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COMLEX > GI > Flashcards

GI Flashcards

1
Q

woman in 50’s, iron def anemia, dysphagia, cervical esophageal web

A

Plummer-Vinson Syndrome

- increased risk esophageal SCC

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2
Q

pseudomembranous colitis

A

C. diff

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3
Q

Barrett esophagus major risk factor for what?

A

esophageal adenocarcinoma

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4
Q

ingestion of hot foods, HPV, chronic tobacco and EtOH use, achalasia, caustic ingestion

A

esophageal SCC

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5
Q

Cowdry Type A inclusions, eosinophilic intranuclear inclusions, multinuclear squamous cells

A

HSV esophagitis

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6
Q

artery that supplies the lesser curvature of the stomach

- also supplies posterior stomach near cardioesophageal junction

A

left gastric A

- anastomoses w/ R gastric (from proper hepatic) and short gastric (from splenic)

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7
Q

artery supplying the pylorus of stomach, proximal duodenum, and head of pancreas

A

gastroduodenal A

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8
Q

diarrhea, steatorrhea, weight loss/fat malabsorption, joint pain
- foamy macrophages, PAS-positive, gram-positive

A 
Whipple disease (Tropheryma whippelli)
- macrophages compress lacteals in the villi of the small intestine, preventing chylomicrons from entering into the lymphatic system
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9
Q

blunted vili w/ T-lymphocytes in epithelium, weight loss, diarrhea, foul smelling stools
- pruritic vesicular rash

A

celiac disease /w dermatitis herpetiformis

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10
Q
  • patchy GI ulcers, varying depth (all 3 layers) and locations
  • noncaseating granulomas
  • “string sign” on barium study
  • creeping fat, cobblestoning
  • ileum almost always involved
A

Crohn disease

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11
Q

uniform, micronodular fibrosis of liver

A

alcoholic cirrhosis

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12
Q

young pregnant female w/abdominal pain, hepatomegaly, portal HTN

  • obstruction of the hepatic veins by thrombus -> centrilobular congestion
  • increased pressure in portal venous system -> ascites
A

Budd-Chiari

- pregnancy or other hyper-coagulable states!!

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13
Q

epigastric pain, jaundice, weight loss, fatigue

  • dark urine, pale stools, pruritis, Courvoisier sign (painless, enlarged/obstructed gallbladder)
  • CA 19-9
A

pancreatic adenocarcinoma

- pancreatic pain radiates to back

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14
Q

gallstones, primary sclerosing cholangitis, porcelain gallbladder are all risk factors for?

A

cholangiocarcinoma (rare)

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15
Q

Murphy’s sign

A

acute cholecystitis
- pain/inflammation of the gallbladder, without distention (unlike Courvoisier’s sign)

NOTE: gallbladder pain refers to the shoulder d/t phrenic nerve dermatome

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16
Q

Trousseau’s syndrome

A

migratory, recurrent superficial thrombophlebitis

- inflammation of superficial veins

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17
Q

falciform ligament

A

connects liver to anterior wall of abdomen

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18
Q

enzyme required to conjugate bilirubin

- not quite mature in newborn physiologic jaundice

A

UDP glucoronyl* transferase

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19
Q

increased total serum bilirubin levels seen with fasting, dehydration, or stress
- high total bili, normal direct/conj bili

A

Gilbert disease

- benign, hereditary condition due to decrease in UDP glucuronOSYL* transferase activity

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20
Q

autoimmune destruction of biliary tract, middle aged female

  • increase in direct and indirect bili
  • increase in alk phos
  • anti-mitochondrial Abs
  • granulomatous destruction of portal triad w/ lymphocytic infiltrate
A

primary biliary cirrhosis

  • other autoimmune disorders likely
  • can lead to liver cirrhosis
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21
Q

elevation of conjugated/direct bili due to defective liver excretion
- grossly black liver

A

Dubin Johnson syndrome

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22
Q
  1. hyperparathyroid (elevated PTH, serum Ca)
  2. pituitary adenoma (prolactinoma -> bitemporal hemianopsia)
  3. pancreatic islet cell tumor (gastrinoma)
A

MEN type 1

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23
Q
  1. parathyroid hyperplasia
  2. medullary thyroid carcinoma
  3. pheochromocytoma

RET gene mutation

A

MEN type 2A

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24
Q
  1. mucosal neuromas
  2. marfanoid body habitus
  3. medullary thyroid carcinoma
  4. pheochromocytoma

