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USMLE > GI > Flashcards

GI Flashcards

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USMLE® Step 1 flashcards
1
Q

What is within the spleen-renal ligament?

A

Splenic artery and tail of the pancreas

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2
Q

Where are the most Goblet cells found in the small intestine?

A

Ileum (duodenum has Brunner’s glands)

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3
Q

What is SMA Syndrome?

A

Intestinal obstruction that occurs when the duodenum gets pinched between the SMA and aorta

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4
Q

What do the I, G, K, S, and D cells in the GI tract secrete?

A 
I - CCK
G - gastrin
K - GIP (potentiates insulin release)
S - secretin
D - SST
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5
Q

What electrolyte abnormality is associated with PUD and GERD?

A

HyperCa - increases gastrin secretion

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6
Q

What regulatory signal produces Migrating Motor Complexes? What antibiotic also stimulates this?

A

Motilin

Erythromycin

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7
Q

What regulatory signal is essential for pancreatic enzyme function in the duodenum?

A

Secretin - stimulates pancreatic HCO3 (neutralize gastric acid to prevent enzyme degradation) and gallbladder bile secretion (break up fats into digestible micelles)

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8
Q

What increases gastric parietal cell HCl secretion and through which GCPR?

A

ACh (M3 = Gq), Gastrin (Gq), Histamine (Gs)

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9
Q

What NT is released from the the vagus nerve to stimulate G cell gastrin secretion?

A

GRP (gastrin releasing peptide) - Atropine doesn’t completely block gastric acid secretion

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10
Q

What do intestinal SGLT1 and GLUT5 transport? How are they transported into the blood?

A

SGLT1 - Na and glucose or galactose
GLUT5 - fructose
Secreted into blood by GLUT2

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11
Q

What does the D-xylose absorption test distinguish?

A

Malabsorption due to GI mucosal damage (increased fecal D-xylose) versus pancreatic enzyme insufficiency/inactivation (normal fecal D-xylose)

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12
Q

How is Cu eliminated from the body?

A

Excretion into the bile

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13
Q

What 4 GI problems are Down Syndrome patients predisposed to?

A

Duodenal atresia, annular pancreas, celiac disease, Hirschsprung disease

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14
Q

Does sympathetic stimulation of salivary glands produce a thick or waters saliva? Where does the signal come from? Parasympathetic?

A

Sympathetic - thick, superior cervical ganglion

Parasympathetic - watery, CN 7 and 9

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15
Q

What salivary tumor is most common?

A

Pleomorphic adenoma (cartilage + epithelium)

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16
Q

What malignant salivary tumor is most common?

A

Mucoepidermoid CA (mucinous + squamous)

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17
Q

What benign salivary tumor has germinal centers and bi-layered epithelium?

A

Warthin tumor

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18
Q

Plummer-Vinson Syndrome

A

Esophageal webs, Fe deficiency anemia, glossitis

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19
Q

What may be the diagnosis in someone with heartburn that is unresponsive to GERD therapy?

A

Eosinophilic esophagitis - due to food allergen in patients with atopic diseases. May lead to strictures

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20
Q

Esophageal strictures is associated with ingestion of what substance?

A

Lye

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21
Q

What type of esophageal cancer are cigarettes, esophageal webs, and obesity risk factors for?

A

Cigarettes - both
Esophageal webs - squamous cell
Obesity - adenoCA

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22
Q

What is a curling ulcer? Cushing ulcer?

A

Curling ulcer = burns (decreased plasma volume leads to mucosal ischemia and sloughing) “curling iron burns”
Cushing ulcer = brain injury (increased vagal stimulation)

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23
Q

What are the 2 most common causes of acute gastritis?

A

NSAIDs and alcohol

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24
Q

What causes type A chronic gastritis? Type B? What type of cancers are increased in each?

A

Type A - autoimmune destruction (therefore also pernicious anemia). Increased risk gastric adenoCA
Type B - H pylori infection. Increased risk gastric adenoCA and MALToma
“A = autoimmune, B = bacteria”

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25
Q

What is Menetrier disease?

A

Precancerous hypertrophy of mucus cells with parietal cell atrophy. Decreased acid production leads to enteric protein loss and edema. Stomach rug look like brain gyri

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26
Q

Dietary intake of what food is associated with intestinal-type gastric adenoCA?

A

Nitrosamines (smoked foods)

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27
Q

If a duodenal ulcer ont he posterior wall ruptures, what vessel would bleed?

A

Gastro-duodenal artery

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28
Q

What is Triple Therapy for H pylori?

