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STEP1 > GI and Renal > Flashcards

GI and Renal Flashcards

1
Q

foregut midgut hindgut borders

A

foregut - esophagus to duodenum
midgut - duodenum to proximal transverse colon
hindgut - transverse colon to anal canal above pectinate line

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2
Q

failure of this -> this defect _____:

  1. rostral fold closure
  2. lateral fold closure
  3. caudal fold closure
A
  1. rostral fold closure -> sternal defects (ectopia cordis)
  2. lateral fold closure -> omphalocele, gastrochesis
  3. caudal fold closure -> bladder exstrophy
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3
Q

common name for aphthous ulcer

A

canker sore

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4
Q

patient comes in with recurrent aphthous ulcers (canker sores), and genital ulcers. what 3rd thing would you expect them to have? and what is pathogenesis?

A

Behcet syndrome
triad: those 2 + UVEITIS

path: immune complex vasculitis involving small vessels

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5
Q

complications of mumps

A

pneumonia
orchitis -> possible sterility
pancreatitis (adds to increased amylase levels)
meningitis

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6
Q

infection of salivary gland from obstructing stone (sialolithiasis) is most likely from what organism?

A

Staph aureus

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7
Q

benign and most common tumor of salivary gland is called _______. composed of _____ and ______

A

pleomorphic adenoma = stroma (e.g. cartilage) + epithelial tissue. may also have glands.

note: irregular borders makes it hard to completely resect -> high rate of recurrence

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8
Q

benign tumor of salivary gland
“cystic tumor w/ lymph node tissue”

dx?

A

Warthin tumor

almost always in parotid, esp bc lymph node and parotid tissues are embryologically related

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9
Q

mucoepidermoid carcinoma is made of ____ and ____ cells

A

name says it all
mucinous and squamous cells

carcinoma so malignant -> usually involves CNVII facial sx

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10
Q

pt has severe iron deficiency anemia and dysphagia. what else does he have? dx?

A

Plummer Vinson syndrome:

  1. iron deficiency anemia
  2. esophageal web -> dysphagia and increased risk for esophageal squamous cell carcinoma
  3. atrophic glossitis -> beefy red tongue
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11
Q

Mallory weiss syndrome (LONGITUDINAL laceration at GE junction from vomiting) has risk of Boerhaave syndrome which is what?

A

esophagus ruptures -> air in mediastinum + SUBCUTANEOUS EMPHYSEMA

if you push on air bubble beneath skin you hear crackles. sounds like gas gangrene? idk

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12
Q

pancreas derived from fore mid or hindgut?

A

foregut

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13
Q

annular pancreas: ______ pancreatic bud encircles _____ part of duodenum

A

ventral pancreatic bud

2nd part of duodenum

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14
Q

what anastomoses causes esophageal varices?

A

left gastric w/ azygos

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15
Q

what anastomoses causes caput medusae?

A

paraumbilical w/ epigastric veins

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16
Q

what anastomoses causes anorectal varices?

A

superior rectal w/ middle and inferior rectal

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17
Q

Achalasia is due to damaged ________

A

ganglion cells in the myenteric plexus (in muscularis propria)

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18
Q

achalasia can be idiopathic or 2ndary to injury such as _______ infection

A

trypanosoma cruzi infection in Chagas dz

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19
Q

histology in GERD b/c of the repeated inflammation/regeneration (3 features)

A
  1. basal zone hyperplasia
  2. elongated papillae of laina propria
  3. scattered eosinophils and neutrophils
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20
Q

Barrett esophagus is from _____ epithelium to _________ epithelium

A

stratified squamous -> nonciliated columnar epithelium w/ goblet cells

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21
Q

is adenocarcinoma or squamous cell carcinoma more common for esophageal cancer?

A

squamous cell carcinoma is the winner

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22
Q

if esophageal cancer spreads to lymph nodes from this, it spreads to this:

  1. upper 1/3 -> ______ nodes
  2. middle 1/3 -> ____ nodes
  3. lower 1/3 -> ____ nodes
A
  1. cervical
  2. mediastinal and tracheobronchial
  3. celiac and gastric
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23
Q

how does increased ICP cause gastritis?

A

inc ICP -> inc vagal nerve activity -> increased HCl in stomach

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24
Q

gastric parietal cells are located in the ___ and ___ of the stomach

A

body and fundus

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25
Q

autoimmune gastritis can be diagnosed from antibodies against parietal cells or intrinsic factor, but what actual type hypersensitivity rxn is pathogenesis?

A

type IV!!!!! whereas a lot of other autoimmune dz is type II. and this also has antibodies, but don’t get confused.

