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Step 2 CK: UWorld Questions > GI U WORLD Questions > Flashcards

GI U WORLD Questions Flashcards

1
Q

infant with constipation and abdominal distention, narrow rectum and rectosigmoid area, rest of colon is significantly dilated =

the __________ and myenteric (auerbach) autonomic plexi are absent in the affected segments. The submucosa of the narrowed area is the most superficial layer where the ____________ can be seen

A

Hirshsprung

submucosal (Meissner)

absence of ganglion

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2
Q

physicians should routinely ask their patients about the use of ______ and advise them on quality, safety, and efficacy of these products

A

supplements

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3
Q

collateral circulation from the _____________ is responsible for preventing ischemia of the descending colon during inferior mesenteric artery ligation during open aneurysm repair

A

superior mesenteric artery

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4
Q

in the absence of normal intestinal microbial flora (after Abx) ________ can overgrow and produce enterotoxin (toxin A) and cytotoxin (toxin ___). Clinical course can range from transient diarrhea to severe pseudomembranous colitis

A

C difficile

B

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5
Q

transplant recipient presents with odynophagia (pain with swallowing), dysphagia, fever, burning chest pain, linear and shallow ulcerations in lower esophagus, biopsy shows enlarged cells with intranuclear inclusion bodies =

A

CMV esophagitis

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6
Q

_______ is a chemokine produced by macrophages that induces chemotaxis and phagocytosis in neutrophils, along with n formylated peptides, LTB4, 5-HETE, and C5a

A

IL8

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7
Q

treatment of chronic hep C involves the use of INFa and __________, which interferes with the duplication of viral genetic material

A

ribavirin

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8
Q

__________ is the first event in pathogenesis of acute appendicitis. Right lower quadrant pain, nausea, vomiting, diarrhea, and fever are the typical manifestations of this

A

obstruction of the lumen of the appendix

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9
Q

________ is an autosomal dominant disease caused by abnormal nucleotide mismatch repair. The mismatch repair system involves MSH1 and 2 genes, which code for MutL and MutS. This syndrome is also called ___________ and present with family history of early onset colonic adenocarcinoma

A

Lynch syndrome

hereditary nonpolyposis colon cancer

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10
Q

C diff toxins A and B exert their effects by disrupting the _______ and intracellular signaling

A

actin cytoskeletal structure

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11
Q

amatoxins are found in a variety of poison mushrooms and are responsible for the majority of mushroom poisoning fatalities worldwide. The toxins bind to DNA dependent RNA polymerase type II and halt ___________. Symptoms include abdominal pain, vomiting, severe cholera like diarrhea, acute hepatic and renal failure. Urine test for alpha amantin can confirm

A

mRNA synthesis

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12
Q

MVA, rigid abdomen, left shoulder pain, bruise on left lower chest wall, hypotensions, tachycardia = ______ with hemoperitoneum. Shoulder pain is referred pain called ____ sign

A

splenic laceration

Kehr

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13
Q

fibrate medications (fenofibrate, gemfibrozil) inhibit _________, which catalyzes the rate limiting step in the synthesis of bile acids. The reduced bile acid production results in decreased cholesterol solubility in bile and favors the formation of cholesterol gallstones

A

cholesterol-7a-hydroxylase

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14
Q

flushing, watery diarrhea, bronchospasm, elevated 5HIAA =

treat with ______ which is a synthetic somatostatin analog

A

carcinoid syndrome

ocetreotide

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15
Q

depression, consumes 2 bottles of insectacide, nausea, vomit, abdominal pain, copious watery diarrhea, hypotension, tachycardia, faint garlic odor to breath, OTc prolong =

treat with

other source of toxin

A

Arsenic poisoning

Dimercaprol

contaminated water

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16
Q

grossly bloody diarrhea 2 days after BBQ, mother had similar symptoms, Ecoli positive, toxin responsible is most similar to the toxin produced by

inhibit the _____ in human cells, blocking protein synthesis

A

Shigella dysenteriae

60S

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17
Q

Celiac disease or gluten sensitive enteropathy is caused by an immune mediated reaction to ______ and can present with bloating, diarrhea, flatulence, as well as short stature and weight loss. Screening tests show elevated ______ against tissue transglutaminase. _____ biopsy is confirmatory, showing villus flattening and intraepithelial lymphocyte infiltrateion

A

gliadin in gluten

IgA

duodenal

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18
Q

immigrant from south asia, intermittent abdominal cramps, multiple respiratory infections over the last 2 years, persistent chronic cough, linear streaks on the thighs and buttocks =

begins following _____ penetration

diagnosed by finding _________

treat with ______

can result in hyperinfection syndrome

A

strongyloides stercoralis

skin

rhabditiform larvae in stool

ivermectin

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19
Q

chronic HepC infection, episodes of bright red vomiting, treated, next morning on rounds patient is disoriented and cannot ID month or current location. Abdominal distention, gynecomastia, repetitive flicking motions of the hands are seen =

frequently precipitated by a stressor that alters ______ like GI bleeding, or inc dietary protein

A

hepatic encephalopathy

ammonia balance

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20
Q

the omphalomesenteric (______) duct normally obliterates during the 7th week of embryologic development. Both enterocysts and Meckel diverticula result from a failure of obliteration of this duct. Cyst is connected by a fibrous band to the ileum and the umbilicus

A

Vitelline

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21
Q

the third part of the duodenum courses horizontally across the ______ and ______ at the level of L3. The superior mesenteric vessels lie _____ to the duodenum at this point

A

abdominal aorta

IVC

anterior

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22
Q

compression of the splenic artery would most likely affect the ____ artery

A

short gastric

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23
Q

diminished relaxation of _________ muscles during swallowing results in increased intraluminal pressure in the oropharynx, which may eventually cause a _______ diverticulum. This presents in elderly patients with oropharyngeal dysphagia, halitosis, regurgitation, and recurrent aspiration

A

cricopharyngeal

Zenker

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24
Q

sharp pain with bright red rectal bleeding on defecation =

most occur at the ______

A

anal fissure

posterior midline

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25
Q

___________ is the hormone responsible for gallbladder contraction. Made in I cells the duodenum and jejunum in response to fatty acids and amino acids.

