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board review > GI > Flashcards

GI Flashcards

1
Q

what is going on at the peyers patches as an example of class switching?

A

peyers patches deliver ingested microorganisms to the APCs –> stimulation of B cells which will differentiate into

IgA!!! secreting plasma cells.

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2
Q

on the boards

what microorganisms invade into M cells of peyers patches

to survive

they remain in endocytic vacuoles – replicate, –> cross cytoplasm to the blood

A

**salmonella typhimurium

shiella flexneri

polio virus

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3
Q

polio cause lower motor signs because

A

infects anterior horn

(lower motor neuron start from anterior horn cells down to peripheral nerve)

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4
Q

Q on boards

child 1-2 yo presenting with sudden onset abdomenal pain, exam him and feel lump. you get xray and see intussusception

what is one of the mechanism this child is getting intussusception!!!

A

hypertrophy of peyers patches

acts as a leadpoint

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5
Q

a pt with hyperparathyroidism, severe dyspepsia, and PUD resistant to PPI tx and Headache with visual field defect.

what does he have?

A. gastric neoplasm

B. non-gastric neoplasm

A

non gastric neoplasm

the majority of gastrinoma are in the pancreas or duodenum

he has MEN 1 syndrome

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6
Q

43 yo obese women C/O Nausea, distension, vomiting and RUQ abdominal pain after eating a fatty meal

What do you think?

A

Cholecystokinin (CCK) - duodenal cells FAT and AA –> GB contraction

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7
Q

where is somatostatin secreted

A

stomach

intestine

DELTA cells in the pancreas

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8
Q

how do you treat carcinoid syndrome?

A

octreotide

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9
Q

what is secreted by hypothalamus to regulate GH

its used in treatment of somatotroph adenoma

A

somatostatin

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10
Q

pt with pituitary adenoma causing acromegaly

you treat with transsphenoidal surgery to take out tumor

however after surgery pt still has high growth hormone level or a little bit of the tumor.

how do you treat after surgery?

A

octreotide!!!

(somatostatin analog)

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11
Q

Carcinoid syndrome or tumor is a neuroendocrine tumor which

originates from ____ cells?

what does it secrete

A

enterochromaffin cells. in the

midgut (common in the appendix)

secrete excessive amount of serotonin and bradykinin

  • most of these vasoavtive substances are inactivated in the liver.

**** carcinoid syndrome, appears only when there are metastases to the liver.

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12
Q

what cardiac manifestation results from carcinoid syndrome?

A

tricuspid regurgitation

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13
Q
A
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14
Q

why can octreotide be used in esophageal varices bleeding?

A

reduces portal venous pressure

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15
Q

how due you diagnose carcinoid syndrome

on board

A

inc 5- hydroxyindolacetic acid (5-HIAA)

in the urine, its an end product of serotonin metabolism

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16
Q

pt with carcinoid syndrome can present with what vitamin deficiency

A

niacin deficiency

bc tryptophan is the source of niacin which is used to fom excessive amount of serotonin

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17
Q

pt with telangiectasia

autosomal dominant

pt with recurrent epistaxis and Gi bleeding

A

osler-Weber Rendu syndrome

(hereditary hemorrhagic telangiectasia)

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18
Q

embryology of the tongue

Q

the terminal sulcus is the line of fusion between the ____ and the ____ parts

the apex of the terminal sulcus is marked by a blidn forament called

A

line of fusion bw the oral and the pharyngeal parts

the foramen cecum

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19
Q

Q

what the foramen cecum

A

the remnaant of median thyroid diverticulum from which thyroid follicular cells derive.

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20
Q

Q on boards

  1. what muscle draws the sides of the tongue up?

2. sticks the tongue out

3. retracts tongue?

A
  1. styloglossus

2. genioglossus

3. hypoglossus

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21
Q

what are causes of macroglossia

A

myxedema (severe hypothyroidism)

acromegaly

amyloidosis (primary and myeloma related)

multiple endocrine neoplasia IIb (mucosal neuroma)

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22
Q

question on boards

you have a pt with a thyroglossal cyst.

you should ask the pt to stick out tongue (not swallow!!!)

what muscle is doing this?

