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Dr. Mel - Gastrointestinal > UWorld 2017 > Flashcards

UWorld 2017 Flashcards

1
Q

Function of enteropeptidase + deficiency

A

In duodenal brush border
Activates trypsinogen to trypsin (that degrades polypeptides + activates chymotrypsin, carboxypeptidase, elastase)

If deficient, impaired protein + fat absorption (diarrhea, failure to thrive, hypoproteinemia)

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2
Q

Adaptive immunity against Giardia lamblia

A

Secretory IgA

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3
Q

6 precipitating factors for Hepatic encephalopathy

A 
Drugs (sedatives, narcotics)
Hypovolemia
Electrolyte changes (hypoK)
High nitrogen lead (GI bleeding)
Infection
Portosystemic shunting
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4
Q

Effect of hyperammonemia in brain

A

Ammonia crosses B-B barrier
Accumulation of excess glutamine in astrocytes
Low conversion to glutamate in neurons
Disruption of excitatory neurotransmission

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5
Q

Complication of Gastric bypass surgery + its consequences

A

Small intestinal bacterial overgrowth
In blind-ended gastroduodenal segment
Deficiency in Vit B12, A, D, E, iron
Increased production of folic acid + Vit K

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6
Q

2 types of pain in appendicitis

A

Dull visceral pain at umbilicus: afferent pain fibers entering at T10
Severe somatic pain at Mc Burney: irritation of parietal peritoneum + abdo wall

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7
Q

4 characteristics in histopathology of esophageal squamous cell carcinoma

A

Solid nests of neoplastic squamous cells
Abundant eosino cytoplasm
Keratinization
Intercellular bridges

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8
Q

Cause of duodenal ulcers

A

H. pylori antral gastritis: destruction of somatostatin-secreting cells in antrum + high gastrin

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9
Q

H. Pylori ass w/

A

Duodenal ulcers
Gastric adenocarcinoma
Gastric lymphoma

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10
Q

Presentation of Hepatitis A infection

A

Acute prodromal symptoms
Then signs of cholestasis
Self-limited

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11
Q

Primary biliary cirrhosis

A

Granulomatous inflammation
Destruction of intrahepatic interlobular bile ducts
Pruritus + fatigue then signs of cholestasis + hypercholest (xanthelasma)

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12
Q

3 causes of infectious esophagitis in HIV+

A

Candida albicans (adherent pseudomembranes)
CMV (linear ulcerations)
HSV-1 (punched-out ulcers)

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13
Q

Iron absorption

A

Duodenum + proximal jejunum

Gastrojejunostomy/gastric bypass result in iron def + malabs of Vit B12, B9, fat-sol vit, Ca

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14
Q

Changes in esophagus in systemic sclerosis

A

Atrophy + fibrous replacement of esophageal muscularis

Esophageal dysmotility
Incompetence of the lower esophageal sphincter
GERD + high risk of Barrett’s

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15
Q

Portal vein thrombosis

A

Causes portal HTN, splenomegaly, varicosities at portocaval anastomoses
Normal histo of hepatic parenchyma
No ascites

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16
Q

Intraabdominal infections + abscesses

A

Polymicrobial

B. fragilis and E. coli +++

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17
Q

HNPCC

A

Gene resp for DNA mismatch repair (MSH2, MLH1)
Inherited mutation in one allele
Mutation in second allele during adult life

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18
Q

Diverticula

A

Pulsion: increased intraluminal P*; false div (muc+submuc+serosa); sigmoid
Traction: infl+scarring of gut wall; true div (w/ muscularis); midesophagus (mediastinal lymphadenitis)

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19
Q

Crohn ds + ileal involvement/resection

A

Bile acid malabsorption
Impaired absorption of fat-soluble vit (ADEK)
Impaired coag (vit K def)

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20
Q

Histology in cirrhosis

A

Diffuse hepatic fibrosis

Fibrous-lined parenchymal nodules

21
Q

Gallstone ileus

A

Large gallstone through cholecystenteric fistula into small bowel
Obstruction of ileum
X-ray: gas in gallbladder + biliary tree

22
Q

Histo in Primary biliary cholangitis (chronic autoimmune ds)

A

Lymphocytic infiltrates + destruction of small/mid-sized intrahepatic bile ducts
Similar histo in hepatic GVHD

23
Q

Cavernous hemangioma

A 
#1 benign liver tumor
Cavernous, blood-filled vasc spaces of variable size
Single epith layer
No biopsy (fatal hge)
24
Q

Liver function measured by

A

Serum albumin, bilirubin, PT

+ greatest prognostic significance in ptts w/ cirrhosis

25
Q

Hereditary hemochromatosis

A 
Missense mutation in HFE gene
Excessive intestinal iron absorption
Organ damage (cirrhosis, db, CM, arthropathy)
No mechanisms to excrete iron (not intest, not renal)
26
Q

