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USMLE > GI Physiology > Flashcards

GI Physiology Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the VACTERL defects associated with omphalocele?

A

Vertebral defects, Anal atresia, Cardiac Defects, TEF, Renal defects, Limb defects
associated with aneuploidy

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2
Q

Omphalocele and Gastrochisis result from defect of which ventral wall closer?

A

Lateral wall

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3
Q

Rostral fold closure results in which ventral wall defect?

A

Sternal defect

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4
Q

Caudal fold closure defect results in which ventral wall defect

A

Bladder exstrosphy

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5
Q

Polyhdramnios, drool, choking, vomiting with first feeding and air in stomach suggest which anomaly?

A

Tracheoesophageal fistula (esophageal atresia)

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6
Q

Cause of duodenal atresia

A

Failure to recanalize

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7
Q

“double bubble” on X-ray with bilous vomiting and abdominal distension in first 1-2 days of life suggest

A

duodenal atresia

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8
Q

“triple bubble sign” with bilious vomiting and abdominal distension in first two days of life suggest

A

jejunal and ileal atresia

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9
Q

cause of jejunal and ileal atresia

A

disruption of superior mesenteric vessels–> ischemic necrosis–> segmental resorption

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10
Q

Common cause of jejunal and ileal atresia

A

Malrotation leading to occlusion of SMA and ischemic necrosis

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11
Q

A “palpable olive mass” in epigastric region and nonbilous projectile vomiting at 2-6 weeks old is suggestive of

A

Hypertrophic Pyloric stenosis

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12
Q

Maternal use of macrolides during pregnancy is associated with

A

Hypertrophic pyloric stenosis

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13
Q

Hypokalemic, hypochloremic metabolic alkalosis in a hungry, dehydrated baby suggest

A

Hypertrophic pyloric stenosis

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14
Q

The uncinate process and main pancreatic duct are derived from

A

Ventral pancreatic buds

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15
Q

The body, tail, isthmus and accessory pancreatic duct are derived from

A

Dorsal pancreatic bud

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16
Q

What is special about the spleen’s embryologic arrangement

A

Derived from mesentery of stomach (mesoderm) but has foregut supply (splenic artery)

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17
Q

Retroperitoneal structures (SADPUCKER)

A 
Suprarenal (adrenal) glands
Aorta and IVC
Duodenum (2 and 4)
Pancreas (except tail) 
Ureters
Colon (ascending and descending)
Kidneys
Esophagus (thoracic)
Rectum (partially)
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18
Q

Foregut structures supplied by celiac artery

A

lower esophagus to proximal duodenum, liver, gallbladder, pancreas, spleen

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19
Q

Midgut structures supplied by SMA

A

Distal duodenum to proximal 2/3 of transverse colon

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20
Q

Hindgut structures supplied by IMA

A

Distal 1/3 of transverse colon to upper portion of rectum

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21
Q

What is SMA syndrome (Wilkie’s syndrome)

A

Occasional post-prandial pain due to compression of third portion of duodenum between SMA and aorta; occurs in malnutrition/low body weight

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22
Q

Which arteries provide anastamoses between IMA and SMA?

A

Middle colic (SMA) and Left colic (IMA)

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23
Q

The right gastric artery branches off of which vessel?

A

Proper hepatic arterty

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24
Q

Three GI arteries that branch off of celiac

A

Common hepatic, L. gastric, Splenic

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25
Q

The short gastrics and L. gastroepiploic arteries branch off of

A

Splenic artery

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26
Q

Lower esophagus blood is provided by

A

Left gastric artery

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27
Q

Superior hemorrhoids occur in which vein

A

Superior rectal

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28
Q

Anorectal varices in cirrhosis occur due to anastomosies between

A

Superior rectal and middle and inferior rectal vein s

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29
Q

Caput medusae around umbilicus occurs due to anastamoses between which two veins?