A

genioglossus

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23
Q

salivary gland disorders

sjogrens syndrome

treatment?

and moa

A

cevimeline

its a parasympathomimetic and muscarinic agonist.

affecting M1 and M3 receptors

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24
Q

salivary gland

is stimulated by?

A

BOTH

para and sympathetics

will increase secretions.

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25
Q

2 questions on boards.

what is the most common tumor of the salivary glands and parotid gland

its painless and mobile.

and what is unique about this tumor

A

pleomorphic adenoma (mixed tumor)

its pleomorphic (variable appearance) formed of epithelial cells mixed w/ myxomatous and cartilaginous strome - biphasic tumor

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26
Q

on boards

pt with erythema, pain, tenderness upon palpation and swelling

plain radiography shows an object in the submandibular gland

diagnosis and most common cause

A

siadladenitis - stone blocking the gland

most common microorganism staph aureus

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27
Q

pt with swelling of parotid and facial nerve palsy

on biopsy tumor has

squamous and mucus secreting cells

A

mucoepidermoid carcinoma

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28
Q

warthins tumor

common in female

describe its histo

A

benign cystic glandular structures surrounded by lymphoid tissue

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29
Q

Q

the malleus and incus are derived from what pharyngeal arches vs the stapes!!!

A

malleus, incus = 1st arch

stapes = 2nd

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30
Q

the anterior belly and the posterior belly of digastric muscles

are derived from which phayngeal arches (mesodermal)

A

anterior belly of digastric = 1st arch

Posterior belly of digastric = 2nd arch

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31
Q

which nerve innervates (derived from) the 4th and 6th arches

A

4th = cn X (SUPERIOR laryngeal n)

6th = cnX (recurrent laryngeal n)

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32
Q

kid with acute tonsilitis.

what is the origin of the palatine tonsil?

A

endodermal orgin from the 2nd pouch.

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33
Q

kid with recurrent

A
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34
Q

is the intra esopahgeal pressure subatmospheric?

true!

why?

A

intrathoracic location

bc its in the intrathoracic cavity.

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35
Q

Question

esophageal lesion distance on EGD is typically measured from?

and

the clinically important distance is from?

A

measure from incisors

clinically important distance is from incisors to GEJ, which is about

40cm

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36
Q

what is the external component of the lower esophageal sphincter?

A

diaphragm

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37
Q

on boards

what nerve might be injured during surgical correction of tracheoesophageal fistula

A

LEFT recurrent laryngeal nerve.

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38
Q

Question

what two findings due you expect for

tracheoesophageal fistula

A

polyydramnios

(unable to swallow the amniotic fluid)

abdominal distension (the air is going into the stomach)

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39
Q

mid age pt never smoked

no history of coronary artery disease, no heart disease no risk factors

all of sudden in ER with severe chest pain given nitrates and feels better.

barrium swallow shows corkscrew pattern

what is diagnosis

A

diffuse esophageal spasm

it mimics unstable angina

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40
Q

what is the most common Gi disease that

mimics acute coronary mi or unstable angina?

A

GERD

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41
Q

on boards

gives you whole stem with patient with achalasia

when you do dilatation of the stricutre at the gastroesophageal junction. bleeding occurs whats the source?

A

left gastric arteries.

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42
Q

pt came to your clinic for check up

he has a hx of lye stricture like 8 years ago

what should you do

A

send pt for endoscopy

bc lye strictures inc risk of squamous cell carcinoma of the esophagus

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43
Q

achalasia

has increased risk of what cancer?

A

squamous cell carcinoma of the esophagus.

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44
Q

where does Zenkers diverticulum occur

“bw what muscles”

A

killian triangle

is the weak are bw inferior constrictor of the pharynx and cricopharyngeus muscle.