Forty, fat, female, biliary colic right subcostal pain

A

Cholecystokinin (CCK)

cholecystitis

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26
Q

99m Tc pretechnetate localizes ectopic gastric mucosa, and its increased uptake is diagnostic for ________

A

Meckel diverticulum

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27
Q

________ is caused by AI destruction of pareietal cells (chronic atrophic gastritis). Parietal cells secrete HCl and intrinsic factor and are found primarily in the ___________ region

A

Pernicious anemia (B12 deficient)

superficial gastric glandular

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28
Q

1 week post op, nausea, fever, fatigue, anorexia, hepatocellular pattern of liver injury, shrunken on autopsy is typical of ______ due to inhaled anesthetic

lab values include elevated serum aminotransferase levels and prolonged ________

A

drug induced liver injury

prothrombin time

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29
Q

physiologic iron loss through menstruation and pregnancy slows the progression of _________ in women.

Disorder presents after age 40 in men, later in women, which skin pigmentation, hepatomegaly, impaired glucose homeostasis, cardiac dysfunction, atypical arthritis, hypogonadism. Hepatocytes stain with Prussian Blue

A

hemochromatosis

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30
Q

Acute cholecystitis is caused by gallstone obstruction of the cystic ducts. US is preferred imaging test, but if not, radionucleotide screen can be used. The gallbladder ___________ due to the obstruction on this test as it will not take up radiotracer

A

will not be visualized

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31
Q

_________ is the most common benign tumor of the liver. Consist of cavernous, blood filled vascular spaces of variable size lined by a single epithelial layer. Biopsy not advisable due to potential hemorrhage

A

cavernous hemangioma

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32
Q

critically ill patient (burn, sepsis, trauma), abdominal pain and fever, RUQ pain, leukocytosis, + Murphy, no gallstones =

due to gallbladder stasis and _____

A

acute acalculous cholecystitis

ischemia

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33
Q

Duodenal S cells secrete ______ in response to increasing H+ concentrations. This increases HCO3 secretion. The chloride content of pancreatic secretions decreases in proportion to bicarbonate concentration increases

A

secretin

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34
Q

infant with poor feeding, emesis, lethargy, tachycardic/pneic, dehydrated, distended abdomen, green vomit, fibrous bands seen extending from cecum and right colon to retroperitoneum, compressing duodenum =

due to failed midgut counterclockwise rotation around the _____ and can result in midgut volvulus (intestinal ischemia due to twisting around a blood vessel)

A

intestinal malrotation

SMA

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35
Q

infant, nonbilious vomit after every meal, prominent peristalsis, olive sized mass is felt on deep palpation =

mass is most likely

A

congential pyloric stenosis

smooth muscle hypertrophy

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36
Q

extensive atrophy of basal ganglia, increased brain copper content =

main mechanism of excess copper removal in the healthy human body is

A

Wilson’s

hepatic excretion into bile

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37
Q

generalized weakness and lethargy for the past 5 years, joint pains, brother died of liver cirrhosis. Serum ferritin = 1800ug/L =

if hereditary, the defect most likely affects ______ gene resulting in excessive ___________

A

hereditary hemochromatosis

HFE

intestinal iron absorption

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38
Q

recently began well varied whole food diet, 3-5 loose non bloody bowel movements per day with occasional vomiting, weight loss, 6-24months old =

duodenal biopsy reveals ________ and intraepithelial lymphocyte infiltration. Treatment with ______free diet resolves

A

Celiac disease

villous atrophy

gluten

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39
Q

_______ are pancreatic islet cell tumors that hypersecrete _______ which increases intestinal chloride loss into the stool and causes excess losses of water, sodium, and potassium. It also inhibits gastric acid secretion. Somatostatin inhibits the secretion of this and is used to treat

A

VIPomas

VIP

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40
Q

Riboflavin is a precursor of the coenzymes FMN and FAD. FAD participates in the TCA cycle and ETC by acting as an electron acceptor for _______ which converts succinate into fumarate

A

succinate dehydrogenase

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41
Q

organ that is supplied by an artery of the foregut, but is not a foregut derivative organ

A

spleen

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42
Q

_______ are composed of islands or sheets of uniform cells with eosinophilic cytoplasm and oval to round stippled nuclei. Derived from neuroendocrine cells in the GI tract and are common in the appendix

A

Carcinoid tumors

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43
Q

development of cataracts in a young girl is due to lenticular accumulation of _______ in the lenses; patient has galactosemia. Cataracts may be the only manifestation of _______ deficiency

A

galactitol

galactokinase

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44
Q

_______ is expressed on the surface of APCs while _______ is expressed on all cells

A

MHC Class II

MHC Class I

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45
Q

treatments for hepatic encephalopathy include ______ which increases conversion of ammonia to ammonium, and rifaximin, which ________________

A

lactulose

decreass intraluminal ammonia production

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46
Q

PPIs such as _________ block the final common pathway of gastric acid secretion from ________, which is stimulated by ACh, Histamine, and gastrin

A

omprazole

parietal cells

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47
Q

C diff infection, placed on an oral macrocyclic Abx that inhibits the sigma subunit of RNA polymerase

A

Fidaxomicin

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48
Q

external hemorrhoids, which originate _____ the dentate line, are covered by modified squamous epithelium and have cutaenous nervous innervation from the inferior rectal nerve, a branch of the _______

A

below

pudendal

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49
Q

indirect inguinal hernias are located _______ to the inferior epigastric vessels and protrude into the scrotum

direct inguinal hernias are located ______ to the inferior epigastric vessels and do not protrude into the scrotum

A

laterally

medially

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50
Q

Vibrio cholerae and ETEC cause a purely toxin mediated watery diarrhea; stool microscopy demonstrates only ________________

A

mucus and some sloughed epithelial cells

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51
Q

the pressure in the ________ is elevated in liver cirrhosis. This vein is medial or just within the right lobe of the liver and anterior to the IVC

A

portal vein

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52
Q

pain with swallowing (odynophagia) in teh setting of chronic dyspepsia and reflux can indicates progression to ____________ and ulceration

A

erosive esophagitis

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53
Q

_______ is a benign disorder characterized by defective hepatic excretion of bilirubin glucuronides across the canalicular membrane, resulting in direct hyperbilirubinemia and jaundice. Grossly, the liver appears black due to impair excretion of Epe metabolites, which histologically appear as dense pigments within lysosomes

