromal edema, inflammation, surface ulceration

53
Q

Juvenile polyposis syndrome- genes and inheritance

A

Autosomal dominant; usually SMAD4 or BMPR1A, sometimes PTEN

54
Q

Juvenile polyposis syndrome- associations

A

pulmonary arteriovenous malformation

55
Q

Cronkite-Canada syndrome- presentation

A

Like juvenile polyposis in older individual. Abnormal intervening mucosa (unlike JP), diarrhea, weight loss, and symptoms with hair, skin, and nails.

56
Q

Peutz-Jeghers syndrome- presentation

A

Hamartomatous polyps throughout GI tract, mucocutaneous hyperpigmentation on buccal mucosa and genitals

57
Q

Peutz-Jeghers syndrome- genes and inheritance

A

Autosomal dominant; LKB1/STK11

58
Q

Cowden syndrome- genes and inheritance

A

Autosomal dominant; PTEN (chromosome 10)

59
Q

Cowden syndrome- associations

A

Macrocephaly, Lhermitte-Duclos disease, benign skin tumors, thyroid tumors, breast tumors, endometrial tumors, Bannayan-Ravulcaba-Riley syndrome

60
Q

Bannayan-Ravulcaba-Riley syndrome

A

Cowden syndrome + developmental delay

61
Q

Familial adenomatous polyposis- genes and inheritance

A

APC (autosomal dominant) or MUTYH (autosomal recessive)

62
Q

Familal adenomatous polyposis- associations

A

Gardner syndrome, Turcot syndrome, congenital retinal pigment epithelial hypertrophy

63
Q

Gardner syndrome

A

FAP + fibromatosis + osteomas

64
Q

Turcot syndrome

A

FAP + CNS tumors (medulloblastoma and glial tumors)

65
Q

Hereditary non-polyposis colon cancer (Lynch) syndrome- genes and inheritance. What do the respective proteins do?

A

Autosomal dominant; usually MSH2 or MLH1 (DNA mismatch repair genes)

66
Q

Adenoma-adenocarcinoma sequence (GI)- steps

A

1) APC mutation increases the risk of polyps.
2) KRAS mutation allows formations allow of polyps
3) p53 mutation and increased COX expression cause cancer

67
Q

APC chromosome location

A

Chromosome 5

68
Q

Hereditary non-polyposis colon cancer (Lynch) syndrome- presentation

A

Fewer polyps that familial adenomatous polyposis, colorectal cancer on the RIGHT side at a young age, sometimes Turcot syndrome

69
Q

Adenoma-adenocarcinoma sequence (GI)- side

A

Usually causes left side tumors

70
Q

Colonic carcinoma is associated with an increased risk of what infection?

A

Streptococcus bovis endocarditis

71
Q

Left side colorectal cancer- symptoms

A

“Napkin ring” lesion causes reduced stool caliber, LLQ pain, blood streaking on stool

72
Q

Right side colorectal cancer- symptoms

A

Iron deficiency anemia (slow bleeding), vague pain

73
Q

What is CEA good for in colorectal cancer?

A

Monitoring treatment response and recurrence.

74
Q

What is CEA NOT good for in colorectal cancer?

A

Screening for colorectal cancer

75
Q

Right side colorectal cancer- cause

A

Microsatellite instability sequence

76
Q

Left side colorectal cancer- cause

A

Adenoma-adenocarcinoma sequence

77
Q

Simplified colorectal cancer staging

A

Stage 1: small tumor
Stage 2: big tumor
Stage 3: regional lymph node involvement
Stage 4: metastasis

78
Q

Carcinoid tumor- appearance

A

non-pedunculated bumps with yellow cut surface

79
Q

Mucus-associated lymphoid tissue (MALT) lymphoma- risk factors

A

H. pylori infection, chronic inflammation

80
Q

Mucus-associated lymphoid tissue (MALT) lymphoma- complications

A

De novo change to diffuse B cell lymphoma

81
Q

Mucus-associated lymphoid tissue (MALT) lymphoma- cell markers

A

CD20+, CD5-, CD10-

82
Q

Gastrointestinal stromal tumor (GIST)- origin

A

Interstiitial cells of Cajal

83
Q

Gastrointestinal stromal tumor (GIST)- targeted treatment

A

Imatinib if c-kit+ (CD117) or PGDFRA+

84
Q

Pancreatic cancer- metastastis mechanism

A

Epithelial-to-mesenchymal transition (EMT)

85
Q

When is ectopic gastric or pancreatic tissue observed?

A

Meckel (ilieal) diverticulum

86
Q

Mechanism of osteoporosis in celiac sprue

A

1) Decreased small bowel absorption of calcium and vitamin D cause osteomalacia
2) Cross-reacting antibodies to osteoprotegerin result in increased osteoclast activation via RANKL

87
Q

Plummer vinson syndrome triad

A

Iron-deficiency anemia, atrophic glossitis, esophageal web

88
Q

Plummer vinson syndrome association

A

increased risk of squamous cell carcinoma of the esophagus

USMLE STEP 1 (24 decks)

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