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26
Q

chronic autoimmune gastritis increases risk for _____ cancer

A

gastric adenocarcinoma. b/c chronic inflammation

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27
Q

h. pylori infection increases risk for ___ and ____ cancers

A

gastric adenocarcinoma and MALT lymphoma

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28
Q

2 tests to confirm eradication of h pylori after course of tx

A

urea breath test

stool antigen test

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29
Q

triple therapy for H. pylori

A
  1. clarithryomycin
  2. amoxicillin or metronidazole
  3. PPI
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30
Q

if posterior duodenal ulcer erodes thru an artery, which artery is it?

A

gastroduodenal artery

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31
Q

if peptic ulcer on lesser curvature of stomach causes bleeding, which artery is it?

A

left gastric artery

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32
Q

left vs right colorectal carcinoma presentation/sx

A

Left: napkin ring lesion, decreased stool caliber, blood streaked stool, Left lower quadrant pain

right: raised lesion, iron deficiency anemia from occult bleeding, vague pain

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33
Q

older adult with _____ has colorectal carcinoma until proven otherwise

A

iron deficiency anemia

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34
Q

what serum marker is useful for assessing tx response and recurrence for colorectal carcinoma, NOT for screening?

A

CEA - carcinoembryonic antigen

also present in pancreatic cancers. and may be in a lot of other cancers..it’s actually very nonspecific

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35
Q

hypocalcemia + periumbilical and flank hemorrhage are features of what?

A

acute pancreatitis

hemorrhage b/c necrosis spreads to soft tissue and rettroperitoneum

fat necrosis -> saponification uses Ca2+ -> hypocalcemia

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36
Q

common cause of pancreatitis in children

A

cystic fibrosis

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37
Q

T or F, lipase and amylase are good markers for pancreatitis

A

BOTH

true for acute

but NOT good for chronic pancreatitis!e

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38
Q

elderly pt presenting with painless jaundice, pale stools, palpable gallbladder

what serum marker?

A

pancreatic carcinoma (adenocarcinoma in pancreatic ducts) in head of pancreas

CA 19-9

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39
Q

elderly pt presenting w/ DM

what serum marker?

A

pancreatic carcinoma (adenocarcinoma in pancreatic ducts) in body or tail of pancreas
(note that having DM is also a risk factor in itself)
CA 19-9

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40
Q

what is Trousseau syndrome and what is it a complication/clinical feature of?

A

it’s migratory thrombophlebitis -> migrating DVT -> swelling, erythema, tenderness in extremities

seen in pancreatic carcinoma

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41
Q

how does estrogen predispose to cholesterol gallstones? (2 ways)

A
  1. increases HMG-CoA reductase activity -> more cholesterol synthesis
  2. increases lipoprotein receptors on hepatocytes -> increased cholesterol uptake by liver
42
Q

how does clofibrate (fibrates) increase risk of cholesterol gallstones?

A

inhibit cholesterol 7alpha-hydroxylase (needed for cholesterol -> bile acids)

43
Q

usually gallbladder stones occurs in women in their 40s. if an elderly woman presents w/ this what should you suspect?

A

gallbladder carcinoma

44
Q

adult PCKD is associated w/ what 3 things?

A

bery aneurysms
hepatic cysts
heart - MVP

45
Q

inheritance pattern of medullary cystic kidney dz (shrunken kidneys and renal failure)

A

autosomal dominant

46
Q

3 drugs that cause acute interstitial nephritis (can progress to renal papillary necrosis)

A

NSAIDs
penicillin
diuretics

note: may see eosinophils in urine!

47
Q

obstruction at eliocecal valve + air in biliary tree (pneumobilia) = ______

A

gallstone ileus
obstruction by gallstone
means there’s a fistula between gallbladder and small bowel

48
Q

porcelain gallbladder

A

chronic cholecystitis. porcelain from dystrophic calcification

49
Q

Hereditary nonpolyposis colorectal carcinoma (HNPCC) = Lynch syndrome. defective what?

increased risk for which cancers? (4)

A

DNA mismatch repair enzymes

colorectal (always), ovarian, endometrial, skin

50
Q

if colorectal carcinoma doesn’t come from adenoma-carcinoma sequence, what other molecular pathway can it be from?

A

microsatellite instability (repeating sequences of noncoding DNA. instability is from defective DNA copy mechanisms such as mismatch repair enzymes)

51
Q

hamartomatous polyps are seen in ____ and ______

A

juvenile polyps
peutz-jegher syndrome

(remember FAP is adenomatous polyps)

52
Q

Peutz jegher syndrome is autosomal dominant of what gene mutation? chromosome?

increased risk for which cancers? (3)

A

SKTII gene, chromosome 19

colorectal (but NOT in the polyps themselves)
elsewhere in GI (including pancreas)
breast and gonadal (ovaries, testis)

53
Q

Turcot syndrome: FAP + ________

A

CNS tumors like medulloblastoma and glial tumors

54
Q

Pt has colonic polyps, and bone tumor in skull

what 3rd thing would you expect them to have? dx?

