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USMLE Step 1 > GI > Flashcards

GI Flashcards

1
Q

Most common location of salivary gland tumors:

A

Parotid gland

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2
Q

Most common salivary gland tumor:

Second most common:

A

Pleomorphic adenoma

Warthin’s tumor

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3
Q

Most common malignant salivary gland tumor:

A

Mucoepidermoid carcinoma

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4
Q

This very common genetic defect is a risk for duodenal atresia:

A

Trisomy 21

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5
Q

Jejunal, ileal, and colonic atresia are due to this event during fetal development. What about duodenal atresia?

A

Duodenal = failure to recanalize

Jejunal et c = vascular accident

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6
Q

This anterior abdominal wall defect can contain a herniated liver, whereas this does not.

A

Omphalocele can have the liver protruding

Gastroschisis does not

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7
Q

These structures are retroperitoneal (9):

A 
A DUCK PEAR:
Adrenals
Duodenoum
Ureters
Colon (descending and ascending)
Kidneys
Pancreas (except tail)
Esophagus
Aorta / IVC
Rectum
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8
Q

Three metabolic abnormalities that may be seen in an infant with pyloric stenosis:

A

Hypochloremia
Metabolic alkalosis
Hypokalemia (K+ shift into cells to allow H+ out into blood)

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9
Q

Pale clay colored stool, tea urine, jaundice in the first weeks of life:

A

Extrahepatic biliary stenosis, failure of the bile ducts to completely re-canalize.

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10
Q

The pancreas is derived from this embryonic structure:

A

Foregut

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11
Q

Which pancreatic bud contributes to the head and main pancreatic duct?

A

Ventral bud

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12
Q

How does an annular pancreas happen?

A

Ventral bud is in two pieces

Dorsal / ventral fuse abnormally and encircle the duodenum.

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13
Q

Where does the spleen come from? From what tissue layer is it derived?

A

The stomach mesentary, it’s mesodermal.

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14
Q

What structures come from the hepatic diverticulum off the ventral foregut?

A

Liver
Gall bladder / biliary tree
Ventral pancreatic bud

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15
Q

Which pancreatic bud travels to meet the other bud?

A

Ventral swings around dorsally to join the dorsal pancreatic bud.

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16
Q

This embryonic structure gives rise to the body, tail, and isthmus of the pancreas:

A

Dorsal pancreatic bud

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17
Q

This ligament contains the portal triad:

A

Hepatoduodenal

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18
Q

Access to the lesser sac through this ligament:

A

Gastrohepatic

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19
Q

The tail of the pancreas is embedded in this ligament:

A

Splenorenal

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20
Q

The gastric arteries are in this ligament:

A

Gastrohepatic

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21
Q

This ligament is the remnant of the fetal umbilical vein:

A

Ligamentum teres hepatis

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22
Q

What are the layers of the gut wall (inside out) (4)?

A

Mucosa
Submucosa
Muscularis externa
Serosa / adventitia

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23
Q

This type of injury extends into the submucosa:

A

Ulceration

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24
Q

Where is the myenteric nerve plexus? What is its other name?

A

Myenteric = Auerbach’s

It is the OUTERbach’s plexus

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25
Q

This nerve plexus is the inner nerve plexus and is located in the _________.

A

Submucosal nerve plexus is the inner one, aka Meissner’s, it’s in the submucosa, of course.

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26
Q

Three arteries to the GI structures come off the aorta anteriorly:

A

Celiac
Superior mesenteric
Inferior mesenteric

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27
Q

What is SMA syndrome?

A

The duodenum gets caught between the SMA and the aorta and is obstructed.

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28
Q

Parasympathetic innervation for the:
Foregut
Midgut
Hindgut

A

Foregut and midgut = vagus

Hindgut = pelvic

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29
Q

The artery that supplies the foregut:

A

Celiac

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30
Q

The three main branches off the celiac trunk:

A

Common hepatic
Splenic
Left gastric

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31
Q

The common hepatic artery gives rise to three arteries, what are they?

A

Gastroduodenal
Right gastric
Hepatic artery proper

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32
Q

This artery gives rise to the main arteries to the pancreas:

A

Gastroduodenal via the anterior superior pancreaticoduodenal arteries

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33
Q

The R gastroepiploic artery comes from this origin, and the left comes from a separate vessel:

A

R from the gastroduodenal (off common hepatic)

L from the splenic (off celiac trunk)

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34
Q

Which zone in the liver is affected first by viral hepatitis?

A

Zone 1 = zone closest to the portal triad

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35
Q

Zone III is located near what structure in the liver?

A

Pericentral / centrilobular veins

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36
Q

What direction does bile flow relative to the central hepatic vein?

A

Away from it, toward the triad.

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37
Q

This hormone causes gall-bladder contraction:

A

CCK

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38
Q

What is the most common kind of stomach hernia? The most dangerous?

A

Sliding hiatal = most common

Paraesophageal = most dangerous, fundus can get trapped in this one.

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39
Q

Where do an indirect and a direct inguinal hernia lie relative to the inferior epigastric artery?

A 
Indirect = lateral
Direct = medial
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40
Q

Gastrin comes from these cells:

A

G cells

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41
Q

Pro-duodenal hormone:

A

CCK

This hormone is anti-gastrin

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42
Q

These two hormones are the main off-switch for gastric acid secretion:

A

CCK
Secretin
Somatostatin

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43
Q

Where is secretin made?

A

S cells in the duodenum

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44
Q

This hormone is the anti-hormone-hormone:

A

Somatostatin

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45
Q

This hormone hits parasympathetic ganglia in the gut:

A

VIP = vasoactive intestinal peptide

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46
Q

This substance helps relax the LES:

A

NO

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47
Q

This hormone is seriously elevated in Zollinger-Ellison syndrome:

A

Gastrin

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48
Q

Three common substances that are potent stimulators of gastrin:

A

Calcium
Phenylalanine
Tryptophan

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49
Q

Three histologic / gross / lab findings in a stomach of someone with ZE syndrome:

A

Thick rugae
High gastrin
Glandular hyperplasia

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50
Q

Cells that make IF:

A

Parietal cells

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51
Q

These glands in the duodenal submucosa secrete alkaline mucus:
When might they be hypertrophied?

A

Brunner’s

Peptic ulcer disease

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52
Q

Gastrin increases acid secretion indirectly. Briefly explain how this happens:

A

Gastrin hits ECL cells in the gut, which release histamine; it is histamine that hits parietal cells and tells them to secrete acid.

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53
Q

Type of receptor on parietal cells most important for stimulating acid secretion:

A

H2

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54
Q

Two Gi coupled receptors on a parietal cell:

A

Prostoglandin
Somatostatin
Both inhibit acid secretion

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55
Q

The H2 receptor on a parietal cell works through what second messenger?

A

cAMP

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56
Q

Two hormones stimulate pancreatic secretions:

A

CCK

Secretin

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57
Q

Where are oligosaccharide hydrolases located?

A

At the brush border of the intestines.

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58
Q

What is the rate-limiting step in carbohydrate digestion?

A

Monosaccharide production by oligosaccharide hydrolases

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59
Q

This sugar transporter sends both glucose and fructose from an enterocyte into the blood:

A

GLUT2

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60
Q

Glucose and galactose enter an enterocyte on this transporter:
What kind of carrier is it?

A

SGLT-1

Na-dependent

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61
Q

How is fructose taken into an enterocyte?

A

Facilitated diffusion through GLUT-5

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62
Q

What is the plasma carrier protein for vitamin B12?

A

Transcobalamin

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63
Q

Where are each of the following vitamins absorbed? Iron, Folate, B12:

A

Iron: Duodenum
Folate: Jejunum
B12: Terminal ileum, needs IF

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64
Q

The cells in Peyer’s patches that take up antigen:

A

M cells

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65
Q

Where do B cells in the gut live?

A

In Peyer’s patches, inside the lamina propria

66
Q

What enzyme catalyzes the rate-limiting step for bile salt formation?

A

Cholesterol 7a-hydroxylase

67
Q

Which form of bilirubin is water-soluble – direct or indirect?

A

Direct = conjugated = water soluble.

68
Q

Gut bacteria convert conjugated bilirubin into this molecule, which either goes out into the feces as stercobilin or gets resorbed via the mesenteric veins and sent to the kidney / liver:

A

Urobilinogen

69
Q

This salivary gland tumor has germinal centers:

A

Warthin’s tumor = papillary cystadenoma lymphomatosum

70
Q

This salivary tumor has mucinous and squamous parts. It is the second most common tumor overall:

A

Mucoepidermoid carcinoma

71
Q

Most tumors in this gland are malignant:

A

Sublingual

72
Q

What does a Warthin’s tumor look like?

A

A lymph node: Columnar epithelium on a wad of lymph cells with a little stroma

73
Q

Loss of innervation to this plexus leads to achalasia:

A

Auerbach’s (myenteric)

74
Q

T/F: Achalasia increases the risk of squamous cell carcinoma:

A

T.

75
Q

Primary achalasia has a high LES opening pressure. This disorder involves a low pressure proximal to the LES:

A

CREST / Scleroderma

76
Q

This infection can give rise to secondary achalasia:

A

Chagas (=Trypanosoma cruzii)

77
Q

CMV esophagitis looks like:

A

CMV: Linear ulcers, large cells with clear perinuclear halo.

78
Q

HSV esophagitis looks like:

A

Punched-out ulcers, large pink nuclear inclusions.

79
Q

What is Whipple’s disease?

A

Infection with Tropheryma whipplei (gram + organism). Leads to malabsorption.

80
Q

Features of Whipple’s disease (5):

A 
WHIPped cream in a CAN:
Cardiac sx
Arthralgias
Neurologic sx
FOAMY macrophages in intestinal mucosa
Lymphadenopathy
81
Q

Malabsorption, neurologic manifestations, autosomal recessive, acanthocytes:

A

Abetalipoproteinemia

82
Q

HLA associated with Celiac:

A

HLA-DQ2, DQ8

83
Q

Three Ab you can find in Celiac disease:

A

Anti-endomysial
Anti-gliaden
Anti-tissue transglutaminase

84
Q

Acute erosive gastritis, 3 features:

A

Neutrophils
Loss of surface epithelium
Purulent exudate with fibrin

85
Q

Chronic gastritis, 2 features:

A

Lymphoid aggregates

Atrophied glands

86
Q

Two injuries that can cause acute erosive gastritis:

A

Burns (Curling ulcer)

TBI (Cushing ulcer)

87
Q

Type A gastritis: autoimmune or caused by H. pylori? Location in the stomach?

A

Autoimmune.
AutoAb, Anemia (pernicious), Achlorhydria
In the body of the stomach

88
Q

H. pylori infection causes this type of gastritis:

A

Chronic, non-erosive, type B (in the antrum)

89
Q

What is Menetrier’s disease?

A

Gastric hypertrophy with huge increase in mucous cells. Patients have protein loss sufficeint to cause hypoalbuminemia.

90
Q

Super hypertrophied rugae:

A

Menetrier’s disease

91
Q

Krukenberg’s tumor, what is it?

A

Bilateral metastasis of stomach cancer to ovaries. See mucus, signet ring cells.

92
Q

Three places you might see signet ring cells:

A

Lobular adenocarcinoma in situ (breast)
Gastric cancer
Kruckeberg’s tumor of the ovary

93
Q

This kind of ulcer will be accompanied by hypertrophy of Brunner’s glands:

A

Duodenal ulcers

94
Q

What is involved in triple therapy for H. pylori?

Quadruple therapy?

A

PPI + clarithromycin + amox or metronidazole

PPI + bismuth + metro + tetracycline

95
Q

Tx for irritable bowel syndrome (5):

A 
Fiber
TCAs
SSRIs
Loperamide
Alosetron
96
Q

Where do false diverticula commonly occur?

A

Most common in the sigmoid colon, where the vasa recta perforate the muscularis externa.

97
Q

Three diverticula above the lower esophageal sphincter:

A 
Zencker = above the UES
Traction = mid-esophageal
Epiphrenic = above the LES
98
Q

Persistence of the vitelline duct, melena.

A

Meckel’s diverticulum

99
Q

Intussusception is most common at this location:

A

Ileocecal junction

100
Q

“Double bubble” on X-ray:

A

Duodenal atresia

101
Q

Pneumatosis intestinalis in a premie:

A

Necrotizing enterocolitis

102
Q

Abdominal pain out of proportion to physical findings in an elderly person:

A

Ischemic colitis

103
Q

Most common sites for angiodysplasia (3):

A

Cecum, terminal ileum, ascending colon

104
Q

Carcinoid syndrome, 3 associated findings:

A

Bronchospasm
Flushing
Diarrhea
Right sided heart disease / murmur

105
Q

Most common sites for carcinoid tumors (3):

A

Appendix, ileum, rectum

106
Q

Neurotransmitter leading to carcinoid syndrome:

A

5-HT

107
Q

T/F: If a carcinoid tumor is confined to the GI tract, you will not see carcinoid syndrome.

A

T. Liver metabolizes 5-HT. Only mets outside the GI system will cause carcinoid syndrome.

108
Q

Treatment for carcinoid syndrome:

A

Octreotide, somatostatin, find it and cut it out

109
Q

This enzyme is elevated in the serum in mumps infection:

A

Amylase

110
Q

Cause of Reye’s syndrome:

A

Hepatoencephalopathy 2/2 mitochondrial damage in the liver caused by aspirin + viral infection in children

111
Q

Two viruses especially linked to Reye’s syndrome:

A

VZV, influenza B

112
Q

Mallory bodies:

A

Alcoholic hepatitis

113
Q

Does ethanol deplete ALT or AST?

A

ALT. This is the reason why AST > ALT in chronic alcoholic hepatitis.

114
Q

What is the serum albumin ascites gradient? What does it mean to have a value >1.1?

A

SAAG = albumin in serum - albumin in ascites fluid. >1.1 cause is portal HTN, heart failure, Budd-Chiari.

115
Q

A very common cause of GI bleeding among the elderly (excluding colon CA and diverticuar bleeds…):

A

Angiodysplasia

116
Q

Most common cause of appendicitis in children:

In adults:

A 
Children = lymphoid hyperplasia
Adults = fecalith
117
Q

Hirschprung’s disease always involves this segment of the GI tract:

A

Rectum

118
Q

Down syndrome patients are at risk for these GI problems (4):

A

Duodenal atresia
Hirschprung
Celiac
Annular pancreas

119
Q

Angiodysplasia is most common in the [3]:

A

Cecum, terminal ileum, ascending colon

120
Q

Type of colon polyp with greatest malignant potential:

A

Villous adenoma

VILlous VILlain

121
Q

This type of polyp is not a risk for CRC:

A

Hyperplastic

122
Q

Non-malignant hamartomas, hyperpigmented lips, mouth, genitalia:

A

Peutz-Jeghers

123
Q

Peutz-Jeghers is associated with cancer, can you name six?

A 
CRC
pancreatic
small intestinal
stomach
breast
uterine
124
Q

Three big-name genes in CRC:

A

APC
K-RAS
p53

125
Q

FAP with osseous and soft tissue tumors:

A

Gardner’s syndrome

126
Q

FAP with a CNS tumor:

A

Turcot’s syndrome
TURcot’s TURban
Usually a medulloblastoma

127
Q

Lynch syndrome is caused by this defect:

A

DNA mis-match repair

128
Q

Cancer in the most proximal colon is most commonly caused by:

A

HNPCC = Lynch syndrome

129
Q

Good marker for colon CA recurrence:

A

CEA

130
Q

Order of gene events for CRC genesis:

A

APC
K-RAS
p53
AK-53

131
Q

Carcinoid syndrome is caused by excess of this neurotransmitter:

A

5-HT

132
Q

Medical treatment for carcinoid syndrome:

A

Octreotide / somatostatin

133
Q

Tumor of neuroendocrine cells in the appendix might be likely to cause these symptoms:

A 
Carcinoid syndrome, B-FDR:
Bronchospasm (wheezing)
Flushing
Diarrhea
R sided heart murmur
134
Q

Carcinoid syndrome can be observed with a tumor in the GI tract. Explain how this happens:

A

Tumor must have mets to the liver. Liver otherwise metabolizes 5-HT and you do not see carcinoid syndrome from GI-confined cancers.

135
Q

Inflammatory bowel disease with skip lesions and rectal sparing:

A

Chron’s

136
Q

Inflammatory bowel disease associated with primary sclerosing cholangitis:

A

UC

137
Q

Inflammatory bowel disease with rectal involvement:

A

UC

138
Q

Microscopic morphology of Chron’s colon:

Of UC:

A 
Chrons = noncaseating gramulomas, lymphoid aggregates
UC = Crypt abscesses and ulcers, bleeding
139
Q

Cell response mediating disease process in:
Chron’s
UC

A 
Chron's = Th1
UC = Th2
140
Q

Gross morphology of Chron’s colon (2 core features):

A

Cobblestoned, transmural thickening

141
Q

Gross morphology of a colon in UC (3 features):

A

Inflammation is mucosal and sub-mucosal
Friable pseudopolyps
Loss of haustra (lead pipe appearance)

142
Q

Embryonic source of tissue above the pectinate line:

Below the pectinate line:

A

Endoderm

Ectoderm

143
Q

Painful hemorrhoids:

A

External hemorrhoids

144
Q

Represents greatest risk for developing squamous cell CA in the anal region:

A

HPV 16, 18, 31

145
Q

The inferior rectal artery is a branch of:

A

The internal pudendal

146
Q

LLQ pain and bleeding:

A

Diverticulitis

147
Q

Treatment for diverticulitis:

A

Metronidazole (covers anaerobes) +

TMP-SMX or Levo or Cipro

148
Q

This virus is associated with intussusception:

A

Adenovirus

149
Q

5-ASA agents (2):

These are used in treatment of?

A

Mesalazine
Sulfasalazine
Chron’s and UC

150
Q

Most likely underlying cause of gallstones in a patient with Chron’s:

A

Bile acid wasting

Terminal ileum usually resorbs, damage to mucosa = less bile acid with more cholesterol = stones

151
Q

Abdominal discomfort, joint pain, greasy stool, weight loss, macrophages with PAS+ granules in the lamina propria:

A

Whipple disease = Tropheryma whippelii

152
Q

Small intestine mucosa contains PAS+ diestase-resistant granules, macrophages with rod-shaped bacilli:

A

Whipple disease

153
Q

Red-violet, flat, macopapular lesions with hemorrhagic nodules on colonoscopy:

A

Kaposi’s sarcoma

154
Q

Basophilic clusters on surface of intestinal mucosal cells:

A

Cryptosporidium

155
Q

Trophozoites containing RBCs:

A

Entamoeba histolytica

156
Q

H. pylori most highly colonizes this part of the stomach:

A

Antrum

Pre-pyloric area

157
Q

Peri-anal fistula: More characteristic of Chron’s or UC?

A

Chron’s

158
Q

Location of the following ulcers:
Cushing
Curling
Which are more prone to rupture?

A

Cushing = esophagus, stomach, or duodenum
Curling = proximal duodenum
Cushing are more prone to rupture (think increased ICP, more likely to pop)

159
Q

What is the definition of an erosion?

An ulcer?

A 
Erosion = loss of tissue that does not fully extend through the muscularis mucosa
Ulcer = damage extending into the submucosa and beyond.
160
Q

Chron’s disease may be linked to activity of NF-kB. What is this protein responsible for?

A

Chron’s = possible NOD2 defect, turns NF-kB on. NF-kB induces cytokine production.

USMLE Step 1 (18 decks)

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