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BSIC > GIT - UWORLD > Flashcards

GIT - UWORLD Flashcards

1
Q

8574: What are the branches of the splenic artery?

A

pancreatic
short gastric
left gastroepiploic

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2
Q

8574: What main artery does the splenic artery branch off?

A

Celiac artery

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3
Q

8574: What branch of the splenic artery is vulnerable to ischaemia following splenic artery blockage?

A

short gastric - (supplies superior fundus - greater curvature of stomach) - it has poor anastomoses

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4
Q

8574: What does the left gastroepiploic artery anastamose with?

A

Right gastroepipoloic artery - (supplies inferior border of greater curvature of stomach)

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5
Q

1068: What monosaccharide has the fastest rate of metabolism in the glycolytic pathway? Glucose, Fructose, Galactose?

A

Fructose - it by-passes Phosphofructokinase-1 (PFK-1), a regulatory step of glycolysis

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6
Q

15383: What is the cause of ‘pill oesophagitis?

A

Prolonged contact of ‘high risk’ medication with mucosal lining of proximal oesophagus -
often in restriction areas: aortic arch, carina, gastroesophageal junction, enlargement left atrium
Tx: remain upright after swallowing, drink water

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7
Q

15383: What drugs cause pill oesophagitis?

A

Tetracyclines - doxycycline
Bisphosphonates - alendronate
potassium chloride
NSAIDS
s/s: odynophagia, retrosternal chest pain

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8
Q

80: In hepatobillary scanning for acute cholecystitis, is the gallbladder visualised / not visualised?

A

Not visualised.
Obstruction prevents radiotracer uptake in the gall bladder.
(Tracer preferentially uptaken by hepatocytes) - seen in liver with excretion into common bile duct and proximal small bowel.
Uptake in GB shows tracer concentration (imageC)

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9
Q

80: What is the main cause of acute cholecystitis?

A

gallstone blocking cystic duct
will see: GB inflammation - wall thickening, pericholecystic fluid

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10
Q

11817: What is a sentinel lymph node?

A

The first 1-4 nodes that drain a specific colon segment -
first site for colon cancer metastasis

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11
Q

11817: What sites do the superior, middle and inferior rectal lymph nodes drain into?

A

superior - Inferior mesenteric LN
middle - internal iliac LN
inferior - superior inguinal LN

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12
Q

11817: What structures does the celiac LN drain?

A

hepatic, splenic, gastric LN

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13
Q

11817: What structures does the superficial inguinal LN drain?

A

genitalia (parts), buttocks, anus (below dentate line), abdominal wall (below umbilicus)
superficial inguinal LN - situated below inguinal ligament

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14
Q

11817: What structures does the superior mesenteric LN drain?

A

ileum, jejunum, vermiform process, ascending and transverse colon

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15
Q

328: What are 2 examples of false diverticula?

A

Colonic
Zenkers (upper oesophagus)
(not all 3 layers involved)

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16
Q

21083: In BIND (bilirubin induced neurologic deposition) - where is bilirubin deposited?

A

basal ganglia
brainstem nuclei

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17
Q

21083: What are signs/symptoms of acute and chronic BIND?

A

Acute: subtle, poor feeding, inconsolable, opisthotonus (tone changes), apnoea
Chronic (Kernicterus): upward gaze palsy, dystonia, chorea, sensorineural hearing loss, developmental delay,

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18
Q

1838: What is the main deficiency seen from a prolonged vegan diet?

A

B12 deficiency
water soluble vitamin
obtained purely from diet - meat, dairy, fish
can’t be obtained from plants alone
Total gastrectomy (los of intrinsic factor) - also a cause of B12 deficiency

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19
Q

1838: What is combined degeneration of spinal cord?

A

seen in B12 deficiency
affects lateral and posterior columns, mostly due to demyelination

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20
Q

101: Dublin Johnson syndrome (AR) is caused by defective hepatic excretion of:

A

bilirubin glucuronides
(‘glucuronic acid’ conjugates bilirubin)

will also see:
Impaired epinephrine excretion, seen as (pink inclusions) in lysosomes - causing (black liver)

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21
Q

283: What are 3 main causes of HIV -associated oesophagitis?
& their typical ulcer presentation?

A

Candida - white pseudomembranes
CMV - linear
HSV - punched out

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22
Q

403: primary biliary cholangitis is a ________________ disorder that commonly affects ________________?

A

autoimmune
middle aged women

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23
Q

403: the main symptoms & lab findings of primary biliary cholangitis are?