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45
Q

Q on boards

is there any increase risk of

esohageal cancer.

if so what kind

A

yes

esophageal squamous cell carcinoma

all the risk factors on exam will increase risk of Squamos cell

the only one that increases adenocarcinoma is barrets esophagus

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46
Q

heart burn and this xray

high yield image

diagnosis

A

hiatal hernia

most common

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47
Q

alendronate

inc risk of what GI adverse effect

A

esophagitis

take med with water and stay sitting up /standing for 1 hour

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48
Q

you have a 78 yo pt that is bed ridden

what medication is Ci in this pt for her Osteoporosis

A

alendronate

bc it can cause esophagitis

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49
Q

young pt treated for acne with doxycyline now complaining of odynophagia (painful swallowing)

diagnosis?

A

esophagitis

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50
Q

17 yo male presents with

fever, vomiting, epigastric pain w swallowing, dysphagia, heartburn, and food impaction

he has hx of asthma and atopic dermatitis

what do you expect on biopsy of eosphagus

A

eosinophilic infiltrates in the esophagus

lungs and LN

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51
Q

how do you diagnosis eosinophilic esophagitis

what do you expect to see

and how do you treat?

A

endoscopic biopsy

see f_urrows,_ or rings on esophageal wall

tx inhaled corticosteriods.

!!! advise pt to swallow!!!

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52
Q

immunosuppressed in odynophagia,

what is the cause of

linear ulceration in the esophagus.

both intranuclear and cytoplasmic inclusion

A

CMV esophagitis.

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53
Q

odynophagia in immunosuppressed

snmall vesicles that evolve into typical punch out ulcers

microscopy: eosinophilic intranuclear inclusions (cowdry-type A )

what is the cause

A

HSV-1

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54
Q

odynophagia in immunosuppressed

grey white pseudomembranes on erthematous mucosa

microscopy shows ?

A

yeast cells and pseudohyphae

caused by Candidia albicans

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55
Q

asthmatic pt has be put on many medications without improvement. what should you try

A

PPI

asthmatic pt even without symptoms of GERD may have improvement in their symptoms with the tx of GERD

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56
Q

a 45 yo male with long hx of GERD

all of the following can cause dysphagia in this pt EXCEPT

A. erosive esophagitis

B. peptic stricture

C. esophageal adenocarcinoma

D. Barrets esophagus

E. GERd -related dysmotility

A

Barretts esophagus

bc only thing that has occured is histologic change from

squamous cell –> columnar epithelium with goblet cells.

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57
Q

lowe substernal tenderness

think

A

GERD (esophagitis)

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58
Q

during surgery your pt is bleeding profusely

in the abdomen from the liver area.

what ligament should you clamp

A

hepatoduodenal

(portal triad)

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59
Q

question on boards

congenital pyloric stenosis

is associated with

A

turner syndrome

or

polyhydramnios

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60
Q

congenital pyloric stenosis

is caused by hypertrophy of?

A

the CIRCULAR layer of pyloric muscular mucosae

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61
Q

how do you tx a 2 week old

pt with projectile non bilious vomiting

labs : hypokalemia, hypochloremic metabolic alkalosis

A

iv fluid and surgical myotomy

(pyloric stenosis)

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62
Q

secretin hormone is formed by S cells in the duodenal mucosa

it inhibits!!! the release of gastrin hormone in the normal stomach

however. what is its role in gastrinoma

A

secretin

STIMULATES gastrin from gastrinoma

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63
Q

what are the two main things stimulated by vagus nerve that increase aicd production by causing down stream activation of proton pump

A

acetylcholine

gastrin from G cells - will bind to cholecystokinin B receptors to stimulate release of histamine (H2) in enterochromaffin ike cells (ECL)

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64
Q

what decreased gastric acid secretion

A

prostaglandin E2 which

stimulates Gi

thus dec cAMP thus no stimulate of H/K ATPASE pump

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65
Q

in terms of increased acid secretion from parietal cells

histamine

is different than Gastrin and ACH that cause inc acid by stimulated increaed intracellular Ca via Gq (IP3)

how?

A

histamine causes inc cAMP

which sitmulates H/K atpase pump

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66
Q

why does pt with systemic masstocytosis (gastric hypersecretion) have significant itching (urticaria pigmentosa)?

because of histamine

more specifically?

A

histamine induces vasodilation by increasing

nitric oxide synthesis in the endothelial cells.