A

Paraumbilical to small epigasteric veins of small anterior abdominal wall

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30
Q

Esophageal varices occur due to abnormal anastamoses between

A

Left gastric and azygos

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31
Q

What is TIPS

A

Transjugular intrahepatic portosystemic shunt to treat portal hypertension

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32
Q

How is TIPS performed

A

Shunt placed between portal vein and hepatic vein to bypass liver and shunt blood to systemic circulation

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33
Q

Which structure is formed where endoderm meets ectoderm

A

Pectinate (dentate) line

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34
Q

Why are internal hemorrhoids not painful

A

Receive visceral innervation

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35
Q

Lymph drainage of structures above pectinate line

A

Internal iliac lymph nodes

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36
Q

Arterial supply of structures above pectinate line

A

Superior rectal artery

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37
Q

Arterial supply of structures below pectinate line

A

Inferior rectal artery (branch of internal pudendal)

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38
Q

Venous drainage of structures below pectinate line

A

Inferior rectal vein–> internal pudendal vein–> internal iliac vein–> common iliac vein–> IVC

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39
Q

Venous drainage of structures above pectinate lin e

A

Superior rectal vein –> inferior mesenteric vein–> portal vein

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40
Q

Lymphatic drainage of structures below pectinate line

A

Superficial inguinal lymph nodes

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41
Q

Inferior rectal branch of pudendal nerve innervates which part of body

A

Structures below pectinate line (external hemorrhoids–painful)

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42
Q

Which hepatic zone contains P450, is most sensitive to metabolic toxins, is first affected by ischemia, and is the first site of alcoholic hepatitis?

A

Zone 3 (pericentral vein/centrilobular zone)

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43
Q

Which hepatic zone is affected by yellow fever?

A

Zone 2 (Intermediate zone)

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44
Q

Which hepatic zone is affected first by viral hepatitis and bacterial/infectious toxins?

A

Zone 1 (Periportal zone)

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45
Q

Which cells store Vitamin A when quiescent and produce ECM when active?

A

Hepatic stellate (Ito) cells in space of Disse

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46
Q

Which cells are the macrophages of the liver?

A

Kupffer cells lining sinusoids

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47
Q

What is the site of protrusion of indirect hernia

A

Deep (internal) inguinal ring

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48
Q

What is the site of protrusion of direct hernia?

A

Abdominal wall

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49
Q

The internal spermatic fascia forms from the

A

Transversalis fascia

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50
Q

The cremasteric muscle and fascia form from

A

Internal oblique

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51
Q

The external spermatic fascia form from

A

External oblique

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52
Q

ICE tie

A

Internal spermatic fascia - transversalis fascia
Cremasteric muscle and fascia- internal oblique
External spermatic fascia- external oblique

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53
Q

What is the site of femoral hernias

A

Femoral ring

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54
Q

What is the most common cause of indirect inguinal hernias in males

A

Patent processus vaginalus (risk of hydrocele)

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55
Q

Which anatomic structures help distinguish Indirect hernias from direct hernias?

A

Inferior Epigasteric vessels

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56
Q

Location of direct hernia relative to inferior epigastric vessel

A

Medial to inferior epigastric vessel

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57
Q

Location of indirect hernia relative inferior epigastric vessel

A

Lateral to inferior epigastric vessels

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58
Q

Internal ingunal ring, external inguinal ring, into scrotum (which hernia)

A

Indirect inguinal

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59
Q

Two complications of hernias

A

Incarceration (not reducible back into abdomen/pelvis) and strangulation (ischemia and necrosis)

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60
Q

Cutting which ligament provides access to pancreas in lesser sac during surgery?

A

Gastrocolic

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61
Q

Which structure does direct inguinal hernia go through

A

External inguinal ring

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62
Q

What is direct inguinal hernia covered with and who usually gets it

A

External spermatic fascia; older men

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63
Q

What are the borders of Hesselbach’s triangle

A

Superior: Inferior epigasteric vessels
Medial: Lateral border of rectus abdominus
Inferior: Inguinal ligament

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64
Q

Where does femoral hernia protrude through and who usually gets it

A

Below inguinal ligament through femoral canal; females

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65
Q

What is the risk assocaited with femoral hernias

A

Incarceration and strangulation

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66
Q

Cause of umbilical hernias

A

Weakened rectus abdominus muscle; protrusion of allantois remnant

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67
Q

Why do diaphragmatic hernias typically occur on left side?