A

Dubin Johnson

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54
Q

__________________ results from failure of the primitive foregut to appropriately divide into separate trachea and esophageal structures. Infants present shortly after birth with excessive secretions and choking/cyanosis during feeds. Inability to pass NG tube into stomach

A

Tracheoesophageal fistula with esophageal atresia

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55
Q

Crohn disease is associated with oxalate kidney stones as impaired bile acid absorption in the terminal ileum leads to loss of bile acids in feces with subsequent fat malabsorption and reduced __________ and enteric oxaluria

A

intestinal calcium oxalate binding

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56
Q

patient presents over the course of years with bouts of crampy abdominal pain, diarrhea, fatigue, weight loss, fever, + fecal occult blood =

_______ inflammation can cause fistulas and abscesses along with other perianal diseases and skin tags/fissures

A

Crohn disease

transmural

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57
Q

the size of adenomatous polyps determines their malignant potential. Adenomas <1cm are unlikley to undergo malignant transformation, whereas those >4cm are likely to progress to adenocarcinoma. ____________ facilitates the growth of adenomas by causing uncontrolled cell proliferation

A

KRAS protooncogene mutation

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58
Q

first two months of life, healthy at first, present with jaundice, dark urine, acholic (pale or clay colored stools) elevated direct bilirubin =

due to

A

biliary atresia

extrahepatic obstruction of bile ducts

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59
Q

chronic diarrhea, failure to thrive, low blood T lymphocyte count, severely decreased serum Ig =

___________ is the second most common cause of this after X-linked, as adenosine accumulation is toxic to B and T cells

A

SCID

adenosine deaminase

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60
Q

diarrhea, flatulence, foul smelling stools, abdominal cramping after hiking trip, ellipsoidal cysts on stool smear with iodine staining =

treat with

A

Giardia lamblia

metronidazole

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61
Q

dietary fructose is phosphorylated in the liver to F1P and is _______ metabolized because it bypasses PFK-1, the major rate limiting enzyme of glycolysis. Other sugars are metabolized more slowly (glucose, galactose, mannose)

A

rapidly

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62
Q

the cephalic and gastric phases ________ gastric acid secretion, while intestinal influences ________ gastric acid secretion

A

stimulate

reduce

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63
Q

hemorrhoids result from distension of arteriovenous plexuses. The venous component of internal hemorrhoids (above the dentate line) drain into the middle and superior rectal veins, which communicate with the internal iliac and _________ veins respectively. External hemorrhoids (below the dentate line) drain via the inferior rectal vein into the internal pudendal vein, which communicates with the ___________ veins

A

inferior mesenteric

internal iliac

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64
Q

signet ring cells on upper endoscopy, unintentional weight loss, epigastric discomfort after meals, father had PUD =

due to loss of _______, they present with diffuse involvement of stomach wall causing a leather bottle stomach (linitis plastica). The intestinal form of this neoplasm forms a solid mass that projects into the stomach lumen and is composed of glandular forming cuboidal or columnar cells

A

signet gastric adenocarcinoma

E cadherin

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65
Q

the __________ bud forms the body tail, and most of the head of the pancreas. The _________ bud is a precursor of the uncinate process, inferior/posterior portion of head, and major pancreatic duct. Failure of the dorsal and ventral buds to fuse leads to pancrease divisum, with the accessory pancreatic duct draining the majority of pancreas and may dispose to the development of recurrent pancreatitis

A

dorsal

ventral

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66
Q

the urease breath test is used to nonivasively detect H pylori infection. The patient consumes 13labeled _____ and his/her breath is then monitored for the presence of 13C labeled carbond dioxide, which would indicate the presence of H pylori product urease in the stomach

A

urea

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67
Q

polyethylene glycol is an ________ laxative. Diarrhea associated with _________ is also osmotic and occurs due to accumulation of nonabsorbable lactose in the intestinal lumen.

A

osmotic

lactase deficiency

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68
Q

ulceration in the posterior wall of the duodenal bulb would most likely penetrate which artery

A

gastroduodenal

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69
Q

4 cals per gram of _____ and _____

9 cals per gram of _____

7 cals per gram of ______

A

protein, carbohydrates

fats

ethanol

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70
Q

flatulence, crampy abdominal pain, watery diarrhea after dairy consumption =

studies show increased breath hydrogen content, ________, and elevated stool osmolality

A

lactose intolerance

reduced stool pH

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71
Q

older women, persistent profuse mucoid diarrhea despite not eating much, hypokalemia and microcytic anemia, colonoscopy reveals a 2.5 cm cauliflower like mass in the sigmoid colon, most likely =

most likely to undergo ______ transformation

________ tend to be more papillary and less dangerous

A

villous adenoma

malignant

tubular

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72
Q

low grade fever, anorexia, nausea, dark colored urine, RUQ pain after a trip to Mexico is suggestive of ________, where ______ is most likely responsible. This causes hepatocyte ballooning and degeneration and apoptosis with mononuclear cell infiltration

A

acute viral hepatitis

HAV

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73
Q

mid 30s males, easy bruising, fatigue, poor apeptite, dulll pain and stiffness in lower back and joints at night, history of Crohn disease with partial bowel resection (terminal ileum), treated with Abx 3 months ago fro perianal fistula, mother died of colon cancer, large ecchymoses on lower extremities =

A

bile acid malformation leading to impaired vitamin a,d,e,K absorption

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74
Q

iron absorption occurs primarily in the __________. By pass of this segment of small bowel by gastrojejunostomy due to PUD results in iron deficiency anemia. Malabsorption of Vitamin B12, folate, fat soluble vitamins and calcium may also be observed

A

duodenum and proximal jejunum

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75
Q

32 year old consumes large amount of alcohol recently, abdominal discomfort and anorexia with TG accumulation within the hepatocellular cytoplasm is most likely _________ related primarily to a decrease in _________ secondary to excess NADH production by alcohol dehydrogenase and aldehyde dehydrogenase

A

alcohol induced hepatic steatosis

free fatty acid oxidation

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76
Q

lactose intolerance is due to decreased or absent

A

lactase

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77
Q

one month onld caucasian male with history of persistent jaundice experiences muscle rigidity, lethargy, and seizures; which hyperbilirubinemia cause is the most likely to produce these neurologic abnormalities

deposition of unconjugated bilirubin in the brain is called

A

Absent liver conjugation enzyme (UGT) (Crigler-Najjar)

kernicterus

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78
Q

upper GI tear caused by forcefull vomiting, submucosal arterial or venous plexus bleeding, vomiting and retching, hematemesis, epigastric pain =

esophageal transmural tear caused by forceful vomiting, esophageal air/fluid leakage in mediastinum and pleura, fever, dyspnea, septic shock, rapid onset

