Brainscape's Knowledge GenomeTM

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


See full index

UWorld > Gastrointestinal and nutritional > Flashcards

Gastrointestinal and nutritional Flashcards

1
Q

what is the benefit of combining magnesium salts and aluminum hydroxide in an antacid preparation

A

to reduce adverse side effects

aluminum hydroxide causes constipation and magnesium salts cause diahrrea

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

indication for magnesium salts and aluminum hydroxide

A

neutralize gastric acid and relieve gastroesophageal reflux symtpoms

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

what is the function of cholangiocytes

A

bile duct epithelial cell that transports solutes and electrolytes into bile

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

what is the function of hepatocytes

A

protein, cholesterol, and bile synthesis
gluconeogenesis
drug and fatty acid metabolism

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

function of Kupffer cells

A

macrophages within hepatic sinusoids

phagocytosis of bacteria and RBCs

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

function of stellate cells

A

quiescent phase: vitamin A storage

activated phase: transform into myofibroblast to secrete collagen (primarily involved in hepatic fibrosis)

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

what cell type contributes to scar formation and cirrhosis in the liver

A

stellate (ito) cells

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

what are the manifestations of cirrhosis (clinical signs)

A

jaundice
scleral icterus
spider angiomas
elevated liver enzymes

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

what is Meckel’s diverticulum

A

partial failure of the ophalomesenteric (vitelline) duct to obliterate

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

how might Meckel’s diverticulum present?

A

(most are asymptomatic)

rectal bleeding or intestinal obstruction

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

what is the rule of 2s with Meckel’s diverticulum

A 
2% of the population
2 feet from the ileocecal valve
2 inches in length
2% are symptomatic
males are 2 times more likely to be affected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what layers are present in a false diverticula vs a true diverticulum

A

false: mucosa and submucosa
true: mucosa, submucosa, muscularis

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

in addition to mucosa, submucosa and muscularis, what other tissue might be present in a Meckel’s Diverticulum

A

ectopic mucosa
(gastric epithelium is most common and pancreatic tissue is the next most common)
(ectopic gastric tissue secretes gastric acid that can cause ulceration and lower GI bleeding)

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

what is the pathogenesis of diabetic gastroparesis

A

autonomic neuropathy
destruction of enteric neurons
failure of relaxation in fundus and uncoordinated peristalsis

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

what is the clinical presentation of a patient with diabetic gastroparesis

A

postprandial bloating and vomiting
early satiety
impaired nutrition and weight loss

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

treatment for diabetic gastroparesis

A

promotility drugs: metoclopramide, erythromycin

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

after food passes down the esophagus, vagally stimulated enteric neurons release ______ to induce relaxation of the fundus of the stomach and accommodate the incoming food bolus

A

nitric oxide

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

specialized gastric pacemaker cells (_______) initiate pacesetter potentials (slow waves), which generate circumferential contractions of the gastric smoth muscle (peristalsis)

A

interstitial cells of Cajal

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

what is the diagnosis of someone with a BMI <18.5 with enlarged parotid glands

A

anorexia nervosa

if they are under 18.5, even if they binge and purge, they are diagnosed with anorexia

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

how does C. Dif. cause diahrrea

A

toxins inactivate Rho-regulatory proteins involved in actin cytoskeletal structure –> loss of cytoskeleton integrity –> cell rounding/retraction –> disruption of intercellular tight junctions –> increased paracelljular fluid secretion

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

how does C. Dif. cause pseudomembrane formation

A

toxins have inflammatory effects (neutrophil recruitment) and can induce apoptosis which results in pain and pseudomembrane formation

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

gastrin: action and secretion site

A 
increase gastric H+ secretion
G cells (gastric antrum and duodenum)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

somatostatin: action and secretion site

A 
decrease secretion of most GI hormones
D cells (pancreatic islets, gut mucosa)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

cholecytokinin: action and secretion site

A 
increase pancreatic enzyme and HCO3 secretion
I cells (small intestine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

secretin action and secretion site

A

increases pancreatic HCO3 secretion and decreases gastric H+ secretion
K cells

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

GIP action and secretion site

A 
increases insulin release and decreases gastric H+ secretion
K cells (small intestine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

motilin action and secretion site

A 
increases GI motility 
M cells (small intestine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is the most potent stimulus for secretin release

A

release of gastric acid into the duodenum

begins at pH below 5 and rises dramatically as the pH drops below 3

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

what are gastric varices

A

dilated submucosal veins that can cause life threatening bleeding in the upper gastrointestinal tract

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

the ____ vein runs along the posterior surface of the pancreas and can develop a blood clot from pancreatic inflammation

A

splenic

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

the ____ veins drain the fundus of the stomach into the splenic vein

A

short gastric

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

splenic vein thrombosis can increase pressure in the short gastric veins and cause gastric varices only in the ____. The rest of the stomach and esophagus are not usually affected.

A

fundus

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

what areas of the intestine are hindgut derivatives

A

distal 1/3 of transverse colon
descending colon
sigmoid colon
rectum

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

hindgut structures receive blood from ____

A

inferior mesenteric artery

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

what is the inferior mesenteric artery a branch of?

A

aorta

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

the hindgut derivatives drain into the ____ which drains into the _____

A

inferior mesenteric vein

portal vein

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

pellagra is due to ____ deficiency

A

niacin

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

what are “the 3 D’s” which characterize pellagra

A

dermatitis
diarrhea
dementia

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

what is the dermatitis presentation in peelagra

A

bilateral and symmetric on sun exposed areas of the body

characterized by rough, thick, scaly skin

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

what causes diarrhea in pellagra,

A

atrophy (and occassional ulceration) of columnar epithelium of the gastrointestinal tract

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

niacin (vitamin B3) is an essential component of what 2 coenzymes that participate in redox metabolism

A

NAD

NADP

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

if niacin is not obtained through dietary intake, what can it be endogenously synthesized from

A

tryptophan

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

what changes occur in the small intestine due to the immune mediated reaction in celiac disease causing impaired nutrient absorption

A

villous atrophy
crypt hyperplasia
intraepithelial lymphocyte infiltration

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

screening for celiac disease tests for elevated serum levels of ______ and ______

A

IgA anti-endomysial and anti-tissue transglutaminase antibodies

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

how is diagnosis of celiac disease confirmed

A

endocscopic biopsy

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

when and how does celiac disease classically present

A

between 6-24 months

abdominal pain, diarrhea, vomiting, weight loss

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

what supplies blood to the stomach, part of the duodenum, gallbladder, liver, spleen and pancreas

A

celiac trunk

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

the superior mesenteric artery and inferior mesenteric artery are connected by a pair of anastomoses: _____ and ____

A

marginal artery of Drummond (principal anastomosis)

arc of Riolan (inconsistently present)

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

how might Chron disease cause gallstones

A

terminal ileum (typical location of Crohn disease) inflammation –> bile acids lost in feces –> increased cholesterol/bile acids ration

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

protein yields ____ calories per gram

A

4

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

fat yields ___ calories per gram

A

9

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

carbohydrates yield __ calories per gram

A

4

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

ethanol yields __ calories per gram

A

7

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

define cholescystitis

A

inflammation of the gallbladder

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

acute cholecystitis is cause by what in more than 90% of cases

A

gallstone obstruction of cystic duct

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

what causes colicky pain in cholecystitis

A

ingestion of fatty foods –> contraction of gallbladder against impacted stone

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

how is ultrasonography used to diagnose acute cholecystitis

A

diagnosis can be made by identifying signs of gallbladder inflammation (wall thickening, pericholecystic fluid)

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

when ultrasound is inconclusive of cholecystitis diagnosis what can be used

A

nuclear medicine hepatobiliary scanning (cholescintigraphy) to asses cystic duct patency and make diagnosis

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

what causes hepatic encephalopathy

A

neurologic complication of cirrhosis due to liver’s inability to convert ammonia to urea (excess ammonia crosses BBB –> altered mental status)

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

how can GI bleeding precipitate hepatic encephalopathy

A

hemoglobin breakdown leads to increased nitrogen products. nitrogen breakdown by intestinal bacteria = primary source of ammonia

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

how does Rifaximin treat hepatic encephalopathy

A

it is a nonabsorbable antibiotic that alters GI flora to decrease intestinal production and absorption of ammonia

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

how does lactulose help treat hepatic encephalopathy

A

it is catabolized by intestinal bacterial flora to short chain fatty acids which lowers the colonic pH and increases conversion of ammonia to ammonium

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

why is vitamin D supplementation indicated in infants

A

if they are exclussively breastfed
lack of sunlight exposure
dark skin pigmentation

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

breast milk contains all vitamins except__ and ___

A

vitamin D

vitamin K

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

how is vitamin K supplmeneted to new borns

A

intramuscular injection at delivery to prevent hemorrhagic disease in the newborn

