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Glorias USMLE stuff > Gee GI and other USMLE step 1 > Flashcards

Gee GI and other USMLE step 1 Flashcards

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USMLE® Step 1 flashcards
1
Q

What is Zenker Diverticulum

A

It’s a false diverticulum that extends only to layers of mucosa and submucosa

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2
Q

Carcinoid Tumor

A

It’s a malignant proliferation of Neuroendocrine cells

Carcinoid Tumor is a low grade malignancy of the small bowel

Grows as a mucosal polyplike nodule

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3
Q

Diagnosis of Zenker’s Diverticulum

A

It can be done using Barium swallow

If Barium swallow is contraindicated may use Ultrasound or Flexible Endoscopy

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4
Q

Problems of Antifreeze (Ethylene glycol)

A

This is a toxin; when ingested it’s broken down to glycolic acid and oxalate acid causing (metabolic acidosis)

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5
Q

Rectal Suction Biopsy

A

Used to to diagnose Hirschsprung’s disease to check for the presence of granuloma cells which is only present in the Sub-mucosa and muscularis propria

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6
Q

What is Abetalipoproteinemia

A

A hereditary Autosomal Recessive deficiency of B-48 and B-100

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7
Q

Chromogranin

A

Is found in Carcinoid Tumors

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8
Q

Killian triangle

A

It is a weak area in the crycopharyngeal muscle where there is weakness which causes herniation and out-pouching (called Zenker’s diverticulum)

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9
Q

Where is Grehlin secreted?

A

In the stomach (PD1 cells) and in the Pancreas (Epsilon cells)

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10
Q

What do Alpha cells in the Pancreatic Islets secrete?

A

Glucagon

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11
Q

What do Beta cells in the Pancreatic Islets secrete?

A

Insulin and Amylin (70%)

and also C-Peptides

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12
Q

What do Delta cells in the Pancreatic Islets secrete?

A

Somatostatins

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13
Q

What do Gamma (PP cells) in the Pancreatic Islets secrete?

A

Pancreatic polypeptides

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14
Q

What do Epsilon cells in the Pancreatic Islets secrete?

A

Grehlin

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15
Q

What is Portacaval Shunt?

A

A surgical procedure where the portal vein is made to empty into the inferior vena cava** in order to **bypass a damaged liver

Hint: “Porta” and “cava”

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16
Q

What is Transjugular intrahepatic portosystemic shunt (TIPS) procedure

A

This is done by going through the jugular vein in the neck to create a connection btw the portal circulation and systemic circulation.

The goal of TIPS is to divert blood flow into hepatic circulation, so that pressure is reduced between the portal and systemic circulation

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17
Q

What is a Spleno renal shunt?

A

In this procedure, the splenic vein is detached from the portal vein

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18
Q

What are the Crypts of Lieberkühn?

A

They are invaginations of the epithelium around the villi, and are lined largely with younger epithelial cells which are involved primarily in secretion.

Toward the base of the crypts are stem cells, which continually divide and provide the source of all the epithelial cells in the crypts and on the villi.

New epithelium is formed here

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19
Q

Central Lacteal

A

Each villus contains a capillary bed and a blunt-ended lymphatic vessel referred to as the “central lacteal”.

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20
Q

Treatment for Hyperthermia

A

Dantrolene

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21
Q

Pepsin

A

Breaks down proteins to polypeptides

  • NOTE: The Chief cells (zymogen) release pepsinogen which is converted to pepsin
  • The Chief cells are in the parietal and body of the stomach
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22
Q

Lipase

A

Breaks down fats into glycerides, fatty acids

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23
Q

Trypsin

A

breaks down polypeptides into peptides

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24
Q

Amylase

A

breaks down starches to sugars (maltose)

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25
Q

Argentaffin Cells in the atrium of stomach

A

Secrete Histamine and Serotonin

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26
Q

Whats Intrinsic factor useful for?

