GI Review Flashcards
50 year old woman with pruritus without jaundice, positive AMA
primary biliary cirrhosis
GI bleeding, buccal pigmentation
Peutz-Jeghers syndrome
60 year old woman, RA, no alcohol history, fatigue, and right abdominal pain; elevated ANA and ASMA, elevated serum IgG levels, no viral serologic markers
autoimmune hepatitis
23 year old woman, no alcohol history; elevated levels of LKM-1 antibodies, no viral serologic markers, liver biopsy with infiltration of the portal and periportal area with lymphocytes
autoimmune hepatitis
fatal disease of unconjugated bilirubin resulting from a complete lack of UDPGT activity
Criggler-Najjar type 1
What drugs and endogenous hormones regulate the secretion of gastric acid?
Hormones that promote gastric acid secretion:
- histamine, ACh, gastrin
Hormones that inhibit gastric acid secretion:
- prostaglandins, somatostatin, secretin, GIP
Drugs that regulate gastric acid secretion:
- PPIs, H2 blockers, antimuscarinic drugs
What is the difference between primary biliary cholangitis and primary sclerosing cholangitis?
primary biliary cholangitis - autoimmune, women, middle aged, + AMA
primary sclerosing cholangitis - men, middle-aged, + p-ANCA, associated with UC and cholangiocarcinoma; ERCP finding: alternating beading and stricturing
What is Reynold’s pentad for cholangitis?
(Charcot triad): 1. fever 2. jaundice 3. RUQ pain PLUS: 4. hypotension 5. altered mental status
What clinical features suggest congenital pyloric stenosis?
- non-billious vomiting (projectile)
- 2-6 weeks old
- males > females
- olive-shaped mass in abdomen
- peristaltic waves before vomiting
- hypochloremic hypokalemic metabolic alkalosis if vomiting >/= 5 days
What are the features of Plummer-Vinson syndrome?
- glossitis
- dysphagia d/t esophageal webs
- iron deficiency
What histological findings of the distal duodenum are most likely seen in a patient with celiac sprue?
- blunting of the villi
- hyperplastic crypts
- lymphocytes in the lamina propria
What is the most common benign salivary gland neoplasm? What is the most common malignant salivary gland neoplasm? What is the most common location for a salivary gland neoplasm?
pleomorphic adenoma
mucoepirdermoid carcinoma
parotid gland
What are the risk factors for adenocarcinoma of the esophagus?
obesity, GERD, smoking, Barrett esophagus, nitrosamines
What are the risk factors for squamous cell carcinoma of the esophagus?
smoking, alcohol, nitrosamines, achalasia, esophageal webs, strictures
What histological findings are seen in alcohol hepatitis?
- fatty infiltration
- Mallory bodies (intracytoplasmic eosinophilic inclusions)
- necrosis and swelling of hepatocytes
Which hormones stimulate pancreatic secretions?
ACh (via vagus n)
CCK
Secretin (stimulates HCO3- secretion)
What are the retroperitoneal organs?
SAD PUCKER
- suprarenal glands
- aorta and IVC
- duodenum (2nd, 3rd, and 4th parts)
- pancreases (except tail)
- ureters
- colon (descending and ascending)
- kidneys
- esophagus (under diaphragm)
- rectum
What are the possible etiologies of acute pancreatitis?
PANCREATITIS P - increased PTH -> hypercalcemia A - Alcohol N - Neoplasm C - Cholelithiasis R - Rx (drugs) E - ERCP A - abdominal surgery T - hypertriglyceridemia I - infection (mumps) T - trauma I - idiopathic S - scorpion sting
What is the typical presentation of a patient with pancreatic insufficiency?
- decreased uptake of fat soluble vitamins (DEAK)
- malabsorption, weight loss
- steatorrhea
- diarrhea
What are the risk factors for development of hepatocellular carcinoma?
cirrhosis Hep B and C hemochromatosis alpha1-antitrypsin hepatic ademona
What are the tumor markers for pancreatic cancer?
CEA, CA19-9 (more specific)
What are the two nervous tissue bundles that run through the GI tract and where are they located?
Meissner’s plexus - located in the submucosa
Auerbach’s plexus - between the layers of the muscularis propria
What is pulsus paradoxus and what are the causes?
> 10mmHg change in SBP with inspiration
-caused by anything that prolongs inspiration: COPD, asthma, cardiac tamponade
How is hnRNA processed before it leaves the nucleus?
5’ cap and poly-A tail; spice out introns
What is the treatment for nephrogenic diabetes insipidus?