3 risk factors for esophageal squamous cell carcinoma

A

US: tobacco, alcohol
Asia: betel nut chewing, food w/ N-nitroso

27
Q

4 risk factors of esophageal adenocarcinoma

A

Barrett’s esophagus
GERD
Obesity
Tobacco

28
Q

Brown pigment gallstones

A

Calcium salts of unconjugated bilirubin
2* to bact or helminthic inf of biliary tract
Beta-glucuronidase released by injured hepatocytes; bact hydrolyzes bili glucuronides to unconj bili
Clonorchis sinensis (liver fluke): East Asian countries

29
Q

Brown pigment gallstones vs cholesterol gallstones

A

Calcium salts of unconjugated bilirubin
2* to bact or helminthic inf of biliary tract (Clonorchis sinensis=liver fluke)
Beta-glucuronidase released by injured hepatocytes; bact hydrolyzes bili glucuronides to unconj bili

cholesterol gallstones (inhibition of 7 alpha-hydroxylase)

30
Q

Internal vs external hemorrhoids

A

Internal: columnar epith, autonomic innervation (inf hypogastric plexus), only sensitive to stretch. Not pain, temperature, touch
External: modified squamous epith, cutaneous somatic innervation (inf rectal nerve branch of pudendal N), very sensitive to pain, touch, temperature

31
Q

Alkaline phosphatase + gamma-glutamyl transpeptidase

A

ALP: esp in bone + liver
GGT: hepatocytes + biliary epith + many organs but not bone
If ALP 3x elevation, not enough. So evaluate GGT to identify if hepatic cause

32
Q

Conditions ass w/ hepatic angiosarcoma

A

Exposure to carcinogens (arsenic, thorotrast, polyvinyl chloride)
Cells express CD31

33
Q

Kidney stones in Crohn ds

A

Oxalate stones
Impaired bile acid absorption (terminal ileum), loss in feces, fat malabsorption
Lipids bind Ca then excreted
Oxalate (not bound to Ca) absorbed then urinary calculi

34
Q

Osmotic diarrhea, osmotic laxative

A

Lactase deficiency

Polyethylene glycol, magnesium hydroxide

35
Q

Reye syndrome

A

Hepatic dysfct: vomiting, hepatomegaly, abnl LFTs, microvesicular steatosis without inflammation
Encephalopathy: by hepatic dysfct, toxic hyperammonemia, cerebral edema

36
Q

MOA of the complications of Crohn’s ds

A

Transmural inflammation: strictures + fistula

37
Q

Diffuse esophageal spasm

A

Impaired inhibitory innervation in myenteric plexus
Periodic, simultaneous, non-peristaltic contractions
Liquid/solid dysphagia w/ chest pain

38
Q

Adenomatous polyps

A

Dysplastic mucosa, premalignant

AdenoK prevention: excision + decrease activity of COX-2 by Aspirin

39
Q

Ttt to control symptoms of carcinoid sd

A

Octreotide (synthetic somatostatin analog)

40
Q

Alpha-fetoprotein

A

Tumor marker
Moderately elevated in chronic viral hepatitis
Strikingly elevated in hepatocellular carcinoma

41
Q

H pylori

A

Chronic non-atrophic gastritis in antrum: duodenal ulcers
Chronic atrophic gastritis in body+fundus: rarely ulcers but high risk of gastric adenocarcinoma and MALT lymphoma; iron def anemia

42
Q

Gallbladder hypomotility

A

Slow/incomplete emptying in response to cholecystokinin stimulation
Excessive dehydration of bile (gallbladder: actively absorb water from bile)
Viscous biliary sludge; transient bile duct obstr (colic), cholest gallstone

43
Q

Generalized malabsorption

A

Fats most severely affected: testing stool for fat (Sudan III stain)

Defects in pancreatic secretion, mucosal disorders, bacterial overgrowth, parasitic ds

44
Q

Pathogenesis of Crohn’s ds

A

Increased activity of TH1: increased IL2, IFNg, TNF
Then intestinal injury
Non-caseating granulomas

45
Q

Dubin-Johnson sd

A

Defective hepatic excretion of bilirubin glucuronides
Direct hyperbilirubinemia + jaundice
Impaired excretion of epinephrine metabolites (black liver)

46
Q

HDV infection

A

HBV surface Ag must coat HDV Ag

47
Q

Strongyloides stercoralis infection

A

After skin penetration by filariform (inf) larva
Dg: rhabditiform (noninf) larvae in stool
Hyperinfection sd: massive dissemination, multiorgan dysfct + septic shock

48
Q

Histo in acute hepatitis

A

By hepatotropic viruses

Hepatocyte ballooning degen + apoptosis w/ mononuclear cell infiltration

Dr. Mel - Gastrointestinal (3 decks)

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