A

The right hemidiaphgragm is protected by the liver

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68
Q

What is the most common diaphragmatic hernia?

A

Sliding hiatal hernia (gasteroesophageal junction displaced upward) “Hourglass stomach”

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69
Q

Sliding hiatal hernias are associated with which condition

A

GERD

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70
Q

Presentation of diaphragmatic hernia on newborn

A

Tachypnea, dyspnea, cyanosis, absent bowel sounds, scaphoid abdomen, hypoplastic left lung
dx with US

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71
Q

Risk of paraesophageal diaphragmatic hernia

A

gastric volvulus (stomach fundus flips onto itself, GE junction is usually normal)

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72
Q

Which three conditions increase gastrin production?

A

Chronic PPI use, Zollinger-Ellison syndrome (gastrinoma), H Pylori

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73
Q

Which medications increase motilin and thus migrating motor complexes

A

Erythromyciin

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74
Q

Clinical presentation of VIPoma

A

Watery diarrhea, Hypokalemia and Achlorydia (WDHA syndrome)

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75
Q

What causes increased lower esophageal sphincter tone in achalasia

A

Loss of NO

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76
Q

What converts trypsinogen to trypsin and where is it found

A

Enterokinase/enteropeptidase, brush border of duodenal and jejunal mucosa

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77
Q

Where is Iron (Fe+2) absorbed

A

Duodenum

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78
Q

Where is Folate absorbed

A

Jejunum

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79
Q

Where is B12 absorbed

A

Terminal ileum along with bile salts; requires intrinsic factor

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80
Q

Where do you find Peyer’s patches

A

Lamina propria and submucosa of ileum

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81
Q

Predominant antibody of Peyer’s patches

A

IgA

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82
Q

Which enzyme catalyzes rate-limiting step of bile acid synthesis

A

Cholesterol-7 alpha-hydroxylase

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83
Q

Three major functions of bile

A
  1. Digestion and absorption of lipids and fat-soluble vitamins
  2. Cholesterol excretion
  3. Antimicrobial activity
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84
Q

6 components of Bile

A 
Bile salts (bile acids + Glycine/Taurine)
Ions
Water
Cholesterole
Biliirubin
Phospholipids
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85
Q

What is bilirubin conjugated with

A

Glucuronate by UGT1

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86
Q

How is unconjugated bilirubin transported in blood

A

Attached to albumin

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87
Q

Failure of facial prominences to fuse causes

A

Cleft lip and palate

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88
Q

What is Behcet syndrome

A

Recurrent apthuous uclers, genital ulcers and uveitis due to immune complex vasculitis involving small vessels

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89
Q

What are the major risk factors for squamous cell carcinoma of oral cavity

A

Tobacco and alcohol

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90
Q

Leukoplakia and erythroplakia must be biopsied to rule out

A

Squamous cell carcinoma

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91
Q

What causes Hairy leukoplakia

A

EBV induced squamous cell hyperplasia in immunocompromised individuals; occurs on lateral tongue

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92
Q

Mobile, painless, circumscribed mass at angle of jaw is suggestive of which condition and containes which tissues

A

Pleomorphic adenoma; stromal and epithelial tissue

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93
Q

Most common salivary gland tumor

A

Pleomorphic adenoma

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94
Q

Common site of Warthin tumor

A

Parotid gland

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95
Q

Histology of Warthin tumor

A

Abundant lymphocytes and germinal centers (lymph-node like stroma); benign tumor

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96
Q

Most common cause of sialadenitis

A

S. aureus infection following obstructing stone

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97
Q

Most common malignant tumor of parotid gland

A

Mucoepidermoid carcinoma (mucinous and squamous cells)

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98
Q

Why does mucoepidermoid carcinoma cause pain

A

Involves facial nerve

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99
Q

Clinical presentation of Plummer-Vinson syndrome

A

1) Dysphagia
2) Esophageal web
3) Iron deficiency anemia
Increased risk of squamous cell carcinoma

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100
Q

Zenker diverticulum occurs where?