RET gene mutation

A

MEN type 2B

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25
Q

abdominal pain, diarrhea, weight loss, edema

  • stomach rugae increase in size
  • corkscrew-shaped glands composed of mucus cells
  • decrease in parietal and chief cells
  • causes protein malabsorption
A

Menetrier disease

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26
Q

abdominal pain, diarrhea

  • parietal cell hyperplasia and thickening of mucosa
  • excess gastrin -> multiple gastric and duodenal ulcers
A

Zollinger-Ellison syndrome

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27
Q

incomplete relaxation of LES

  • MC in 20-40 y/o’s
  • lack of nitric oxide synthase producing neurons (ganglion cells) in the myenteric plexus
  • heartburn, hiccups, difficulty swallowing
A

achalasia

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28
Q
  • calcification of soft tissues
  • raynaud’s
  • esophageal dysmotility
  • sclerodactyly (skin thickening)
  • telangiectasias
A

CREST syndrome

- anti-centromere Abs

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29
Q

what causes decreased plasma oncotic pressure?

A

decrease in albumin synthesis -> liver cirrhosis

- fluid shifts from capillaries to interstitial space

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30
Q

KIT gene mutation

  • spindle shaped cells
  • early satiety, abdominal bloating
A

gastrointestinal stromal tumor (GIST)

- non-epithelial benign neoplasm

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31
Q
  • ANA Ab = sensitive
  • anti-dsDNA Ab, anti-Smith Ab = specific

…for what?

A

SLE

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32
Q

positive murphy sign (inflamed gallbladder) refers pain to shoulder due to what nerve?

A

phrenic nerve (shoulder dermatome)

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33
Q

motile trophozoite or oval cysts??

A

giardia

- protozoa are non-invasive, motile, and have bilobed nuclei

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34
Q

baby being introduced to solid food

  • fatigue, vomiting, diaphoresis
  • what enzyme deficiency?
A

hereditary fructose intolerance

- DEFICIENCY of aldolase B enz causes a BUILDUP of fructose-1-phosphate

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35
Q

dilated subepithelial vascular cushions consisting of arteriovenous communications between terminal branches of the superior rectal artery and rectal veins
- common in pregnancy and liver disease

A

internal hemorrhoids

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36
Q

arise from the inferior hemorrhoidal veins located below the pectinate line
- covered with squamous epithelium of the anal canal or perianal region

A

external hemorrhoids

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37
Q

inflammation and fibrosis medium/large vessels of the biliary tree

  • if sx, profound fatigue and pruritus
  • hepatomegaly
  • elevated alk phos
  • assoc with UC
  • beads on a string appearance (aka multifocal stricturing and dilation) of biliary ducts caused by intermittent sclerosis
A

primary sclerosing cholangitis

- increased risk for cholangiocarcinoma (unlike PBC)

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38
Q

young pt w/family hx colon cancer

  • disorder of DNA mismatch repair -> error in nucleotide pairing
  • poorly differentiated tumors in the right (proximal) colon
  • mucin containing tumors
A

Lynch syndrome, aka hereditary nonpolyposis colorectal cancer
-AD

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39
Q

caput medusae is caused by congestion between what anastomosing vessels?

A

periumbilical and superficial epigastric veins

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40
Q

esophageal varices are caused by congestion between what anastomosing vessels?

A

azygous and left gastric veins

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41
Q
  • Carbamazepine
  • Rifampin
  • Griseofulvin
  • Phenobarbital
  • Phenytoin
  • St John’s wort
  • Chronic ethanol consumption
A

CYP 450 inducers

42
Q
  • Diltiazem
  • Itraconazole
  • Ketoconazole
  • Erythromycin
  • Clarithromycin
  • Grapefruit juice
  • Protease inhibitors
  • Nefazodone
  • Acute ethanol consumption
A

CYP 450 inhibitors

- make other drug half lives longer

43
Q

what vessel supplies the gallbladder?

A

cystic A

- common hepatic A -> R hepatic A -> cystic A

44
Q

MCC of severe watery (non-bloody) diarrhea in children under 5?

A

rotavirus (ds-RNA virus)

45
Q

cruise ship virus, common among school aged-children (daycares)?

A

norovirus (positive sence, ss-RNA)

46
Q

hernia that passes through the inguinal ring, lateral to the inferior epigastric vessels?

A

indirect inguinal hernia

47
Q

hernia medial to inferior epigastric vessels?

