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UWorld > GI 3 > Flashcards

GI 3 Flashcards

1
Q

epigastric pain, relieved by eating, TTP dx

majority caused by __, particularly in developing countries

to reduce likelihood of recurrence, tx w antibiotics like T/M and PPI aka __ often w __

avoid __ as they promote ulcer formaton

can use prostaglandin analgoues like __ for NSAID induced ulcers

A

duodenal ulcer

H pylori

tetracycline, metro, prazole
bismuth salicylate

GC

misoprostal

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2
Q

Pt w cirrhosis, progressed to hepatic encephalopathy due to recent __

failuree of liver to metabolize __ such as ammonia

GI bleeding causes inc __ delivery to gut via hemoglobin, which is converted to __ and absorbd into the bloodstream

with liver failure, this leads to accumulation of __, dec cerebral __ metabolism

ultimately, inc __ NT and dec __ NT release

A

GI bleed

waste products

nitrogen, ammonia

ammonia, glucose

inhib, excitatiry

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3
Q

another trigger for HE is __ meal

in hepatic encephalopathy, lower blood ammonia levels via disaccharide like __, trapping it in stool and inc __ excretion

cirrhosis is assc w __ BUN as ammonia is not converted to __

A

high protein meal

lactulose, nitrogen

dec, urea

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4
Q

__ is a nonabsorbable antibioitc that alters GI flora to dec prodxn/absorption of __

can also inhibit bacteria __ synthesis by binding to DNA Dep RNA polymerase

use in addition to ___ to produce ammonium

A

Rifaximin, ammonia

RNA

Lactulose,

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5
Q

EHEC produces a __ toxin

VT1 inhibits __

__ toxin, transmitted by temperate __

B subunits for a pore to recognize speicifc __ on ttarget cells, allowing for toxin __

enzyme A released, remooves __ residue, preventing tRNA from binding to 60S ribosomal subunit to dec protein synth

A

shiga like

protein synthesis

AB bacteriophage

receptors, entry

Adenine

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6
Q

___ characterized by fever, ab pain, diarrhea, erythematous macules on abdomen (rose spots)

A

salmonella typhi

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7
Q

HDV has polypeptide __ w short __ molecule

__ defective, as it must be coated by HBsAg to penetrate hepatocyte

A

HDAg, ss RNA

replication

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8
Q

__ is odor/tasteless and easily ingested

seen in P/contaminated _, mining

binds to __ groups, impairing __ via inhibiting pyruvate dehydrogenase

Sx include V/severe __, __TN

___ can lead to life threatening TdP

__ is often noted

A

arsenic

pesticides, water

sulfhydryl, cell respiration

vomiting, watery diarrhea, hypoTN

QT prolongation

garlic odor

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9
Q

chelating agent for arsenic is __

inc urinary excretion by forming stable ___

__ group of dimercaprol combines w arensic to displace it

SE of tx include N/H/F

A

dimercaprol

chelates

sulfhydryl

nephrotoxic, hyperTN, fever

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10
Q

lead poisoning sx C/A/C
__ is tx option to inc __

__ poisoning presents w confusion/flushing/ab pain/vomiting
antidote is __, allowing formation of ___ to excrete in urine

__ used to tx methemoglobinemia
sx include gray/blue skin, SOB, chocolate colored blood
reduces methemoglobin via __ pathway

A

constipation, anemia, confused
CaNa2EDTA, urinary excrete

cyanide
hydroxycobalamin, cyanocobalamin

methylene blue
NADPH

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11
Q

uniform shape and size of cels in islands indicates ___ tumor
__ cytoplasm and oval/round __

usually contain S/B/H or G

transformations of __ cells
go from GI tract to __ system

common presentation is __ tumor, may lead to appendicitis

can metastasize to __ to produce syndrome

A

carcinoid
eosinophilic, stippled nuclei

serotonin, bradykinin, histamine, gastrin

neuroendocrine, bronchopulmonary

appendiceal

liver

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12
Q

__ runs through the HD ligament

w traumatic liver injury, can occlude the ligament to identify __ of bleed (__ maneuver)

if it does not cease, likely means injury to ___ or __ vein

__ arises via the right hepatic artery, and would be devascularized

venous blood is __

A

portal triad

source, Pringle

IVC, hepatic vein

cystic

nonpulsatile

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13
Q

w elevated ALP, measure ___ to confirm it is a hepatocellular/biliary process

A

GGT

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14
Q

H pylori assc antral gastritisleads to dec __ producing cells

somatostatin normally inhibits __ release

w/out SS, high __ inc Acid secretion

will not be neutralized by duodenal __ secretion, leading to ___

H pylori also assc w gastric __/__

A

somatostatin

gastrin

gastrin

bicarb, duodenal ulcer

adenoca, lymphoma

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15
Q

H pylori assc gastric ulcers due to disrupted __ layer

not due to dec number of __ producing cells

A

mucosal

somatostatin

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16
Q

__ pain is midline, poorly localzed
due to __/__ of smooth muscle via visceral afferent fibers of ANS

__ is due to inflamed peritoneum
is __ localized, more __

affarent pain fibers for vsiceral peritoneum cross through __ plexus and enter SC at __ level

as appendix is inflamed, it irritates __ to shift to __ location

A

visceral
distension/stretching

peritoneal
well, severe

SM, T10

peritoneum, McBurney poiint

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17
Q

use __ as a landmark to find the inflamed appendix

TC begin as a continuous layer of __ surrounding the rectum

at RS jxn, layer forms 3 distinct __ that travel outside colon and converge at the __

compared to small intestinal folds, haustra in TC are __ and do not span __ circum