A

In opening of cricopharnyngeal muscle

101
Q

Three clinical features of Zenker diverticulum

A

Halitosis, dysphagia, feeling of obstruction, especially nocturnal

102
Q

Longitudinal lacerations at gastroesophageal junction due to excessive vomiting (alcoholics and bulemics) suggest which condition

A

Mallory-Weiss syndrome

103
Q

How does Mallory-Weiss syndrome present

A

Painful hematemesis (bloody vomit); risk of Boaerhaave syndrome

104
Q

Clinical sign of Boerhaave syndrome

A

Crepitus in neck after severe vomiting, suggesting esophageal rupture

105
Q

What causes achalasia

A

Damaged ganglion cells in myenteric plexus (no NO so LES cannot relax)

106
Q

Trypanasoma cruzi infection in Chagas disease increases risk of which condition

A

Achalasia

107
Q

Four signs of Achalasia

A

Dysphagia for solids and liquids
Putrid breath
High LES pressure on manometry
Bird beak sign on barium swallow study

108
Q

What is Nutcracker esophagus

A

Overactivity of cholinergic neurons causing persistaltic contraction of high amplitude, dysphage for solids and liquids or asymptomatic

109
Q

Heartbburn, adult-onset asthma and cough, damage to enamel of teeth and ulceration are indicative of which condition?

A

GERD

110
Q

Risk factors for GERD

A

Alcohol, tobacco obesity, fat-rich diet, caffeine and hiatal hernia

111
Q

What causes GERD

A

Reduced LES tone

112
Q

What is Barrett esophagus

A

Metaplasia of lower esophageal mucosa from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells. May progress to dysplasia and adenocarcinoma

113
Q

Where is esophageal adenocarcinoma most common

A

the West

114
Q

Which is the most common esophageal cancer worldwide?

A

Squamous cell carcinoma (upper or middle third of esophagus)

115
Q

Squamous cell carcinoma typically spreads through which lymphatics

A

Upper 1/3 - cervical nodes

middle 1/3- mediastinal or tracheobronchial nodes

116
Q

Adenocarcinoma spreads through which lymph routee

A

Lower 1/3- celiac and gastric nodes

117
Q

Most common cause of esophageal squamous cell carcinoma

A

Alcohol and tobacco

Hot tea in East

118
Q

Labs for baby with pyloric stenosis

A

Hypochloremia, hypokalemic metabolic alkalosis, increased bilirubin

119
Q

HSV-1 esophagitis presents as

A

punched-out ulcers

120
Q

CMV esophagitis presents as

A

linear ulcers

121
Q

Candida esophagitis presents as

A

white pseudomembranes

122
Q

What are esophageal strictures associated with

A

caustic ingestion and GERD

123
Q

How does CREST syndrome cause acid reflux and dysphagia

A

Causes esophageal smooth muscle atrophy, leading to decreased LES tone and reflux

124
Q

Risk factors for esophageal adenocarcinoma

A

GERD, Barrett esophagus, obesity, smoking, achalasia

125
Q

Two types of esophageal cancers

A

Adenocarcinoma
Squamous Cell carcinoma
both poor prognosis

126
Q

Meconium ileus is a very specific finding for which condition?