A

Intrinsic factor is needed for the absorption of vitamin B12 in the lower small intestine and coagulation

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27
Q

Meckel’s diverticulum

A
  • Is an outpouching of the 3 layers of the small bowel (mucosa, submucosa and lamina propria) It’s a true diverticulum.
  • Caused by the failure of the Vitellin Duct to Involute
  • It occurs in the Distal ileum
  • Often leads to volvulus, intussusception or bowel obstruction
  • Diagnosed with Rectal suction biopsy or Technicium 99m scan

Rule of 2’s

  • Seen in 2% of the population, occurs in first 2 yrs of life, usually about 2 inches long and about 2 feet from the ileocecal valve.
  • Meckel’s diverticulum is the most common congenital abnormality of the GI tract. 2:1 male vs. female ratio​​

Clinical presentation

  • Painless, rectal bleed such as melena-like black, foul-smelling stools, followed by intestinal obstruction: either volvulus or intussusception.

NOTE:

Any Child under 2 yrs with the symptoms of appendicitis or acute abdominal pain with rebound, you should think Meckel’s diverticulum (common test question).

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28
Q

Epsilon cells in the pancreas

A

Secrete Ghrelin (which stimulates hunger sensation in the hypothalamus)

Grehlin opposes the effect of Leptin (appetite suppression)

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29
Q

Leptin

A

When fat mass increases, leptin levels also increases and appetite is suppressed until weight loss occurs.

  • Ghrelin: stimulates hunger
  • Leptin: suppresses appetite
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30
Q

Parietal Cells in the Antrum of stomach

A

Secrete HCl and intrinsic factors

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31
Q

what do P/D1 cells in the Fundus of the stomach secrete?

A

P/D1 cells Secrete Ghrelin

(Note: Ghrelin also secreted in Epsilon cells of pancreas)

32
Q

What do Chief (zymogen) cells in the Fundus of the stomach secrete?

A

The chief (zymogen) cells in the fundus secrete Pepsinogen which becomes pepsin in an acid environment

33
Q

What secretory cells are in the Antrum of the stomach and what do they secrete?

A
  • G-cells–Gastrin
  • Parietal cells:–HCL and intrinsic factor
  • Argentaffin cells –Histamine and Serotonin
34
Q

What secretory cells are in the Fundus of the stomach and what do they secrete?

A
  • Chief (zymogen) cells: – secrete Pepsinogen
  • P/D1 cells; –secrete Ghrelin (also in epsilon cell of pancreas
35
Q

Trichinellosis

A
  • This is a parasitic infection caused by a relative of pig speciescalledTrichinella spiralis
  • Infected patients are usually positive for Creatinine Kinase (CK) because the Trichina larvae invades the striated muscle cells which cause myositis
  • It comes from eating infected pig meat, and especially pig that is grown on a small farm.
36
Q

What do the D (Delta cells )in the stomach secrete?

A

Somatostatins

Note:

Somatostatins inhibits the production of HCL in the stomach by

  • inhibiting the G-cells from secreting Gastrin
  • inhibiting the parietal cells from secreting HCL
  • and inhibiting the enterochromaffin cells from secreting Histamine
37
Q

Nurse Cell

A

This is the protective collagenous capsule produced by Trichinella spiralis parasite (Trichinellosis) the Nurse cell is produced when the parasite penetrates a striated muscle fiber.

38
Q

Enterochromaffin-like cells or ECL cells

A

Enterochromaffin cells are a type of neuroendocrine cells in the gastric mucosa of parietal cells. They release Histamine which helps in the production of HCL acid in the stomach.

39
Q

Budd Chiari Syndrome

A

Budd-Chiari syndrome is condition induced by thrombotic or non-thrombotic obstruction of the hepatic venous outflow ( an example is a woman who smokes cigarettes while on OCPs.