A

Tania coli

long muscle

long bands, appendix

wide, entire

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18
Q

Hep B patients can also present w serum like sickness
ie J/L/U

dx w AST/ALT > __ ULN

A

JP, LAN, urticaria

10x

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19
Q

hemochromatosis caused by excessive intestinal __ and acumulation w in organs

caused by __ mutation in HFE gene
usually __ in caucasians

HFE protein interacts w __ to facilitate endocytosis
transferrin then __, and Fe released

w mutation, enterocytes inc apical expression of __ to inc intestinal Fe absorption

hepatocytes also dec __ synthesis, to inc __ expression

A

iron absorption

missense
C282Y

transferrin
degraded

DMT1

hepcidin, ferroportin

20
Q

iron loss occurs via __ of intestinal lining and __ in women

no regulatory __ to excrete iron

A

sloughing, menstruation

mechanism

21
Q

prolonged cholestasis leads to deposition of __ in hepatic parenchyma

leads to malabsorption of __ which require BA for absorption

A

bile salts

fats and FSV

22
Q

___ is secreted by panc acinar cells to inhibit __

typsin also inhibits self via cleaving __ at second site

can get __ from mutations in trypsinogen/SPKIN gene

most commonly due to mutation in __ making it not susceptible to inactivation by trypsin

A

SPINK1, tryspin

active trypsin

Hereditary panc

trypsin, trypsin

23
Q

women present w hemochromatosis later bc of protective effect of __

therefore, preferred tx is __

alcohol use in hemo exacerbates ___

__ enhances absorption of __, worsening hemo

A

menstruation

phlebotemy

liver dz

VC, iron

24
Q

clonal mast cell proliferation in bone marrow, skin seen in __ dz
assc w mutation in __ a RTK

prominent expression of mast cell __, w excessive __ release

presents w S/F/P/H/U and __ ulceration, D

look for clusters of __ in skin

A

systemic mastocytosis
KIT

tryptase, histamine

syncope, flushing, pruritis, hypoTN, urticaria, duodenal, diarrhea

mast cells

25
Q

colitis (as compared to sporadic) CRC more likely to

affect \_\_ pt
progress from F/N dysplasia
appear \_\_ or \_\_
develop early \_\_ or late \_\_ mutations 
located in \_\_ colon
be \_\_\_
grade is

__ is assc w highest risk of CRC
thus, evaluate __ pt on regular basis

A 
younger
flat/nonpolypoid
signet ring, mucinous
p53, APC
multifocal
higher

pancolitis
IBD

26
Q

pt w liver dz, COPD, jaundice as child has __ deficiency

AAT inhibits __
emphysema appears __

inherited A___, C__

look for abnormal __ and __ and __

A

A1AT
neutrophil elastase
panacinar

autsomal, codominant

lvier enzymse, cirrhosis, HCC

27
Q

in pt w recurrent GI bleed, tx w ____

Distal transverse colon, descending colon, sigmoid colon, rectum all __ derived

thus, receive blood from __
drained by __ into splenic vein and portal vein

A

arterial embolization

hindgut

IMA
IMV,

28
Q

Celiac trunk suppliesblood to lowr __ to mid __
all __ derived

SMA supplies blood to __, which is dstal duodenum to mid ___

IPA supplies __

A

esophagus, duodenum
foregut

midgut
transverse colon

external genitalia

29
Q

fluid filled cavity, fever, chills, RUQ pain indicate __

usually due to __ infection

pyogenic bacteria can access liver via __ ie ascending cholangitis or __ pyemia (bowel/peritoenum)

also systemic __ seeding, or from __ source

hematogenous seeding most common via __ infection

A

liver abscess

parasitic

biliary tract infect, portal vein

hematogenous, adjacent

staph aureus

30
Q

ascending cholangitis caused by enteric gram neg bacilli like E/K or e

traumatic injuries can lead to liver abscess, bacteria are mixed A/A

Entamoeba uses __ to ascend from colon to liver

hepatic abscess via portal vein arises from ab infections like A/D
never includes ___

A

e coli, klebsiella, enterococcus

aerobic/anaerobic

portal system

appendicitis, diverticulitis
S penumo

31
Q

__ occur in elderly pt and are considered __

risk of malignancy determined by S (esp greate rthan 4cm), V and degree of __

mutation in __ thought to progress from early to late adenoma by leading to uncontrolled __
KRAS becomess oncogene, with constit active __ protein

