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USMLE > GI > Flashcards

GI Flashcards

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USMLE® Step 1 flashcards
1
Q

Meckel’s Diverticulum

A

-persistant vitelline duct, Rule of 2’s, presents with intestinal obstruction or rectal bleeding -has 2 types of ectopic tissue, gastric and pancreatic

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2
Q

Drug Toxicity in liver

A

centrilobular or zone 3 necrosis

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3
Q

ZES (Zollinger-Ellison Syndrome)

A

-peptic ulcers in “non-traditional locations”-negative for H. pylori and NSAID use-excessive gastrin production (normally produced by…G-cells)

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4
Q

Wilson’s disease

A

-copper accumulation-psych changes, shuffling rigid gate, kayser-fleischer rings-tx; copper chelators: D-penicillamine

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5
Q

Kuppfer cells

A

-reticuloendothelial cells of the liver, help clear infections from blood- (mesangial cells are equivalent in kidney and spleen)

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6
Q

HLA B27

A

PAIR- psoriasis, ankylosin spondylitis, inflammatory bowel (UC), Reiter’s

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7
Q

hepatic adenoma

A
  • typically benign- classically associated with OCP (resolves when discontinued)
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8
Q

PSC

A
  • commonly associated with UC (70% of PSC have UC, only 4% of UC have PSC)-intrahepatic and extrahepatic bile duct degredation-increased risk of colon cancer- beading on retrograde imaging
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9
Q

PBC

A
  • increased serum anti-mitochondrial antibodies- destruction of small intrahepatic ducts- autoimmune destruction- leads to high cholesterol levels and subsequent deposition, xanthomas
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10
Q

acute pancreatitis

A
  • often brought on after a bout of heavy drinking- complications include pseudocysts after pancreatic enzymes are trapped and damage large portions of tissue
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11
Q

Dubin-Johnson

A
  • unable to excrete conjugated (direct) bili- other liver enzymes normal- generally benign, occasional bouts of icterus/jaundice- liver is black on gross examination- (rotor’s is same deal, less severe, no pigment of hepatocytes)
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12
Q

paneth cells

A
  • release antibacterial and antifungal granules in small intestine
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13
Q

small bowel obstruction (associations)

A
  • common complication of gallstone illeus- air/fluid levels on upright x-ray
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14
Q

tobacco and peptic ulcers

A

twice as likely, particularly duodenal

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15
Q

hereditary hemochromatosis

A
  • due to disorder of HFE gene, resulting in unregulated absorption of iron from GI tract- gynecomastia, cirrhosis, bronze diabetes, spider telangectasias- tx with serial phlebotomy
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16
Q

H. pylori ulcer (location and consequence)

A
  • duodenal - perf, leading to rupture of gastroduodenal artery
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17
Q

Hirschprung Disease

A

-failure of neural crest cells to migrate appropriately-lack innervation needed to relax sphincters, severe constipation and dilation of colon proximal to aganglionic region-associated with downs syndrome

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18
Q

Chron’s (complications)

A

-kidney stones, erythema nodosum, uveitis, migratory polyarthritis- granulomas

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19
Q

hypercalcemia

A

-fatigue, muscle weakness, constipation-high serum calcium, low phosphate and low potassium

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20
Q

carcinoid syndrome

A

-tumor of neuroendocrine cells, produce 5-HT-triad of chronic diarrhea, facial flushing, tricuspid stenosis-only if mets to liver (otherwise 5-HT is metabolized in liver)

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21
Q

annular pancreas

A

-pressure on the duodenum-bilious vomit (green)

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22
Q

Chrons Tx

A

-sulfasalazine, glucocorticoids, azithioprine, methotrexate (immunosuppresives)-infliximab (TNF-alpha inhibitor) for refractory

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23
Q

Brunner’s glands

A

secrete bicarb in the duodenum

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24
Q

Duodenal ulcer vs. peptic ulcer

A

-duodenal ulcer feels better after eating (stimulates brunner’s glands to secrete bicarb, neutralize acid –> weight gain-peptic ulcers feel worse after eating as it increases acid production –> weight loss

25
Q

type A vs type B chronic gastritis

A

type A - autoimmunie, fundus and bodytype B - H. Pylori, antrum (increased risk of MALT lymphoma)

26
Q

peyer’s patches

A

-lympoid tissue only found in illeum-shigella, yersina, mycobacterium avum and some e.coli use peyer’s patches M cells to gain access to host

27
Q

VIPoma

A

-tumor in the tail of the pancreas-causes secretion of water and electrolytes into intestinal lumen as well as relaxing smooth muscle and sphincters… profuse watery diarrhea

28
Q

gastric neoplasm

A

-almost always adenocarcinoma-sister mary joseph nodule (periumbilical) and/or virchow nodule (supraclavicular) -intestinal, associated with H. pylori-diffuse, linitis plastica

29
Q

crigler-najjar

A

-lack of glucuronyl transferase -unconjugated hyperbili- (gilbert’s is same deal, but less severe deficiency)

30
Q

kasai procedure

A

-direct connection of intrahepatic bile ducts to small bowel-Tx for extrahepatic biliary atresia, must happen quickly, cirrhosis occurs in 6 mo if untreated-elevated direct bili, clay stools, dark urine (making bili, can’t get it where it needs to go, excreted in urine