HCTZ - helps concentrate urine
Amiloride - K+-sparing diuretic (Tx DI d/t Lithium toxicity)
Indomethacin -> decrease RBF
What is schizotypal disorder?
personality disorder with interpersonal awkwardness, odd thoughts, and odd appearance
Which causes of vaginal discharge/vaginitis are associated with a high vaginal pH? Which are associated with a low vaginal pH?
high pH - garnerella, trichomonas
low pH - physiologic and candida
Which cell wall inhibitor is the next step in treatment of otitis media if amoxicillin resistant?
Amoxicillin/Clavulanic acid
Which cell wall inhibitor is prophylaxis against bacterial endocarditis?
penicillin V, aminopenicillins, 1st generation cephalosporin
Which cell wall inhibitor is sufficient for the treatment of syphilis?
penicillin G
Which cell wall inhibitor is used as a single-dose treatment for gonorrhea?
ceftriaxone
What are the kubler-ross stages of grief?
- denial
- anger
- bargaining
- depression/grief
- acceptance
What are the common causes of restrictive cardiomyopathy?
sarcoidosis amyloidosis hemochromatosis Loeffler's Dz (endomyocardial fibrosis with eosinophilic infiltrate) endocardial fibroelastosis post-radiation fibrosis
Which type of antipsychotic is often the first line of treatment for psychosis? Which antipsychotic should be reserved for severe refractory psychosis because of the risk of agranulocytosis?
- atypical antipsychotics
- clozapine should be reserved
What is Budd-Chiari syndrome?
thrombosis of IVC or hepatic veins -> hepatic congestion
What substances are known for causing methemoglobinemia?
nitrates, antimalarials, dapsone, metochlopramide, sulfonamides, local anesthetics (lidocaine)
Which glomerular disease has IF: granular pattern of immune complex deposition and LM: diffuse capillary thickening?
membranous, diffuse proliferative
Which glomerular disease has IF: granular pattern of immune complex deposition and LM: hyper cellular glomeruli?
post-streptococcal glomerulonephritis
Which glomerular disease has IF: liner pattern of immune complex deposition?
Goodpasture
Which glomerular disease has EM: sub endothelial humps and “tram track” appearance?
membranoproliferative glomerulonephritis
Which glomerular disease has nephritis, deafness, and cataracts?
Alport syndrome
Which glomerular disease has LM: crescent formation in the glomeruli?
RPGN (rapidly progressive)
Which glomerular disease has LM: segmental sclerosis and hyalinosis?
FSGN (focal segmental)
Which glomerular disease has IF: Anti-GBM Abs?
Goodpasture
Which glomerular disease has LM: Kimmelstiel-Wilson lesions?
diabetic nephropathy
Which glomerular disease has purpura on backs of arms and legs, abdominal pain, IgA nephropathy?
Henoch-Schonlein purpura
Which glomerular disease has EM: spiking of the GBM due to electron dense subepithelial deposits?
membranous glomerulonephritis
Which genetic syndrome is caused by absence of HGPRTase?
Lesch Nyhan
Which genetic syndrome is caused by deficiency of aldolase B?
fructose intolerance
Which genetic syndrome is caused by deficiency of cystathione synthase?
homocystinuria
Which genetic syndrome is caused by galactose-1-phosphate uridyl transferase deficiency -> intellectual disability, hepatosplenomegaly, cataracts?
galactosemia
Which genetic syndrome is caused by deficiency of tyrosinase?
albinism
What medication inhibits alcohol dehydrogenase? What about acetaldehyde dehydrogenase?
alcohol dehydrogenase is inhibited by fomepizole
Acetaldehyde is inhibited by disulfiram
What is the rate-limiting enzyme of beta oxidation of fatty acids?
carnitine acyltransferase 1
Which cofactors are required for the function of pyruvate dehydrogenase? Which other enzyme requires the same cofactors?
TLC For Noone TPP Lipoic acid CoA FAD NAD
alpha-ketoglutarate dehydrogenase requires the same cofactors
What disorder is associated with hypertension, hypokalemia, and metabolic alkalosis?
Conn Syndrome/hyperaldosteronism
What disorder is associated with fever and night sweats and weight loss?
lymphoma or TB
What disorder is associated with adrenal hemorrhage due to meningococcemia?
Waterhouse-Friedrichson Syndrome
What disorder is associated with blue sclerae?
osteogenesis imperfecta
What disorder is associated with hyperplasia, hypersexuality, hyperoralitiy, and hyper docility?
bilateral amygdala lesions -> Kluver-Bucy Syndrome
What disorder is associated with nystagmus, intention tremor, and scanning speech?
Charcot triad of MS
What disorder is associated with lower extremity purpura, arthralgias, and renal disease?
Henoch-Scholein purpura