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

what causes annular pancreas

A

abnormal migration of the ventral pancreatic bud

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

the ventral pancreatic bud is a _____ derrivative that appears the 5th week of gestation and rotates ___ the duodenum during the 7th week

A

foregut

behind

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

the ventral pancreatic bud gives rise to what portions of the pancreas

A

uncinate process portion of the head and the main painceatic duct (of Wirsung)

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

what is an annular pancreas

A

congenital anomaly in which pancreativ tissue completely surrounds the second part of the duodenum

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

while most patients with annular pancreas are asymptomatic, what are 2 ways it can cause symptoms

A

it can compress the duodenal lumen causing obstruction or result in obstructed pancreatic drainage and cause acute or chronic pancreatitis

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

what are 2 ways that gastric secretions are neutralized in the gut

A

alkaline mucous secreted by submucosal Brunner glands

pancreatic alkaline secretions

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

where are submucosal (Brunner) glands found

A

most numerous at the pylorus but may be found intermittently up to the ampulla Vater

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

how are submucosal (Brunner) glands stimulated

A

tactile stimulation and increased parasympathetic activity following meals
acid –> secretin release –> stimulation of submucosal glands and pancreas

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

what can cause hyperplasia of the submucosal (Brunner) glands

A

chronic overproduction of gastric acid

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

what does the presence of a fluid filled cavity in the liver in conjunction with fevers, chills, and right upper abdominal pain suggest

A

hepatic abscess

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

what is the most common cause of hepatic abscesses in developing countries

A

parasitic infections (entamoeba histolytica, echinococcal)

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

what are hepatic abscesses in the united states most oftenly caused by

A

bacterial infection

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

what route of hepatic access would cause a hepatic abscess due to staphylococcus aureus

A

hepatic artery due to hematogenous seeding

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

how could Entamoeba histolytica cause a hepatic abscess

A

(most often transmitted though foodborne exposure)

ascending from the colon through the portal venous system

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

how can enteric bacteria cause hepatic abscesses

A

ascending the bilary tract (ascending cholangitis)
portal vein pyemia
direct invasion from adjacent area (cholecystitis)

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

Is Hep B or C more likely to be passed sexually

A 
Hep B
(Hep C is more commonly spread through intravenous drug use)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

acute hepatitis B presentation

A

systemic, skin, and joint symptoms; hepatomegaly; elevated transaminase levels
patients may also develop serum sickness-like syndrome and right upper quadrant pain

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

what is the most important early serum marker of acute infection of hepatitis B

A

hepatitis B surface antigen (HBsAg)

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

the spleen is derived from what embryologic tissue

A

mesoderm

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

how do diltiazem and verapamil cause constipation

A

they are non-dihydrophyridine calcium channel blockers
constipation is due to inhibition of the colonic migrating motor complex resulting in slowed contractions of colonic smooth muscle

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

what is ascites

A

accumulation of fluid within the peritoneal cavity

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

what effect does portal hypertension in cirrhosis have on splanchnic vascular resistance

A

nitric oxide is released in cirrhosis –> splanchnic vasodilation –> decreased splanchnic vascular resistance

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

what effect does cirrhosis have on effective arterial blood volume

A

NO release –> splanchnic vasodilation –> blood pools in splanchnic vascular bed –> decreased effective arterial blood volume

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

what effect does cirrhosis have on RAAS

A

low perfussion pressure –> activation of RAAS –> retention of sodium and water

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

how is vascular permeability altered in chirrosis

A

it is not changed

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

what change does cirrhosis have on oncotic pressure

A

decreased plasma oncotic pressure (due to hypoalbuminemia due to impaired hepatic function)

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

what are the 3 main causes of HIV associated esophagitits

A

Candida
CMV
HSV

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

how can CMV esophagitis be characterized endoscopically?

A

large, shallow linear ulcerations with intraneuclear and cytoplasmic inclusions microscopically

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

where does most cutaneous lymph from the umbilicus down drain?

A

superficial inguinal lymph node

exceptions = glans penis and posterior calf drain to deep inguinal nodes

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

where does lymph from the superior portion of the bladder drain?

A

external iliac nodes

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

where does lymph drain from inferior portion of the bladder

A

internal iliac nodes

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

lymph from the prostate drains primarily to what lymph node?

A

internal iliac nodes

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

lymph from the testes drains where?

A

abdominal para-aortic lymph nodes

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

lymph from the upper 1/3 of the rectum drains to where?

A

inferior mesenteric lymph nodes

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

what can cause diabetic diarrhea

A

diabetic autonomic neuropathy

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

what are the branches of the splenic artery

A

pancreatic branches
left gastroepiploic artery
short gastric branches

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

why are tissues supplied by the short gastric arteries vulnerable to ischemic injury following splenic artery blockage

A

they have poor anastomoses

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

the splenic artery originates from the ___ artery

A

celiac

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

what is pernicious anemia

A

autoimmune disorder caused by cell mediated destruction of parietal cells –> decreased intrinic factor–> B12 deficiency –> megaloblastic anemia

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

where are parietal cells found? (layer and area of stomach)

A

upper glandular layer of gastric body and fundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

what substrate can bypass phosphofructokinase in glycolysis

A

fructose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

why is fructose metabolized by the liver faster than the other monosaccharides

A

fructose bypasses phosphofructokinase which is one of the key enzymes involved in regulating the rate of glycolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

dietary fructose is phosphorylated in the liver to ____ by _____

A

fructose-1-phosphate

fructokinase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

what does 99mTc-pertechnetate have an affinity for and what does increased uptake of 99mTc-pertechnetate in the periumbilical/right lower quadrant indicate?

A

parietal cells

Meckel diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

what is the prognosis of colorectal cancer confined to the basement membrane or lamina propria? what is the strongest predictor of metastatic potential in colorectal cancer

A

good prognosis

lymph node spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

what type of transport is blocked by omeprazole

A

primary active transport (K+H+ ATPase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

A histopathologic analysis of a colon sample shows acute inflammatory changes, epithelial necrosis, and a layer of denuded epithelium, fibrin, and inflammatory cells overlaying the mucosa. What is this describing?

A

a psuedomembrane (can be caused by C. Diff)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Patients with severe C. Dif. may develop nonobstructive colonic dilation, aka ________, which increases their risk of colonic perforation

A

toxic megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

what is Wilson disease?

A

autosomal recessive disorder characterized by excessive copper deposition in the liver, basal ganglia, and cornea due to impaired hepatocellular copper transport (decreased biliary excretion of copper)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

what is the first line treatment of Wilson disease and how does it work

A

penicillamine
copper chelating agent
binds free copper and reduces copper bound to other proteins –> increases urinary excretion of copper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

in a female presenting with a tender bulge below the inguinal ligament, lateral to the pubic tubercle, what has likely occurred?

A

femoral hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

in a femoral hernia, what are the structures that run directly lateral to teh bulge

A

femoral vein –> femoral artery –> femoral nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

what muscles must relax in order to defecate?

A 
internal sphincter (reflex)
external sphincter and puborectalis muscle (voluntary)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

what is dyssyndergia

A

stool remains in rectal vault despite attempts to initiate bowel movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

what causes secondary lactase deficiency

A

aquired condition resulting from inflammation/infection (ie bacterial overgrowth, infectious enteritis, Crohn disease) that causes injury to mucosal brush border where lactase is expressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

what changes in stool pH are seen in lactase deficiency

A

decreased stool pH

fermentation of undigested lactose –> short chain fatty acid production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

what changes in hydrogen breath content are seen in lactase deficiency

A

increased breath hydrogen content (due to hydrogen production during lactose fermentation in the gut)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

what changes are seen in stool osmolarity in lactase deficiency

A

elevated stool osmolarity due to high amounts of undigested lactose in the stool (causes excess water to enter lumen causing osmotic diarrhea)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

what vitamins can be produced by enteric bacteria that may overgrown in the gut?

A

vitamin K

folate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

enteric bacteria can digest unabsorbed dietary sugars and convert them to ____

A

fatty acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

small intestinal bacterial overgrowth results in a deficiency of most vitamins and iron, but increased production of ____ and ____

A

folic acid

vitamin K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

vitamin B12 (cobalamin) is acquired from ______

A

animal products and cannot be obtained from plant products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

vitamin B12 deficiency develops only after the complete absence of intake for ____ years

A

4-5

body is capable of storing about 1,000 times the daily requirement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

what severe neurologic changes can occur due to vitamin B12 deficiency

A

subacute combined degeneration of the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

to discourage abuse, diphenoxylate is combined with ____, which induces adverse effects if taken in high doses

A

atropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

A patient with impaired driving in low light conditions (night blindness) and thickened, dry skin (hyperkeratosis) are suggestive of ____ deficiency.