It is characterized by

  • hepatomegaly
  • ascites
  • abdominal pain
40
Q

What is the role of Prostaglandin E2 and Prostaglandin I2 (inflammatory mediators) in Gastric acid secretion?

A

The inflammatory mediators Prostaglandin E2 and Prostaglandin I2 (derived from Arachidonic acid) help promote the secretion of Gastric acid in the stomach.

  • How is this done?*
  • Arachidonic acid uses the Cox enzymes to synthesize Prostaglandin E2 and Prostaglandin I2 then it binds the synthesized prostaglandin to the prostaglandin receptors in the stomach to produce HCL

NOTE:

Prostaglandin E2 and Prostaglandin I2 can also bind to an activate mucus cell in the stomach to secrete mucous and Bicarbonate (key substances in neutralizing HCL in the stomach).

41
Q

How does Acetylcholine produce HCL acid in the stomach?

A

Stimulation of the vagus nerve (part of the parasympathetic nerve) causes the production of acetylcholine which binds to the muscarinic receptors on the parietal cells and enterochromaffin cells (sites of Histamine) to produce HCL.

  • Note:
  • This is why patients taking Anticholinergic drugs have increased risk of stomach acid -related conditions
42
Q

How does NSAIDs increase the risk of Gastritis?

A
  • NSAIDs increase the risk of gastritis because they block the COX enzymes responsible for converting Arachidonic acid to prostaglandin E2 and prostaglandin I2. These prostaglandins help secrete mucous and Bicarbonate neutralizers that help neutralize stomach acid.
43
Q

What are the Risk factors for esophageal squamous cell carcinoma in the US?

A

Smoking and Alcoholism

44
Q

How would you identify Fibrinoid Necrosis on Histology?

A

It can be identified as the high lighter pink vessel wall (light pink) around the vessel

45
Q

What are the Risk factors for esophageal Adenocarcinoma in the US?

A

Barrett’s esophagus

46
Q

Treatment for Pyloric Stenosis

A
  • Good hydration
  • Correct electrolyte imbalance (hypochloremia and hypokalemia)
  • Surgery (Pyloromyotomy) or Ramstedt’s procedure
  • In the Ramstedt’s procedure, the pylorus is cut and separated to allow food to pass more easily.
47
Q

What is Linitis Plastica?

A
  • Linitisplastica, a diffuse infiltrative gastric adenocarcinoma which gives the stomach a shrunken “leather bottle” appearance with extensive mucosal erosion and a markedly thickened gastric wall. This type of carcinoma has a very poor prognosis.
48
Q

Role of Secretin?

A

Secretin causes the release of Bicarbonates from the Brunner’s glands in the duodenum

49
Q

Role of Cholecystokinin (CCK)

A
  • Stimulates the gallbladder to contract and the pancreas to get ready for the arrival of chyme
  • Stimulates the release of bile and Bicarbonates and pancreatic secretions
50
Q

Gastric inhibiting peptide

A

Shuts down gastric secretion and motility

51
Q

Role of Urogastrone?

A
  • It’s found in the Brunner’s gland
  • It stops the secretion of HCL in the parietal cells of the stomach
52
Q

What is the most common cause of Congestive Hepatomegaly?

A

Rt Heart failure

53
Q

What is Dressler’s Syndrome?

A

Dressler’s syndrome is an Autoimmune type of pericarditis that occurs weeks after a myocardial infarction or after a heart surgery or traumatic injury to the heart

54
Q

What artery supplies the posteromedial papillary muscle?

A

The RCA

55
Q

Describe an ASD murmur

A
  • Wide, fixed, splitting, systolic ejection murmur
  • Heard best in 2nd ICS Left sternal Border

Hint: ASD for hole in Atria, wide part, think wide, splitting! left SB

56
Q

What artery supplies the Anterolateral papillary muscle?

A

The LAD artery

57
Q

What are the risk factors for stroke?