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67
Q

whats the pathogenesis of H pylori in the antrum causing duodenal ulcer

A

stimulation of G cells to secrete more gastrin hormone –> inc parietel cell production gastric acid –> duodenal damage and ulceration

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68
Q

question on boards

the fasting serum gastrin is normal in patients with duodenal ulcer but the gastrin response to a meal is ?

A

high

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69
Q

if H pylori colonize the body of the stomach

(where the acid secreting parietal cells are located –> dec acid production –> atrophy of the gatric muscose –> gatric ulcer and increases the risk for?

A

stomach cancer

note H pylori of the stomach –> achlorhydra bc of atropy of parietal cells.

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70
Q

how do H pylori survive the acid environment

A

expresses urease –> hydrolyze urea –> ammonia to buffer the acid environment

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71
Q

on boards

a women comes in with abdominal pain

a lesion is found in the posterior wall of the proximal part of the duodenum

what structure is at risk for injury?

(meaning that pt has ulceration, if it penetrates through the posterior wall what structure can be effected)

A

pancreatic head

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72
Q

on boards for sure

posterior wall ulcers perforation may induce?

A
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73
Q

a man comes in with pain after meals and this pain has not responded to PPI therapy

what is a possible causes of this mans pathology

A

lesion of the pancreas (GASTRINOMA)

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74
Q

major surgery and sick pt in the ICU develops acute erosive gastritis

due to?

A

local ischemia due to hypotension and splanchnic vasoconstriction

75
Q

acute gastritis

pt with burns – hypovolemia –> mucosal ischemia

vs

brain injury –> inc vagal stimulation –> inc ACh –> inc hcl production

A

curling ulcers = burns

cushing ulcer = brain injury

76
Q

autoimmune chronic gastritis

is most commonly caused by

and what part of stomach?

A

pernicious anemia

body/fundus of stomach

77
Q

on boards

why do 20% people with H pylori gastritis develop

gastric carcinoma and lymphoma

A

the strain of H pylori contain a “pathogenicity island that has the

cagA protein (cytotoxin associated gene A)

it causes chronic gastritis –> atrophy of mucosa –> achlorhydria –> intestinal metaplasia –> dysplasia -> neoplasia (carcinoma of the intestinal type)

78
Q

boards

bleeding in mallory-weiss syndrome or

gastro-esophageal laceration syndrome

is coming from what artery?

A

left gastric artery!

it supplies the lower esophageal area.

79
Q

boerrhaave syndrome

you have esophageal rupture

due to?

A

sudden rise in internal esophageal pressure

caused by vomting as a result of neuromuscular incoordination

(cricopharyngeus msucle (a sphincter within the esophagus failed to relax)

80
Q

H pylori with cagA protein is associated with what type of gastric cancer

A

intestinal type

h pylori, metaplasia or nitrosamines are not associated with diffuse type

81
Q

(Q) metoclopramide

is used to increase Gi perisalsis without increasing gastric secretion.

whats its moa

**SE**?

A

dopamine (D2) receptor antagonist in the enteric NS - myenteric auerbachs) and submucosal (meissners) pleuxs

side effect**** extrapyramidal effects (parkinsonism)

82
Q

Q on boards

cisapride

serotonin (5-HT4) agnoist in the enteric Ns –> inc ACH –> GI motility

side effect

A

fatal ARRHYTHMIA - due to Long QT syndrome

83
Q

high yield board

9 yo boy is seen with recurrent painless RECTAL BLEEDING.

no fever, no skin rask, no fam hx of colon cancer. sigmoidscopy was normal.

what is the most likely cause of the bleeding

A

mechels diverticulum

when you see this age and bleeding think this!!!

the omphalomesenteric (vitelline) duct attached to the ileum

84
Q

Q

gastric mucosa may be seen which produces acid –> ulcerations and bleeding in young children with meckels diverticulum

this is an example of?

A

ectopy!!

85
Q

hirshsprungs disease

is caused by

associated with downs

A

failure of neural crest cell migration during embryogenesis

rectum is most common affected

86
Q

pathology of hirschsprungs disease (congenital aganglionic megacolon)

A

abscence of ganglion cells in the submucosa and myenteric plexus (meissners submucosal plexus and auerbachs myenteric plexuses)

87
Q

Q

know that REt mutation is associated with?