A

vitamin A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

what are causes of vitamin A deficiency in patients who have adequate dietary intake of vitamin A

A

Malabsorption related to biliary obstruction, exocrin pancreatic insufficiency, or bowel resection (ie Crohn disease, bariatric surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

what age related changes happen in the liver which decrease its ability to metabolize drugs

A

decreased liver mass
decreased hepatic blood flow
decreased cytochrome P-450
reduced rate of hepatic regeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

do aminotransferase levels change naturally due to age?

A

no (elevations should raise concern for hepatic disease or hepatotoxin exposure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

vitamin B12 deficiency can result in elevated levels of serum ____ and ______

A

methylmalonic acid

homocysteine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

in patients with vitamin B12 deficiency, increased levels of ____ can disrupt myelin synthesis and result in subacute combined degeneration of the doral columns and lateral corticospinal tract

A

methylmalonic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

what is the mnemonic for retroperitoneal abdominal organs?

A 
SAD PUCKER
suprarenal (adrenal) glands
aorta and inferior vena cava
duodenum (except first part)
pancreas (head and body)
ureters
colon (ascending and descending)
kidneys
esophagus
rectum (mid-distal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

what is gallstone ileus

A

an uncommon complication of longstanding cholelithiasis that usually occurs in elderly women when a large gallstone causes formation of a cholecystoenteric fistula between the gallbladder and adjoining gut due to pressure necrosis and erosion of these tissues
the gallstone passes into the small bowel and becomes trapped at the ileum (narrowest portion) an causes symtpoms of a small bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

what is pneumobilia

A

when gas enters the biliary tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

what is biliary atresia

A

progressive, complete, or partial obstruction of extrahepatic bile ducts
biliary tree is normal at birth but subsequently undergoes destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

what symptoms are caused by biliary atresia

A

jaundice within first 2 months
dark urine
acholic (pale/clay colored) stools

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

what laboratory finding is indicative of cholestasis

A

elevated direct bilirubin

and elevated gamma-glutamyl transferase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

how is Strongyloides stercoralis transmitted?

A

filariform (infectious) larvae found in soil contaminated with human feces, on contact the larvae penetrate the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

how does Strongyloides stercoralis spread within the body?

A 
penetrates the skin
migrates hematogenously to the  lungs
enter alveoli
travel up bronchial tree to pharynx
swallowed
develop into adults in intestines and lay eggs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

what is found in the stool of a person infected with Strongyloides stercoralis

A

rhabditiform (noninfectious) larvae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

how is Strongyloidiasis treated

A

ivermectin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

what is larva currens (see in stronguloidiasis infection)

A

pruritic, erythematous linear streaks that may occur on the thighs and buttocks as the larva migrate subcutaneously away from perianal region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

how does a strongyloides stercoralis become a hyperinfection?

A

Rhabditiform larvae can mature into filariform larva in the human gastrointestinal tract, precipitating an autoinfection cycle and can massively disseminate leading to multiorgan dysfunction and septic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

a draining fistula near a patients coccyx who is complaining of abdominal cramping pain over several years and fluctuating diarrhea likely has what diagnosis

A

Crohn Disease

inflames all layers of the bowel making it likely to form fistulas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

anal fissures occur most commonly at what location

A

posterior midline (likely due to decreased blood flow in this area)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

low fecal elastase can help diagnose what?

A

pancreatic insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

what does Sudan staining on stool samples identify?

A

fecal fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

what are the 3 main airway protective movements that occur during normal swallowing

A

displacement of the larynx superiorly and anteriorly under the tongue
tilting of the epiglottis
adduction of the vocal folds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

a chin tuck maneuver (flexion of the head and neck during swallowing) is helpful to some stroke patients to prevent choking by simulating what air way protective movement of normal swallowing

A

elevation of the larynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

what infection can cause achalasia and is endemic to central and south america

A 
trypanosoma cruzi
(Chagas)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

what are possible manifestations of Trypanosoma cruzi (Chagas) infection?

A

achalasia
nonischemic cardiomyopathy
megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

what is the only part of the duodenum that is not retroperitoneal

A

first part

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

what portion of the duodenum contains the ampulla of Vater and is in close relation to the head of the pancreas

A

second part

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

what is the ampulla of vater

A

the site where pancreatic and common bile duct secretions are released

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

what part of the duodenum courses over the abdominal aorta and inferior vena cava

A

third part

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

what portion of the duodenum is in close association with the unicate process of the pancreas and the superior mesenteric artery and vein

A

third part

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

what is the vasa recta

A

terminal vessels derived from the superior and inferior mesenteric arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

how are diverticula related to the vasa recta

A

diverticula tend to form at weak points in the colon such as where the vasa recta penetrate through the smooth muscle layer of the colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

what is the likely cause of painless hematochezia in a patient with chronic diverticula

A

as diverticula enlarge, the vasa recta are exposed and become vulnerable to chronic injury which can lead to intraluminal hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

bisacodyl MOA

A

stimulant laxative

others include senna and castor oil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

what is the manifestation of Reye syndrome

A

acute liver failure

encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

what affect does administering salicylates to children with viral infection have that precipitates Reye syndrome

A

salicylates can damage mitochondria within hepatocytes and inhibit enzymes involved in FA beta oxidation –> liver cannot keep up with metabolic demands –> acute liver failure –> build up of ammonia –> enceophalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

an acid fast stain revealing oocysts in stool and histopathology showing villous blunting with inflammatory infiltrate in the lamina propria in a HIV patient with diahrrea likely has what infection

A

cryptospordium parvum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

ulcers located on the ____ wall of the duodenal bulb are more likely to perforation

A

anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

ulcers located on the ___ wall of the duodenal bulb are more likely to cause hemorrhage

A

posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

when an ulcer penetrates the posterior duodenal wall, it is likely to erode into the ____ artery

A

gastroduodenal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

The distal esophagus is normally attached to the diaphragm by the ________ at the _____ junction

A

phrenoesophageal membrane

gastroesophageal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

sliding hiatal hernias are the most common form of hiatal hernia and occur due to _____

A

laxity of the phrenoesophageal membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

what causes paraesophageal hernias and what structure herniates into the thoracic cavity?

A

defects in the membrane

gastric fundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

Wilson disease is characterized by copper accumulation due to defective ____

A

copper transport protein (ATP7B)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

in midgut malrotation, the cecum rests in the right upper quadrant and _______ connect the retroperitoneum in the RLQ to the right colon/cecum by passing over the second part of the duodenum causing intestinal obstruction

A

Ladd’s (fibrous) bands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

what is midgut volvus

A

intestinal ischemia due to twisting around the blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

cystic fibrosis causes steatorrhea and failure to thrive due to malabsorption secondary to _____

A

pancreatic insufficiency

pancreatic enzyme supplementation can help correct this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

explain the inflammation distribution of the liver in acute viral hepatitis

A

panlobular lymphocytic inflammation

it may bridge into adjacent hepatic lobules due to collapse of the reticulin framework

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

in acute viral hepatitis what causes hepatocytes to appear as Councilman bodies: round, acidophilic (pink on hematoxylin and eosin staining)

A

cytotoxic T cell mediated apoptosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

describe the inflammation in chronic viral hepatitis

A

usually significant inflammation surrounding the portal triad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

intravenous drug use is a major risk factor for hepatitis ___ and ____

A

B

C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

what is intussusception

A

invagination of a portion of the intestine into the lumen of the adjacent intestinal segment (telescoping)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

where is the most common region that intussusception occurs

A

area of ileocecal valve/ileocolic junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

what are the symptoms of intussusception

A

intermittent, sever, colicky abdominal pain
currant jelly stools
palpable mass in the right lower abdominal quadrant (sometimes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

Zollinger Ellison syndrome is caused by a ____-secreting neuroendocrine tumor

A

gastrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

symtpoms of Zollinger-Ellison syndrome

A

abdominal pain and acid reflux

sometimes diarrhea as gastric acid damages intestinal epithelial cells and inactivates pancreatic enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

what should be excluded when making a diagnosis of zollinger ellison syndrome

A

multiple endocrine neoplasia type 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

what is Lynch syndrome

A

hereditary nonpolyposis colon cancer due to defective DNA mismatch repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

mutations in what 2 genes account for around 90% of cases of Lynch syndrome

A

MSH2 and MLH1

MutS and MutL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

Cirrhosis can cause hyperestrinism which results in what clinical features

A

gynecomastia
spider angiomata
testicular atrophy
decreased body hair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

cholangiocarcinoma is malignancy of the _____

A

bile duct epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

what condition is cholangiocarcinoma associated with? (although it can occur sporadically)

A

sclerosing cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

when does cholangiocarcinoma start to produce symptoms

A

when the tumor obstructs bile drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

what symptoms are caused by cholangiocarcinoma

A 
progressive weight loss
RUQ pain
jaundice 
hepatomegaly
(cholestatic liver injury)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

how does loperamide slow peristalsis

A

inhibits acetylcholine release

197
Q

All biochemical functions of folate require the reduced ______ form of the vitamin which is synthesized by dihydrofolate reductase (rate limiting step in folate metabolism)

A

tetrahydrofolate

198
Q

The enzyme ____ is responsible for converting dUMP to dTMP

A

thymidylate synthase

199
Q

folate deficiency inhibits the synthesis of nucleic acids but ____ supplementation bypasses this enzyme and can reduce erythroid cell apoptosis

A

thymidine

200
Q

prognosis of esophageal squamous cell carcinoma

A

poor

201
Q

the histopathological features of esophageal ______ include solid nests of neoplastic squamous cells with abundant eosinophilic cytoplasm and distinct borders with areas of keratinization (keratin pearls and intracellular bridges.