A

CF

127
Q

Clinical feature of meconium ileus

A

Green inspissated mass (dehydrated meconium) in distal ileum

128
Q

Most common cause of death of patients with meconium ileus (CF)

A

Pneumonia, bronchiectasis and cor pulmonale

129
Q

Progressive dysphagia (solids to liquids), weight loss, pain and hematemesis suggest

A

Esophageal carcinoma

130
Q

Which gastric carcinoma also presents with hoarseness and cough

A

Squamous cell carcinoma due to involvement of recurrent laryngeal nerve or trachea

131
Q

What causes a curling ulcer

A

Severe burns

132
Q

What causes a Cushing ulcer

A

Increased intracranial pressure (stimulates vagus nerve to increase acid production)

133
Q

6 risk factors for acute gastritis

A

Curling ulcer, NSAIDs (decrease PG32), heavy alcohol consumption, chemo, Cushing ulcer, hypotensive shock (decreased nutrient delivery to mucous/foveolar cells)

134
Q

Clinical presentation of duodenal ulcer

A

Epigastric pain that improves with meals

135
Q

Most common cause of duodenal ulcers (95%)

A

H. Pylori

136
Q

Rare cause of duodenal ulcer

A

ZE syndrome

137
Q

What risks are associated with a ruptured ulcer in posterior duodenum?

A

Bleeding from gastroduodenal artery or acute pancreatitis

138
Q

Diagnostic endoscopy of duodenal ulcer

A

Ulcer with hypertrophy of Brunner glands

139
Q

Risk factors for intestinal type gastric carcinoma

A
  1. Intestinal metaplasia (autoimmune/ H. pylori)
  2. Smoked foods (Japan)
  3. Blood type A
140
Q

Diffuse type gastric carcinoma profile

A

Young, worse prognosis, occurs in entire stomach, signet ring cell s

141
Q

What is the Leser-Trelat sign and what does it indicate

A

Sudden occurrence of keratoses all over skin; gastric malignancy

142
Q

Intestinal gastric carcinoma lymph drainage

A

Periumbilical region (Sister Mary Joseph nodule)

143
Q

Gastric carcinoma drains to lymph nodes via

A

Left supraclavicular node (Virchow node

144
Q

Diffuse type gastric carcinoma drains to which organ

A

bilateral ovaries (Krukenberg tumor)

145
Q

Cause of duodenal atresia

A

Failure of duodenum to canalize

146
Q

A 1-2 year old with bleeding, volvulus, intussusception or appendicitis-like symptoms may present with

A

Meckel diverticulum (true diverticulum)

147
Q

Cause of Meckel diverticulum

A

Failure of vitelline duct to involute

148
Q

Most common location of volvulus in elderly

A

Sigmoid colon

149
Q

Most common cause of volvulus in young adults

A

cecum

150
Q

Most common cause of intussusception (telescoping bowel) in children

A

Rotavirus infection

151
Q

Occlusion of which two vessels can cause small bowel infarction?

A

SMA or mesenteric vein

152
Q

Clinical features of small bowel infarction

A

Abdominal pain, bloody diarrhea, decrease bowel sounds, hypotension

153
Q

Which antigen do APCs present on MHCII in Celiac disease?

A

deamidated gliadin

154
Q

What causes dermatitis herpetiformis in patients with Celiac disease?

A

Deposition of IgA on dermal papillae

155
Q

Flattening of villi, hyperplasia of crypts and increased intraepithelial lymphocytes indicate which condition

A

Celiac disease

156
Q

Where is damage in Celiac disease

A

Duodenum

157
Q

What is tropical sprue

A

Malabsorption disorder common in tropics; damage most prominent in jejunum and ileum

158
Q

Triad of symptoms with Whipple disease (CAN) along with steatorrhea

A 
Cardiac symptoms (murmur) 
Arthralgias (arthritis)
Neurologic symptoms (confusion, forgetfulness)
159
Q

Why does Whipple disease cause steatorrhea

A

Infiltration of small bowel lacteals prevents chylomicron absorption

160
Q

Causative agent of Whipple disease and histology

A

Tropheryma whippeli; foamy macrophages in lamina propria (connective tissue of SI villus)

161
Q

Clinical features of abetalipoprotenemia

A

AR, deficiency of APO B-48 (chylomicrons) and B-100 (VLDL, LDL)
Malabsorption of fat (Steatorrhea)
absent plasma VLDL and LDL

162
Q

Clinical features of carcinoid syndrome

A

Flushing, bronchospasm and diarrhea

163
Q

Why does carcinoid heart disease only lead to right-side valvular fibrosis (tricuspid regurg and pulmonary stenosis)?