A

colon adenoma, premalignant

size, villous architecture, dysplasia

KRAS, cell prolif
GTP bound

32
Q

internal hemorrhoids drain into __ vein, and eventually the __ vein

extenral hemorrhoids drain via __ vein into __/__ veins

external hemorrhoids are __

A

SR, nferior mesenteric

IR, IP/II

painful

33
Q

HCV strains differ at __ genomic regions, encoding the envelope ___

no __ 3’-5’ in RNA polymerase leads to mutations, making it unstable

5’-3’ activity necessary for DNA poly 1 to repair __ and remove RNA ___

A

hypervariable, glycoproteins

proofreading

DNA, primers

34
Q

__ results from AD mutation in __ reeptor gene

majority expressed in __ to remove __/__

worse prognosis in __

comps include __ at yong age

A

familial hypercholesterolemia, LDL

liver, IDL/LDL

homozygotes

CAD

35
Q

w high humidity and temp, strains of __ produce __ as byproduct

aflatoxin __ is most toxic

strongly assc w __
usually assc w __ mutation, with G:C to T:A transversion in codon __

significant inc risk assc w __ infection

A

Aspergillus, aflatoxins

B1

HCC
p53, 249

HepB

36
Q

Goblet cells in the esophagus indicates ___ as metaplasia removes SS epithelium and replaces w intestinal type __

may see beefy __ above LES

A

Barret Esophagus
columnar cells

red mucosa

37
Q

inc activity of ___ is seen in colon cancers, which may lead to epithelial prolif

regular use of __ has been assc w lower rates of colon adenoma/carcinoma’

A

COX2

aspirin

38
Q

apoptotic hepatocytes form __ bodies aka __ bodies

seen w nuclear __, and intense __

hepatocyte __ occurs in attempt to regenerate cells

__ cells may hypertrophy and contain __ pigment

A

councilman, acidophilic

fragmenting, eosinophilia

hyperplasia

Kupffer, lipofuscin

39
Q

1st part of duodenum located over __
second part goes from __ to ___, close to __ of panc
site of AoV, where __/__ ducts drain

3rd part courses by uncinate and __
tumor can compress ___

CBD formed by meeting of __/__ ducts

A

L1
L1-L3
head, panc/CB

SMA/aorta/IVC
SMA

cystic/hepatic

40
Q

__ is progressive obsructon of extrahepatic bile duct

infant presents w J/Dark __ and alcoholic __ due to excessive excretion of bilirubin

may have hepatomegaly, inc __ and __

__ is diagnostic
see intrahepatic __, with portal tract __ and __

lack of intervention leads to __

A

biliary atresia

jaundice, urine, stools

direct bilirubin, GGT

liverbiopsy
proliferation, edema, fibrosis

cirrhosis/death

41
Q

__ is indirect hyperbilirubinemia before 2 wks

usually due to __ in beast milk deconjugating bilirubin
inc __ circ of bilirubin

A

breast milk jaundice

beat glucuronidase
enterohepatic

42
Q

Inhled anesthetic hepatotoxicity- assc w __

__ pattern of injury, potentially fulminant __

liver is rapidly __ and __

widespread centrilobular __ and inflam of ___

thought to be do to __ rxn and immune mediated attack

sx include F/A/N
__ hepatomegaly, inc __ and prolongd __ due to def of factor __
leukocytosis/eosinophilia

__ has long half life, so acute liver injury presents __

A

halothane

hepatocellular, hepatitis

atrophic, shruken

necrosis, periportal areas

hypersensitivity

tender, ALT, PT, 7

albumin

43
Q

__ is a marker of HCC
look for pt w chronic __, large __ mass, and satellite lesions

elevated __ seen in carcinoid tumors

_ is marker assc w ovarian cancer

__ assc w panc cancer

CEA assc w ___

HCG may be elevated in __ tumors

A

AFP
HepC, hepatic

5HIAA

CA 125

CA 19-9

CRC

germ cell tumors

44
Q

__ disease due to gastric mucosal defect in response to severe stress

ulcers usually __ and __
can __

often have impaired mucous prodxn due to local __ via hypoTN and splanchnic VC

ulcers in proximal duodenum arising from trauma/burns known as ___ ulcer

ulcer in esophagus/stomach/duodenu, due to intracranial injury called __ ulcer
direct __ stimulation

A

stress related mucosal

small, variable
bleed

ischemia

Curling

Cushing ulcer
vagus nerve

45
Q

well differentiated mucosal cells forming glands/crypts type of polyp

__ polyp seen in UC/CD w regenrating mucosa

__ polyps w submucosal structures that bulge

__ polyps are folds resembling polyps

due not transform to __

A

hyperplastic

inflam

submucosal

mucosal

adenocarcinoma

46
Q

Adenomatous polyps can transform to __

A

adenocarcinoma

47
Q

hallmark of esophageal SCC is nests of neoplastic __ w abundant __ cytoplasm

also see ___ and presence of __

usually present w __ dysphagia, and eventually __ and WL

A

squamous cells, eosinophilic

keratin pearls, intracellular bridges

solid, liquid

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