A

squamous cell carcinoma

202
Q

what is the initial diagnostic testing done for celiac disease

A

anti-tissue transglutaminase IgA assay

203
Q

diagnosis of celiac disease is confirmed with duodenal biopsy showing what

A

earliest histologic finding= intraepithelial lymphocytosis

later: crypt hyperplasia and villous blunting

204
Q

celiac disease occurs almost exclusively in individuals with what HLA sterotypes

A

HLA-DQ2 or DQ8

205
Q

what is acute acalculous cholecystitis

A

acute inflammation of the gallbladder in absence of gallstones that typically occurs in critically ill patients (those with sepsis, severe burns, trauma, immunosupression) due to gallbladder stasis and ischemia

206
Q

how do hydrophilic bile acids treat gall stones

A

reduce cholesterol secretion and increase biliary bile acid concentration which increases cholesterol solubility and promotes stone dissolution

207
Q

what arteries run along and perfuse the lesser curvature of the stomach and are a common source of hemorrhage from penetrating gastric ulcers

A

left and right gastric arteries

208
Q

why are infarcts in an otherwise normal liver rare?

A

it has a dual blood supply (portal vein and hepatic artery)

209
Q

what is a possible diagnosis for postpradial epiastric pain which does not respond to antacids and associated food aversion/weight loss in a patient with generalized atherosclerosis

A

chronic mesenteric ischemia

210
Q

what is the diagnosis of a newborn with respiratory distress, unilateral decreased breath sounds, scaphoid abdomen and chest xray revealing cystic structures

A

congenital diaphragmatic hernia

211
Q

congenital diaphragmatic hernia is a congenital malformation caused by failure of the ______ folds to close

A

pleuroperitoneal

212
Q

what 4 tissues form the diaphragm

A

septum transversum
esophageal mesentery
musculature from the body wall
pleuroperitoneal folds

213
Q

______ is a nonmalignant lesion, most commonly occuring in young women that appears as small, solitary, pale nodules composed of cords of normal-appearing hepatocytes and central stellate scar with fibrous septae that surround abnormally large artery

A

focal nodular hyperplasia

214
Q

what is the best, most sensitive strategy for screening for malabsorption

A

test for fat malabsorption via qualitative assay of stool with Sudan III stain
(stool should usually contain no measurable fat)

215
Q

how does carbon tetrachloride induce hepatic injury

A

it is oxidized by p450 and forms free radicals resulting in lipid degeneration and hydrogen peroxide formation (lipid peroxidation)

216
Q

the venous components of internal hemorrhoids drain into the ____ vein which communicated with the ____ vein

A

superior rectal

inferior mesenteric

217
Q

external hemorrhoids drain via the _____ vein into the _____ vein which communicates with the ____- veins

A

inferior rectal
internal pudendal
internal iliac

218
Q

parietal cells release HCl in response to what 3 major stimulants

A

histamine
vagal output/ Acetylcholine
gastrin

219
Q

gastric cancer occurs with highest incidence in patients from eastern asia, eastern europe, and south africa possible due to increased consumption of _____

A

salt preserved foods

220
Q

what is systemic mastocytosis

A

clonal mast cell proliferation in bone marrow, skin, and other organs

221
Q

mast cell proliferation often is associated with mutations in the ____ receptor tyrosine kinase

A

KIT

222
Q

what are some symptoms of systemic mastocytosis

A 
(all due to increased histamine release)
hypotension
flushing
pruritus
hypersecretion of gastric acid
223
Q

excessive _____ secretion can result in watery diarrhea, hypokalemia, and achlorhydria (WDHA) syndrome

A

vasoactive intestinal peptide

pancreatic cholera

224
Q

vasoactive intestinal peptide stimulates pancreatic ___ and ____ secretion

A

bicarbonate

chloride

225
Q

how does vasoactive intestinal peptide cause secretory watery diarrhea

A

binds intestinal epithelial cells –> activated adenylate cyclase –> increased cAMP –> sodium, chloride, and water secretion into bowel

226
Q

what decreases VIP production and can be used to treat some VIPomas

A

somatostatin (ocretotide)

227
Q

epidural metastasis (most commonly from lung cancer) can cause which syndrome causes bilateral lower extremity weakness, bowel/bladder dysfunction, and impaired perineal sensation

A

cauda equina syndrome

228
Q

what nerves provide parasympathetic innervation to the hindgut, bladder, and urinary sphincters

A

pelvic splanchnic nerves

S2-S4

229
Q

what stimulant of gastric acid secretion also has trophic effect on parietal cells causing parietal cell hyperplasia

A

gastrin

230
Q

zollinger-ellison syndrome causes peptic ulcers and parietal cell hyperplasia with _____ enlargement due to gastrin hypersecretion

A

gastric fold

231
Q

what cellular changes characterize hepatocyte necrosis

A

cellular swelling and cytoplasmic emptying

ballooning degeneration

232
Q

what cellular changes occur during acute hepatits

A

hepatocyte ballooning degeneration
apoptosis
mononuclear cell infiltration

233
Q

proton pump inhibitors can cause malabsorption of what 4 things?

A

calcium
iron
magnesium
vitamin B12

234
Q

why might PPI initiation increase fat absorption in patient on exogenous pancreatic enzyme replacement

A

lipase is inactivated by acidic environment

PPI increases lipase activity by protecting it in stomach by decreasing acidity

235
Q

what is primary biliary cholangitis

A

chronic liver disease characterized by autoimmune destruction of the intrahepatic bile ducts and cholestasis

236
Q

what is usually the first symptom of primary biliary cholangitis

A

pruritus

fatigue is also often reported

237
Q

primary biliary cholangitis diagnosis is confirmed by _____ antibodies

A

anti-mitochondrial

238
Q

What causes hypervariability in hepatitis C virus

A

no proof reading 3’ –> 5’ exonuclease activity

239
Q

why can D-xylose be absorbed normally in pancreatic insufficiency

A

it is a monosaccharide which do not requires pancreatic enzymes, they are directly taken up by epithelial cells of small intestine through sodium dependent cotransport or facilitated diffusion

240
Q

how does NSAID use affect risk of esophageal adenocarcinoma

A

NSAIDs may be protective

241
Q

what are risk factors for esophageal adenocarcninoma

A

chronic GERD
obesity
smoking
meds that lower esophageal sphincter pressure (nitroglycerin)
consumption of nitroso containing foods (processed meats)

242
Q

____ is important cofactor for carboxylase enzymes, playing a role in carbohydrate, lipid, and amino acid metabolism. In the liver it is required for conversion of pyruvate to oxaloacetate for gluconeogenesis

A

biotin (vit B7)

243
Q

what disorder causes abdominal pain, heme positive stool, and noncaseating granulomas on microscopy of colon biopsy

A

Chron disease

244
Q

what changes are seen in intestinal epithelium for patients with celiac disease

A

loss of small bowel intestinal villi and mucosal atrophy

245
Q

what causes microcytic anemia in celiac disease

A

iron deficiency due to less absorption in the duodenum

246
Q

what age related changes occur in the parotid salivary glands causing dysphagia in the elderly

A

acinar atrophy and fatty infiltration

247
Q

are the following likely to be high or low in a patients gall bladder with gall stones?
cholesterol
phosphatidylcholine
bile acids

A

cholesterol: high
bile acids: low
phosphatidylcholine

248
Q

what promotes aggregation of cholesterol into stones

A

mucis hypersecretion
calcium salts
gallbladder hypomotility

249
Q

what does a positive anti-HAV IgM indicate

A

active disease

250
Q

what is the common route of infection of Hepatitis A in the united states

A

shellfish

transmitted fecal orally and contaminates water or food

251
Q

what causes Whipple disease

A

Tropheryma whipplii

252
Q

whipple disease is a rare systemic illness that involves what 3 parts of the body?

A

small intestine
joints
central nervous system

253
Q

in Tropheryma whipplii infection, Whipple disease, the actinomycete proliferates only within what cells?