A

Hirschsprungs disease

downs syndrome

neuroblastoam

medullary thyroid cancer.

88
Q

intestinal obstruction in the first day of birth in DOWN syndrome

upright abd xray = double bubble sign

associated with polyhydramnios

A

duodenal atresia

89
Q

colicky abd pain, vomiting, red current jelly stool in healthy 7-10 month infant

A

intussception

90
Q

anal fissures are very common in

A

newborns!

91
Q

a women loses a signifcant amount of wt complaisn of pain in the abd region

particularly when she eats why?

A

constriction of the duodenum by the SMA due to decreased fat

(superior mesenteric artery syndrome)

92
Q

granulomatous inflammation

(sarcoidosis, crohns disease)

also TB skin test, contact dermatitis, graft versus host

are associated w/ what HSR?

A

type IV delayed

93
Q

chronic lower GI bleeding with abdominal pain

in middle age patient that has never traveled outside US

no signs of parasitic or bacteria infection

you should think

A

ulcerative colitis

94
Q

primary sclerosing cholangitis

associated with

A

UC

95
Q

Q on board

colon cancer screening should start when? in pt diagnosed today with colon cancer

A

start 8-10 years after diagnosis

then every 2-3 years

96
Q

Q on boards (trick!!!)

UC patient has colonscopy and results show mild dysplasia

what are you going to do?

A

surgery immediately

97
Q

on the boards

mild cases of UC with no bloody diarrhea start tx with?

A

sulfasalazine (5-aminosalicyclic acid)

98
Q

the most appropraite tx of UC in a pt with fever

bloody diarrhea and abdominal pain is ?

A

prednisone

note both sulfasalazine and prednisone are safe during pregnancy

99
Q

pt with primary sclerosing cholangitis on CT

and elevated LFTs

what does pt have

A

ulcerative colitis

100
Q

on the boards

mild cases of UC with no bloody diarrhea start tx with?

A

sulfasalazine (5-aminosalicyclic acid)

101
Q

high yield q on boards

bloody diarrhea in the young

A

UC

102
Q

fecal soiling

(pt has fecal products in underwear)

A

think fistula –> crohns

103
Q

hydronephrosis w/out stones

(obstruction from inflammatory mass) think

A

crohns disease

104
Q

pneumatura (fistula to the bladder)

air passing with the urine

A

crohns disease

105
Q

high yield q on boards

delayed type hsr rxn

A

crohns

106
Q

what the first factor causing appendicitis

A

obstruction of the lumen

107
Q

Q on board

in acute appendicitis

the initial periumbilical pain is a referred visceral pain

the RLQ pain is ____ due to what

A

somatic pain due to

inflammation of the parietal peritoneum

108
Q

know this

obturator sign

A

passive flexion and internal rotation of the right hip ==> pain

109
Q

psoas sign identifies?

A

pain with passive extension of the right hip

110
Q

if you diagnosis

acute appenditis and surgery is in 4-6 hours

what abx do you give

A

piperacillin/tazobctam

antibiotic piperacillin and the B lactamase inhibitor tazpbactam

covers gram - / + including pseudomonas

111
Q

pt w/ hx of celiac disease for 15 years following gluten free diet

starts to be symptomatic why

A

intestinal T cell lymphoma

112
Q

child is started on cereal, develops

diarrhea and vomiting.

cause?

A

celiac sprue

113
Q

High yield boards

what effect does celiac sprue have on the liver?

A

hepatomegaly (steatosis- fatty infiltration)

anicteric cholestasis (malabsorption, inc stool fat, no jaundice)

malabsorptioon (inc stool fat - normal 2-7 grams/day)

intestinal villus atrophy

114
Q

boards

50 yo man. with unexplained fever, polyarthritis and memory problem (neurologic symptom)

A

whipples disease

tropheryma whipplei

pas +

if no memory problems and pt was 20 yo. = celiac sprue

115
Q

34 yo women has episodic facial flushing

bronchospasm

watery diarrhea

diagnosed pulmonic stenosis

A

carcinoid syndrome

116
Q

young pt with common variable hypogammaglobulinemia

A

giardia

could be seen in homesexuals.