A

The lungs have MAO, which break down serotonin before it reaches left side of heart

164
Q

Three major clinical features of Hirschsprung disease

A
  1. Failure to pass meconium
  2. Empty rectal vault on digital rectal exam
  3. Massive dilatation of bowel proximal to obstruction
165
Q

Cause of Hirschsprung disease

A

Failure of neural crest cells to migrate into Auerbach (meynteric) and Meissner (submucosal) plexuses

166
Q

Which part of colon is defective in Hirschsprung

A

distal sigmoid colon and rectum (associated with Trisomy 21)

167
Q

Most common location for colonic diverticula

A

Sigmoid colon

168
Q

What is diverticulitis

A

Inflammation of diverticuli (mucosal/submucosal outpouchings into muscularis propria) that cause LLQ pain and hematochezia (bloody stool); common in elderly, especially those with low-fiber diets

169
Q

Presentation of AD Hereditary Hemorrhage Telengiectasia

A

Ecchymoses of lips, GI bleeds

170
Q

High stress in right colon causes; high stress in left colon causes

A

Angiodysplasia right; Diverticulosis left

171
Q

Three clinical features of ischemic colitis

A

Post-prandial LUQ pain
Bloody diarrhea
Weight loss

172
Q

Common area of ischemic colitis

A

Splenic flexure (watershed area between SMA and IMA)

173
Q

Most common cause of Ischemic Colitis

A

Atherosclerosis of SMA

174
Q

Bloating, flatulence and change in bowel habits (diarrhea or constipation) without any identifiable cause is termed

A

Irritable bowel syndrome

175
Q

How is aspirin protective in the adenoma-carcinoma sequence?

A

Prevents progression from adenoma to carcinoma by inhibiting expression of COX

176
Q

What are the three risk factors for progressing to carcinoma?

A

1) size >2cm
2) sessile growth
3) villous histology

177
Q

Two types of FAP syndromes

A

Garner and Turcot

178
Q

What is Gardner syndrome

A

Familial Adenomatous Polyposis syndrome with colonic cancer (thousands of polyps in colon and rectum) and osteomas and soft tissue tumors

179
Q

What is Turcot syndrome

A

FAP with colorectal carcinoma and CNS tumors (medulloblastoma/glioblastoma)

180
Q

How is FAP inherited

A

AD mutation of APC on chromosome 5 (Endoscopy warranted in people with family history of colorectal cancer)

181
Q

Rectal polyps in children <5 yo are likely

A

Hamartomatous (disorganized tissue) juvenile polyps

182
Q

Clinical presentation of intussusception (target bowel on CT), hamartomatous polyps in small bowel, bluish spots/hyperpigmented freckle-like spots on lips, oral mucosa, palms and genitals in a young adult suggest

A

Peutz-Jeghers syndrome

183
Q

Peutz-Jehger syndrome is mutation in which gene and increases risk of which malignancies

A

AD STK1 (serine threonine kinase) mutation, breast, colorectal, gynecologic cancer

184
Q

Colorectal cancer on right side with other cancers such as ovarian and endometrial suggest

A

Lynch (HNPCC) syndrome

185
Q

Decreased stool caliber, LLQ pain and blood-streaked stool suggestive of left-sided colorectal cancer arose from which mutation

A

Adenoma-Carcinoma sequence (APC, KRAS, TP53 mutations)

186
Q

Raised lesions, Iron-deficiency anemia and vague pain in an older adult suggestive of right-sided colorectal carcinoma likely arose from

A

MSI (alternate) sequence; microsatellite instability

187
Q

Streptococcus bovis endocarditis is highly suggestive of

A

colonic carcinoma

188
Q

Which organ is most commonly involved in GI cancers?

A

Liver

189
Q

Which serum marker is useful for assessing treatment response and detecting recurrence of colonic cancer?

