9. GI Flashcards Preview

Step 1 DIT > 9. GI > Flashcards

Flashcards in 9. GI Deck (84):
1

What is the most common location of salivary gland tumors?

parotid gland

2

What is the most common salivary gland tumor? What is the histological appearance of this tumor?

pleomorphic adenoma (benign)
--> composed of both epithelial and mesenchymal type cells

3

What is the 2nd most common benign salivary gland tumor?

Warthin tumor
(benign cystic tumor where you have double layer of columnar epithelium around the cyst; looks like lymphoid tissue)

4

What is the most common malignant salivary gland tumor (the 2nd most common tumor overall of the salivary gland)?

Mucoepidermoid carcinoma

5

What medication is often used in the treatment of allergic rhinitis, nasal polyps, and eustachian tube dysfunction?

intranasal steroids

6

What are the names of the diverticula found in the esophagus based on their anatomical locations? (3)

- Zenker: immediately above UES
- Traction: mid
- Epiphrenic: immediately above LES

7

What upper GI problem is associated with biopsy of a patient with esophagitis reveals large, pink, intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus?

HSV esophagitis
(punched out ulcers)

8

What upper GI problem is associated with biopsy of a patient with esophagitis revealing enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo?

CMV esophagitis
(linear ulcers)

9

What upper GI problem is associated with an esophageal biopsy revealing a lack of ganglion cells b/w the inner and outer muscular layers?

achalasia

10

What upper GI problem is associated with protrusion of the mucosa in the upper esophagus

plummer-vinson (esophageal webs)

11

What upper GI problem is associated with outpouching of the esophagus found just above the LES?

epiphrenic diverticulum

12

What upper GI problem is associated with goblet cells in the distal esophagus

Barrett esophagus

13

What upper GI problem is associated with a PAS stain on a biopsy from a pt with esophagitis revealing hyphate organisms?

Candida esophagitis (white pseudomembrane)

14

What upper GI problem is associated with esophageal pouch found in the upper esophagus

Zenker diverticulum

15

What disorder is characterized by an excess of gastrin? What is the treatment?

Zollinger Ellison syndrome
Tx: PPI +/- octreotide

16

What receptors found on gastric parietal cells regulate acid secretion? (5)

- H2 receptor (most important)
- CCKb receptor (directly stim by gastrin)
- M3 receptor (directly stim by vagus)
- Prostaglandin receptor (inhibitory)
- somatostatin receptor (inhibitory)

17

What happens to serum pH at the time of gastric acid secretion?

serum pH rises slightly (alkaline)

18

Which antacid can cause diarrhea?

magnesium hydroxide

19

Which antacid can cause constipation?

aluminum hydroxide

20

Which antacid can cause hypercalcemia?

calcium bicarb

21

Which antacids can cause hypokalemia?

all of them

22

A patient taking NSAIDs develops anemia, has pain with eating, and is positive on occult blood test. What drug would most directly address the mechanism behind this patient's current problem?

Misoprostol (PGE2 analog)
--> b/c NSAIDs are blocking prostaglandin production

23

Where is Virchow's node located?

left supraclavicular lymph node (can indicate gastric cancer)

24

What important secretory products are secreted from G cells?

gastrin

25

What important secretory products are secreted from I cells?

CCK

26

What important secretory products are secreted from S cells?

secretin

27

What important secretory products are secreted from D cells?

somatostatin

28

What important secretory products are secreted from gastric parietal cells?

gastric acid, intrinsic factor

29

What GI ligament contains the portal triad and may be compressed to control bleeding?

hepatoduodenal

30

What GI ligament attaches the spleen to the posterior abdominal wall?

splenorenal

31

What GI ligament attaches the spleen to the stomach?

gastrosplenic

32

What is the MoA of metoclopramide?

- antagonist @ D2 receptor
- serotonin agonist

increases contractility in GI tract

33

What serum antibodies are associated with celiac disease?

- anti-gliadin
- anti-tissue transglutaminase

34

What is the tx for celiac sprue?

gluten-free diet

35

What organism is associated with Whipple disease?

Tropheryma whipplei

36

What pathology of the small intestine is associated with small intestinal mucosa laden with distended macrophages in the lamina propria?

Whipple disease

37

What pathology of the small intestine is associated with defect in chylomicron exportation?

Abetalipoproteinemia

38

What pathology of the small intestine is associated with cramping associated with milk products?

lactase deficiency

39

What intestinal disorder is common in the NICU to premature babies that receive oral feeds too soon?

Necrotizing enterocolitis

40

What are the classic symptoms of carcinoid syndrome? (4)

Bronchospasm
Flushing
Diarrhea
Right-sided heart murmur

41

What is the fundamental problem in Hirschsprung disease?

- neural crest cells fail to migrate to the colon
- missing enteric ganglia/nerve plexuses

42

What is the most abundant bacteria in the colon of most individuals?

Bacteroides fragilis

43

Which pathological lesions of the colon are considered precursors to malignancy? which colon pathology has the most malignant potential?

- adenomatous polyps
- villous adenomas have highest malignant potential

44

What gene mutations are commonly seen in the development of colorectal cancer?

1. loss of APC gene --> KRAS mutation --> loss of tumor suppressor genes (p53, DCC)

2. dysfunction of DNA mismatch repair enzymes (Lynch)

45

What is the treatment for diverticulitis?