A

PPI + clarithromycin + amoxacillin or metronidazole

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29
Q

What is Quadruple therapy for H pylori?

A

PPI + metronidazole + bismuth + tetracycline

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30
Q

How is Tropical Sprue different from celiac sprue?

A

Responds to abx, thus infectious (although exact bug is not known)

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31
Q

How does Whipple Disease present? What stain is used to identify the organism?

A

“Whipped cream in a CAN” - cardiac symptoms, arthralgia, neurologic symptoms
PAS acid-Schiff stains positively in foamy macrophages

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32
Q

What HLA genes are associated with Celiac sprue?

A

HLA-DQ2 and HLA-DQ8

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33
Q

How would Celiac sprue affect stool pH?

A

Decrease pH (undigested lactose is fermented by colonic bacteria into short chain FAs + H causing acidosis and an osmotic diarrhea)

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34
Q

What is the mechanism of disease in abetalipoproteinemia?

A

Deficiency ApoB48 causes CMs to be stuck in the enterocytes. Inability to absorb fats leads to fat-vitamin deficiencies

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35
Q

What hematologic abnormality is seen in abetalipoproteinemia?

A

Acanthocytes (star-shaped RBCs)

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36
Q

What renal complication is associated with Chron disease?

A

Nephrolithiasis (oxalate stones) - decreased bile repute increases lipid content = saponification with fecal Ca = less free Ca to bind oxaloacetate and prevent absorption = supersaturation and stone formation

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37
Q

What rheumatoid conditions are associated with both Chrons and UC?

A 
Seronegative spondyloarthropathies (HLA-B27) 
"PAIR" - Psoriatic arthritis, ankylosing spondylitis, IBD, reactive arthritis
38
Q

What is the most common cause of appendicitis in children?

A

Lymphoid hyperplasia and obstruction

39
Q

How would you diagnose a Meckel Diverticulum?

A

Pertechnate study - measure radiolabelled pertechnate uptake by gastric tissues. If it labels are portion of the intestine, there is ectopic gastric mucosa due to Meckel Diverticulum

40
Q

What pathology is associated with currant jelly stools?

A

Intussusception

41
Q

What are the 3 most common causes of bowel obstruction?

A

Adhesions, hernias, and cancer

42
Q

What gene mutation is associated with Hirschsprung disease?

A

RET

43
Q

What is angiodysplasia?

A

Tortuous dilation of vessels in the GI tract. Causes hematochezia (bright red blood) and is found in elderly patients

44
Q

What pathology is associated with patient reported abdominal pain that is out of proportion of physical exam findings?

A

Ischemic colitis

45
Q

What pathology is associated with apple peel intestinal architecture?

A

Atresia due to vascular accident in newborns

46
Q

What causes abundant mucinous secretory diarrhea (that is non-infectious)?

A

Villous-type adenomatous polyp

47
Q

Single mass lesion in the rectum of a young child

A

Juvenile polyp

48
Q

What is Peutz-Jeghers syndrome?

A

Many non-malignant hamartomatous polyps in GI tract + hyperpigmention of mouth and hands
DOES increase risk of colorectal CA

49
Q

What is Gardener Syndrome?

A

FAP + osteomas + soft tissue tumors

50
Q

What is Turcot syndrome?

A

FAP + medulloblastoma

“Turcot = turban”

51
Q

What is the mutation in HNPCC/Lynch syndrome?

A

DNA repair genes - leads to microsatellite instability

52
Q

What is the tumor marker used to monitor recurrence of colorectal cancer?

A

CEA

53
Q

What sequence of mutations (4) leads to non-inherited colorectal CA?

A

APC (tumor supressor) - Kras (oncogene) - p53, DCC

54
Q

What enzyme may contribute to progression of colorectal CA?

A

COX2 - aspirin may be protective

55
Q

What gastric pathology is associated with cirrhosis and why?

A

Portal HTN causes congestion - decreased perfusion to the stomach weakens/thins the mucosa predisposing to peptic ulcers

56
Q

How does Reye syndrome present? What is damaged?

A

Hypoglycemia + hepatomegaly (fatty liver) + encephalopathy

Asprin damages the mitochondria

57
Q

What pathology is associated with Mallory bodies?

What are Mallory bodies?

A

Alcoholic hepatitis

Damaged intermediate filaments

58
Q

What carcinogen is associated with HCC?

A

Aflatoxin (from Aspergillis)

59
Q

What is the tumor marker used to monitor recurrence of HCC?

A

AFP

60
Q

What paraneoplastic syndrome is associated with HCC?