A

macrophages

254
Q

classic histologic staining of Whipple disease includes foamy macrophages packed with ____ and _____

A

rod-shaped bacilli

PAS-positive, diastase-resistant granules

255
Q

clinically, Whipple disease is most commonly seen in middle-aged Caucasian males, presenting with what possible symptoms?

A 
malabsorption
diarrhea
weight loss
arthropathy
polyarthritis
psychiatric abnormalities
cardiac abnormalities
256
Q

If the appendix cannot be identified by palpation during an appendectomy, it can be located by following the _____ to its origin at the cecal base

A

teniae coli

257
Q

the teniae coli are 3 separate ______ that travel longitudinally on the outside of the colon and converge at the root of the _____

A

smooth muscle ribbons

vermiform appendix

258
Q

describe esophagus contractions in diffuse esophageal spasm

A

several segments contract inappropriately at the same time which appears as disorganized non-peristaltic contractions

259
Q

how does diffuse esophageal spasm appear on barium esophagogram

A

corkscrew

260
Q

what is the pathogenesis of diffuse esophageal spasm

A

impaired inhibitory neurotransmission within the esophageal myenteric plexus

261
Q

what is the presentation of diffuse esophageal spasm

A

intermittent solid/liquid dysphagia, chest pain, heartburn, and food regurgitation

262
Q

define cholestasis

A

any condition in which bile flow from the liver stops or slows

263
Q

what is characterized by the deposition of bile pigment within the hepatic parenchyma, often with green-brown plugs in the dilated bile canaliculi

A

cholestasis

264
Q

in contrast to true cysts with walls lined by epithelial cells, the walls of pseudocysts consist of ____

A

granulation tissue and fibrosis

265
Q

what are the common symptoms of anal squamous cell carcinoma

A

rectal bleeding
pain
pruritis

266
Q

what is the histologic description of anal squamous cell carcinoma

A

large, eosinophilic, hyperchromatic squamous cells with scant cytoplasm arranged in islands
nuclear atypia and prominent keratinization and/or keratin pearls are usually observed

267
Q

what disease is associated with anogenital and oropharyngeal squamous cell carcinoma

A

HPV (types 16 and 18 are particularly associated with malignancies)
(also HIV due to immunocompromised state)

268
Q

A vitelline duct cyst forms if peripheral portions of the vitelline duct obliterate but central parts remain. The cyst is connect to the ____ and the abdominal wall by fibrous bands

A

ileum

269
Q

Hepatitis B virus does not have cytotoxic effects itself so what causes liver damage in HBV?

A

HBsAg and HBcAg on the cell surface stimulate CD8 T lymphocytes to destroy infected hepatocytes

270
Q

what is an autosomal recessive disorder characterized by defective hepatic excretion of bilirubin glucuronides due to mutation in the canalicular membrane transport protein

A

Dubin-Johnson syndrome

271
Q

In Dubin Johnson syndrome, patients have episodes of what symptom

A

jaundice

otherwise it is asymptomatic and benign

272
Q

in Dubin Johnson syndrome, the liver appears black due to impaired excretion of _____ metabolites that accumulate within lysosomes

A

epinephrine

273
Q

How is hepatitis B transmitted

A

sexual
percutaneous
vertical

274
Q

what does Anti-HBsAg indicate

A

successful HBV vaccination
or
HBsAg clearance
(indicator of non-infectivity and immunity)

275
Q

how is hepatitis C transmitted

A

intravenous drug use

276
Q

how is HDV transmitted

A

inoculations (vaccination)
blood transfusions
sexual transmission is far less common

277
Q

neural crest cells give rise to ganglion cells of the submucosal and myenteric plexus of the bowel wall, where do they enter and how do they migrate?

A

enter developing foregut mesenchyme then migrate caudally reaching the rectum lastly at week 12

278
Q

The arrest of migration of neural crest cells causes ____ disease, in which a distal segment of colon lacks ganglion cells

A

Hirschsprung disease

279
Q

what are clinical features of Hirschsprung disease

A

delayed passage of meconium in neonates
chronic constipation
abdominal distension

280
Q

If the angle between the superior mesenteric artery and aorta diminishes less than 20 degrees, the _____ can get entrapped between the SMA and aorta

A

transverse portion of the duodenum

281
Q

What can cause narrowing of the aortomesenteric angle

A

diminished mesenteric fat (low weight, recent weight loss, severe burns, etc)
pronounced lordosis
following surgical correction of scoliosis (decreased mobility of SMA due to lengthened spine)

282
Q

irritation to what nerve can cause hiccups due to spasmodic diaphragmatic contraction pulling air against a closed larynx

A

phrenic

283
Q

although a majority is converted to nontoxic metabolites, what metabolite of acetaminophen is hepatoxic

A

unconjugated NAPQI

product of CYP450 metabolism

284
Q

when acetaminophen dosage is appropriate, NAPQI is conjugated by ____ into a nontoxic compound and eliminated in urine

A

glutathione

285
Q

although ethanol is primarily metabolized by alcohol dehydrogenase, it can also be converted to acetaldehyde by _____

A

cytochrome P450 2E1

286
Q

If a patient has an elevated alkaline phosphatase, what can be checked next in order to determine if it is of hepatic or bony origin

A

gamma glutamyl transpeptidase (GGTP)

not present in bone

287
Q

Leptin decreases the production of _____, a potent appetite stimulant, in the arcuate nucleus of the hypothalamus

A

neuropeptide Y

288
Q

Leptin stimulates the production of _____ in the arcuate nucleus.

A

proopiomelancortin

POMC

289
Q

_____ is produced by cleavage of POMC and inhibits food intake

A

alpha melanocyte stimulating hormone

alpha-MSH

290
Q

If the leptin receptor is mutated, what will the serum leptin levels and body weight of the specimen be?

A

elevated

profoundly obese

291
Q

if leptin production is impaired, what will the specimen’s leptin levels and body weight be?

A

decreased serum leptin

obese

292
Q

how is methylnatrexone able to treat opiate induced constipation without causing withdrawal symptoms

A 
peripherally acting (does not cross blood brain barrier)
so it will not induce withdrawal symptoms or disrupt analgesic effects of opioid treatment
293
Q

______ is a potential manifestation of chronic cholecystitis and is often associated with multiple gallstones. It is due to dystrophic intramural deposition of calcium salts in the setting of chronic inflammation.

A

porcelain gallbladder

294
Q

porcelain gallbladder is associated with an increased risk of ________

A

adenocarcinoma of the gallbladder

295
Q

what is the diagnosis of an esophageal mass that significantly narrows the lumen and has flattened polyhedral or ovoid epithelial cells with eosinophilic cytoplasm, keratin nests or pearls within or between cells, and intercellular bridgin

A

esophageal squamous cell carcinoma

296
Q

what are risk factors of esophageal squamous cell carcinoma

A

cigarette smoking and alcohol intake are most significant in US
N-nitroso containing foods
underlying esophageal disease
ingestion of high temperature liquids

297
Q

children with watery diarrhea should be treated with oral rehydration solutions containing hypotonic, equimolar concentrations of ____ and ____ to help prevent dehydration and electrolyte abnormalities

A

sodium

glucose

298
Q

congenital pyloric stenosis is thought to develop secondary to hypertrophy of the _____

A

pyloric muscularis mucosae

299
Q

alcohol and gallstones are the most common causes of pancreatitis. A less common cause is hyper-______

A

hypertriglyceridemia

also hypercalcemia

300
Q

In a patient with alcoholic liver disease, hematemsis, orthostatic symptoms, and normocytic anemia are likely due to acute bleeding where?

