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USMLE Step 1 Random Facts > GI > Flashcards

GI Flashcards

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USMLE® Step 1 flashcards
1
Q

what structure contains the ligamentum teres hepatis?

A

falciform ligament

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2
Q

what structure contains the portal triad?

A

hepatoduodenal ligament

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3
Q

what is the portal triad?

A

hepatic artery, portal vein, common bile duct

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4
Q

what structure connects the greater and lesser omentum sacs?

A

hepatoduodenal ligament

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5
Q

what structure contains the gastric arteries?

A

gastrohepatic ligament (liver to LESSER CURVATURE of stomach) - cut during surgery to access lesser sac

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6
Q

what structure contains the gastroepiploic arteries?

A

gastrocolic ligament (GREATER CURVATURE and transverse colon) - part of GREATER omentum

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7
Q

what structure contains short gastric and left gastroepiploic vessels?

A

gastrosplenic ligament (GREATER curvature + spleen)

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8
Q

what structure separates the greater and lesser sacs on the right?

A

gastrohepatic

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9
Q

what structure separates the greater and lesser sacs on the left?

A

gastrosplenic

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10
Q

what structure contains the splenic artery and vein, and tail of the pancreas?

A

splenorenal

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11
Q

ulcers can extend to?

A

submucosa

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12
Q

erosions can extend to?

A

mucosa only (epithelium, lamina propria, muscularis mucosa)

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13
Q

this part of the pancreas is formed from the VENTRAL bud alone

A

uncinate process

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14
Q

pancreas derived from?

A

foregut

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15
Q

ventral pancreatic buds form?

A

inferior/posterior part of head
main pancreatic duct of Wirsung
uncinate process

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16
Q

dorsal pancreatic buds form?

A 
body
tail
isthmus
accessory pancreatic duct
MOST of head
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17
Q

third part of duodenum trapped b/w?

A

aorta and SMA

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18
Q

only duodenal part not retroperitoneal?

A

1st

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19
Q

2nd part of duod in ass w/?

A

head of pancreas (ampulla of Vater)

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20
Q

3rd part of duod in ass w/?

A

uncinate process of pancreas

SMA/SMV

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21
Q

RF for increased incidence of cholangiocarcinoma

A

primary sclerosing cholangitis
infection w/ Clonorchis sinenus
ulcerative colitis

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22
Q

carcinoid synd produces what?

A

high levels of serotonin

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23
Q

when is carcinoid synd not seen?

A

if limited to GI tract (bc serotonin undergoes first-pass metab in liver)

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24
Q

sympt of carcinoid synd

A

recurrent diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular disease

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25
Q

dx/tx of carcinoid synd

A

**increased 5-HIAA (metabolite of serotonin) in urine
niacin deficiency
tx = octreotide (somatostatin analog)

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26
Q

window period in Hep B?

A

when HbsAg is (-), AND HbsAb (-), but HbcAb (+)

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27
Q

virchow’s node involves the

A

left supraclavicular node (mets from stomach)

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28
Q

sister mary joseph nodule involves

A

subcut periumbilical metastasis

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29
Q

what PUD causes pain w/ eating?

A

gastric ulcer

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30
Q

what PUD causes relief w/ eating?

A

duodenal ulcer

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31
Q

bleeding from what artery w/ ruptured gastric ulcer on lesser curvature?

A

left gastric artery

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32
Q

bleeding from what artery w/ ulcer on posterior wall of duodenum?

A

gastroduodenal artery

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33
Q

most common stomach cancer

A

adenocarcinoma

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34
Q

ligaments cut when removing spleen

A

gastrosplenic + splenorenal ligaments

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35
Q

arterial supply/venous drainage above pectinate line (proximal)?

A

A: superior rectal artery (branch of IMA)
V: superior rectal vein –> inferior mesenteric vein –> portal system

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36
Q

hemorrhoid/cancer seen above pectinate line?

A

internal hemorrhoid - NOT painful (bc visceral innerv)

adenocarcinoma

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37
Q

arterial supply/venous drainage below pectinate line (distal)?

A

A: inferior rectal artery (branch of internal pudendal artery)
V: inferior rectal v. –> internal pudendal v. –> internal iliac v. –> IVC

38
Q

hemorrhoid/cancer seen below pectinate line?

A

external hemorrhoid - painful! (bc somatic innerv - inferior rectal branch of pudendal n.)

squamous cell carcinoma

39
Q

autoimmune gastritis located in what part of stomach?

A

fundus/body

40
Q

H.pylori chronic gastritis located in what part of stomach?

A

antrum

41
Q

Mallory bodies typically seen w/?

A

alcoholic hepatitis

42
Q

triad of Budd-Chiari synd

A

hepatomegaly
ascites
abdominal pain

43
Q

cholelithiasis is

A

gallstones

44
Q

cholecystitis is

A

inflamm/infection of GB

45
Q

cholangitis is

A

inflamm/infection of biliary tree

46
Q

choledocholithiasis is

A

gallstones in bile ducts

47
Q

area of colon most suscept to infarction?