A

CEA

190
Q

What is the source of visceral pain and why is it poorly localized? (described as vague, colicky, aching, crampy)

A

Source is mesentary– due to low density of pain receptors with shared sensory convergence

191
Q

Visceral pain is indicative of which sort of stimulus

A

Tension, overdistension, ischemia, mesenteric traction

192
Q

What is the source of parietal pain and why can it be precisely located (sharp, knife-like, constant, severe)

A

Peritoneal lining of abdominal wall; somatic free nerve ending meshwork with increased sensory nerves allows fine mapping

193
Q

Stimuli for parietal pain

A

Mechanical, chemical, thermal irritation

194
Q

Cause of annular pancrease

A

Failed migration of ventral pancreatic bud around duodenum

195
Q

How does alcohol increase risk of acute pancreatitis

A

Causes premature contraction of sphincter of Oddi, decreases drainage of pancreas, increases risk of premature activation of enzymes

196
Q

Trauma, hypercalcemia, hyperlipidemia, drugs, scorpion stings, rupture of posterior duodenal rupture and mumps can cause

A

acute pancreatitis

197
Q

Which serum enzyme is specific for pancreatic damage?

A

Lipase

198
Q

Abdominal mass with persistently elevated serum amylase suggests

A

Pancreatic pseudocyst

199
Q

Abdominal pain, fever, and persistently elevated amylase suggests pancreatic abscess formation by which pathogen

A

S. aureus

200
Q

Mutated PRSS1, SPINK1 (trypsin inhibitor) and CF increase risk of

A

pancreatitis

201
Q

Most common cause of chronic pancreatitis in children

A

CF

202
Q

Obstructive jaundice, pale stools, palpable gallbladder suggest

A

Pancreatic adenocarcinoma

203
Q

Most common cause of pancreatic adenocarcinoma

A

smoking and chronic pancreatitis

204
Q

Neonatal presenation of jaundice and progression to cirrhosis in first 2 months of life suggests

A

Biliary atresia (failure/early destruction of extrahepatic biliary tree)

205
Q

Which condition presents as air in biliary tree?

A

gallstone ileus

206
Q

Three risk factors for hepatocellular carcinoma

A

Chronic hepatitis
Cirrhosis
Aflatoxins from Aspergillus

207
Q

Hepatic vein obstruction that results in painful hepatomegaly and ascites is likely

A

Budd-Chiari syndrome

208
Q

Serum tumor marker for hepatocellular carcinoma

A

alpha-fetoprotein

209
Q

What causes asterixis in cirrhosis?

A

Buildup of ammonia

210
Q

Treatment for hepatic encephalopathy and asterixis in cirrhosis

A

Lactulose (increase H+ bacteria –> increase NH4+ for excretion)
Neomycin (kill NH3 producing bacteria)

211
Q

Which second messenger increases with Histamine binding to H2 receptors on parietal cells

A

cAMP

212
Q

Which second messenger is increased with ACh binding M3 muscarinic receptors on parietal cells

A

Intracellular calcium

213
Q

Which second messenger is increased with Gastrin binding to CCK B receptors

A

Intracellular calcium

214
Q

Patient comes with syncope, flushing, hypotension, pruritus and urticaria after showering. Skin biopsy reveals mast cells positive for KIT (CD117). Patient likely has which condition?

A

Systemic mastocytosis

215
Q

What causes systemic mastocytosis

A

Mutation in KIT receptor tyrosine kinase, leads to excessive histamine release

216
Q

A rigid and tender abdomen with persistent left shoulder pain and bruise on lower chest wall after MCV indicates

A

Splenic laceration

217
Q

Why do some people get C Diff infections when exposed while others may not?

A

Protection from GI microbiome

218
Q

What are the markers of liver hepatocyte injury

A

Elevated AST and ALT (AST usually > ALT in cirrhosis)

219
Q

What are the markers of cholestasis/biliary injury

A

Elevated alkaline phosphatase, elevated GGT

220
Q

What are the markers of impaired liver biosynthetic activity that help evaluate liver function

A

Elevated prothrombin time, hypoalbuminemia and elevated bilirubin

221
Q

What is the key determinant of prognosis in patients with cirrhosis?