A

Polycythemia (EPO production)

61
Q

Arsenic and vinyl chloride exposure predispose to what liver pathology?

A

Angiosarcoma (malignant endothelial tumor)

62
Q

What 2 antibodies are associated with type 1 Autoimmune hepatitis?

A

ANA and anti-smooth-muscle

63
Q

What 2 antibodies are associated with type 2 Autoimmune hepatitis?

A

Anti-liver/kidney-microsomal and anti-liver-cytosol

64
Q

What is the greatest concern with Echinococcus granulizes infection?

A

Can form liver abscess (tapeworm). If ruptured during removal or biopsy could trigger anaphylactic shock

65
Q

What pathology is associated with PAS+ globules within hepatocytes?

A

Alpha 1 antitrypsin deficiency

66
Q

Which type of Crippler-Najjar syndrome is responsive to phenobarbital?

A

Type 2 (some UDP-glucuronosyltransferase activity remains)

67
Q

What hereditary hyperbilirubinemia is associated with a grossly black liver?

A

Dubin-Johnson syndrome

68
Q

What CNS changes are associated with Wilson disease?

A

Parkinsonism (degeneration of the basal ganglia)

69
Q

What genetic mutation is associated with Wilson disease?

A

Defective hepatocyte Cu transporting ATPase (ATP7B)

70
Q

What pathology is associated with bronze diabetes?

A

Hemochromatosis

71
Q

What is seen on histology in Primary Biliary Cirrhosis?

A

Lymphocytic infiltrate with granulomas

72
Q

What antibodies are associated with PBC?

A

Anti-mitochondrial (AMA)

73
Q

What is seen on histology in Primary Sclerosing Cholangitis?

A

Concentric onion skinning of bile ducts, “beads on a string” intra and extra-hepatic bile ducts

74
Q

What antibodies are associated with PBC? What other autoimmune disease is associated with PSC?

A

pANCA

Ulcerative colitis

75
Q

What pathology is associated with RUQ pain radiating to the right scapula?

A

Acute cholecystitis

76
Q

What pathology is associated with Rokitansky-Aschoff sinuses?

A

Chronic cholecystitis (herniation of gallbladder mucosa into the muscular wall)

77
Q

What should be considered in an elderly female presenting with new onset cholecystitis?

A

Gallbladder adenoCA

78
Q

What hematologic pathology is associated with pigmented gallstones?

A

Hemolytic anemia - bilirubin stones

79
Q

How does Clofibrate increase the risk for cholesterol gallstones?

A

Decreases bile acid production

80
Q

What is Charcot’s triad?

A

RUQ pain + jaundice + fever (also associated with HoTN and altered mental status) indicating cholangitis (inflammation of the biliary tree)

81
Q

What viral infection is associated with acute pancreatitis?

What drugs can cause acute pancreatitis?

A

Mumps
Sulfa drugs and HIV NRTIs/PIs
ALSO scorpion sting!

82
Q

What tumor markers are used in pancreatic adenoCA?

A

CA 19-9 and CEA

83
Q

What is Trousseau syndrome? What pathology is associated with it?

A

Migratory thrombophlebitis

Pancreatic adenoCA

84
Q

What is the mechanism of action of Metoclopramide? What is it’s clinical use?

A

Increases 5HT4 and decreases D2 in the GI tract

Diabetic gastroparesis

85
Q

What are the side effects of Cimetidine?

A

P450 inhibitor, anti-androgen

86
Q

Which antacid causes constipation and which causes diarrhea?

A

Aluminum OH = constipation “alu-minimum”

Magnesium OH = diarrea “Mg = must go”

87
Q

What drug is used to treat the seronegative spondyloarthropathies (including IBD)?

A

Infliximab (anti-TNFa Abs)

88
Q

What two types of necrosis are present in acute pancreatitis?

A

Liquefactive (pancreatic tissue) and fat (surrounding adipose tissue)

89
Q

What skin findings are seen with acute pancreatitis?

A

Periumbilical and flank hemorrhages (migrates into the retroperitoneal fat

90
Q

Infection with what organism can cause fulminant liver failure in a pregnant woman?

A

Hepatitis E

91
Q

What are the causes of acute pancreatitis?

“pancreatit-s”

A

hyperParathyroid (hyperca), Alcohol, Neoplasm (obstructive), Cholelithiasis, Rx (HIV, sulfa drugs), ERCP, Abdominal surgery, Trauma, Infection (mumps), hyperTriglycerides, and Scorpion sting

92
Q

What is the mechanism of orlistat?

A

Pancreatic lipase inhibitor (Alli weight loss drug)

USMLE (12 decks)

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