A

from esophageal varices

301
Q

Any condition that causes portal hypertension can lead to splenomegaly with congestive hyperslenism, causing apparent expansion of the ____ of the spleen

A

red pulp

302
Q

the red pulp of the spleen is composed of blood-filled sinuses and cords lined by _____ cells

A

reticuloendothelial-type

303
Q

how can somatostatin/octreotide reduce portal venous pressure

A

inhibit release of glucagon and vasoactive intestinal peptide which induce splanchnic vasodilation
(vasodilation increases the portal blood flow)

304
Q

what is CREST syndrome

A

systemic sclerosis

Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia

305
Q

What is the function of alpha-1 antitrypsin

A

serine protease inhibitor

306
Q

what causes liver disease in patients with alpha-1 antitrypsin deficiency

A

accumulation of improperly folded alpha-1 antitrypsin

307
Q

what is the pathogenesis of biliary cholangitis

A

autoimmune liver disease (antimitochondrial antibody positive)
lymphocytic infiltrates cause destruction of small and midsized intrahepatic bile ducts

308
Q

the pathogenisis of acute pancreatitis begins with either a toxic or an ischemic injury to the acinar cells that leads to premature activation of ___ inside the pancreatic acini

A

trypsin

309
Q

Pancreatic zymogens are normally converted into their active form by __ in the duodenal lumen

A

trypsin

310
Q

what is characterized histologically by the presence of “spotty necrosis” with ballooning degeneration (hepatocyte swelling with wispy/clear cytoplasm), Councilman bodies and mononuclear cell infiltrates

A

hepatitis A

311
Q

what are Councilman bodies (histologic finding in hep A)

A

eosinophilic apoptotic hepatocytes

312
Q

what are the typical presenting symptoms of hepatitis A

A 
fever
malaise
anorexia
nausea/vomiting
upper right quadrant pain
313
Q

what symptoms of Hepatitis A arise about a week after prodromal symptoms arise

A

signs of cholestasis: jaundice, pruritis, dark-colored urine, and acholic stool

314
Q

what autoimmune liver disease is histologically represented by interface hepatits: portal and periportal lymphoplasmocytic infiltrate

A

autoimmune hepatits

315
Q

what autoimmune liver disease is histologically represented by florid duct lesion: granulomatous destruction of small bile ducts

A

primary biliary cholangitis

316
Q

what autoimmune disorder is histologically represented by fibrous obliteration of bile ducts with concentric periductal deposition of connective tissue (onion skin pattern)

A

primary sclerosing cholangitis

317
Q

how does CMV esophagitis usually present

A

odynophagia (pain with swallowing) or dysphagia (difficulty swallowing) that can be accompanied by fever or burning chest pain

318
Q

what does an endoscopy of CMV esophagitis show

A

linear and shallow ulerations in the lower esophagus that sometimes diffusely involve the esophagus

319
Q

what does tissue biopsy of CMV esophagitis usually show

A

enlarged cells with basophilic or eosinophilic intranuclear inclusion bodies

320
Q

what receptor should be targeted by an anti-emetic treating nausea in a patient with travelers diarrhea

A

5HT3

321
Q

what type of hernia originates lateral to the inferior epigastric vessels

A

indirect inguinal

322
Q

what type of hernia emerges inferior to inguinal ligament

A

femoral

323
Q

what type of hernia protrudes medial to the inferior epigastric vessels

A

direct inguinal

324
Q

what is the pathophysiology of indirect inguinal hernias

A

patent processus vaginalis

325
Q

what type of hernia protrudes through the deep inguinal ring into inguinal canal and may extend into the scrotum

A

indirect inguinal

326
Q

what is the pathophysiology of a direct inguinal hernia

A

weakness of transversalis fascia

327
Q

what is the pathophysiology of a femoral hernia

A

widening of the femoral ring

328
Q

what 2 deficiencies can cause megaloblastic anemia

A

folic acid

B12 (cobalamin)

329
Q

if megaloblastic anemia due to cobalamin (B12) deficiency is treated with folate, what symptom will not improve and may get worse

A

neurologic dysfunction

330
Q

drug induced liver injury caused by inhaled anesthetic hepatotoxicity is most frequently associated with what drug

A

halothane

331
Q

how can a GI bleed exacerbate hepatic encephalopathy

A

GI bleeding causes increased hemoglobin to go to the gut which is converted to ammonia and absorbed into the bloodstream

332
Q

in hepatic encephalopathy, accumulation of ammonia and other neurotoxins results in increased _____ neurotransmission and decreased _____ neurotransmission
(excitatory or inhibitory)

A

increased inhibitory

decreased excitatory

333
Q

what location of the intestine should be biopsied when making a diagnosis for celiac disease

A

duodenum or proximal jejunum

334
Q

what antibodies are markers for celiac disease

A

tissue transglutaminase IgA

antiendomysial antibodies

335
Q

what are pigment gallstones composed of

A

calcium salts of unconjugated bilirubin

336
Q

what is typical cause of brown pigment gallstones

A

secondary to bacterial or helminthic infection of biliary tract

337
Q

what enzyme is released from damaged hepatocytes and bacteria in order to form brown pigment gallstones

A

beta glucuronidase

338
Q

beta glucuronidase hydrolyzes bilirubin glucuronides –> increased ______

A

unconjugated bilirubin

339
Q

what is the typical cause of black pigment gallstones

A

chronic hemolysis or increased enterohepatic cycling of bilirubin

340
Q

both brown and black gallstones are the result of increased levels of ______

A

unconjugated bilirubin

341
Q

how does pregnancy increase risk of GERD

A

progesterone decreases LES tone

342
Q

how does pregnancy increase risk of cholelithiasis or cholecystitis

A

estrogen increases cholesterol secretion into bile

progesterone reduces gallbladder motility

343
Q

what causes increased constipation, bloating and flatulence in pregnancy

A

progesterone decreases colonic smooth muscle activity and decreases fasting migrating myoelectric complex
gravid uterus mechanically impedes small intestine transit

344
Q

how does pregnancy cause increased risk of hemorrhoids

A

gravid uterus increases venous pressure

345
Q

what is pneumobilia?

A

air in the biliary tract

346
Q

Cesarean delivery typically involves midline vertical separation of the rectus abdominis muscle but when additional space in necessary, it can be transected horizontally which puts what vessel at risk?

A

inferior epigastric artery

347
Q

why are the inferior epigastric arteries more susceptible to injury below the arcuate line?

A

lack of a supporting posterior rectus sheath

348
Q

failure of what embryologic event results in a reducible, soft, nontender bulge at umbilicus that protrudes with increased abdominal pressure

A

incomplete closure of abdominal muscles/umbilical ring

congenital umbilical hernia

349
Q

SPINK1 function

A

(serine peptidase inhibitor Kazal-type 1)

inhibits activity of trypsinogen molecules that become prematurely activated in the pancreas

350
Q

what determines if a carcinoid tumor will cause carcinoid syndrome or not?

A

secreted vasoactive substances must bypass the liver to avoid being degraded so tumor must be extraintestinal (ie. metastasized to the liver)

351
Q

what are symptoms of carcinoid syndrome

A

skin flushing, telangiectasia, cyanosis;watery diarrhea; bronchospasms, dyspnea

352
Q

diagnosis of carcinoid syndrome includes elevated urinary excretion of _____

A

5-HIAA

5-hydroxyindoleacetic acid

353
Q

what is the result of perforated viscus in the abdomen and can be visualized on a thoracic xray

A

pneumoperitoneum (free air under the diaphragm)

354
Q

what antiemetics can be used to treat chemo induced nausea and vomiting

A

dopamine receptor antagonist
5-HT3 receptor antagonist
NK1 receptor antagonists

355
Q

what are 3 contributing factors of benign neonatal hyperbilirubinemia

A

high bilirubin production bc fetal RBCs have shorter life span
low bilirubin clearance from lower levels of hepatic uridine diphosphogluconurate (UDP) glucuronsultransferase
low bacteria in gut which usually reduces bilirubin, allowing it to be excreted into the stool

356
Q

Hepatitis B infection causes the hepatocellular cytoplasm to fill with ______

A

hepatitis B surface antigen

357
Q

Hepatocytes with finely granular, pale eosinophilic, ground glass appearing inclusions are characteristic of what disease

A

hepatitis B

358
Q

nonocclusive ischemia resulting in ischemic colitis occurs primarily at the watershed areas: _____ and _____

A

splenic flexure

rectosigmoid junction

359
Q

In a patient with acute pancreatitis, what causes chalky, white lesions to appear in the mesentery

A

lipase digests adipose cells –> fatty acids bind calcium ions –> insoluble calcium salts
these can spread to mesentery, omentum, and other parts of abdominal cavity

360
Q

Abdominal distension, bloody stools, and pneumatosis intestinalis is diagnostic for what?

A

necrotizing enterocolitis

361
Q

why are premature newborns susceptible to necrotizing enterocolitis

A

immunologic immaturity + bacteria introduction during enteral feeding –> bacteria proliferate excessively –> inflammation and ischemic necrosis

362
Q

what are possible manifestations of schistosoma infections

A

urinary (hematuria, dysuria, pyelonephritis, squamous cell carcinoma bladder)
intestinal (diarrhea, abd pain, ulceration)
hepatic (hepatomegaly, fibrosis, portal HTN)

363
Q

The spleen is intra or retroperitoneal?