A

mallory weiss tear

Boerhave syndrome

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79
Q

a number of ____ tissues are found in Meckel Diverticulum, most commonly gastric epithelium. Pancreatic acini can be present too. Often presents with painless melena

A

ectopic

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80
Q

tubulovillous adenomatous polyp during colonoscopy, first mutation to occur is ______, followed then by KRAS, DCC, and p53 in the adenoma to carcinoma sequence

A

APC

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81
Q

the ______ is regulated by two distinct mechanisms, negatively by binding of the repressor protein to the operator locus and positively by cAMP-CAP binding upstream from the promoter region. Constitutive expression of the structural genes of the _____ occurs with mutations that impair the binding of the repressor protein (Lac I) to its regulatory sequence in the operator region

A

lac operon

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82
Q

immigrant to the US with + HAV IgG titer suggest

A

anicteric (subclinical) viral infection as a toddler

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83
Q

vomiting due to nausea during self limited travel illness, use ________ to treat the visceral nausea. Use ________ and anticholinergics for vestibular nausea. Dipamine antagonists are used for migraine associated nausea

A

5 HT3 receptor antagonists

antihistamines

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84
Q

administration of mu-opioid analgesics can cause contraction of ________ in the sphincter of Oddi leading to new onset abdominal pain shortly after adminstration

A

smooth muscle cells

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85
Q

simvastatin _______ cholesterol synthesis in the liver, while bile acid binding resins such as cholestyramine ________ hepatic cholesterol and bile acid synthesis

A

decreases

increases

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86
Q

__________ is the most common cause of acute gastroenteritis in children and adults in the industrialized countries; fecal oral route, pet puppy had diarrhea one week ago

A

Campylobacter jejuni

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87
Q

fever, abdominal pain, vomiting, RLQ pain with rebound and palpable mass, pelvic CT shouws periappendiceal fluid collection =

the intraabdominal fluid would most likely contain ______ and E coli

A

perforated appendicitis

Bacteroides fragilis

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88
Q

depending on the age and condition of the host and species of _____, as few as 10-500 cells can cause infection

presents with pain, watery diarrhea

A

Shigella

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89
Q

_______ is the result of abnormal migration of neural crest cells during embryogenesis. These cells are the precursors of ganglion cells of intestinal wall plexi. Since neural crest cells migrate caudally, the _____ is always affected

A

Hirschsprung disease

rectum

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90
Q

in order to encircle the stomach, an adjustable gastric band must pass through the ________

A

lesser omentum

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91
Q

man with nocturnal cough, esophageal biopsy shows elongation of lamina propria papillae with several eosinophils and neutrophils scattered, started on pantoprazole and symptoms resolve =

cause of disease is

if esosinophilic esophagitis,

A

GERD

gastroesophageal junction incompetence

symptoms would not have improved

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92
Q

femoral hernias are inferior to the inguinal ligament, lateral to the pubic tubercle, and _______ to the femoral vein

A

medial

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93
Q

the esophagus is located between the trachea and the _______ in the superior thorax CT view. IT is typically collapsed with no visible lumen

A

vertebral bodies

94
Q

classic ______ results from deficiency of galactose 1 phosphate uridyl transferase. Clincial features include vomiting, lethargy, jaundice, and E coli sepsis in an infant. Cessation of breastfeeding and switching to soy milk based formula is recommended

A

galactosemia

95
Q

abdominal pain, periodic diarrhea, heme positive stools, negative culture, transmural inflammation and noncaseating granulomas on LM, cobblestone appearance, skip lesions, contrast barium shows string sign

A

Crohn’s disease

96
Q

increase AST ALT are indicators of hepatocellular damage, while increased alkphos and gamma glutaml transpeptidase indicate biliary injury. Serum albumin levels, bilirubin levels, and ______ are reflective of liver function and are of greatest prognostic importance in patients with cirrhosis

A

prothrombin time

97
Q

chronic HepC, large hepatic mass, multiple satellite lesions has___________

serum marker

A

hepatocellular carcinoma

AFP

98
Q

mutation in SPINK1 prevents trypsin from being permanately inactivated by cleavage, patients will suffer from ________ which can also develop in mutations in trypsinogen

A

hereditary pancreatitis

99
Q

serum sickness like syndrome with joint pain, LAD, pruritic urticarial rash, RUQ pain, hepatomegaly, elevated liver enzymes

most important early marker =

marker that correlates with infectivity =

A

acute HepB

HBsAg

HBeAg

100
Q

right sided colon cancers usually grow as exophytic masses that present with occult bleeding and symptoms of iron deficiency anemia, _______ and _______. Left side colon cancers tend to infiltrate the intestinal wall and encircle the lumen, causing constipation and symptoms of intestinal obstruction. Rectosigmoid inolvement often causes hematochezia

A

weight loss, and progressive fatigue

101
Q

recurrent respiratory infections and diarrhea in a child or young adult suggests cystic fibrosis with secondary exocrine pancreatic insufficiency. CF patient presents with neuromuscular disease, hemolytic anemia indicates _________ due to insufficient pancreatic enzymes

A

Vitamin E deficiency

102
Q

Shigella exhibits specificity for the microfold ____ cells at the base of the mucosal villi within a Peyer patch

A

M

103
Q

patients with Zollinger Ellison syndrome develop PUD and parietal cell hyperplasia with gastric fold enlargement due to _____ hypersecretion

A

gastrin

104
Q

the hindgut encompasses the distal 1/3 of the transverse colon, the descending colon, the sigmoid colon, and the rectum. These structures receive their main arterial blood supply from the _____

A

IMA

105
Q

_______ is a hormone produced by the intestinal ____ cells that increases bicarbonate secretion

A

secretin

S cells

106
Q

patient presents with fatigue, generalized itching, no visible rash, hepatomegaly, striking increase in alkphos, moderate increase in bilirubin and hepatic enzymes, dilated bile canaliculi with green/brown plugs and yellow green pigment accumulations in hepatic parenchyma =

greatest risk for

A

cholestatic liver disease

fat soluble vitamin deficiency (require bile salts)