A

symptoms:
fatigue
pruritus
jaundice
cholestasis

labs:
raised ALP
raised gamma glutamyl transferase
raised direct hyperbilirubinaemia
automitochondrial antibodies

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24
Q

403: What are the histology findings for primary biliary cholangitis?

A

lymphocytic infiltration + granulomatous destruction of interlobular bile ducts

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25
Q

1064: What vitamin deficiency causes pellagra?

A

niacin B3
(rough skin)

B3 deficiency characterised by 3Ds:
dementia - neuro degen, like pernicious anaemia
dermatitis - sun exposed areas
diarrhoea - atrophy columnar epithelium

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26
Q

1064: What amino acids can be precursors to synthesis of the coenzyme NAD+

A

tryptophan
niacin

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27
Q

14892: Eosinophilic oesophagitis is a ________ mediated disorder triggered by ____________ exposure.

A

T2 cell
food antigen

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28
Q

14892: Eosinophilic oesophagitis is most common in ________ with a history of _________ conditions. They often have solid food ___________.

A

males
atopic (eczema, asthma)
dysphagia

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29
Q

The typical presentation in eosinophilic oesophagitis is?

A

oesophageal rings
linear furrows
scattered small white papules - micro abscesses
eosinophilic mucosal infiltration

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30
Q

MALROTATION vs volvulous

A

midgut volvulous

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31
Q

19789: what are 4 common deficiencies in a vegan diet?

A

b12 - meat
calcium - dairy
vitamin D - dairy
iron (nonheme plant iron harder to absorb)

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32
Q

12068: what type of anaemia is macrocytic and linked with autoimmune disease?

A

Pernicious anaemia
macrocytic megaloblastic anaemia
b12 deficiency
assoc.: with autoimmune conditions - diabetes, hashimotos
(CD4 response against parietal cells)

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33
Q

12068: What lab findings do you find in pernicious anaemia?
serum gastrin _______
gastric pH ________
parietal cell mass _________

A

serum gastrin - increased (alkalinity stimulates gastrin)
gastric pH - increased (achlorhydria increases pH)
parietal cell mass - decreased oxyntic mucosa (decreased acid and IF production)

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34
Q

1971: pancreatic secretions are __________. A _________ increases, _________ decreases as they are exchanged at the apical surface of pancreatic ductal cells.

A

isotonic
HCO3
CL-

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35
Q

14873: pregnant women usually develop GERD at any stage during their pregnancy due to LES relaxation caused by?

A

oestrogen & progesterone
relax sm ms of LES - decreasing tone

Also: gravid uterus pressing on stomach can alter angle of LES

there is not an ‘increase’ in gastric acid in pregnancy

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36
Q

What is the cause of Gastroschisis and is it covered or uncovered?

A

Defect in anterior abdominal wall formation (full thickness)
Defect is periumbilical
Bowel contents end up in amniotic cavity, not covered by a membrane
Umbilicus usually normal and unaffected

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37
Q

What is the cause of Omphalocele and is it covered or uncovered?

A

Failed gut rotation and physiologic return of bowel to the abdomen
Bowel contents herniated within umbilical cord sac
Bowel is covered by a peritoneal membrane

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38
Q

does gastroschisis or omphalocele have higher maternal serum AFP levels?

A

Gastroschsis has higher AFP levels
direct AFP leakage into amniotic fluid
absorbed by maternal circulation

39
Q

292: what is the most common cause of PUD - peptic ulcer disease?

A

Helicobacter pylori
gastric ulcer 70%
duodenal ulcer 90%

40
Q

21033: out of the following normal changes in an aging liver - what decrease, what stay the same:
liver mass
cytochrome P450
ALT
hepatic regeneration

A

ALT - stays same

liver mass - decreased hepatic blood flow
cytochrome P450 - decreased drug metabolism
hepatic regeneration - decreased ability to recover from injury

(overall increases risk of drug-toxicity)

41
Q

11548: What are 3 key symptoms and 2 pathological findings of CMV oesophagitis

A

symptoms:
odynophagia - pain on swallow
dysphagia - difficulty to swallow
burning/chest pain

pathology:
intracellular inclusions - owl eye (enlarged cells with basophilic or eosinophilic inclusions)
linear/shallow ulcers distal oesophagus

42
Q

11548: What are 3 causes of CMV oesophagitis?

A

immunosuppressed patients:
- HIV
- immunosuppressant drugs
- transplant (transmitted or immunosuppressed)

43
Q

321: In Meckels diverticulum -
1) what tissues can present within it?
2) if ulcer occur, are the painful/less?
3) what is the cause of Meckels diverticulum?

A

1) heterotopic (ectopic) - gastric, pancreatic, colonic mucosa
2) brisk and painless
3) failed obliteration of vitelline duct connecting ileum to umbilicus

44
Q

11850: ____________ artery is at risk of haemorrhage/injury during cesarian if a horizontal incision is made, due to the lack of supporting _______________

A

inferior epigastric artery
posterior sheath

inferior epigastric arteries enter the rectus abdominus at the levels of the arcuate line

45
Q

14880: what is the cause of sliding hiatal hernia?

A

laxity of phrenoesophageal membrane

46
Q

14880: what is the cause of paraoesophageal hernia?

A

hole defect in phrenoesophageal membrane

47
Q

What is the cause of bochdalek hernia?

A

failure of posterolateral diaphragm foramena to close
causes - pulmonary hypoplasia, pulmonary distress

48
Q

1766: what effect is lansoprazole (as drug A) having an effect on?

A

proton pump inhibitor
inhibits H+/K+ATPase pump
inhibiting common pathway of histamine, gastrin, vagal stimulation of HCl

49
Q

What is the acid base disorder that occurs from the underlying causal factor of Mallory Weiss syndrome?

A

vomiting
metabolic alkalosis
(high intra-abdominal/gastric pressure)

50
Q

358: what are 3 common system anomalies found in cystic fibrosis?

A

1) sinopulmonary infections - pseudomonas aeruginosa, burkholderia capacia
2) pancreatic insufficiency
3) absent vas deferens

51
Q

358: what is seen histologically in pancreatic insufficiency caused by cystic fibrosis?

A

distension and obstruction of pancreatic ducts
due to thickened secretions due to CFTR dysfunction

52
Q

FA what are the adverse effects of Cimetidine (H2 blocker)?

A

P450 inhibitor
antiandrogenic
cross BBB
reduced renal creatinine excretion

53
Q

FA name three H2 blockers

A

cimetidine
famotidine
nazatidine

‘dine’
(reversibly block H2 receptors - decreasing H+ secretion by parietal cells)

54
Q

FA Do proton pump inhibitors reversibly or irreversibly inhibit H+/K+-ATPase in parietal cells?

A

irreversibly

‘prazole’
(omeprazole, lasoprazole, esomeprazole, pantoprazole, dexlansoprazole)

55
Q

FA What are 3 adverse effects of PPI’s? i.e. omeprazole

A

pneumonia
acute interstitial nephritis
increased risk C Diff infection
fracture
B12 malabsorption
decreased Mg

56
Q

FA Bismuth and Sucralfate bind to ______ to provide physical ______ allowing HCO3 secretion to re-establish ______.

A

ulcer base
protection
pH

57
Q

FA sucralfate need an _______ environment

A

acidic

don’t give with PPIs/H2 (reduce acidity)

57
Q

FA Bismuth is used to treat?

A

travellers diarrhoea
ulcer healing
(or quadruple therapy for H pylori)

58
Q

FA Misoprostol is a _______ analog. It protects the ________ and reduces ________ production. It prevents __________-induced peptic ulcers

A

PGE1
mucosal barrier
acid
NSAID

58
Q

FA Three actions of misoprostol are?
It is contraindicated in?

A

prevents ulcers
maintains PDA
ripens cervix
CI in childbearing potential women - (abortifacient)

59
Q

FA octreotide is a _____________ analog. It inhibits splanchnic ____________ hormones.

A

somatostatin
vasodilatory

60
Q

FA octreotide treats acute ____________, ____-oma and _________ tumours

A

acute variceal bleeds (decreases portal pressure)
VIPoma
carcinoid tumours

61
Q

FA all antacids can cause?

A

hypokalaemia

62
Q

FA aluminum hydroxide (antacid) causes?

A

CHOPS
constipation
hypophosphatemia
osteodystrophy
proximal muscle weakness
seizures

63
Q

FA calcium carbonate (antacid) can cause?

A

hypercalcaemia
milk-alkali syndrome
rebound acid

64
Q

FA calcium carbonate (antacid) can chelate and decrease the effect of drug ________?

A

tetracycline

65
Q

FA magnesium hydroxide (antacid) can cause?

A

diarrhoea
hyporeflexia
hypotension
cardiac arrest

66
Q

FA lactulose (osmotic laxative) can be used to treat?

A

hepatic encephalopathy
gut mictobiota degrade lactulose into lactic acid/acetic acid - promotes nitrogen excretion (trapping In colon)

67
Q

FA odansetron is an ________ that works centrally as an antagonist of _______ receptor

A

antiemetic
5-HT3

68
Q

FA metochlopramide is an ________ that works centrally as an antagonist of _______ receptor. Metochlopramide is a ____________ agent

A

antiemetic
D2
prokinetic

69
Q

FA side effects of Metochlopramide can be?

A

extrapyrimidal symptoms
(tardive dyskinesia / parkinsonism) due to D2 receptor target

70
Q

FA odansetron can interact with what drug?

A

digoxin
some diabetic medications

71
Q

FA odansetron can cause what side effects?

A

QT interval prolongation
serotoinin syndrome

72
Q

15049: what tests are used to identify clostridium difficile?

A

NAAT - polymerase chain reaction (PCR)
enzyme immunoassay - ID toxins or antigens

73
Q

15049: what causes pseudomembranous colitis, and toxic megacolon with fulminant infection?

A

clostridium difficile

74
Q

15049: What are the virulence factors of clostridium difficile?

A

toxins A and B
- damage enterocytes
- lead to watery diarrhoea

75
Q

70: What are the main causes of cholesterol and black or brown pigment stones?

A

cholesterol stones - too much cholesterol (7a-hydroxylase ma contribute - but stones here usually only unconjugated bilirubin)
black stones - haemolysis
brown stones - infection - bacterial/injured tissure release b-glucuronidase

76
Q

70: what is the consistency of cholesterol vs pigment stones?
What are the 5F’s of cholesterol stones?

A

cholesterol - yellow/grey + hard
pigment - black/brown + soft
5Fs: fat, female, fertile, forty, (fair)

77
Q

8547: What does the left gastric vein anastomose with in the presence of oesophageal varices?

A

oesophageal vein

78
Q

8547: name the 3 sets of porto-caval anastomoses …

A

oesophageal varices: left gastric - oesophageal
caput meducae: paraumbilical - superior/inferior epigastric
anorectal varices: middle/inferior rectal - superior rectal

79
Q

1597: What cytokine has anti-inflammatory properties?
It is secreted by? _____ and _______

A

IL-10
Th2, Treg

80
Q

8578: what conditions can induce hepatic encephalopathy (NH3 production and removal)?

A

increased NH3 production:
GI bleed - tissue injury -> protein breakdown -> ammonia metabolites increased
constipation
infection

decreased NH3 removal:
diuretics
renal failure
post-TIPS

81
Q

8578: in hepatic encephalopathy, what will be elevated in astrocytes?

A

glutamine

normal astrocyte process:
Astrocytes take up glutamte present in synapses - undergoes condensation reaction with ammonia (NH3) via glutamine synthase to form glutamine (non-neuro active compound).
Then released by astrocytes and taken up by neurons where its converted back to glutamate (active neurotransmitter).
Excess ammonia - crosses BB - taken up by astrocytes -> increasing glutamine. Causes astrocyte swelling & decreased release.

82
Q

1701: in pre-sinusoidal portal hypertension, will there be enlargement of the:
spleen
liver
ascites

A

spleen - yes
liver - no
ascites - no

portocaval anastamoses shunt blood in portal hypertesion

83
Q

1701: acetaminophen toxicity does what to liver cells?

A

causes centrilobar hepatic necrosis

24-48hrs liver failure

84
Q

1701: what does Budd Chiari do to liver cells?

A

causes centrilobar congestion and fibrosis

85
Q

18541: Loperamide is an antagonist of _______ receptors and has poor penetration of ________.

A

mu-opioid receptors (u)
BBB

Treats diarrhoea
decreases gut motility
low addictive potential

(vs diphenoxylate - does cross BBB)
combined with LD atropine to reduce abuse

86
Q

1875: why is the liver least vulnerable to infarction compared to other organs?

A

dual blood supply
portal vein and hepatic artery

usually copes well
unless supper hepatic artery in persons with liver transplant - collateral blood supply severed

87
Q

15244: following an infection and subsequent watery diarrhoea - what should a child consume orally to replenish fluids?

A

hypotonic equimolar mixture of
sodium-glucose

osmotic gradient for water reabsorption established by - active co-transport sodium + glucose/chloride/amino acids

88
Q

20428: What is the link between celiac disease and microcytic anaemia?

A

iron deficiency
celiac disease affects duodenum
iron is absorbed in duodenum

89
Q

6510: what infection is pseudomembranous colitis seen in?

A

clostridium difficile

gram +, spore forming, anaerobic, toxigenic rod

90
Q

6510: how would you describe gross and micro histology of pseudomembranous colitis?

A

White-yellow patchy pseudomembranes
neutrophil inflammatory infiltrate
fibrin, bacteria, necrotic epithelium

Toxin A and B -> disrupt cellular cytoskeletons and tight junctions -> colonocyte apoptosis
can lead to toxic megacolon (non-obstruction colon dilation) and perforation

91
Q
A

BSIC (8 decks)

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