A

direct inguinal hernia

48
Q

hernia that enters the anterior thigh through the femoral ring

  • inferior to inguinal ligament
  • medial to the femoral vein and lateral to the lacunar ligament
A

femoral hernia

49
Q

multiple dilated loops of bowel, multiple air fluid levels, colicky abdominal pain
- smooth muscle contracting against an area of resistance

A

small bowel obstruction

50
Q
  • elevated conjugated bilirubin d/t hepatic storage defect
  • liver histology is normal
  • total urinary coproporphyrin excretion is 250-500% of normal
A

Rotor syndrome

- similar to Dubin-Johnson, but liver isn’t black (milder form of dz)

51
Q

decreased activity of glucuronyl transferase enzyme

  • buildup of unconjugated bili
  • milder of two unconjugated bili disorders, usually diagnosed in childhood/teenagers
A

Gilbert syndrome

- NOTE: giving phenobarbital can drop bili levels to normal! (phenobarb is CYP inducer)

52
Q

absent activity of glucuronyl transferase enzyme

  • buildup of unconjugated bili
  • presents in infancy, pts often die early d/t kernicterus
A

Crigler-Najjar syndrome

53
Q

hypoalbuminemia makes you think of what?

A

liver cirrhosis or malnutrition

54
Q

ascities, spider angiomatas, palmar erythema, asterixis, encephalopathy, increase PT/PTT, thrombocytopenia

A

liver cirrhosis

55
Q

mild febrile illness, abdominal pain, cough, HA, hives

  • zoonotic, from dog feces
  • eosinophilia
A

toxocara canis

56
Q

R sided colon cancer is associated with what?

L sided colon cancer is associated with what?

A

R -> anemia, +FOBT

L -> constipation/obstruction

57
Q

jaundice, dark urine, fatigue, splenomegaly

  • sx brought on by oxidative stress (NSAIDs, sulfa drugs, fava beans)
  • x-linked recessive
  • more common in AA’s, Asians, Mediterranean descent
A

G6PD deficiency

58
Q

U-shaped, distended sigmoid colon that looks like a bent inner tube or coffee bean

  • insidious onset, slowly worsening abdominal pain
  • nausea, constipation, abd distension
A

volvulus

59
Q

benzo OK to use in liver disease?

A

lorazepam for liver dz! (or oxazepam)

  • both skip first pass metabolism
  • Lorazepam for a sick Liver
60
Q

superior rectal vein drains to which venous system?

A

portal venous system

- inferior and middle rectal veins to IVC (systemic)

61
Q

what causes inflammatory exudate in colon?

- composed of mucinous debris, fibrin, necrotic epithelial cells and polymorphonuclear cells

A

pseudomembranous colitis

62
Q

baby, poor feeding, chronic diarrhea, macrocephaly w/bulging fontanelles, corneal opacification, repeated infections
- increased heparin sulfate and dermatan sulfate on UA

A

Hurler syndrome, aka mucopolysaccharidosis type I

- d/t glycosaminoglycan accumulation in lysosomes

63
Q

colicky abd pain, intestinal obstruction

  • N/V (leads to bilious vomiting)
  • elongated mass in RLQ
  • bloody stools mixed with mucus
  • bullseye appearance on US
A

intussusception

64
Q

young male, painless GI bleed (caused by mucosal ulceration)

  • persistence of the omphalomesenteric (vitelline) duct
  • diverticulum 2 feet proximal to ileocecal valve (in SMALL intestine)
  • technitium-99 scan
A

Meckel’s diverticulum

65
Q

alpha-fetoprotein is a marker for what?

A

hepatocellular carcinoma and yolk sack tumors

66
Q

alkaline phosphatase is a marker for what?

A

tumors that have metastasized to bone, Paget’s dz of bone, obstructive biliary disease

67
Q

HBsAg (–), anti-HBc (–), anti-HBs (+)

A

immune from vaccination

68
Q

HBsAg (+), anti-HBc (+), IgM anti-HBc (+), anti-HBs (–)

A

acute infection

69
Q

HBsAg (+), anti-HBc (+), IgM anti-HBc (–), anti-HBs (–)

A

chronic infection

70
Q

HBsAg (–), anti-HBc (+), anti-HBs (+)

A

immune from prior infection

71
Q

what cleaves pepsinogen to pepsin?

A

HCl in stomach

- Pepsin helps break down Protein (though trypsin is more important)

72
Q

what hormone relaxes the sphincter of Oddi, allowing release of pancreatic enzymes?