107
Q

pancreatic pseudocysts are a common complication of acute pancreatitis. Its walls consist of _________, and is full of fluid rich in enzymes and inflammatory debris

A

granulation tissue and fibrosis

108
Q

6 yr old boy, confusion, intraceable vomiting, febrile illness two days ago, gave him OTC pills to help his fever =

histological finding of hepatocytes

A

Reye Syndrome (hepatic failure and encephalopathy)

micrvesicular steatosis w/o inflammation and cerebral edema

109
Q

______ and alcoholism are the most common causes of acute pancreatitis. Less common causes include ________

A

Gallstones

hypertriglyceridemia

110
Q

MVA, retroperitoneal hematoma with ecchymosis over area of seatbelt =

A

contusion to body of pancreas

111
Q

the Fc receptor site on IgG is for attachment to _________

A

phagocytic cells

112
Q

older patient who smokes cigars, progressive solid and eventually liquid dysphagia and weight loss, nests of neoplastic squamous cells with areas of keratinization =

A

esophageal squamous cell carcinoma

113
Q

severe night blindness, generalized pruritus, not seen physician in years, skin is coarse and dry =

can be due to prolonged

A

Vitamin A deficiency

biliary obstruction

114
Q

abdominal pain, diarrhea, mild tenderness no rebound, high leukocyte count, white yellow plaques on colonic mucosa composed of fibrin and inflammatory cells =

A

pseudomembranous colitis due to C diff

115
Q

base excision repiar is used to correct single base DNA defects induced by exogenous chemicals (nitrates). ______ remove the defective base, sugar is cleaved by _________ and lyase, _________ replaces the missing nucleotide, the _______ seals teh nick

A

glycosylase

endonuclease

DNA polymerase

ligase

116
Q

intermittent abdominal pain, bloating, Asia, aversion to dairy =

small bowel mucosa would be

A

lactase deficiency

normal

117
Q

total gastrectomy, patient must receive lifelong administeration of _______, a water soluble vitamin

A

B12

118
Q

the spleen is derived from the

A

mesoderm

119
Q

______ is a cytokine that inhibits Th1 cytokines, reduces MHCII expression, and suppresses activation of macrophages and DC, leading to anti-inflammatory properties

A

IL 10

120
Q

HIV patient with red flat maculopapular lesions or hemorrhagic nodules on colonscopy, spindle shaped tumore cells with small vessel proliferation =

A

Kaposi’s sarcoma (HHV8)

121
Q

______________ causes portal HTN, splenomegaly, varicosities at portocaval anastomoses, but does not cause histologic changes to hepatic parenchyma unlike _______ (centrilobar congestion and fibrosis-

A

portal vein thrombosis

Budd Chiari syndrome

122
Q

patient with uncomplicated diarrhea given diphenoxylate =

A

binds mu opiate receptors to slow motility

123
Q

severe shock or sepsis followed by blood in NG tube and sharp decrease in Hb =

ulcers arising in proximal duodenum in association with severe trauma/burns are called =

ulcers in esophagus/stomach/duodenum in patients with intracranial injury are _________ and are prone to performation

A

stress related mucosal disease

Curling’s

Cushing’s

124
Q

patient on TPN after bowel resection develops gallstones due to decreased _______________ from lack of enteral stimulation

A

Cholecystokinin release

125
Q

infant receives honey, poor feeding, weakness, and complete loss of extremity muscle tone =

A

infant botulism: spores; toxin in stools

126
Q

EHEC: shiga-like toxin MOA:

A

inactivates ribosomal subunits

127
Q

the short gastric veins drain blood from the gastric fundus into the ______. Pancreatic inflammation can cause a blood clot within the ________, which can increase pressure in the short gastric veins and lead to gastric varices

A

splenic vein

splenic vein

128
Q

______ cholesterol, _______ bile salts, and ______ phosphatidylcholine all increase the likelihood of gallstone formation

A

increased

decreased

decreased

129
Q

21 yo male presents with mild jaundice after a hiking trip, similar episodes when fasting, rest of exam unremarkable except for mild unconjugated hyperbilirubinemia

production of __________ is reduced

A

Gilbert syndrome

UDP glucuronyl transferases

130
Q

the HBsAg of HepB must coat the HepD antigen of hepatitis D before it can ________

A

infect hepatocytes

131
Q

nonsurgical therapy to dissolve cholesterol gallstones -

A

hydrophilic bile acids supplementation

132
Q

pancreatectomy to remove exocrine pancreas, what will be normal after:

A

monosaccharide absorption

133
Q

two year history of abdominal discomfort, greasy stool, weight loss, treated for joint pain, intestinal biopsy shows macrophages laden with PAS + granules in the lamina propria =

treated with

A

Whipple disease: Tropheryma whippelii

Abx

134
Q

infant with large reducible midline abdominal protrusion covered by skin that is more pronounced when he crie near umbilicus =

common in =

due to =

if a midline abdominal herniation covered with thin membranous sac =

full thickness abdominal wall defect =

both due to =

A

umbilical hernia

Down syndrome

defect at linea alba covered by skin or incomplete closure of umbilical ring

Omphalocele

gastroschisis

failure of extraembryonic gut to return to abdominal cavity

135
Q

acute pancreatitis is likely related to _______ if AST:ALT ratio >2 and there is an absence of gallstones

_____ is also seen due to folate deficiency

A

alcohol abuse

macrocytosis (MCV >100)

136
Q

gastrin levels that elevate in response to exogenous secretin + duodenal ulcer =

A

Zollinger Ellsion gastrinoma

137
Q

Colonic diverticula often develop due to _______ or increased intraluminal pressure created during straining. May cause hematochezia or diverticulitis

A

pulsion

138
Q

vague abdominal pain, low grade fever, diarrhea, skin lesion over abdomen, fever, midly distended and tender, bowel contents draining to the surface of the skin =

Crohn disease typically spares the_______ while it is always involved in UC (continuous lesions). ________ as seen in this case are not present in UC

A

Crohn, fistula

rectum

Fistulas

139
Q

______ levels are increased in colon cancer and is helpful in detecting residual disease and recurrence

A

CEA

140
Q

occlusion of the portal triad (pringle maneuver) is a surgical technique used to distinguish the source of RUQ bleeding. If hepatic bleeding persists after occlusion, the _____ or hepatic veins are likely injured