117
Q

36 yo man from ireland

chronic diarrhea and vsicular rash on his arms

A

celiac sprue

dermatitis herpitiform

tx for celiac sprue? = gluten free

tx rash = dapsone

118
Q

acquired herniations of the

mucosa and submucosa through the muscular layers of the colonic wall

the pathology word for this is PULSION!!!!

A
119
Q

ADENOMATOUS POLYP

seen on colonscopy

pt presents with

hypokalemia, and diarrhea with profuse mucus

what type of polyp

A

villous adenoma

villous adenoma syndrome

120
Q

is there increase risk of cancer with

serrated polyp

A

no not premalignant

its describing hyperplastic polyp

note: first aid says hyperplastic polyps can evolve into serrated polyp that is premalignant

121
Q

familial adenomatous polyposis syndrome

is inherited autosomal dominant

. what is the mutation causing this

A

inactivating mutation of tumor suppressor gene APC on chromsome 5

122
Q

Q

FAP

100 % cancer risk

screening = proctoscope to confirm diagnosis

  1. tx?
A

proctocolectomy age 20

123
Q

Question on boards

once pt has proctocolectomy for Familial adenomatous polyposis

they arent going to develop colon cancer.

what is the next best step in managemant

A

continue to do EGD to check for possible duodenal adenomas/cancer

bc they are at inc risk for this

124
Q

40 yo pt requests colon cancer screening

in the past, several bony prominences were removed from his mandible.

his father died of colon cancer at age 42.

is he at inc risk of colon cancer?

A

yes

he has gardner syndrome (osteomas, soft tissue tumors)

125
Q

adenomatous polyps with CNS tumors

(medulloblastoma!!!)

A

turcot syndrome

126
Q

most common malignant brain tumor in children

presents with hydrocephalus and ataxia

A

medulloblastoma

127
Q

presents with bleeding and increase incidence of intussusception

(common cause of death)

A

peutz jeghers syndrome

128
Q

peutz jeghers syndrome

has inc risk for gastric, pancreatic, lung, ovarian.

and what are the other two important ones?

A

breast

(PJS women w/ mutations in the STK11 gene = 12.5% lifetime risk)

uterine

129
Q

one presents with colon cancer.

on colonoscopy you see no polyps, but cancer located in the proximal RIGHT colon

this is an autosomal dominant mutation of?

this patient has increase risk of what kind of cancer

A

autosomal dominant mutation of DNA mismatch repair genes with subsequent microsatellite instability

inc risk of ovarian, endometrial, skin

130
Q

know that ulcerative collitis

associated colon cancer has early p53 and late APC gene mutations

A
131
Q

pt with anal pain and bloody streaks on toilet paper

hx of hemorroids

A

thrombosed hemorrhoids

132
Q

boards very high yield

nitroglycerine

and can used for hemorrhoids and anal fissure for pain.

why

A

donor of nitric oxide mediates relaxation of internal anal sphincter

its oinment.

133
Q
A
134
Q

dubin johnson syndrome

increase conjugate hyperbilirubinemia (inability of the heaptocytes to excrete bilirubin) –> black liver

this is all caused by a dysfunction in?

A

MRP2 protein

135
Q

Q!

gilberts syndrome is linked to a dec in how much % of the enzymatic activity of hepatic bilirubin UDP glucouronyl transferase?

and most appropriate advice to pt?

A

20-30% dec!

and reassurance

136
Q

pt with jaundice due to immature UDP glucuronyl transferase

phsiologic neoatal jaundice

how will the baby present

treatment?

A

appears healthy and breast feeding normally

usually develops on the second day of life.

treatment : phototherapy

bc it changes trans bilirubin into the water soluble cis bilirubin isomer

137
Q

inc in estrogen (pregnancy or OCP)

does what to cholesterol levels in bile

and what to gallbladder contraction?