A

CHADS2 Score

  • C: Congestive Heart Failure = 1
  • H: Hypertension = 1
  • A: Age greater than 75 = 1
  • D: Diabetes Mellitus = 1
  • S2: Stroke history = 2 (A previous stroke hx is the highest risk factor for stroke)
58
Q

Why does fetal hemoglobin carry more oxygen?

A

One of the reasons that fetal cells contain a higher affinity for oxygen is because fetal hemoglobin does not contain a beta subunit, but instead a gamma subunit. Therefore the pocket that binds BPG differs which lowers the affinity for BPG while inducing higher oxygen binding, which allows the fetal HbF to extract more O2 from Maternal HgA.

59
Q

What is the main side effect of Phenylephrine?

A

Reflex Bradycardia due to increased venous return

60
Q

What is Bacillary angiomatosis

A

It’s a bacterial vascular and skin lesion found in AIDs or immunocompromised patients. Its caused by Bartonella Henselae- Rod Bacteria

61
Q

Fibrinoid Necrosis (FN) can be found in what 2 cases?

A
  • 1. Malignant HTN
  • 2. Polyarteritis Nodosa or in Vasculitis
62
Q

Describe an VSD murmur

A

Harsh holosystolic murmur heard best in left lower sternal border

Hint: VSD for ventricles, narrow part, think holo!

63
Q

What is the Transposition great vessels?

A
  • This is when the great vessels of the Aorta and Pulmonic trunk are switched
  • The Right ventricle gets connected to the Aorta
  • And the Left ventricle gets connected to the Pulmonary artery
  • This causes mixing of oxygenated and deoxygenated blood
  • Left to right shunt occurs with early cyanosis
64
Q

How and when is the primitive heart tube formed?

A

The primitive heart tube is formed on day 21 by the fusion of the 2 endocardial tubes (day 20).

65
Q

What is the most common location for a VSD?

A

The most common site for the VSD is the membranous interventricular septum

Most VSDs are small and resolve on their own, the larger ones cause left to Right shunt (early cyanosis) and may need to have surgery to repair

66
Q

The Endocardial Cushion gives rise to??

A

The endocardial Cushion gives rise to:

  1. Atrial Septum
  2. Membranous portion of Interventricular septum,
  3. The AV and semilunar valves,
67
Q

How is the Aorticopulmonary septum derived?

A

The Aorticopulmonary septum is derived from neural crest cells that migrate into the conotruncal ridges.

This helps separate the truncus arteriosus into the aorta (outflow tract for the right ventricle) and the pulmonary trunk (outflow tract for the right ventricle).

As the septum descends it spirals to form the above outflow tracts, but failure to spiral would cause congenitlal malformations such as

Transposition of great vessels (The Aorta and Pulmonary trunk switched)

Persistent Truncus arteriosus (failure of formation of the AV septum)

Tetrallogy of Fallot (

68
Q

Where is Acetylcholine synthesized?

A

Basal Nucleus of Meynert

69
Q

Where in the brain is Dopamine synthesized?

A

Ventral Tegmentum, SNc

70
Q

Where in the brain is GABA synthesized?

A

Nucleus accumbens

71
Q

Where in the brain is Norepinephrine synthesized?

A

Locus ceruleus

72
Q

Where in the brain is Serotonin (5-HT) synthesized?

A

Raphe nucleus

73
Q

What is the main complication of Central Pontine Myelinolysis (CPM)?

A

“Locked in syndrome” (total paralysis where nothing moves except the eyes)

  • CPM is common in alcoholics and malnourished patients
  • Imaging will show demyelination at the center of the pons
74
Q
A
75
Q

What is progressive Multifocal Leukoencephalopathy?

A

This is an encephalopathy that involves the white matter in multiple areas

  • It is due to the JC virus infection of oligodendrocytes
  • The JC virus is in the body but is often reactivated as a latent virus
  • It presents with rapidly progressive neurological signs that lead to death

Glorias USMLE stuff (1 decks)

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