31
Q

space of disse

A

-contain stellate cells, which contain vitamin A and produce collagen-cells responsible for fibrosis following liver injury

32
Q

IBS

A

-diagnosis of exclusion, all lab values should be normal-ish-diffuse abdominal pain that is relieved by defecation

33
Q

achalasia

A

-loss of neurons in auerbach plexus-leads to dysphagia to solids and liquids-Tx with ballooning-associated with chagas-bird beak

34
Q

terminal illeum

A

-most commonly involved site of chrons-site for absorption of B12 and fats

35
Q

Hepatitis E

A

-single stranded non-enveloped RNA-self-resolving, N/V, diarrhea, jaundice-especially dangerous (20% mortality) in pregnant women

36
Q

FAP

A

-APC gene on chromosome 5… Autosomal DOMINANT-100% convert to colon cancer, Tx: colectomy -Subtypes: garnder– FAP + soft tissue/bone tumors, Turcot– FAP + CNS tumors (turcot…turban)

37
Q

saliva secretion (ion composition)

A

-starts similar composition to plasma at acinar cells-ductal cells reabsorb Na/Cl, excrete K and bicarb-flow rate increase, less time to change ions-exeption: bicarb, selectively secreted at higher rates w/high flow

38
Q

Weight loss, fatigue, painless jaundice

A

-think pancreatic adenocarcinoma-in the head of the pancreas, obstructs common bile duct-direct hyperbili

39
Q

indirect vs. direct hernia

A

-indirect: newborn, failure of process vaginalis to close, passes lateral to the inferior epigastric artery-direct: older men, passes through abdominal wall, medial to inferior epigastric artery

40
Q

Lynch’s syndrome

A

-HNPCC, mismatch repair-80% risk of colon cancer-associated risk of other GI and GU cancers (also female reproductive organs)

41
Q

GI blood supply (celiac, SMA, IMA)

A

-celiac: foregut… esophagus, stomach, spleen, first part of duodenum, pancreas-SMA: midgut… lower duodenum to first 2/3 of transverse colon-IMA: hindgut… distal 1/3 of colon to rectum

42
Q

Malonyl CoA

A

-building block for FAS, made from acetyl-CoA by enzyme acetyl-CoA carboxylase (biotin as cofactor)-important INHIBITOR of rate limiting step in beta-oxidation, prevents assoc. with carnatine and subsequent transport into mitochondria

43
Q

intussusception

A

-sudden onset, colicky pain-most commonly ileocecal-possible complication of henoch-schonlein purpura

44
Q

Nutrient absorption in GI tract (Duodenum, Jejunum, Ileum)

A

-Duodenum: Iron-Jejunum: Folate-Ileum: B12, vitamins ADEK (fat), FFA, and carbs

45
Q

scleroderma

A

-autoimmune disease, connective tissue disease-affects the lower 2/3 of smooth muscle in esophagus, dysphagia

46
Q

Barret’s Esophagus

A

-metaplasia of squamous cell to intestinal columnar epithelium

47
Q

acute pancreatitis

A

-often self-resolving, requiring only supportive tx-electrolyte abnormality: hypocalcemia… leads to hyperexcitability of nerve cells (Chvostek’s sign)

48
Q

Chvostek’s sign

A

-pain elicited by tapping over 7th cranial nerve-hypocalcemia

49
Q

Infiltrative liver enzyme tests

A

-only alk phos is elevated, normal everything else-(one possible cause entamoeba histolytica)

50
Q

Tumor markers in Pancreatic cancer

A

-CA 19-9 and carcinoembryonic antigen (CEA)-also elevated serum lipase, amylase and alk phos

51
Q

food poisoning.. all of it

A

see screenshot on desktop

52
Q

celiac sprue

A
  • villous blunting
  • northern european descent
  • dermatitis herpetiformis
53
Q

secretin

A
  • causes increases in pancreatic and biliary secretion of bicarb
  • produced in duodenum in response to high acid levels
54
Q

Tumors of the cheek

A
  • most common: pleomorphic adenoma (well circumscribed, painless, slow growing)
  • Warthin’s: well circumscribed, benign mass of lymphoid cells
  • less common: poorly circumscribed, mixed cells, think carcinoma
55
Q

Pyoderma gangrenosum

A

-associated with IBD

56
Q

glucose transporters (glut 2, glut 4, glut 5, sglt-1)

A
  • Glut-2: basolateral intestinal transporter, glucose, galacose and fructose
  • Glut-4: glucose in muscle and adipose tissue
  • Glut-5: fructose across apical border of intestine, Na INDEPENDENT
  • SGLT-1: glucose and galactose across apical border of intestine, Na DEPENDENT
57
Q

Cushing’s Ulcer

A
  • acute stress related ulcer (resulting in superficial capillary bleeding into GI tract, related to HEAD INJURY
  • elevated ICP
58
Q

most common cause of appendicitis in children

A

-lymphoid mass causing obstruction, typically following viral infection

59
Q

GI cell types

A
  • A: (pancreas) glucagon
  • B: (pancreas) insulin
  • D: (pancreas) somatostatin
  • G: (antrum and dueodenum) gastrin
  • I: (duodenum and jejunum) cholesystikinin
  • K: (duodenum and jejunum) gastric inhibitory peptide
  • S: (duodenum) secretin (inhibits gastric acid, stimulates bicarb)

USMLE (17 decks)

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