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USMLE Step 1 > GI > Flashcards

GI Flashcards

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USMLE® Step 1 flashcards
1
Q

classic paraneoplastic symptoms of small intestine carcinoid tumor?

A

heart murmur, hepatomegaly, flushing w hypoTN

-rosettes on histo

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2
Q

What is the best drug for hepatic encephalopathy?

A

lactulose (traps ammonia)

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3
Q

What are the findings for esophagus w Scleroderma?

A

decreased LES tone + decreased peristalsis

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4
Q

What are the hallmarks of abetalipoproteinemia (Apo B def)?

A

Chronic mal-absorption leading to signs of severe vitamin deficiencies (retinal degeneration, ataxia, motor dysfunction) + acanthocytosis + low cholesterol

-acanthocyte = RBC w spiny projections

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5
Q

Which nerve structures increase acid production in the stomach?

A

vagal trunks (parasymp)

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6
Q

What causes hereditary hemochromatosis (bronze diabetes)?

A

increased intestinal Fe absorption in the small intest

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7
Q

How does alcohol cause acetaminophen toxicity?

A

induces cytochrome p450 = increased hepatotoxic metabolites

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8
Q

What are the symptoms of a VIPoma?

A

Copious Watery Diarrhea, Hypokalemia, and Achlorhydria, hyperglycemia, flushing (vasodilation), big poop

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9
Q

If smoking can cause adenocarcinoma and squamous cell carcinoma, how to differentiate?

A

Adenocarcinoma is most common in non-smokers; so smoker = SCC

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10
Q

What is the Hallmark Triad of Plummer-Vinson syndrome?

A

Dysphagia (esophageal webs), glossitis, iron deficiency anemia
-others: angular stomatitis, spoon-shaped nails

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11
Q

What is Necrotizing enterocolitis

A

Necrosis of intestinal mucosa (primarily colonic)

  • premature formula-fed infants
  • colic + bloody diarrhea in the first week of life
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12
Q

Which branches of the abdominal aorta supplies blood to the spleen?

A

AA –> celiac trunk –> splenic artery –> spleen

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13
Q

Which drugs are MOS def used to treat mild-to-moderate Ulcerative colitis?

A

Mesalamine
Olsalazine
Sulfasalazine

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14
Q

What affect does atropine have on gastrin, Ach, and histamine to secrete acid from parietal cells?

A

Gastrin, Ach, and histamine are synergistic, so Atropine DECREASES acid production in all of them.

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15
Q

What is steatorrhea and its cause?

A

Bulky, oily, malodorous stool from bacterial overgrowth (acting on undigested lipids)

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16
Q

What is secretory diarrhea and its cause?

A

Large vol of watery stool; does not stop w fasting; caused by infectious agents transporting electrolytes into the lumen

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17
Q

What is osmotic diarrhea and its cause?

A

Watery diarrhea + bloating, gas that does NOT stop w fasting; caused by malabsorption

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18
Q

What is the difference between direct and indirect bilirubin?

A

direct: conjugated by the liver = soluble
indirect: not removed from blood by liver yet = insoluble

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19
Q

Which enzyme conjugates bilirubin?

A

UDP-glucuronosyltransferase

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20
Q

What is Crigler-Najjar Syndrome?

A

Absent UDP-glucuronosyltransferase =
jaundice, kernicterus (bilirubin deposition in brain),  unconjugated bilirubin.
Tx: plasmapheresis and phototherapy.

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21
Q

What drug is used to treat carcinoid syndrome?

A

Octreotide (helps w the flushing and diarrhea)

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22
Q

The splenic artery and vein travel with which ligament?

A

splenorenal ligament

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23
Q

Which 3 arteries come off the celiac trunk?

A

splenic
left gastric
common hepatic

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24
Q

Which artery supplies the body & tail of the pancreas?

A

splenic artery

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25
Q

What is the MOA of the preferred drug to treat cholesterol gallstones?

A

ursodiol = decreases cholesterol synthesis, secretion, and absorption

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26
Q

What is primary biliary cirrhosis?

A 
Autoimmune reaction (anti-mitochondrial abs) = 
Ž lymphocytic infiltrate + granulomas --> destruction of intralobular bile ducts.

-assoc w other autoimmunes

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27
Q

What are the mesodermal defects assoc w tracheoesophageal atresia?

A 
VACTERL:
Vertebral defects
Anal atresia
Cardiac defects 
Tracheo-Esophageal fistula 
Renal defects
Limb defects (bone and muscle)
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28
Q

Which drug is contraindicated in pts with alcohol disorder?

A

metronidazole bc it causes disulfiram rxn w alcohol

acetaldehyde accumulates, contributing to hangover symptoms

29
Q

Reye syndrome affects which organelles?

A

mitochondria

30
Q

What is the cause of duodenal atresia and its hallmarks?

A

cause: fail of recanalization of duodenal lumen
hallmarks: assoc w Down syndrome & “double bubble” on xray

31
Q

How does H.pylori damage the gastric mucosa?

A

By increasing mucosal levels of ammonium

32
Q

Which structures are retroperitoneal?