A

IVC

141
Q

Parietal cells released H+ ions into the gasgric lumen by means of the H/K ATPase, which is an _______ transport mechanism inhibited by PPIs like omeprazole

A

active

142
Q

mid 40s presents with liver disease and COPD with history of jaundice =

can result in _______ emphysema and is an autosomal codominant disorder

A

Alpha 1 antitrypisin deficiency

panacinar

143
Q

_________ ulcers are not associated with an increased risk of carcinoma in the same location, while esophageal, gastric, and colorectal cancers are frequently ID’d as ulcerative lesions

A

duodenal

144
Q

dry cough at night present for several years, obese =

can result in ______ esophagus, which puts the patient at risk for developing ________

A

GERD

Barrett

adenocarcinoma

145
Q

CF causes steatorrhea and failure to thrive due to malabsorption secondary to pancreatic insufficiency, which can be corrected by _______ supplementation

A

pancreatic enzyme

146
Q

_____ is a protein hormone produced by adipocytes in proportion to the quantity of fat stored and acts on the arcuate nucleus of the hypothalamus to inhibit the production of NPY to decrease appetite and stimulate alpha -MSH to increase satiety. Mutations in this protein or receptor result in hyperphagia and profound obesity

A

Leptin

147
Q

the _________ provides oxygenated blood to the spleen, stomach, liver, abdominal esophagus, and parts of the duodenum and pancreas. The proper hepatic artery is a distal branch of this and supplies arterial blood to the liver

A

Celiac trunk

148
Q

family history of infants/children dying from disseminated mycobacterial disease is due to inherited defects in ________

A

IFNy signaling

149
Q

lymphatic drainage of the rectum proximal to the anal dentate line occurs via the inferior mesenteric and _______ lymph nodes. Distal to the dentate line drain to the ________

A

internal iliac

inguinal

150
Q

abdominal pain, chalky white lesions that reveal fat destruction and calcium depostion =

A

acute pancreatitis

151
Q

_________ most often ocurs in children younger than 2 years of age and in the region of the ileocecal valve. It manifests with intermittent, severe, colicky abdominal pain, currant jelly stools, and palpable mass in the RLQ

A

intusssception

152
Q

father died of colon cancer, sister developed endometrial cancer all at a young age =

A

Lynch syndrome: MSH2,1,6

153
Q

_______ associated carincoma is more likely to affect younger patients, progress from flat and non polypoid dysplasia, histologically appear mucinous or have signet ring morphology, develop early p53 mutations and late APC gene mutations (________ of spordadic disease), be distrubed within the proximal colon (especially Crohns or concurrent primary sclerosing cholangitis), and to be multifocal in nature

A

colitis

opposite

154
Q

_______ should be supplmented in infants who are exclusively breast fed, have a lack of sun exposure, and have dark skin pigmentation

A

Vitamin D

155
Q

Annular pancreas is caused by the failure of the ____________ pancreatic bud to properly migrate and fuse with the ________ bud during week 7 and 8 of gestation. Usually asymptomatic but can present with duodenal obstruction or pancreatitis

A

ventral

dorsal

156
Q

gene responsible for the transformation from advanced adenoma to adenocarcinoma

A

TP53

157
Q

_______________ antral gastritis is associated with the formation of duodenal ulcers due to increased gastric acidity, secondary to the destruction of _________ secreting cells

A

H pylori

somatostatin

158
Q

Ras is active when _______ is bound and inactive when _________ is bound

A

GTP

GDP

159
Q

the splenic flexure and the ______________ lie between regions of perfusion of major arteries. These watershed areas are susceptible to ischemic damage during hypotensive states, especially in patients with underlying arterial insufficiency

A

rectosigmoid junction

160
Q

motion sickness treat with scopolamine, diphenhydramine, common side effects with these are blurry vision, ________, urinary retention, and constipation

A

dry mouth

161
Q

fevers, chills, RUQ pain and the presence of a fluid filled cavity in the liver is suggestive of ________. The underdeveloped countries, hepatic abscesses have a relatively high incidence and are usually caused by parasitic infections, while in develop countries are usually caused by bacterial infection. The most likely bugs and routes of access are:

entertic gram negatives and ascending cholangitis

portal vein pyremia from bowel or peritoneal sources

___________________________

direct invasion from adjacent source or penetrating trauma

A

S aureus from hematogenous seeding of the liver

162
Q

appendicitis causes dull visceral pain at the umbilicus, while progressive inflammation in the appendix irritates the pareital peritoneum. The somatic pain will shift from the umbilicus to ___________

A

McBurney point

163
Q

the live attenuated oral poliovirus produces a stronger mucosal ____________ than does inactivated poliovirus vaccine

A

secretory IgA immune response

164
Q

patient with firm, palpable gallbladder and extensive calcification throughout the gallbladder wall has typical findings of _________, which is associated risk with __________ of the gallbladder

A

porcelain gallbladder

adenocarcinoma

165
Q

the appendix can be located by following the _______ to their origin at the cecal base

A

teniae coli

166
Q

patient with Vitamin B12 in the setting of prexisting autoimmune disease (T1DM, Hashimotos) is suggestive of ________, which presents with elevated luminal pH, elevated gastrin, and loss of parietal cell mass

A

pernicious anemia

167
Q

narrowing of the aortomesenteric angle can occur with any condition that causes ____________ including low body weight or weight loss, which can obstruct the __________

A

diminished mesenteric fat

transverse portion of the duodenum

168
Q

a patient with Crohn disease most likely developed gallstone due to inflammation of the terminal ileum causing ___________

A

decreased bile acid reabsorption

169
Q

pancreatic zymogens are normally converted into their active form by trypsin in the duodenal lumen. Premature cleavage of _________ to trypsin within the pancreas leads to uncontrolled activation of these zymogens, causing pancreatic autodigestion and acute pancreatitis

A

trypsinogen

170
Q

the HBV replicates via the following the sequence: dsDNA to _________ to dsDNA progeny. ALthough it is a DNA virus, HBV replicates via reverse transcription