A

intraperitoneal

364
Q

what is the blood supply to the spleen

A

splenic artery off the celiac trunk

365
Q

venous return from the spleen courses through the ____ vein to return to portal circulation rather than systemic circulation

A

splenic

366
Q

the spleen is of what embryonic tissue origin

A

mesodermal

367
Q

what is the mechanism of action of fibrates (2)

A

upregulate lipoprotein lipase

inhibit cholesterol 7 alpha hydroxylase

368
Q

how can fibrates increase risk of gallstones

A

inhibition of cholesterol 7 alpha hydroxylase –> inhibited synthesis of bile acids
less bile acids –> decreased cholesterol solubility in bile and favors formation of cholesterol stones

369
Q

A patient who develops lower abdominal tenderness and diarrhea while in the hospital after a round of antibiotics should be assessed for what pathogen

A

C dif

370
Q

what is the most sensitive test of C. dif diagnosis

A

nucleic acid amplification test (PCR for bacterial gene encoding toxin)
(enzyme immunoassay is more specific but has poor sensitivity

371
Q

what are 6 potential nutritional deficiencies of people on vegan diets

A 
vitamin B12
vitamin D
calcium
iodine
iron
zinc
372
Q

H pylori preferentially colonizes what portion of the stomach causing duodenal ulcers

A

antrum

373
Q

how does H. pylori cause duodenal ulcers

A

decrease somatostatin –> increased gastrin secretion –> increased gastric acid production from parietal cells

374
Q

what portion of the stomach does H. pylori colonize that is associated with gastric ulcers

A

gastric corpus (body of the stomach)

375
Q

Statins competitively inhibit what enzyme

A

HMG CoAreductase

376
Q

what effect does cholestyramine have on hepatic cholesterol and bile acid synthesis

A

increases both

377
Q

cholestyramine MOA

A

bile acid binding resin

378
Q

gemfibrozil MOA

A

fibrate: reduce bile acid synthesis by inhibiting cholesterol 7-alpha hydroxylase

379
Q

anti- smooth muscle antibody elevation is highly specific for what liver disease

A

autoimmune hepatitis

380
Q

what histologic findings demonstrate autoimmune hepatitis

A

lymphocyte and plasma cell infiltration of portal and periportal regions of the liver

381
Q

secretin stimulates the pancreatic ductal cells to secrete what?

A

bicarb

382
Q

secretin is produced by duodenal S cells in response to what

A

increased duodenal H+ concentrations

383
Q

repetitive vomiting leads to what acid-base status

A

metabolic alkalosis

384
Q

what causes a linear mucosal tear at the gastroesophageal junction

A

(Mallory-Weiss syndrome)
forceful retching is most common or straining during defecation or weight lifting, seizures, blunt abdominal injury or upper GI endoscopy

385
Q

what are the 4 sites where prolonged portal hypertension can cause varices

A

esophagus
rectum
umbilicus
retroperitoneal

386
Q

in evaluation of Hirschsprung disease, biopsy should be done of what segment and what layer of the instesine?

A

rectal (narrowed segment) submucosa to see if submucosal ganglia are absent

387
Q

what is the most common benign liver tumor that morphologically consist of cavernous, blood filled vascular spaces lined by a single epithelial layer

A

cavernous hemangiomas

388
Q

how do the lesions and location of colitis-associated colorectal cancer differ from sporadic

A

origins of dysplasia are flat (nonpolypoid) lesions and tumors are multifocal
(sporadic: polypoid lesions and singular tumors)

389
Q

in sporadic and colitis associated colorectal cancer, which which has early/late p53/APC gene mutations

A

sporadic: early APC, late p53

colitis associated: early p53, late APC

390
Q

what vessels are used as landmarks in a laparoscopic hernia repair to distinguish between direct and indirect inguinal hernias

A

inferior epigastric vessels

391
Q

Where do direct and indirect hernias protrude in respect to the inferior epigastric vessels

A

direct: medial to inferior epigastric vessels
indirect: lateral

392
Q

A poor prognosis in cirrhotic patients is indicated by poor liver functioning. what serum lab values could best indicate this (3)

A

hypoalbuminemia
elevated bilirubin
prolonged PT

393
Q

what are the symptoms of scurvy and what nutritional deficiency causes it

A

Ascorbic acid (vitamin C)
microvascular bleeding
gingivitis
impaired wound healing

394
Q

alcohol induced hepatic steatosis appears related to decreased _____ oxidation

A

free fatty acid

395
Q

what causes decreased free fatty acid oxidation in alcohol induced hepatic steatosis

A

excess NADH from alcohol metabolism

396
Q

what is a good stain for identifying tropheryma whippelii

A

PAS

397
Q

PAS staining stains what dark pink?

A

polysaccharides

398
Q

perinicious anemia occurs as a result of CD4 cells mediated immune response against what?

A

parietal cells

399
Q

how is vitamin B12, gastric acid secretion, and gastrin secretion affected by perinicious anemia

A

decreased vit B12 (loss of intrinsic factor)
decreased gastric acid secretion
increased gastrin secretion

400
Q

what is primary biliary cholangitis

A

Tcell destruction of small intralobular bile ducts

401
Q

how does primary biliary cholangitis appear histologically

A

dense lymphocytic inflammation of portal tracts with granulomatous destruction of interlobular bile ducts

402
Q

what antibodies are highly characteristic of primary biliary cholangitis

A

antimitochondrial antibodies

403
Q

what is the cause of intestinal atresia of the jejunum/ileum

A

vascular injury in utero

404
Q

what is the cause of duodenal atresia

A

failure of recanalization at 8-10 wks gestation

405
Q

what changes occur in the gallbladder due to cystic duct obstruction that causes acute calculous cholecystitis

A

mucosal disruption by lysolecithins
bile salt irritation of luminal epithelium
proataglandin release with transmural inflammation
gallbladder hypomotility
increased intraluminal pressure causing ischemia
bacterial invasion

406
Q

how is peristalsis and sphincter tone effected in achalasia

A

decreased amplitude of peristalsis in mid esophagus

incomplete relaxation at LES

407
Q

what is the cause of achalasia

A

reduced number of inhibitory ganglion cells in the esophageal wall

408
Q

are the following increased or decreased in ascites: serum antidiuretic hormone, urine sodium, total body volume

A

serum antidiuretic hormone: increased
urine sodium: decreased
total body volume: increased

409
Q

what are the 3 causes of benign neonatal hyperbilirubinemia

A

increased bilirubin production from increased hemolysis
decreased bilirubin conjugation from lower UDP glucuronosyltransferase
increased enterohepatic circulation of bilirubin due to gut sterility

410
Q

external hemorrhoids have cutaneous innervation from what nerve?

A

rectal nerve, a branch of the pudendal nerve

411
Q

Abetalipoproteinemia is an inherited inability to synthesize ______

A

apolipoprotein B

412
Q

what is the cause of Gilbert syndrome

A

decreased hepatic UDP glucuronosyltransferase activity –> decreased conjugation of bilirubin

413
Q

When excess ammonia is present in the blood, it crosses the blood brain barrier and is taken up by astrocytes, increasing ______ production

A

glutamine

414
Q

Lymphatic drainage of the rectum proximal to the anal dentate line occurs in what nodes? distal to the dentate line?

A

proximal to dentate line: inferior mesenteric and internal iliac nodes
distal: inguinal nodes

415
Q

what supplementations are recommended in vegan diet due to common deficiences

A

vitamin B12 (cobalamin)
calcium
vitamin D
(other less common deficiencies: iodine, iron, zinc)

416
Q

what causes the rebound gastric acid hypersecretion when PPIs are stopped?

A

increased gastrin release in response to increased pH while on PPI

417
Q

what is seen on histologic examination of patients with primary lactase deficiency

A

normal

418
Q

Are duodenal ulcers associated with increased risk of carcinoma in the same location? what about gastric? esophageal? colon?

A

duodenal: no

gastric, esophageal, colon: may be malignant and biopsy is required

419
Q

appendicitis causes dull visceral pain at ____ due to afferent pain fibers entering at T10. Progressive inflammation irritates the parietal peritoneum shifting the pain to ______

A

umbilicus

McBurney’s point

420
Q

what 2 medications are often used to increase natriuresis and prevent electrolyte disturbances in ascites

A

spironolactone

furosemide

421
Q

Shigella sonnei infection is specific to infecting what cells?

A

Microfold (M) cells
(within Peyer patches)
(via endocytosis)

422
Q

What is the most common pathologic lead point for intussusception

A

(intussusception = intestine telescopes into itself)

Meckel diverticulum

423
Q

what is pancreas divisum

A

when the ventral and dorsal pancreatic buds fail to fuse and the pancreatic secretions are instead drained via two separate duct systems

424
Q

The ventral pancreatic bud is a precursor to what 3 portions of the pancreas?

