UWorld

Question 0

Mallory-Weiss tear

Answer 0

Tear of the gastric mucosa near the gastroesophageal junction caused by forceful vomiting. Presents with vomiting and retching, hematemesis, and epigastric pain.

Question 1

Classic glactosemia

Answer 1

Autosomal recessive absence of galactos-1-phosphate uridyltransferase. Accumulation of toxic substances causes problems. Failure to thrive, jaundice, hepatomegaly, infantile cataracts, intellectual disability

Question 2

Boerhaave Syndrome

Answer 2

Esophageal transmural tear caused by forceful vomiting (often from Mallory-Weiss tear). Results in air escaping into the mediastinum and pleura –> chest and upper abdominal pain, fever, dyspnea, shock.

Question 3

Mallory-weiss syndrome acid-base disturbance?

Answer 3

Vomiting –> metabolic alkalosis

Question 4

What does a 99mTc-pertechnetate scan detect?

Answer 4

Presence of gastric mucosa

Question 5

Accumulation of 99mTc-pertechnetate in R lower abdomen is diagnostic of

Answer 5

Meckel diverticulum

Question 6

What causes Meckel diverticulum, and how does it manifest?

Answer 6

Failure of obliteration of the emphalomesenteric duct.

Lower GI bleed due to acid secretion by ectopic gastric mucosa

Question 7

Congenital defect in Hirschsprung disease

Answer 7

Failure of neural crest cell migration

Question 8

What gets blood supply from the foregut even though it isn’t part of the foregut?

Answer 8

Spleen

Question 9

How many calories of energy does 1g of protein yield?

Answer 9

4

Question 10

Imperforate anus is associated with what other congenital malformations?

Answer 10

Urogenital tract anomalies

Question 11

Annular pancreas

Answer 11

Pancreas encircles duodenum, can cause obstruction

Abnormal migration of ventral pancreatic buds

Question 12

What embryonic cells give rise to Meissner and Auerbach plexi?

Answer 12

Neural crest cells

Question 13

When do the neural crest cells reach the proximal colon? The rectum?

Answer 13

8th week, 12th week

Question 14

Where are lipids digested? Where are they absorbed?

Answer 14

Digested in duodenum (bile salts), absorbed in the jejunum

Question 15

What is the difference between a true and false diverticulum?

Answer 15

True: contains all 3 layers of intestinal wall (mucosa, submucosa, muscularis)

False: contains only mucosa and submucosa.

Question 16

What does bilious vomiting after first 24 hours of life indicate?

Answer 16

Intestinal obstruction below second part of duodenum.

Question 17

Enlargement of what heart chamber can cause dysphagia?

Answer 17

Left atrium

Question 18

Total gastrectomy - what needs to be supplemented?

Answer 18

B12, because of intrinsic factor deficiency

Question 19

Linkage disequilibrium

Answer 19

Pair of alleles are inherited together in the same gamete (haplotype) more or less often than would be expected by random chance. Can occur even if genes are on different chromosomes.

Question 20

Which organ is impaired in a pt with weight loss, pain, excessive excretion of neutral fat?

Answer 20

Exocrine pancreas, seen in alcoholics

Question 21

What structure lies underneath the angle of the SMA/aorta?

Answer 21

transverse duodenum

Question 22

What organs/structures are retroperitoneal?

Answer 22

SAD PUCKER

Suprarenals (adrenals), aorta (IVC), duodenum (2nd-4th part), pancreas (except tail), ureters, colon (ascending and descending), kidneys, esophagus, rectum

Question 23

What hormone stimulates exocrine pancreas to release bicarb?

Answer 23

Secretin, from S cells in the duodenum. Most potent stimulus is HCl.

Question 24

Name the 3 poral-systemic anastomoses and their clinical manifestations.

Answer 24

1) Esophagus: left gastric - esophageal arteries –> esophageal varices
2) Umbilicus: Paraumbilical - small epigastric –> caput medusae
3) Rectum: superior rectal - middle and inferior rectal –> anorectal varices

Question 25

Where does a ruptured gastric ulcer from lesser curvature bleed?

Answer 25

Left gastric artery

Question 26

Where does a ruptured duodenal ulcer on posterior wall bleed?

Answer 26

gastroduodenal artery

Question 27

What is pancreas divisum

Answer 27

Failure of the dorsal and ventral pancreatic buds to fuse. Ends up with two ducts, one for each part.

Question 28

Crohn’s disease: gross appearance and histology

Answer 28

Linear ulcers and normal mucosa interspersed –> cobblestone appearance. Creeping fat.

Histo: non-caseating granulomas, lymphoid inflammatory infiltrate (Th1 mediated)

Question 29

What cell type mediates Crohn’s disease?

Answer 29

Th1

Question 30

Describe squamous cell carcinoma histology. What is the importance of keratin?

Answer 30

Nests of neoplastic squamous cells with abundant eosinophilic cytoplasm and distinct borders

Keratinization means that the tumor is poorly differentiated –> poor prognosis.

Question 31

What 3 organisms are most common causes of esophagitis? What patients is this found in?

Answer 31

Found in immunocompromised. Candida albicans, HSV-1, and CMV.

Question 32

Gross and histologic features: Candida esophagitis

Answer 32

Gross: white pseudomembranes

Histo: yeast cells and pseudohyphae that invade mucosal cells

Question 33

Gross and histologic features: HSV esophagitis

Answer 33

Gross: “punched out” ulcers

Histo: eosinophilic intranuclear inclusions in multinuclear squamous cells at margins of ulcers.