A

increase cholesterol levels in bile and

decrease gallbladder contraction –> gallstone formation

138
Q

why do middle age obese females get choleithiasis

A

due to effects of estrogen

inc HMG-CoA activity –> inc cholesterol

inc lipoprotein receptors on the liver cells –> inc cholesterol uptake.

139
Q

on boards

give you a picture of a beautiful CHOLESTEROL gall stone (no pigmented, solitary and large)

what is it caused by

A

low bile salts

140
Q

pt with hx of gallstone

now he has acute pancreatitis

why?

A

the stone moved to the

ampulla of vater

141
Q

pt presents with for xray

you see gallbladder with calcified outline (porecelain gallbladder) on xray

what should you do.

A

send for prophylactic cholecystectomy

bc most likely adenocarcinoma

142
Q
A
143
Q

question on boards for sure!

the most common extraintestinal involvement of the liver is?

A

right lobe of liver abscess

144
Q

how do you differentiate bw pyogenic and amebic abscess in liver?

how do you tx ameibic (entamoeba histolytica) abscess?

how do you tx pyogenic abscess?

A

gram stain

tx amebic = metronidazole

tx pyogenic = incision and drain

145
Q

Q on boards

what portion of the liver is impacted primarily by ischemia (due to severe bleeding and shock)?

A

pericentral zone

***area around central vein (zone III)

146
Q

microvesicular steatosis (hepatic steatosis) - small vessels

has no effect on cell function

what would you see this in

A

acute fatty liver of pregnancy

REYEs syndrome

147
Q

macrovesicular steatosis - large vesicles –> displacement of the nucleus - cell rupture and death

A

alcohol

diabetes

obesity

148
Q

high yield

whatdoes cholestasis mean

A

decreased bile flow

obstructive or hepatocellular

(think obstructive jaundice!)

will have high alkaline phosphatase

bc it comes from the billary tract in the liver

149
Q

He said to remember this!

what is alcohols effect on body temperature?

A

alcohol –> HYPOthermia - alcohol and cold temps are a lethal combo -

alcohol will inc BF to skin - lethal in cold weather

150
Q

Q

chronic alcohol use

  1. what memory will be impaired vs intact
  2. what part of hypothalamus is damaged
A
  1. recent memory impaired

remote memory intact

2. mammillary bodies of the posterior hypothalamus –> korsakoff psychosis

151
Q

Q

pt is highly intoxicated and goes into a coma

what is the cause

A

alcohol stimulating the GABA receptors

152
Q

Q on boards

in alcoholic hepatitis

explain the pathology of the below image

Mallory hyaline =

ballooning degeneration =

A

mallory hyaline = eosinophilic due to accumulation of pre-keratin filaments in hepatocytes

Ballooning degenertion = swelling of hepatocytes due to excess fat, water and protein

neutrophil infiltration

153
Q

the swollen ballooning cells in alcoholic hepatitis

can press on the bile canaliculi cause

A

cholestasis

154
Q

high yield

AST > ALT

cause

why?

A

alcohol

bc AST in mainly in the mitochondra

(the site of toxic effect of alcohol)

ALT is in the hepatocyte

155
Q

classic boards question

55 yo 8 month of hx pruritus and yellow sclera

prominence on right side of her abdomen whic his non tender

complains of fatigue and has occasional malodorous loose stools

what serologic test can be used to diagnose

A

primary biliary cirrhosis

Anti-mitochondrial antibodies - IgM

156
Q

Q on boards!

primary biliary cirrhosis

pts are at increased risk of what?

A

OSTEOPOROSIS

bc these pts cant absorb

vit D

157
Q

a 46 yo male with chronic ulcerative colitis for 15 years is seen with jaundice, right upper quad pain and elevated LFTs

ERCP

what is diagosis

A

primary sclerosing cholangitis

158
Q

high yield

a 47 yo W male presents with grey skin and arthritis mainly in the 2nd and 3rd MCPs

he has blood sugar level of 180 elevated LTs

abscence of body hair

A

hemochromatosis

159
Q

arthritis 2nd and 3rd MCP

what diagnosis

A

hemachromatosis

160
Q

on xray you see hook shape osteophytes and calcifications on of joint

IRISH man

diagnosis

A

hemochromatosis

161
Q

autosomal RECESSIVE disorder with

mut in HFE gene -C282Y chromo 6- inc rate of iron absorption from intestine

HLA-A3

A

primary hemochromatosis

162
Q

tx of hemochromatosis is

phlebotomy and deferoxamine

what is the side effect of deferoxamine?