A

uncinate process
inferior/posterior portion of the head
major pancreatic duct

425
Q

What causes obstruction to portal venous flow upstream to the liver, causing portal hypertension while not affecting liver parenchyma

A

portal vein thrombosis

426
Q

in Budd-chiari syndrome, there is an occlusion of the ____ vein. What will the liver biopsy show

A

hepatic

centrilobular congestion and fibrosis

427
Q

what causes bowel obstruction in Chron disease

A

strictures due to bowel wall edema, fibrosis, and hypertrophy of the muscularis mucosae which narrows the intestinal lumen

428
Q

What is the diagnosis of someone having white-yellow plaques composed of fibrin, inflammatory cells, and cellular debris on the colonic mucosa

A

Clostridium difficile

429
Q

What is the diagnosis of someone with fibrosis and nodular parenchymal regenerations in the liver

A

cirrhosis

430
Q

what is the most important risk factor for cancer in polyps

A

increasing polyp size

431
Q

what histology on adenomatous polyps increase risk of cancer

A

villous histology and high grade dysplasia

432
Q

Esophageal varices is due to what portal vein anastomosing with what systemic vein?

A

left gastric

esophageal

433
Q

anorectal varices is due to what portal vein anastomosing with what systemic vein

A

superior rectal

middle and inferior rectal

434
Q

caput medusae is due to what portal vein anastomosing with what systemic vein

A

paraumbilical

superficial and inferior epigastric

435
Q

what is hemochromatosis

A

increased intestinal iron absorption with deposition of excess iron in parenchymal tissues

436
Q

why do men present earlier than women with hemochromatosis

A

premenopausal women have ongoing blood and iron losses due to menstruation

437
Q

what branch of the aorta supplies the liver and spleen

A

celiac trunk

438
Q

what mutation causes hereditary hemochromatosis

A

missense mutation in HFE gene

439
Q

what causes iron accumulation in hemochromatosis

A

increased intestinal iron absorption

decreased hepcidin synthesis in hepatocytes –> increased ferroportin expression

440
Q

what occurs in hepatocytes to cause Reye syndrome

A

mitochondrial toxicity –> impaired fatty acid metabolism –> microvesicular fat deposits in the liver –> hepatic dysfunction

441
Q

carcinoid tumors are malignant transformations of what cell type

A

neuroendocrine

442
Q

what are causes of secondary lactose intolerance

A

inflammation (celiac) or infection (giardiasis) –> damaged cells sloughed off and replaced with immature cells with little lactase expression

443
Q

Why are newborns who do not receive prophylactic supplementation at risk for bleeding complications? Why is the risk increased in cystic fibrosis

A

vitamin K does not cross the placenta well and it is not in breast milk
cystic fibrosis –> poor absorption of fat soluble vitamins

444
Q

_____ is produced primarily in the stomach in response to fasting, levels surge leading up to meals and fall after eating

A

Grehlin

445
Q

what could cause intermittent dysphagia and esophageal food impaction in a child who has ezcema

A

eosinophilic esophagitis: chronic Th2 cell mediated disorder triggered by food antigens –> eosinophilic infiltration of the esophageal muscosa

446
Q

what causes GERD in pregnant women

A

pregnancy –> elevated estrogen and progesterone –> relax smooth muscle of LES
also, later in pregnancy, the gravid uterus presses on the stomach and causes increased intrabdominal pressure

447
Q

what lifelong supplementation is required in patients who have undergone total gastrectomy? Why is HCl or pepsin not required?

A

vitamin B12 due to inability to produce intrinsic factor

pancreatic enzymes can break down protein without pepsin or HCl

448
Q

what diets increase risk of diverticulosis

A

high amounts of red meat and fat

low levels of fiber

449
Q

ulcers found beyond the duodenal bulb and elevated gastrin levels that rise in response to secretin are suggestive of what diagnosis

A

Zollinger-Ellison syndrome (gastrin secreting tumor, gastrinoma)

450
Q

why would a patient on total parenteral nutrition be at increased risk of gallstones

A

decreased cholecystokinin release due to decreased enteral stimulation

451
Q

recurrent sinopulmonary infections and congenital absence of vas deferens are consistent with what diagnosis

A

cystic fibrosis

452
Q

what cell types promote granuloma formation in Crohn disease

A

Th1

macrophages

453
Q

what are symptoms of vitamin E deficiency

A

increased susceptibility of neuronal and erythrocyte membranes to oxidative stress –> ataxia, impaired proprioception and vibratory sensation, hemolytic anemia

454
Q

what is the determinant of colorectal adenocarcinoma prognosis

A

stage of the tumor (extent of expansion) NOT the grade

455
Q

iron absorption occurs predominantly where?

A

duodenum and proximal jejunum

if resected, supplementation is required

456
Q

malabsorption of what 6 things is common after gastric bypass procedures

A 
thiamine
folate
vit B12
fat soluble vitamins
calcium
iron
457
Q

what are common presenting symptoms of right sided colon cancers vs left sided colon cancers

A

right: occult bleeding and symptoms of iron deficiency anemia
left: constipation and symptoms of intestinal obstruction

458
Q

motor dysfunction of what muscle is thought to be the underlying mechanism of Zenker diverticulum

A

cricopharyngeal

deminished relaxtion –> increased intraluminal pressure

459
Q

MOA sofosbuvir (hepatitis C treatment)

A

nucleotide/non-nucleoside RNA polymerase inhibitor

HCV requires RNA-dependent RNA polymerase to replicate

460
Q

Ledipasvir MOA (hepatitis C treatment)

A 
NS5A inhibitor
(NS5A is crusial for viral replication and assembly by unclear mechanisms)
461
Q

Why might NSAIDs be protective against some types of colon adenocarcinoma

A

increased activity of COX2 has been linked with some forms of colon adenocarcinoma

462
Q

Patients with Celiac disease are at an increased risk of what cancer

A

Tcell lymphoma

Tcell expansion can occur in the small bowl mucosa

463
Q

what connects the liver to the lesser curvature of the stomach and the beginning of the duodenum

A

lesser omentum

464
Q

what is a treatment option for C. Dif that is a macrocyclic antibiotic that inhibits sigma subunit of RNA polymerase, leading to protein synthdsis impairment and cell death

A

Fidaxomicin

465
Q

what serum tumor marker is elevated in patients with hepatocellular carcinoma

A

alpha fetoprotein

466
Q

what tumor marker is elevated in patients with pancreatic cancer

A

CA 19-9

467
Q

what tumor marker is commonly elevated in ocarian cancer

A

CA 125

468
Q

what is the diagnosis of a patient presenting with proximal weakness and inflammatory features affecting the skin such as heliotrope rash

A

dermatomyositis

469
Q

What cause of diarrhea in an HIV patient will show spindle shaped tumor cells with small vessel proliferation on biopsy of colon lesions

A

Kaposi’s sarcoma

470
Q

why is hepatitis B virus required for a hepatitis D infection

A

hepatitis B surface antigen must coat the hepatitis D antigen before it can infect hepatocytes and multiply

471
Q

what is the cause of carcinoid syndrome

A

carcinoid tumor secreting serotonin and other biologically active substances

472
Q

what medication can be used to treat symptoms of carcinoid syndrome before surgery?

A

octreotide

473
Q

what is the first event in pathogenesis of acute appendicitis

A

obstruction of the lumen of the appendix

474
Q

what are histological findings of squamous cell carcinoma of the esophagus

A

sheets of eosinophilic squamous cells with keratin pearls, and intercellular bridges

475
Q

what cause of atrophic gastritis results in pernicious anemia

A

autoimmune gastritis

476
Q

what are the complications of chronic H. pylori infection

A

adenocarcinoma

MALT lymphoma

477
Q

What rare vascular tumor is associated with arsenic and polyvinyl chloride exposure and expresses CD31

A

hepatic angiosarcoma

478
Q

what structures run through the hepatoduodenal ligament

A

the portal triad:
hepatic artery
portal vein
common bile duct

479
Q

what could be the sources of right upper quadrant bleeding that persists after occlusion of the portal triad?

A

inferior vena cava

hepatic veins

480
Q

what complication of Crohn disease can cause vitamin B12 deficiency and postprandial voluminous diarrhea

A

short bowel syndrome due to loss of intestinal absorptive surface area

481
Q

Congestive hepatopathy is a complication of what heart problem

A

right sided heart failure

482
Q

what are the 3 leading causes of infections esophagitis in immune compromised patients

A

candida albicans
HSV
CMV

483
Q

what cause of infectious esophagitis shows eosinophilic intranuclear inclusions in multinuclear squamous cells at ulcer margins

A

HSV

484
Q

what type of infectious esophagitis has punched out ulcers? large linear ulcerations?

A

HSV

CMV

485
Q

treatment for HSV esophagitis

A

acyclovir

486
Q

treatment for CMV esophagitis

A

ganciclovir

487
Q

how is megacolon diagnosed

A

xray

488
Q

what kind of kidney stones are associated with Chron disease and why?

A

oxalate
impaired bile acid resorption –> intestinal lipids bind calcium ions –> free oxalate is absorbed unbound to calcium and forms urinary calculi

489
Q

how does hepatitis A cause liver damage

A

triggers robust CD8 T cell and NK cell response to clear infected hepatocytes

UWorld (19 decks)

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