Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

USMLE® Step 1 > USMLE (S1) Gastrointestinal > Gastro - Pathology (Part 3) > Flashcards

Gastro - Pathology (Part 3) Flashcards

1
Q

What is the finding seen in this image and what is the associated disease?

A

String sign; Crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pictured is the large intestine of a 25-year-old female with a history of bloody diarrhea and weight loss. What is the likely diagnosis?

A

Ulcerative colitis (pseudopolyps)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the name for this classic ocular finding, and with which disease is it associated?

A

Kayser-Fleischer ring; associated with Wilson’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What cancer is associated with Wilson’s disease?

A

Hepatocellular carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What movement disorder is associated with Wilson’s disease?

A

Choreiform movements due to preferential copper deposition in the basal ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

With what medication are patients with Wilson’s disease treated?

A

Penicillamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

With what pattern of inheritance is Wilson’s disease passed?

A

Autosomal recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What specific type of anemia is associated with Wilson’s disease?

A

Hemolytic anemia (remember ABCD to recall the other common findings: Asterixis, Basal ganglia degeneration, Ceruloplasmin [decreased], Cirrhosis, Corneal deposits, Copper accumulation, Carcinoma (hepatocellular), Choreiform movements, and Dementia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A 30-year-old patient presents with new-onset dementia, choreiform movements, and flapping hand tremor; he also has severely elevated liver enzymes and discolored rings around his irises on ocular exam. What lab results will confirm the diagnosis? How will you treat the patient?

A

This patient has Wilson’s disease. Decreased ceruloplasmin; chelation with penicillamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hemochromatosis classically affects what three organs?

A

Liver, skin, and pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hemochromatosis classically causes what liver finding?

A

Micronodular cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A man presents to the office with new-onset insulin-dependent diabetes. His skin is darkly pigmented and he is found to have elevated liver enzymes. What is his likely diagnosis?

A

Hemochromatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Iron deposition in the heart due to hemochromatosis can lead to what condition?

A

Congestive heart failure secondary to restrictive cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hemochromatosis is associated with an increased risk of what cancer?

A

Hepatocellular carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

With what pattern of inheritance is primary hemochromatosis passed?

A

Autosomal recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

True or False: It is possible to develop hemochromatosis without being genetically predisposed to the disease.

A

True (secondary hemochromatosis); due to recurrent blood transfusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the most common cause of secondary hemochromatosis?

A

Chronic transfusion therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe ferritin capacity, iron capacity, and total iron-binding capacity and transferrin saturation in patients with hemochromatosis.

A

High; high; low; high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What two treatments are often used for hemochromatosis?

A

Repeated phlebotomy and deferoxamine chelation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hemochromatosis is associated with what genetic marker?

A

Human leukocyte antigen A3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Is primary sclerosing cholangitis intrahepatic, extrahepatic, or both?

A

Both; the entire biliary tree is affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the underlying change in primary sclerosing cholangitis?

A

Fibrosis of the bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is likely to be found on biopsy of a patient with primary biliary cirrhosis?

A

Lymphocytic infiltrate and granulomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the appearance of primary sclerosing cholangitis on endoscopic retrograde cholangiopancreatography?

A

Alternating strictures and dilation of the bile ducts, which is also called “ beading”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which symptoms are common in the presentation of biliary tract disease?

A

Jaundice, light stool, pruritus, dark urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What disease is associated with primary sclerosing cholangitis?

A

Ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which autoantibodies are seen in the serum of patients with primary biliary cirrhosis?

A

Antimitochondrial antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

The biliary stasis caused by PSC can be so severe as to cause liver failure, a process known as what?

A

Secondary biliary cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What abnormal lab results are common to most forms of biliary tract disease?

A

Increased conjugated bilirubin, cholesterol, and alkaline phosphatase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Primary biliary cirrhosis is commonly associated with what autoimmune disorders?

A

Rheumatoid arthritis, CREST syndrome, celiac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What class of immunoglobulin is elevated in primary sclerosing cholangitis?

A

Immunoglobulin M

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What causes secondary biliary cirrhosis?

A

Extrahepatic biliary obstruction

33
Q

In secondary biliary cirrhosis, increased pressure in the intrahepatic ducts leads to what?

A

Hepatic injury and fibrosis

34
Q

Secondary biliary cirrhosis is often complicated by what infectious process?

A

Ascending cholangitis, a bacterial infection facilitated by biliary stasis

35
Q

Disproportionately high amounts of _____ and/or _____ in bile tend to favor the formation of gallstones.

A

Cholesterol; bilirubin

36
Q

Which substances in bile increase the solubility of bilirubin and cholesterol to prevent formation of gallstones?

A

Bile acid and lecithin

37
Q

List the two types of gallstones.

A

Cholesterol stones and pigment stones

38
Q

Are most cholesterol stones radiolucent or radiopaque?

A

Radiolucent; as a result, ultrasound is the preferred method of imaging

39
Q

About what percent of cholesterol stones are radiopaque?

A

10% to 20%

40
Q

Why are some cholesterol stones radiopaque?

A

Calcified stones are radiopaque

41
Q

Why does Crohn’s disease predispose patients to gallstones?

A

Because of the inability of the diseased terminal ileum to absorb bile salts

42
Q

List the risk factors associated with formation of cholesterol stones.