A

pain and sweeling at the injection site

163
Q

autosomal recessive (ATP7B) gene

A

wilsons

164
Q

kaysers fleischer ring

brownish pigmentation.

what is the cause?

A

copper deposition in *Decemets membrane of the cornea

165
Q

on boards

they give you a presentation that looks like PSYCHOSIS

however most of the time its not, its wilsons

they will even put psychosis as an answer

what should you look for?

A

jaundice in adolescents with inc LEFTs

166
Q

on the boards

adolescent pt presents with jaundice, inc liver enzymes, neurologic symptoms including psychosis, tremor, dysarthria

A

wilsons disease

167
Q

what is the reason for ascites in cirrhosis?

A

inc capillary hydrostatic pressure within splanchnic bed

or dec oncotic pressure secondary to hypoalbuminemia

168
Q

portal htn

A
169
Q

portal HTN can cause all of the following

name what anastomes are involved with each

esophageal varices

caput medusa

secondary hemorrhoids (painless)

A

esophageal varices

-left gastric / esophageal v.

caput medusa

- paraumbilical / superior and inferior epigastric

secondary hemorrhoids

superior rectal / middle and inferior rectal

170
Q

what is the most common drug abuse causing portal htn

A

alcohol

171
Q

know each line bc each could be Q

hepatic encephalopathy

  1. accumulation of toxic substances (ammonia) due to portosystemic shunts
  2. ammnoia can cross BBB -> swelling of ___ cells –> inc ICP and coma
  3. inverted sleep wake pattern

loos of coordination –> jerking movements (asterixis)

A

accumulation in astrocytes

172
Q

Q on boards chronic alcohol abuse

decreased libido

severe gyncomastia

testicular atrophy

widespread bruises

diagnosis

A

hepatic failure

why gyncomastia and dec libido - bc estrogen accumulates and its not metabolized by the liver anymore since the liver is failing

173
Q

all of the following with trigger hepatic encephalopathy

EXCEPT.

A. hyponatremia, hypokalemia

B. Gl bleed (esophageal varicies)

C. constipation

D Acidosis

E. Alkalosis

A

acidosis

174
Q

pt with hepatic coma will have increase ___ levels

A

ammonia

175
Q

on boards

(stable pt after MVA)

pt involved in motor vehicle accident and now he has CT of abdomen.

see retroperitoneal hematoma

what is the cause

A

pancreatic injury

176
Q

Question on boards

young white male

recurrent overwhelming respiratory infections commonly psuedomonas aeruginosa and occassional sinusitis.

the pancreatic ducts filled w/ mucous plugs –> accumulate in pancreatic ducts –> pancreatic insufficiency –> steatorrhea and poor weight

A

cystic fibrosis

177
Q

know that

CF pt may develop insulin dependent diabetes due to?

A

chronic destruction of the pancreas

178
Q

pancreatitis

has hyper or hypo calemia

A

HYPOCALEMIA

179
Q

pt presents with

N/V and severe mid epigastric and LUQ pain, pain worsens with eating

  • look for jaundice
  • labs: leukocytosis and elevated serum amylase, and lipase (most specific)

hypocalcemia

A

acute pancreatitis

180
Q

chronic alcoholic pt with pain that radiates to his scapula and upper back

A
181
Q

most common cause of acute pancreatitis in us

A

alcohol then gallstones

182
Q

calcification of the pancreas

on xray

diagnosis?

A

CHRONIC pancreatitis

183
Q

boards

calcification of the spleen on xray

diagnoiss

A

Histoplasmosis

184
Q

trick question on boards

adenocarcinoma of the pancreas

origin/ where is the tumor

A

ducts!!!

(ductal adenocarcinoma)

the ducts form glands that secrete mucin

its not coming from the acini.

board review (20 decks)

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