A

Gardner syndrome:

  1. FAP
  2. osteomas (usually in skull, benign)
  3. Fibromatosis - fibroblasts, non neoplastic but destroys local tissue, in retroperitoneum (desmoid)
55
Q

causes of renal papillary necrosis (gross hematuria and flank pain) (5)

A
  1. chronic analgesic abuse (phenacetin, aspirin)
  2. DM
  3. sickle cell trait or dz
  4. severe acute pyelnehpritis
  5. progress from acute interstitial nephritis
56
Q

nephrotic syndrome:
loss of ______ -> ______
3 things

A
  1. loss of albumin -> pitting edema, hyperlipidemia/cholesterolinemia
  2. loss of gammaglobulins -> infections (except in MCD)
  3. loss of antithrombin III -> hypercoagulable state -> thrombosis
57
Q

minimal change dz is associated w/ what cancer?

A

Hodgkin lymphoma (b/c lots of cytokins in lymphoma can mediate damage in renals -> MCD)

58
Q

FSGS is similar to MCD. what 3 things is it associated w/? (besides being idiopathic)

A

HIV
heroin use
sickle cell dz

59
Q

effacement of foot processes -> ____ and _____

renal IC deposits -> _____ and ______

A

effacement of foot processes -> MCD and FSGS

renal IC deposits -> membranous nephropathy, membranoproliferative nephropathy

60
Q

which nephropathies are associated w/ HBV and HBC

A

membranous nephropathy (spike and dome seen on EM)

type I membranoproliferative GN (subendothelial deposits, tram track appearance)

61
Q

membranous nephropathy is a/w what 4 things?

A

SLE
Hep B or C
drugs (NSAIDs, penicillamine, gold)
solid tumors

62
Q

idiopathic membranous nephropathy has antibodies to what? IC is made of what?

A

PLA2 receptor antibody

IgG and C3 immune complexes

63
Q

type II membranoproliferative GN, aka dense deposit dz, is intramembranous or subendothelial deposits? and associated w/ what autoantibody?

A

intramembranous

C3 nephritic factor (autoantibidoy, stabilizes C3 convertase -> overactivation of complement, low C3 levels b/c being used up)

64
Q

nephrotic syndrome from amyloidosis, what will show on EM?

A

small non-branching fibrils w/ haphazard arrangement

65
Q

crescents in Bowman space in rapidly progressive GN is madeup of what?

A

fibrin and macrophages

NOT COLLAGEN

66
Q

what is the only GN with linear IF pattern?

A

goodpasture/anti-GBM

67
Q

which rapidly progressing GN’s have negative IF (pauci immune)? (3)

A

Wegener granulomatosis
microscopic polyangiitis
Churg Strauss

68
Q

IgA nephropathy (Berger dz): IC’s are deposited where in renals? what else is in the IC’s besides IgA?

A

mesangium of glomeruli. seen on IF

IgA + C3

69
Q

Alport syndrome pathogenesis and inheritance pattern?

presentation? (3 things)

A

X linked dominant

defective synthesis of alpha5 chain of type IV collagen

hematuria, sensory hearing loss, ocular disturbances

70
Q

3 most common pathogens causing pyelonephritis

A

e coli
enterococcus faecalis
klebsiella

71
Q

thryoidization of kidney is due to what, which is due to what?

A

vesicoureteral reflux (children) or obstruction (BPH, cervical carcinoma) -> chronic pyelonephritis -> atrophic tubules w/ eosinophilic proteinaceous material = thyroidization of kidney

72
Q

pt has chronic pyelonephritis. scarring at upper and lower poles suggests the underlying etiology is what?

A

vesicoureteral reflux

73
Q

what renal cells make EPO exactly?

A

renal peritubular interstitial cells

74
Q

renal angiomyolipoma (a hamartoma) is seen more frequently in what condition?

A

tuberous sclerosis

75
Q

duodenal atresia vs jejunal ileal atresia pathogenesis

A

duodenal = recanalization problem

jejunal and ileal = disrupted blood vessels -> ischemic necrosis

76
Q

staghorn calculi seen in adult is what kind of stone, caused by what?

in children?

A

Adult: ammonium, magnesium, phosphate stone. urease positive organism infection (proteus, Klebsiella).