A

RNA template

171
Q

hard mass obstructing the ileocecal valve with cholesterol content of 85% =

radiographic finding

A

gallstone ileus

air in the biliary tree

172
Q

______________ is one of the most common GI emergencies affecting newborns. It is characterized by bacterial invasion and ischemic necrosis of the bowel wall, and is associated with prematurity and initiation of enteral feeding. Abdominal X-ray sowing _____________ or air in the bowel wall confirms the diagnosis

A

Necrotizing enterocolitis

pneumatosis intestinalis

173
Q

bacterial mRNA can be polycistronic, meaning that one mRNA codes for ________, example being the lac operon

A

several proteins

174
Q

H pylori found in the greatest concentration in the _______ of the gastric antrum

A

prepyloric area

175
Q

the gallbladder functions to absorb water from bile. Gallbladder hypomotility (cholecystokinin stimulation test shows slow and incomplete gallbladder emptying) causes the bile to become concentrated, which forms __________ that can cause transient bile obstruction and gallstone formation

A

biliary sludge

176
Q

familial hypercholesterolemia is one of the most common AD disorders and causes _______ underexpression of functional LDL receptors and can lead to accelerated atherosclerosis and early onset CAD

A

hepatocyte

177
Q

direct hernias are medial to the inferior epigastric vessels, protrude only through the only external inguinal ring, are covered by the external spermatic fascia, and are caused by weakness of the

A

transversalis fascia

178
Q

the most common GI disorder in patients with CF is

A

pancreatic insufficiency

179
Q

____________ refers to the fraction of administered drug that reaches the systemic circulation in a chemically unchanged form. It can be determined by examining a graph of plasma concentration versus time and then applying the formula
F= AUC oralxdoseIV/AUC IVxdoseoral

A

bioavailability

180
Q

large hepatocytes filled with finely granular homogenous pale pink cytoplasm in a patient with fatigue and weight loss and history of IV drug us

A

HepB

181
Q

ulcers are defined as erosions if they extend into, but not completely through, the __________

A

muscularis mucosa

182
Q

liver biopsy shows extensive lymphocyte infiltration and granulomatous destruction of interlobular bile ducts =

case would be a 45 yo women with long history of pruritis and fatigue who has pale stools and xanthelasma

A

primary biliary cirrhosis

183
Q

studies have linked increased ______ to some forms of colon adenocarcinoma and suggest that regular aspirin use decreases adenomatous polyp formation

A

COX2

184
Q

erythematous distended gallbladder with patchy necrosis, severe RUQ tenderness, similar pain with fatty meals, fever =

initiated by gall bladder

A

acute calculous cholecystitis

outflow obstruction (cystic duct)

185
Q

fever, jaundice, and anorexia in an IV drug user suggests ________. Liver biopsy reveals mononuclear cell infiltrates, hepatocyte swelling and acidophilic bodies. Formation of acidophilic bodies is the result of

A

acute viral hepatitis

apoptosis

186
Q

_______is characterized by diffuse hepatic fibrosis with replacement of the normal lobular architecture by fibrous lined parenchyma nodules

A

Cirrhosis

187
Q

the main modes of _______ transmission include sexual, IV drug use, needlestick accidents, and blood transfusions. The risk of sexual transmission of _____ is low.

A

HepB

HepC

188
Q

PAS stain can highlight ____________ in a bright magenta color. The glycoprotein in the cell walls of actinomycete Tropheryma whippelii colors with PAS and is diastase resistant, making this stain an excellent choice in evaluating tissue for Whipple disease

A

polysaccharides of fungal cell walls

189
Q

a palpable but nontender gallbladder (+ Courvoisier), weight loss, obstructive jaundice (dark urine pale stools) are indicative of adenocarcinoma at the head of the pancreas compressing the bile duct. ______ is the most important environmental risk factor for pancreatic cancer, it doubles the risk

A

smoking

190
Q

the most common malignant lesion in the liver is a ____________,not HCC

A

metastasis from another site

191
Q

bilious emesis ina neonate is a sign of intestinal obstruction below the second part of the duodenum and may be a result of volvulus, intestinal stenosis, or atresia. Intestinal atresia distal to the duodenum occur due to _______________ in utero, and result in blind ending proximal jejunum, a length of absent bowel and mesentery, and finally a terminal ileum spiraled around an ilieocecal valve

A

vascular occlusion

192
Q

_______ is caused by reduced numbers of inhibitory ganglion cells in the esophageal wall. Manometry shows decreased amplitude of peristalsis in the mid esophagus, with increased tone and incomplete relaxation at the lower esophageal sphincter

A

Achalasia

193
Q

deep peptic ulcer localized at lesser curvature of stomach, most likely penetrated

A

Right or Left gastric artery

194
Q

Meckel’s diverticulum is a ________ that contains all of the layers of the intestinal wall, while a _______ contains only the the mucosa and submucosa

A

true diverticulum

false diverticula

195
Q

decreased MHC Class I expression, which cell will kill

A

NK cells

196
Q

patient with pain/distension, bloody diarrhea, fever, signs of shock in the setting of noncompliant treatment for ulcerative colitis likely has _______, for which plain abdominal X ray is the preferred diagnositc study. Barium studies and colonoscopy are contraindicated due to the risk of perforation

A

toxic megacolon

197
Q

several intestinal resections, patient has watery diarrhea shortly after eating, easy fatigability, weight loss, vibratory and position sense are decreased in LE, macrocytic anemia and low B12 =

cause of symptoms is loss of intestinal absorptive area and a decrease in intestinal transit time leading to malabsorption. Loss of a functional distal ileum may lead to B12 deficiency

A

short bowel syndrome

198
Q

moldy grains in some region of China cause a specific G-to-T mutation in TP53, leading to an increased risk of _______ due to ________

A

liver cancer

aflatoxins

199
Q

recurrent GI bleeding, advanced liver cirrhosis due to HepC, jerking motion of the arm =

due to increased circulatory levels of ammonia, which crosses the BBB and causes excess ______ to accumulate within astrocytes

A

hepatic encephalopathy

glutamine

200
Q

infectious esophagitis is common in patients with HIV. THe most common cause is ________, althoughlarge, shallow linear ulcerations with intranuclear and cytoplasmic inclusions seen microscopically are indicative of ________ esophagitits

A

Candida albicans

CMV

201
Q

longitudinal mucosal tears at the esophagogastric-squamocolumnar junction describe __________ which occurs due to a rapid increase of IAP such as during retching and vomiting. Commonly associated with alcoholism