A

SAD PUCKER:
Suprarenal (adrenal) glands
Aorta and IVC
Duodenum (2nd through 4th parts)

Pancreas (except tail)
Ureters
Colon (descending and ascending) 
Kidneys
Esophagus (thoracic portion) 
Rectum (partially)
33
Q

Whats the general function of the duodenal hormones?

A

They decrease acid secretion rates

34
Q

What are the hormones secreted by the duodenum?

A

prostaglandin E2
somatostatin
secretin
gastric inhibitory peptide (GIP)

35
Q

What is biggest consequence of duodenal resection?

A

loss of inhibitory hormones = increase in acid secretion

36
Q

Your pt has cholecystitis but no jaundice, where do you suspect stones?

A

Cystic duct or gallbladder (less common)

37
Q

Your pt has cholecystitis and jaundice, where do you suspect stones?

A

Common bile duct

38
Q

Whats the MOA of -azole antifungals?

A

inhibit fungal cytochrome P-450 lanosterol 12-a-demethylase

39
Q

Where is the abnormal APC gene located for Familial adenomatous polyposis (FAP)?

A

5q21

40
Q

Which artery supplies the DISTAL lesser curvature? the PROXIMAL lesser curvature?

A

distal: right gastric (dr)
proximal: left gastric (pl)

41
Q

How does gastrin strengthen the mucosal barrier?

A

Gastrin release initiates cell division in proliferative zone of gastric mucosa

42
Q

What is primary sclerosing cholangitis? What other diseases is it associated with?

A

PSC: concentric “onion skin” bile duct fibrosis w alternating strictures and dilation (=“beading” of intra- and extrahepatic bile ducts)
-assoc w ulcerative colitis

43
Q

Which nerve is responsible for the defecation reflex?

A

pelvic splanchnic nerve

44
Q

What is Ménétrier disease?

A

Gastric hyperplasia of mucosa = hypertrophied rugae

excess mucus production –> protein loss and parietal cell atrophy with acid production.
- increased TGF-a

45
Q

What hormone causes gallbladder contraction? And which cell secretes it?

A

CCK from I cells.

46
Q

Stress ulcers are caused by an increase in what?

A

pepsin production and gastric acid

47
Q

Whats the most common location for Menckel’s diverticulum?

A

ileum

48
Q

Which tumor markers are associated with pancreatic cancer?

A

CEA and CA19-9

49
Q

Which organism is responsible for punched-out ulcers in the esophagus of IC pts?

A

HSV-1

50
Q

What does serum alkaline phosphatase indicate?

A

Metastases to bone or liver, Paget disease of bone, seminoma

51
Q

What drug is used to treat esophageal varices?

A

Octreotide (decreases portal blood flow)

52
Q

which pressure changes cause pitting edema?

A

 INC capillary pressure ( INC Pc; e.g., HF)
ƒ DEC plasma proteins ( DEC πc; e.g., nephrotic syndrome, liver failure)
ƒ INC capillary permeability ( INC Kf ; e.g., toxins, infections, burns)
ƒ INC interstitial fluid colloid osmotic pressure ( INC πi; e.g., lymphatic blockage)

53
Q

Whats the MOA and indication for prochlorperazine?

A

Antiemetic that blocks dopamine receptors used for chemotherapy pts.

54
Q

Where is a shunt created to help relieve portal HTN?

A

splenic vein (portal)-left renal vein (IVC)

55
Q

What 3 factors stimulate gastric acid secretion in the parietal cells?

A
  1. histimine
  2. gastrin
  3. vagal stimulation
56
Q

What is meconium ileus and what is the other disease it is associated with?

A

In cystic fibrosis, meconium plug obstructs intestine, preventing stool passage at birth.

57
Q

What are normal levels of unconjugated and conjugated bilirubin in the portal vein?

A

unconjugated > conjugated

58
Q

What part of the colon is denervated in Hirschprung’s disease?

A

Distal rectum always involved.

59
Q

What clinical features would indicate enterovesicular fistula secondary to Crohn’s?

A
  • ab pain
  • brown-yellow urine (fecal contamination)
  • multiple enteric orgs
60
Q

Other than motility, what is the other function of migrating motility complexes?

A

Maintain low bacteria counts in the upper intestine

61
Q

What is angiosarcoma?

A

Highly aggressive tumor that arises from blood vessels

62
Q

What is a major risk factor for angiosarcoma?

A

Exposure to vinyl chloride

63
Q

What characterizes carcinoid heart disease?

A

Right-sided endocardial fibrosis w tricuspid valve damage

64
Q

Which apoprotein turns on lipoprotein lipase?

A

CII

65
Q

Def in apoprotein CII causes what?

A

hyperlipidemia + high chylo levels

66
Q

What is Zollinger-Ellison syndrome?

A

Gastrin-secreting tumor in the pancreas

67
Q

Parietal cells provide which 2 excretory products?

A
  1. Intrinsic factor

2. Gastric acid

68
Q

What 2 fetal abnormalities result in polyhydramnios?

A
  1. tracheoesophageal atresia

2. anencephaly

USMLE Step 1 (13 decks)

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