A

CCK

73
Q

what is released when H+ ions and FA’s are delivered to the duodenum?
- what does this hormone inhibit?

A

secretin, inhibits gastrin release

74
Q

what hormone is located within the parasympathetic ganglia in sphincters, gallbladder, and small intestine
- increased by gastric distention and vagal stimulation, leading to relaxation of the intestinal smooth muscle and sphincters

A

VIP

  • also acts to increase intestinal water and electrolyte secretion
  • VIPoma -> voluminous diarrhea
75
Q

what are Mallory bodies?

A

eosinophilic inclusion bodies, seen in alcoholic cirrhosis

  • *MICROnodular = alcoholic cirrhosis
  • *MACROnodular = viral hepatitis
76
Q
  • benign hamartomatous polyps in Gl tract
  • hyperpigmented macules on the lips and oral mucosa
  • STK11 gene mutation
A

Peutz-Jeghers syndrome

77
Q

variant of familial adenomatous polyposis

  • osteomas, epidermoid cysts, lipomas, dental abnormalities and congenital hypertrophy of the retinal pigment epithelium
  • mutation in APC gene on 5q21 (same as FAP)
A

Gardner syndrome

78
Q

drug of choice for nematodes? (hookworms, pinworm, ascaris, filaria)

A

Albendazole

- inhibits microtubule polymerization by binding tubulin

79
Q

drug of choice for cestodes (tapeworm) and trematodes (flukes)

A

Praziquantel

- increases calcium influx, causing spastic paralysis

80
Q

treatment for hepatic encephalopathy?

A

lactulose

- acidifies gut lumen by increasing movement of ammonia from tissues into gut

81
Q

MCC painless rectal bleed (LGIB) in elderly?

A

diverticuLOSIS

82
Q

crypt abscesses?

  • relapsing/remitting bloody diarrhea
  • superficial friable mucosa
  • smoking makes it worse
  • erythema nodosum on anterior tibia
  • toxic megacolon
A

UC

83
Q

tumor marker for colorectal cancer?

A

carcinoembryonic antigen (CEA)

84
Q

anti Ro/La Abs?

A

Sjogren syndrome

85
Q

what is the portal triad and where is it located?

A
  1. common bile duct
  2. hepatic artery
  3. portal vein

found in the hepatoduodenal ligament

86
Q

the more villous the polyp, the higher risk of what?

A

colon adenocarcinoma

  • tubular adenomas MC adenoma… more benign than villous polyps
  • villains are bad!
87
Q

where is the myenteric plexus located?

A

between the longitudinal and circular layers of muscularis externa

88
Q

pancreatic tumor marker?

A

CA 19-9

89
Q

Chagas dz side effects? (3)

A
  1. megacolon
  2. achalasia
  3. myocarditis
90
Q

initial drug of choice for UC?

A

sulfasalazine

- followed by TNF-alpha inhibitors (infliximib)

91
Q

young kid, had meconium ileus, now foul smelling stools, protrusion inside nose

A

CF

- increased risk of DM

92
Q

vomiting, rash, and liver injury (high ALT/AST) after aspirin use during a viral illness

A

Reye syndrome

- liver histology shows nonspecific fatty change

93
Q

MC tumor of the appendix?

A

carcinoid tumor

94
Q

CCk acting on the pancreas causes secretion of what?

A

Trypsinogen

  • enteropeptidase converts to trypsin in duodenum
  • helps break down protein
95
Q

what is the hallmark of UC?

A

crypt abscesses

- aka collection of neutrophils within crypts of Lieberkuhn

96
Q

fever, jaundice, RUQ pain

A

charcot triad -> ascending cholangitis

97
Q

meconium ileus, chronic respiratory infections, chronic pancreatitis

A

CF

98
Q

3 abx for H.pylori

A
  1. omeprazole
  2. clarithromycin
  3. amoxicillin
99
Q

MOA of metronidazole?

A

induces free radical formation

100
Q

Jaundice and right upper quadrant pain in a patient with ulcerative colitis?

A

primary sclerosing cholangitis

  • inflammatory process of the biliary ducts leading to fibrosis and stricturing of the intrahepatic and extrahepatic biliary ducts
  • highly correlated with UC
101
Q

anti-endomysial Ab?

A

celiacs

102
Q

anti-smooth muscle Abs?

A

autoimmune hepatitis

COMLEX (14 decks)

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