A

Obesity, Crohn’s disease, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, and Native American origin

43
Q

What percentage of gallstones are cholesterol stones?

A

80%

44
Q

Are pigment stones radiolucent or radiopaque?

A

Radiopaque

45
Q

A patient presents with right upper quadrant pain, jaundice, and fever. He is found to have gallstones on ultrasound and a high white blood cell count. What is the likely diagnosis?

A

Acute cholangitis

46
Q

In addition to biliary infections, what two other medical conditions are associated with pigment stone formation?

A

Chronic RBC hemolysis and alcoholic cirrhosis

47
Q

Gallstones are best diagnosed by what radiologic modality?

A

Ultrasound

48
Q

Symptomatic gallstones are treated with _____.

A

Cholecystectomy

49
Q

Gallstones can cause what four major complications?

A

Ascending cholangitis, acute pancreatitis, bile stasis, and cholecystitis

50
Q

Define biliary colic.

A

Pain caused by gallstones interfering with bile flow, causing bile duct contraction

51
Q

In what population of patients is biliary colic uncommon?

A

Diabetic patients; neuropathy can reduce the sensation of pain from gallstones

52
Q

What radiographic finding is associated with obstruction of the ileocecal valve by a gallstone?

A

Air in the biliary tract (also known as pneumobilia)

53
Q

Name the “four F’s” associated with increased risk of developing gallstones.

A

Female, fat, fertile, and forty

54
Q

Name the components of Charcot”s triad of symptoms of cholangitis.

A

Jaundice, fever, and right upper quadrant pain

55
Q

A patient presents complaining of abdominal pain. On deep palpation of the right upper quadrant, she appears to hold her breath. Name this finding.

A

The patient has a positive Murphy’s sign, which is inspiratory arrest on deep palpation

56
Q

Name three possible causes of cholecystitis.

A

Gallstones (most common), infection (cytomegalovirus), ischemia

57
Q

Define the pathophysiology of acute pancreatitis.

A

Pancreatic enzymes become activated leading to the autodigestion of the pancreas

58
Q

List the causes of acute pancreatitis.

A

Gallstones, ethanol, trauma, steroids, mumps, autoimmune disease, scorpion sting, hypercalcemia/hyperlipidemia, drugs (sulfa drugs) (remember: GET SMASHeD)

59
Q

What pattern of pain is characteristic of acute pancreatitis?

A

Epigastric pain that radiates to the back

60
Q

What two laboratory findings are classically diagnostic of acute pancreatitis?

A

Elevated amylase and lipase

61
Q

Which has higher specificity for acute pancreatitis: amylase or lipase?

A

Lipase

62
Q

What are complications of acute pancreatitis?

A

Disseminated intravascular coagulation, acute respiratory distress syndrome, hypocalcemia, diffuse fat necrosis, pseudocyst formation, hemorrhage, infection, multisystem organ failure

63
Q

Chronic calcifying pancreatitis is strongly associated with what condition?

A

Alcoholism

64
Q

What is the mechanism causing hypocalcemia in acute pancreatitis?

A

Ca2+ collects in pancreatic calcium soap deposits, causing hypocalcemia

65
Q

Chronic pancreatitis leading to pancreatic insufficiency results in what constellation of symptoms?

A

Steatorrhea, fat-soluble vitamin deficiency, and diabetes mellitus

66
Q

Is acute or chronic pancreatitis associated with an increased risk of pancreatic cancer?

A

Chronic

67
Q

What is the average survival of a person newly diagnosed with pancreatic adenocarcinoma?

A

Six months or less

68
Q

A patient presents with weight loss, night sweats, and painless jaundice. He is found to have a mass on his pancreas suspicious for malignancy. What is the most likely location of the mass?

A

The head of the pancreas

69
Q

A mass is found on the head of the pancreas of a patient. What abnormal lab findings would be found in this patient?

A

Increased alkaline phosphatase and bilirubin levels indicating obstructive jaundice

70
Q

True or False? Pancreatic adenocarcinoma often presents with inguinal lymphadenopathy.

A

False; presentation typically includes abdominal pain that radiates to the back, weight loss, migratory thrombophlebitis, and obstructive jaundice

71
Q

What is an abdominal exam finding in a patient with pancreatic adenocarcinoma?

A

Courvoisier’s sign (palpable gallbladder)

72
Q

When migratory thrombophlebitis is noted in patients with pancreatic adenocarcinoma, it is called what?

A

Trousseau’s syndrome

73
Q

What two ethnic groups have an increased risk of pancreatic cancer? Male or female?

A

Jewish and African-American males

74
Q

Name two tumor markers associated with pancreatic cancer.

A

Carcioembryonic antigen and carbohydrate antigen 19-9

75
Q

True or False? Pancreatic cancer has a strong association with alcohol abuse.

A

False; pancreatic cancer has been linked to cigarette smoking

76
Q

What is the inheritance pattern for familial adenomatous polyposis ?

A

It is inherited in an autosomal dominant fashion. Afflicted individuals inherit one faulty copy of the gene and lose the other through an acquired mutation; this is two-hit hypothesis

77
Q

A patient with this finding after liver biopsy is at increased risk for which malignancy?

A

Hepatocellular carcinoma

78
Q

What prognosis does a patient with this liver pathology have?

A

Good; the macrovesicular fatty change may reverse with cessation of alcohol intake

USMLE (S1) Gastrointestinal (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions