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UWORLD Q REVIEWS > Neuro/GI Wk 4 > Flashcards

Neuro/GI Wk 4 Flashcards

1
Q

How can acute hepatitis B present?

A

Like serum sickness with joint pain, lymphadenopathy and rash.

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2
Q

Positive and negative predictive values is dependent on what feature?

A

The prevalence in a tested population

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3
Q

MOA of triptans?

A

Triptans are serotonin agonist that inhibit trigeminal nerve activation and prevent vasoactive peptide release and induce vasoconstriction.
Abortive therapy for migraines

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4
Q

HDAg is considered to be replicative defective and must be ____ before it can penetrate the hepatocyte?

A

Coated by the external coat hepatitis B surface antigen (HBsAg)

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5
Q

The spleen is an embryological derivative of?

A

Mesoderm

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6
Q

What meds can you treat Chronic Hepatitis C with?

A

Direct acting antivirals (DAAs). E.g Ledipasvir and sofosbuvir. These target specific HCV enzymes that inhibit viral replication and assembly.

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7
Q

How does the histopathology of celiac sprue present?

A

Crypt hyperplasia, villous atrophy and intraepithelial lymphocyte infiltration.

**mostly affects distal duodenum and proximal jejunum

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8
Q

Metabolism of 1g protein/carbohydrate produces __ calories of energy?

1g of fat?

A

4 calories of energy

9 calories of energy

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9
Q

In alcoholic induced hepatitis, what is the ratio of AST to ALT?

A

AST>ALT

**every other cause of hepatitis has a ALT>AST.

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10
Q

Elevated concentrations of ____ & ____ increase cholesterol solubility and decrease risk of gallstones

A

Bile salts and phosphatidylcholine

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11
Q

Lymphatic drainage of the recum proximal to the anal dentate line occurs via these lymph nodes?

A

Inferior mesenteric and internal iliac LN

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12
Q

Areas of the rectum distal to the dentate line drain to these Lymph Nodes?

A

Inguinal LNs

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13
Q

This inflammatory mediator plays a central role in the pathogenesis of Crohn’s Disease?

A

TNF-Alpha

**promotes intestinal inflammation by inducing lymphocyte proliferation, enhancing migration of neutrophils and stimulating macrophage activity.

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14
Q

What is the most common cause of inherited intellectual disability?

A

Fragile X

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15
Q

Cytogenic studies of fragile X show ?

A

Small gap near the tip of the long arm.

**Due to expansion of CGG (trinucleotide repeats) in the FMR gene (fragile X mental retardation gene) located on long arm of X. Area of increased repeat does not stain and appears broken.

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16
Q

Occlusion of the portal triad should stop bleeding except if the bleeding is in these vessels?

A

IVC or hepatic vein.

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17
Q

What makes up the portal triad?

A

Hepatic artery, portal vein and common bile duct (encased in the hepatoduodenal ligament).

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18
Q

What are some examples of afferent pupillary defect?

A

Optic neuritis (demyelination) and retinal detachment, ischemic optic neuropathy & trauma.

**implies ipsilateral optic defect.

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19
Q

Prostaglandins are important in the GI tract for?

A

Maintenance of intestinal mucosa (decrease gastric acid formation, increase bicarb production and increase mucuosal blood flow).

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20
Q

Absence of normal enteral stimulation in patients receiving total parenteral nutrition can lead to ?

A

Gallstones (via decrease in cholecystokinin release, biliary stasis)

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21
Q

Diphenoxylate MOA?

A

Binds to mu receptor agonist in the gut and slows motility.

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22
Q

To avoid abuse of diphenoxylate what is typically co-administered?

A

Atropine - anticholinergic effects (induces adverse effects if taken in high doses).

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23
Q

Hereditary nonpolyposis colon cancer is also known as?

A

Lynch syndrome

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24
Q

HNPCC leads to occurence of ___ at young age <50?

A

Colonic adenocarcinoma and increased disposition for extraintestinal malignancies (endometrial and ovarian)

** Fam Hx will be +ve for cancers.

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25
Q

Mutations in ____ are responsible for HNPCC?

A

DNA mismatch repair genes (MSH2 & MLH1)

*Autosomal dominant.
Inherit mutated copy, 2nd copy affected in adulthood.

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26
Q

Patients with MS often develop these symptoms?

A

Respiratory failure (also COD) due to inspiratory muscle weakness (Decreased vital capacity), expiratory m. weakness (ineffective cough) and bulbar dysfunction (dysphagia and chronic aspiration).

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27
Q

Pathology of abetalipoproteinemia?

A

Inherited inability to synthesize apolipo B. Lipid absorbed cannot be transported into blood and accumulate in intestinal epithelium -> enterocytes with foamy cytoplasm.

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28
Q

Describe the inclusions found in Hepatitis B?

A

Finely granular, pale eosinophilic ‘ground glass’ appearance.

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29
Q

What is a pseudomembrane?

A

Exudate on colonic mucosa consisting of fibrin and inflammatory cells.

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30
Q

What can lead to the formation of pseudemembrane?

A

Antibiotics -> disrupt normal flora -> overgrowth of clostridium -> watery diarrhea and colitis

**Also common in pts with recent hospitalization, PPI.

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31
Q

This is a potentially fatal neonatal bleed that occurs during delivery when emissary veins between the dural sinuses and scalp are sheared?

A

Subgaleal hemorrhage.

**Accumulation of blood between periosteum and galea aponeurosis. Px with fluctuant scalp and neck swelling.

**Massive blood loss -> shock and death.

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32
Q

How does IL-10 attenuate inflammatory response?

A

Inhibition of TH1 cytokines, reduction of major histocompatibility complex II expression and suppression of activated macrophages and DC.

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33
Q

Hepatic angiosarcoma is associate with exposure to ?

A

Arsenic, thorotrast (radio contrast agent), and PVC exposure.

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34
Q

What endothelial cell markers does a hepatic angiosarcoma express?

A

CD31

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35
Q

What are the most common causative agents in intraabdominal infections?

A

Normal colonic bacteria: E. coli and B. fragilis (anaerobic, favors abscess formation).

Others: enterococci and streptococci

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36
Q

Small intestinal bacterial overgrowth is characterized by increased production of?

A

Vitamin K and folate.

**asx with nausea, abd discomfort and malabsorption.

Decrease in B12, ADE and iron.

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37
Q

Gastric bypass can cause this in the blind-ended gastroduodenal segment?

A

Small intestinal bacterial overgrowth.

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38
Q

Patients with parkinson disease may benefit from high frequency deep brain stimulation suppressing activity of these brain regions?

A

Globus plallidus internus or Subthalamic nucleus.

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39
Q

What factors inhibit acid secretion?

A

Somatostatin & Prostaglandins

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40
Q

Charcot’s triad for acute cholangitis?

A

Fever, jaundice, RUQ pain

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41
Q

Reynolds Pentad for acute cholangitis?

A

Fever, janudice & RUQ + hypotension and altered mental status

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42
Q

What is acute cholangitis?

Most common causes?

A

Ascending infection due to biliary obstruction

Gallstones, malignancy, stricture Primary scelrosing cholangitis), biliary stent blocakage.

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43
Q

These drugs are useful in treatment of visceral nausea due to GI insults, gastroenteritis, chemo and general anesthesia?

A

5-HT3 antagonist

**gastric irritation results in increased release of serotonin and activate 5HT receptors -> spinal afferent via vagal n. -> medullary vomiting center-> emesis

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44
Q

What type of nausea is treated by antihistamines and anticholinergics?

A

Vestibular nausea

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45
Q

Dopamine antagonists are useful for this types of nausea?

A

Nausea associated with migraine

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46
Q

Patients with these injuries are particularly susceptible to Sciatic neuropathy ?

A

Femoral head dislocation, hip fracture and or arthroplasty

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47
Q

Injury to the sciatic (L4-S3) nerve causes these deficits?

A

Knee flexion, common peroneal n (dorsiflexion, numbness of calf and dorsal foot) and tibial n (plantar flexion, ankle reflex).

48
Q

What nerve is responsible for the ankle reflex?

A

Tibial n.

49
Q

How can botulinum toxin help with achlasia?

A

Prevents acetylcholine release into NM synapse (prevents fusion of vesicles) -> inhibition of cholinergic neurons -> muscle weakness -> LES relaxation.

50
Q

Treatment options for Clostridium difficile?

A

Oral vancomycin or fidaxomicin

51
Q

MOA of fidaxomicin?

A

Macrocyclic antibodies that inhibits sigma subunit of RNA polymerase -> protein synthesis impairment and cell death.

52
Q

Where are bile acids reabsorbed?

A

Terminal ileum

53
Q

How can crohns disease affecting the terminal ileum lead to coagulation disorders?

A

Decreased absorption of bile acids -> fat malabsorption -> ADEK (fat soluble vitamins) ->
Vitamin K is cofactor for 1972 -> coagulation problems (easy bruising, hematoma formation).

54
Q

Increased uptake of Tc-pertechnetate in the periumbilical/RLQ is characteristic of?

A

Meckel’s diverticulum

**pertechnetate has an affinity for parietal cells of the gastric mucosa which is often found in a meckel’s diverticulum

55
Q

What arteries does the splenic artery give off?

A

Short gastric (vulnerable to ischemic injury - due to poor anastamoses), L. gastroepiploic and pancreatic.

56
Q

In which gastric layer are parietal cells located?

A

Predominantly in the upper glandular layer

57
Q

What cells does pernicious anemia destroy?

A

Parietal cells (secrete Hydrochloric acid and Intrinsic Factor).

58
Q

Abusive head trauma (shaken baby syndrome) usually leads to?

A

Subdural (due to tearing of bridging veins) and retinal hemorrhages.

59
Q

Single brain abscess is usually caused by?

A

Direct spread of a contiguous infection

Multiple brain abscesses typically indicate hematogenous dissemination

60
Q

Temporal lobe abscess is usually as a result of?

A

Otitis media that has spread to the mastoid air cells.

61
Q

Frontal lobe abscess is usually as a result of ?

A

Ethmoid or frontal sinusitis

62
Q

The vomiting reflex is initiated by what part of the brain?

A

The chemoreceptor zone (area postrema) and nucleus tractus solitarius within the dorsal medulla.

**has a poor BBB -> so activated by emetogenic substances (drugs, toxins)

63
Q

How do chemo agents trigger vomiting?

A

Chemo agents cause damage to enterocytes -> stimulate release of 5HT3 receptors on vagal afferent fibers in bowel wall -> ascend to area postrema -> vomiting reflex.

Can also be via direct activation of area postrema by NK1 receptors in area postrema by release of substance P.

64
Q

Zollinger Ellinger Syndrome is often associated with which MEN syndrome?

A

MEN 1

Along with Pituitary adenoma (prolactinemia) and parathyroid hyperplasia.

65
Q

Umbilical hernia are often seen with children with this condition?

A

Downs Syndrome

66
Q

Umbilical hernia is associated with incomplete closure of?

A

Umbilical ring

** associated with defect in linea alba.
These protusions are reducible and soft.

67
Q

The protein utilizes the RAS-MAPK pathway?

A

G protein.

RAS (GDP) -> active RAS (GTP) -> RAF -> MAPK -> gene activation.

68
Q

How would a pt presenting with obstructive jaundice present?

A

Elevated bilirubin, dark urine, pale stools.

69
Q

What should be considered in a patient presenting with painless obstructive jaundice and weight loss?

A

Pancreatic adenocarcinoma

70
Q

What is Courvoisier sign?

A

Painless palpable gallbladder in jaundiced patient.

71
Q

What is the most important RF for pancreatic cancer?

A

Smoking

72
Q

Dystonia is often as a result of impaired function in the?

A

Basal ganglia

73
Q

Vitamin B deficiency is also called?

Symptoms are caused by demyelination of which tracts?

A

Subacute combined (ascending & descending pathway) degeneration

Demyelination of dorsal columns, spinocerebellar and corticospinal tract

Can be thought of as (tabes dorsalis + corticospinal tract).

74
Q

Cholangiocarcinoma is a malignancy of?

Associated with?

A

Bile duct epithelium

Primary sclerosing cholangitis

75
Q

There are two main causes of cholangiocarcinoma, what are they?

A

Primary sclerosing cholangitis & Clonorchis sinensis (liver fluke).

**both obstruct bile drainage

76
Q

How would cholangiocarcinoma px? Imaging

A

Cholestasis: markedly increased alk phos, hyperbilirubinemia
Is an adenocarcinoma so Cuboidal/columnar cells arranged in glandular structures (mucin production).

Bile duct dilation in absence of stone.

77
Q

Adenocarcinoma is the esophagus often drain to these LN?

SSC drain to which nodes?

A

Celiac and gastric nodes

Mediastinal LN

78
Q

Diverticular disease can present with ____ bleeding?

A

Painless bleeding

79
Q

In CMV reactivation, what are some of the common syndrome?

A

CMV retinitis, CMV colitis.

80
Q

Colonoscopy in CMV colitis shows?

Histology?

A

Mucosal erythema, erosions and ulceration.

Giant cells with centralized intranuclear basophilic inclusions

81
Q

How do protease inhibitors work?

A

Block viral protease from cleaving gag pol polyproteins -> formation of immature virions that are non infectious

82
Q

Failure of neural tube closure at ___ weeks results in neural tube defects?

A

Week 4

83
Q

Early onset (<60) alzheimer’s is associated with these 3 protein mutations?

A

APP (chromosome 21), Presenilin 1 and presenilin 2.

84
Q

What are the altered proteins involved in the sporadic form of Alzheimer’s disease? Which is protective and which is not?

A

ApoE -2 -> Protective

ApoE-4 -> Increased risk

85
Q

What are the two ezymes that are deficient in PKU?

A

Phenylalanine hydroxylase and BH4 (tetrahydropterin).

86
Q

What is the hallmark px for PKU?

A

Intellectual disability

87
Q

What molecules need BH4 for production?

A

Tyrosine -> Dopa
Niacin -> Serotonin
Arginine -> NO

88
Q

What products are converted from propionyl-CoA -> Methylmalonyl -COA

A

Odd chain FA, branched AA (Leucine, Isoleucine and Valine), Methionine and threonine

89
Q

The “on” and “off” phenomenon is thought to be a consequence of ?

A

Progressive nigrostriatal neuodegenration leading to a decreased therapeutic window.

90
Q

Why should you not give only glucose infusion to patient presenting with chronic alcohol dependency?

A

Thiamine absorption is affected in alcoholism. When you give glucose -> use up last stores of thiamine (thiamine is cofactor in many glucose pathways)-> Wernicke’s Encephalopathy (nystagmus, gait ataxia).

91
Q

What is the endrophonium test used for?

A

To differentiate between myasthenic (pt is undertreated) or cholinergic crisis (too high doses -> excessive AchE).

Endrophonium will improve symptoms if myasthenic crisis and since in cholinergic crisis, the NMJ becomes insensitive to excess AChE, Endrophonium will have no effect.

92
Q

These antidepressants can treat diabetic neuropathy?

A

TCAs
SNRIs
Gabapentoids

93
Q

In Ataxia telangiectasia, the function of the ATM gene is?

A

DNA break repair

94
Q

The immune deficiency in Ataxia telangiestasi presents as?

A

IgA deficiency- infections in the upper and lower airways.

95
Q

How does isonazid cause numbing and tingling?

A

Isoniazid is structurally similar to pyridoxine (B6) -> competes with B6 synthesis of many neurotransmitters e.g GABA. Also leads to increased urinary excretion of pyridoxine -> B6 deficiency -> Isoniazid induced neuropathy

96
Q

First line treatment for trigeminal neuralgia?

A

Carbamazepine

97
Q

Multiple sclerosis is an immune mediated disorder of CNS characterized by?

A

Focal demyelination (plaques) which contain perivenular infiltrates (made up of autoreactive T lymphocytes & macrophages).

Patchy demyelination followed by astrocyte hyperplasia.

98
Q

In ataxia telangiectasia, what is the DNA of patients hypersensitive to?

A

Ionizing radiation (defect in DNA repair genes)

99
Q

Where do vestibular schwannomas typically arise?

A

Cerebellopontine angle

100
Q

Bilateral acoustic neuromas are assoicated with?

A

Neurofibromatosis type 2

101
Q

What other nerves would a vestibular schwannoma affect?

A

CN 5&7

102
Q

Involvement of the lower vermis and the flocculonodular lobe of the cerebellum would cause?

A

Vertigo and nystagmus (dysregulation of the vestibular nuclear complex).

103
Q

Most cases of cerebellar hemorrhage are caused by?

A

Hypertensive vasculopathy

104
Q

Klumpke palsy shows paralysis of?

A

All the intrinsic hand muscles (claw hand deformity)

105
Q

Which animals can act as a reservoir for west nile virus reside?

A

Harbored in birds and transmitted to humans by mosquitoes.

Often cause self limited flu like illness with maculopapular rash. Rare cause of menningtitis, encephalitis and flaccid paralysis (neuroinvasive).

106
Q

Traumatic vascular dissection is a relative common cause of ischemic stroke in the young and affects primarily these vessels?

A

Carotid and vertebral arteries

can be easily injured by cervical spinal trauma

107
Q

Lateral medullary syndrome is also called?

A

Wallenberg Syndrome

108
Q

Gerstmann syndrome results from damage to this brain part?

A

Angular gyrus of the dominant parietal lobe

*Supplied by MCA

109
Q

Gerstmann Syndrome is characterized by?

A

Agraphia (inability to write), acalculia (inability to carry out mathematical calculations), finger agnosia (inability to identify individual fingers on the hand) and left right disorientation.

110
Q

Subacute sclerosing panencephalitis is a rare complication of?

A

Measles.

**occurs several years after initial infection.

111
Q

What is the pathology for the development of subacute sclerosing panencephalitis?

A

Measle virus with mutated/absent matrix. Allows evasion by the immune system -> accumulation of the virus within neurons and oligodendrocytes -> inflammation, demyelination and gliosis.

112
Q

The most common pineal gland tumor is a?

A

Germinonma.

**Px with obstructive hydrocephalaus (from aqueductal stenosis) and dorsal midbrain (Parinaud) Syndrome.

113
Q

Wilson’s disease has a mutation in what gene?

A

ATP7B - impaired cellular transport of copper.

114
Q

Manifestations of wilson’s disease?

A

Psych symptoms (depression, emotional liability, and impulsivity)
Parkisonism
Kayser Fletcher rings

**low ceruplasmin

115
Q

Treatment for Wilsons disease?

A

Copper chelator (penicillamine)

116
Q

Berry saccular aneurysm arising from PCA, would most likely affect this nerve?

A

Oculomotor (CN III)

117
Q

Berry aneurysms mainly occur in these vessles?

A

Anterior circulation (ACA, PCA & MCA)

UWORLD Q REVIEWS (13 decks)

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