A

Mallory Weiss syndrome

202
Q

young female, periodic diarrhea and abdominal pain, aunt had UC, father died of colon cancer; UC would be suggested by _______ mucosal involvement, inflammation in the mucosa and submucosa only, and the rectum is always involved

A

continuous

203
Q

abdominal pain, chronic diarrhea, recent weight loss, worse after eating, consumes alcohol regularly, calcifications in the epigastric region =

diarrhea due to digestive enzyme _______

A

chronic alcoholic pancreatitis

deficiency

204
Q

acquired spider angiomata occur with _________ states and share a mechanism with the development of gynecomastia in alcoholic liver cirrhosis

A

hyperestrogenic

205
Q

intermittent dysphagia or solids and liquids, periodic simultaneous and non peristaltic contractions of large amplitude and long duration =

due to impaired neural

A

diffuse esophageal spasm

inhibition

206
Q

a moderately elevated alkphos of unclear etiology should be followed up with

A

y-glutamyl transpeptidase

207
Q

nonatrophic chronic gastritis (inflammatory cell infiltrate involving the superficial mucosal layers) is most often due to

A

H pylori

208
Q

noncaseating granulomas seen at the terminal ileum =

due to increased activity of _____

A

Crohn

Th1 cells

209
Q

air in the the gallbladder and biliary treat =

gallstone most likely lodged in

large gallstone causes formation of cholecystenteric fistula

A

gallstone ileus

ileum

210
Q

nausea and vomiting 2 hours after consuming potato salad at picnic =

symptoms caused by ______ formed prior to ingestion

A

S aurus

exotoxin

211
Q

scattered telangiectasisa, ulcers on tips of fingers, small calcium deposits in the soft tissues of the hands and elbows, severe heart burn =

heartburn is due to fibrous repalcement of the muscularis in the lower esophagus

A

CREST (calcinosis, raynaud, esophageal dysmotility, sclerodactyly, telangiectasia)

212
Q

the most effective method to prevent peptic ulcer recurrence caused by H pylor is

A

amoxicillin plush clarithromycin

213
Q

wieght loss, anorexia, iron deficiency anemia, pleomorphic cells with large dark nuclei and irregular crowded glands, mutliple mass lesions in liver and lungs =

left sided lesions present with obstructing symptoms (altered bowel habits, constipation, abdominal distention, nausea and vomiting)

A

right sided colon cancer (Ascending colon)

214
Q

fatigue, itching, hepatomegaly, serum alkphos elevated is typical of _______ which shows lymphocytic infilrate with destruction of intrahepatic bile ducts. THis most resembles graft versus host disease

A

Primary Biliary Cholangitis (cirrhosis)

215
Q

abdominal discomfort, loose stools, 22lb weight loss despite normal diet =

best assessment for impaired nutreint absorption is stool microscopy with ______

A

malabsorption

Sudan III stain

216
Q

dark tan, hepatomegaly, cardiac arrhythmias =

A

hemochromatosis

217
Q

lots of ulcers due to a tumor secreting ______ (Zollinger Ellison)

A

gastrin

218
Q

fatigue, rash, flushing, abdominal cramps, itching after hot showers, dizzy, skin biopsy shows large clusters of mast cells that are positive for KIT (CD117) =

can cause gastric _________ of gastric acid

A

systemic mastocytosis (excessive histamine release)

hypersecretion

219
Q

immigrant from Peru, difficulty swallowing, dilated esophagus, absent peristalsis =

can cause similar changes in the sigmoid colon and ureter. Destroys the myenteric plexus

A

Tyrpanosoma cruzi parasite (reduviid bud)

220
Q

infant, mild abdominal distention, muscle wasting, pitting edema, absence of enteropeptidase activty in proximal intestinal villi = impaired activty of

A

trypsin

221
Q

Gastric bypass surgery can cause small intestinal bacterial overgrowth due to excessive bacterial proliferation in the blind ended gastroduodenal segment, which results in deficiency of most vitamins and iron, but increased production of _______ and _______

A

folate, vitamin K

222
Q

older man, postprandial epigastric pain, associated food aversion/weight loss in the setting of atherosclerosis is consistent with ______________ due to diminished blood supply, similar to stable angina

A

chronic mesenteric ischemia

223
Q

Sjogrens, severe pruritus, high alkphos =

A

primary biliary cirrhosis

224
Q

5 month old boy, poor weight gain, bulky and greasy stools, jejunal bipsy shows enterocytes with clear and foamy cytoplasm =

inhertited inability to synthesis apolipoprotein B, an important component of chylomicrons and VLDL. Lipids absorbed by the small intestine cannot be transported into the blood

A

abetalipoproteinemia

225
Q

brown pigment gallstones are composed of calcium salts of unconjugated bilirubin and arise secondary to bacterial or helminthic infection of the biliary tract. ________ released by injured hepatocytes and bacteria hydrolyzes bilirubin glucuronides to unconjugated bilirubin. The liver fluke Clonorchis sinensis has a high prevalence in east Asian countries and is a common cause of pigment stones

A

Beta glucuronidase

226
Q

the two most significant risk factors for the development of esophageal SCC (keratin pearls and nests) are _____________. Betel nut chewing and the consumption of foods containing N-nitroso compounds are important risk factors in Asian countries

A

Alcohol and Tobacco consumption

227
Q

esophageal varices arise from shunting through _____

Hemorrhoids ______

Caput medusa ______

A

left gastric vein

superior rectal vein

paraumbilical veins

228
Q

mutations in ______ have a srong association with Crohn diease, which result in decreased activtiy of NFkB, leading to decreased cytokine production. This allows for luminal bacteria to penetrate submucosal tissues, causing an exaggerated immune response

A

NOD2

229
Q

cobble stone mucsoa, linear ulcerations, skip lesions =

reason for fistula development

A

Crohn

transmural inflammation

230
Q

acute hepatitis A is a self limited infection that typically presents acutely with fever, malaise, anorexia, nausea/vomiting, RUQ pain followed by signs of ___________ (jaundice, pruritus, dark colored urine, clay colored stool)

A

cholestasis

231
Q

________ should be avoided in patients with underlying gallbladder disease

A

Gemfibrozil

Step 2 CK: UWorld Questions (20 decks)

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