- metronidazole with
- fluoroquinolone or TMP-SMX

46

Determine which of the following characteristics are associated with Crohn's disease, UC or both
- skip lesions

crohn's

47

Determine which of the following characteristics are associated with Crohn's disease, UC or both
- loss of haustra

UC

48

Determine which of the following characteristics are associated with Crohn's disease, UC or both
- fistulas

Crohn's

49

Determine which of the following characteristics are associated with Crohn's disease, UC or both
- increased risk of colorectal cancer

both (but UC > crohn's)

50

Determine which of the following characteristics are associated with Crohn's disease, UC or both
- noncaseating granulomas

crohn's

51

Determine which of the following characteristics are associated with Crohn's disease, UC or both
- associated with primary sclerosing cholangitis

UC

52

Determine which of the following characteristics are associated with Crohn's disease, UC or both
- associated with ankylosing spondylitis

both

53

Which hormones stimulate pancreatic secretion? (3)

- CCK
- Secretin (=> bicarb secretion)
- ACh (vagus nerve; technically not hormone)

54

What enzyme catalyzes the rate-limiting step in carbohydrate digestion?

oligosaccharide hydrolases (ex. sucrase) found @ intestinal brush border

55

What are the typical presentation of a pt with pancreatic insufficiency?

- diarrhea
- steatorrhea
- malabsorption
- wt loss
- deficiency of fat-soluble vitamins (A, D, E, K)

56

What is the treatment for pancreatic insufficiency?

- limit fat intake
- pancreatic enzyme supplements
- fat-soluble vitamin supp.

57

From which embryonic germ layer is the liver derived?

endoderm

58

What 3 structures make up a portal triad?

1. branch of hepatic artery
2. branch of portal vein
3. bile ductule

59

Where is the portal triad located relative to the flow of arterial blood and the flow of bile?

blood flows away from triad
bile flows towards triad

60

What enzyme is responsible for the conjugation of bilirubin?

UDP-glucoronyl transferase

61

Which hereditary hyperbilirubinemia matches mildly decreased UDP-GT?

Gilbert

62

Which hereditary hyperbilirubinemia matches completely absent UDP-GT?

Crigler Najjar type 1

63

Which hereditary hyperbilirubinemia matches grossly black liver?

Dubin-Johnson

64

Which hereditary hyperbilirubinemia responds to phenobarbital?

CN type 2

65

Which hereditary hyperbilirubinemia matches treatment that includes plasmapheresis and phototherapy?

CN type 1

66

Which hereditary hyperbilirubinemia is asymptomatic unless under physical stress (ex. alcohol, infection)?

gilbert

67

What cocktail of medication is commonly taken by pts suffering from severe cirrhosis?

- diuretics
- beta blockers
- vit K
- lactulose

68

What conditions are associated with Budd-Chiari syndrome? (3)

- occlusion of IVC, hepatic veins
- associated with polycythemia vera, pregnancy, HCC

69

What is the mechanism by which aspirin can cause Reye syndrome?

- aspirin metabolites inhibit mitochondrial enzymes
- decreased beta-oxidation

70

A young man presents with ataxia and tremors. He has brown pigmentation in a ring around the periphery of his cornea. What treatment should he receive?

penicillamine

71

What is the underlying problem in Wilson disease?

impaired copper excretion into bile
- copper accumulation

72

What is the classic triad of symptoms in hemochromatosis?

Bronze diabetes
- diabetes
- bronzing of skin
- cirrhosis

73

What lab tests are used to diagnose hemochromatosis?

- elevated ferritin, transferritin saturation, serum iron
- decreased TIBC

74

What is the treatment for hemochromatosis?

- repeated phlebotomy
- also can chelate with deferoxamine

75

Which hep viruses are transmitted through the fecal/oral route?

Hep A, Hep E

76

Which antibodies can be used to help make the diagnosis of autoimmune hepatitis type 1?

ANA, anti-smooth muscle ab

77

Which antibodies can be used to help make the diagnosis of autoimmune hepatitis type 2?

- anti-liver-kidney microsomal ab
- anti-liver cytosol ab

78

Identify the hepatitis B status based on serologic markers
- Hep BsAg neg
- Hep BsAb positive
- Hep BcAb positive

recovered

79

Identify the hepatitis B status based on serologic markers
- Hep BsAg neg
- Hep BsAb neg
- Hep BcAb positive

window

80

Identify the hepatitis B status based on serologic markers
- Hep BsAg pos
- Hep BsAb neg
- Hep BcAb positive IgM

acute

81

Identify the hepatitis B status based on serologic markers
- Hep BsAg pos
- Hep BsAb neg
- Hep BcAb positive IgG

chronic

82

Identify the hepatitis B status based on serologic markers
- Hep BsAg neg
- Hep BsAb positive
- Hep BcAb neg

immunized

83

What is the fate of bilirubin after its conjugated and secreted into the GI tract?

- bacteria in the colon converts it to UROBILINOGEN
--> most excreted in stool as STERCOBILIN
--> some reabsorbed and recycled into bile
------> tiny amt excreted in urine as UROBILIN

84

What is the diff. between primary biliary cirrhosis and primary sclerosing cholangitis?

PBC:
- autoimmune disease
- (+)ANA
- middle-age women

PSC:
- (+)pANCA
- men over 40
- associated with ulcerative colitis and cholangiocarcinoma