Child: cystine. from cystinuria

77
Q

classic triad of renal cell carcinoma

A
  1. hematuria
  2. palpable mass
  3. flank pain
78
Q

molecular pathway of Renal cell carcinoma:

loss of function mutation in _____ gene -> increased ____ and _____(increases ____ and _____)

A

LOF VHL(3p) tumor supressor gene -> increased IGF-1 and HIF transcription factor (increased VEGF and PDGF)

79
Q

LOF VHL mutation -> increased risk of which cancers? (2)

A

Von Hippel Lindau dz:

renal cell carcinoma (probs will be bilateral)
hemangioblastoma of the cerebellum

80
Q

deletion of WT1 tumor supressor gene results in _______

mutations of WT1 results in _______

mutations of WT2 results in _______

A

deletion -> WAGR syndrome: Wilms tumor, Aniridia (absent iris), Genital abnormalities, Retardation (both mental and motor)

mutation WT1 -> Denys-Drash syndrome: wilms tumor, glomerular dz, male pseudohermaphroditism

mutation WT2 -> Beckwith Wiedemann syndrome: Wilms tumor, neonatal hypoglycemia, muscular hemihypertrophy, organomegaly (tongue!) (increased IGF-2)

81
Q

what drugs increase risk of urothelial carcinoma? (2)

A

cyclophosphamide

Phenacetin

82
Q

adenocarcinoma of lower urinary tract or bladder arises from what?

A

urachal remnant. at dome of bladder.

since bladder doesn’t normally have glands, adenocarcinoma needs that urachal remnant to happen

83
Q

horseshoe kidney gets caught on what blood vessel that blocks its ascension?

A

IMA

84
Q

normal breakdown pathway of hemoglobin:

A

Hb -> heme + globin
globin -> amino acids. recycled
heme -> Fe + UCB

UCB carried to liver by albumin -> liver converts to CB by Uridine glucuronyl transferase (UGT) -> put into bile -> intestinal flora converts CB into urobilinogen -> stercobilin (makes stool brown) + urobilin (reabsorbed -> makes urine yellow)

85
Q

incidental finding on surgery, you find a dark liver. what does pt have? (what are they missing)

A

Dubin Johnson syndrome
deficiency of bilirubin canalicular transport protein
not clinically significant

86
Q

dark urine in extravascular hemolysis is due to ______

whereas dark urine in biliary tract obstruction is due to ______

A

extravas hemolysis - urobilinogen (NOT UCB, which is elevated, but UCB is not water soluble so it’s not even in the urine)

biliary tract obstruction - bilirubin. this one has increased CB which is water soluble

87
Q

which liver condition has increased both CB and UCB?

A

viral hepatitis. the inflammation messes up the liver function and obstructs small bile ductules. so dark urine here is also due to CB

88
Q

liver damage in viral hepatitis is mediated by ______

whereas, cirrhosis is mediated by _______

A

viral hepatitis: MHCI -> CD8+ T cells. aka it’s not the virus itself, it’s the immune response

cirrhosis: TGF-beta from stellate cells

89
Q

ballooning degeneration in liver = ______

Mallory bodies (made up of ___)= _______

A

acute hepatitis

mallory bodies = damaged cytokeratin filaments = alcoholic liver dz

90
Q

genetic stuff of hemochromatosis:
___ mutation in ___ gene, chromosome #__
HLA type _____
inheritance pattern

A

C282Y (or less commonly H63D) in HFE gene, chromosome 6
HLA-A3
autosomal recessive

91
Q

lipofuscin is a bproduct from the turover of _____

A

peroxidized lipids

92
Q

Wilson dz genetics: inheritance pattern, gene and chromosome

A

autosomal recessive
ATP7B gene, chromosome 13

mutation in copper transporting ATPase

93
Q

in wilson dz, you get parkinsonian sx due to deposition of copper in what part of brain?

A

basal ganglia (same place that UCB deposits in liver dz -> kernicterus)

94
Q

what liver thing has antimitochondrial antibody present?

A

primary biliary cirrhosis (Reye syndrome also has mitochondrial damage of hepatocytes, but not antibody)

95
Q

periductal fibrosis w/ onion skin appearance

uninvolved regions are dilated -> beaded appearance on contrast imaging

A

primary sclerosing cholangitis

96
Q

hepatic adenoma can be caused by use of what drug?

A

oral contraceptives. grow w/ exposure to estrogen (like in pregnancy. risk of rupture during pregnancy)

97
Q

how do aflotoxins from Aspergillus increase risk for HCC?

A

induce p53 mutations

98
Q

serum tumor marker for HCC

A

alpha fetoprotein

99
Q

liver cancer is more from metastasis than from primary. 5 most common primary organs that metastasize to liver?

A 
colon
stomach
pancreas
lung
breast
100
Q

in spontaneous bacterial peritonitis what is most common organisms causing? what is empirical tx?

A

aerobic gram ⊝ organisms (eg, E coli, Klebsiella) or less commonly gram ⊕ Streptococcus

tx: 3rd gen cephalosporin = ceftriaxone, cefotaxime

101
Q

if patient has elevated alkaline phosphatase, what elevated level would exclude bone as cause for that?

A

y-glutamyl transpeptidase

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