A

watershed area of splenic flexure

48
Q

hereditary hyperbilirubinemia responding to phenobarbitol

A

Crigler-Najjar type II
Gilbert synd

bc increases liver enzyme synth

49
Q

hereditary hyperbilirubinemia w/ black liver

A

Dubin-Johnson synd

50
Q

air seen in GB and biliary tree a sign of?

A

cholecystenteric fistula leading to gallstone ileus (stone stuck in ileocecal valve)

51
Q

level of celiac trunk

A

T12

52
Q

level of SMA

A

L1

53
Q

level of LEFT renal artery

A

L1

54
Q

level of IMA

A

L3

55
Q

level of bifurcation of aorta

A

L4

56
Q

receives blood from both SMA + IMA

A 
splenic flexure (watershed area)
first affected in hypotension
57
Q

the 4 anastomoses + origins

A

sup epigastric (internal thoracic/mammary) inf epigastric (external iliac)

sup pancreaticoduod (celiac) inf pancreaticoduod (SMA)

middle colic (SMA) inf colic (IMA)

sup rectal (IMA) middle + inf rectal (internal iliac)

58
Q

3 portal systemic shunts

A

forms varices!

1) left gastric v. esophageal v.
2) paraumbilical v. superficial and inf epigastric v. (BELOW umbilicus), sup epigastric and lateral thoracic v. (ABOVE umbilicus)
3) sup rectal middle + inf rectal

59
Q

rectal drainage above + below pectinate line

A

above: sup rectal v. –> IMV –> portal system
below: inf rectal v. –> internal pudendal v. –> internal iliac v. –> IVC

60
Q

zone I of liver

A

affected 1st by viral hepatitis

61
Q

zone III of liver

A

pericentral vein zone

  • affected 1st by ischemia (bc farthest from O2 blood)
  • contains P450 system
  • most sensitive to toxic inj (acetaminophen OD, alc tox)
  • site of alcoholic hepatitis
62
Q

blood flows from

A

zone 1 –> 3

63
Q

bile flows from

A

zone 3 –> 1

64
Q

tumor of pancreatic head blocks

A

common bile duct ONLY

65
Q

diaphragmatic hernia in infants can be due to

A

defective dev’t of pleuroperitoneal membrane

66
Q

potent gastrin stimulators

A

phenylalanine
tryptophan
Calcium

67
Q

bile acids conjugated to what substances?

A

glycine or taurine

68
Q

rate-limiting enzyme in bile prod

A

cholesterol 7alpha-hydroxylase

69
Q

bilirubin conjugated to what to make soluble?

A

glucuronic acid

70
Q

tx of esoph varices

A

vasopressin

71
Q

duodenal ulcer perforation usually in

A

anterior > posterior

72
Q

rectal SPARING

A

Crohn’s!

73
Q

continuous lesions w/ RECTUM ALWAYS involved

A

UC

74
Q

unique ass w/ Crohn’s (vs. UC)

A

migratory polyarthritis
erythema nodosum
kidney stones
strictures

75
Q

unique ass w/ UC (vs. Crohn’s)

A

pyoderma gangrenosum (tissue necrosis causing deep ulcers)
primary sclerosing cholangitis
toxic megacolon

76
Q

colorectal cancer presenting w/ Fe-def anemia is located where

A

ascending

77
Q

tx for ulcer hemorrhages

A

somatostatin (octreotide) - bc decreases splanchnic blood flow

78
Q

microvesicular fatty change

A

Reye’s synd

79
Q

macrovesicular fatty change

A

hepatic steatosis (mod alc intake)

80
Q

why is AST&raquo_space; ALT in alcoholic hep?

A

bc B6 def decreases ALT

81
Q

centrilobular congestion + necrosis

A

halogenated inhalation anesthetics injury
nutmeg liver
Budd-Chiari

82
Q

cirrhosis w/ PAS positive globules in liver

A

alpha1-antitrypsin def

83
Q

tx for physiological neonatal jaundice?

A

phototherapy (converts UCB to water soluble form)

84
Q

tx of PBC

A

ursodiol

85
Q

black pigment stones

A

ass w/ hemolysis

radiopaque (white)

86
Q

brown pigment stones

A

ass w/ infection

radiolucent (black)

87
Q

air in biliary tree ass w/

A 
cholecystenteric fistula in SI (b/w GB and SI)
gallstone ileus (stone obstructing ileocecal valve)
88
Q

positive Murphy’s sign usually in

A

cholecystitis

89
Q

charcot’s triad of cholangitis? Reynold’s pentad?

A

triad - jaundice, fever, RUQ pain

pentad - triad + hyPOtension, altered mental status

90
Q

pancreatic pseudocyst = complic of what? and lined by?

A

acute pancreatitis

lined by granulation tissue

91
Q

signs of pancreatic cancer

A
  • abd pain radiating to back
  • wt loss
  • Trousseau’s sign (migratory thrombophlebitis)
  • Courvoisier’s sign (palpable, NONTENDER [aka painLESS] GB w/ obstructive jaundice)

USMLE Step 1 Random Facts (35 decks)

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