A

Liver’s functional reserve (prothrombin time, albumin levels)

222
Q

Diffuse hepatic fibrosis with replacement of normal lobular architecture by fibrous-lined regenerative parenchymal nodules indicates

A

Cirrhosis

223
Q

Granulomatous destruction of bile ducts is seen in which condition

A

Primary biliary cirrhosis

224
Q

What is the most common GI manifestation of cystic fibrosis

A

Pancreatic insufficiency characterized by duct obstruction and distension

225
Q

Where in the retroperitoneum is the esophagus located

A

Behind the trachea (appears black on CT) and in front of spine

226
Q

Light microscopy showing apoptosis of hepatocytes, acinar necrosis and periportal mononuclear inflammatory infiltration indicates

A

Viral hepatitis

227
Q

Light microscopy of liver showing microvesicular steatosis, presence of small fat vacuoles in cytoplasm of hepatocytes indicates

A

Reye syndrome

228
Q

Centrilobular congestion occurs in patients with which condition

A

RHF

229
Q

Middle-aged woman complaining of severe pruritus, PMH of autoimmune disease, xanthometous lesions on eyelids or tendons, and elevated AST>ALT indicates

A

Primary biliary cirrhosis

230
Q

Which organs are the two primary sources of alkaline phosphatase

A

Bone and liver

231
Q

Why check GGT after noticing elevated alkaline phosphatase?

A

GGT is mainly expressed in GB and liver and can distinguish whether origin of AP elevation is related to bone dz or hepatobiliary dz

232
Q

Hepatitis B assists Hepatitis D infect an organism through which mechanism

A

Coating Hepatitis D viral particles to penetrate hepatocyte

233
Q

Common life-threatening complication of noncompliant ulcerative colitis patient

A

Toxic megacolon (bloody diarrhea, abdominal pain/distension, fever, shock)

234
Q

Most benign liver tumor that looks like enlarged ectasia with blood cells in the gaps

A

Cavernous hemangioma

235
Q

What is the most sensitive screening for malabsorptive disorders

A

Testing for fat in stool using Sudan III stain

236
Q

As a consequence of total gastrectomy, patients require lifelong supplementation of

A

B12

237
Q

What causes gynecomastia, testicular atrophy, decreased body hair and spider angiomata in cirrhosis?

A

Decreased estrogen metabolism by liver, increased androstenedione production leading to increased conversion to estrogen by adrenal glands, thus decreasing free testosterone/estrogen ratio

238
Q

Where do most gastric ulcers arise and which arteries are at risk of hemorrhage?

A

Lesser curvature of stomach. Left gastric at proximal, right gastric at distal

239
Q

Ulcers in the posterior duodenal bulb can erode and cause hemorrhage in which artery?

A

Gastroduodenal

240
Q

The greater curvature of the stomach is supplied by which arteries?

A

Left (Branch of splenic) and right gastroepiploic (branch of gastroduodenal/common hepatic)

241
Q

Most common site of intussusception in children less than 2

A

Ileocecal valve

242
Q

Nodules of cirrhotic liver are composed of

A

Hepatocytes

243
Q

These cells of the liver lack a basement membrane

A

Sinusoidal endothelial cells

244
Q

This liver cell differentiates into myofibroblasts in injury and causes fibrosis

A

Stellate cell

245
Q

Entaemoeba histolytica infections (abdominal pain and diarrhea) are more common in which demographic?

A

Men who have sex with men

246
Q

Stool examination of Entamoeba histolytica reveal

A

Trophozoites with phagocytosed RBCs

247
Q

Stool samples of Cryptosporidium parvum reveal

A

Large number of oocysts, especially in AIDS pts

248
Q

Sudden, fouls-smelling watery diarrhea with cramping after a camping trip; and stool exam with cysts or trophozoites suggests

A

Giardia lamblia infection

249
Q

Described as friable, inflamed mucosa beginning from rectum and ascending proximally. Also have neutrophils in crypts

A

Ulcerative Colitis

USMLE (36 decks)

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