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USMLE STEP 1 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

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1
Q

The most common cause of acute abdomen

A

appendicitis

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2
Q

Appendicitis- causes

A

1) lymphoid hyperplasia (children)

2) fecaliths (adult)

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3
Q

Appendicitis- presentation

A

periumbilical pain migrating to RLQ pain, nausea, guarding, rebound tenderness, periappendiceal abscess (complication)

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4
Q

Ulcerative colitis- distribution of inflammation

A

Ulceration in the mucosa and submucosa, usually extending contiguously from the rectum. May go up to cecum.

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5
Q

Ulcerative colitis- presentation

A

Bloody diarrhea, LLQ pain

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6
Q

Ulcerative colitis- histology

A

Crypt abscesses with neutrophils

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7
Q

Ulcerative colitis- gross and radiological findings

A

Pseudopolyps, loss of haustra (“lead pipe” appearance on imaging)

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8
Q

Ulcerative colitis- complications

A

Toxic megacolon, carcinoma

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9
Q

Ulcerative colitis- associated disorders

A

primary sclerosing choleangitis, p-ANCA positivity

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10
Q

Crohn’s disease- distribution of inflammation

A

full thickness from mouth to anus, often with skip/patchy distribution. Often involves ileum; rarely involves rectum.

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11
Q

Crohn’s disease- presentation

A

non-bloody diarrhea, RLQ pain

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12
Q

Crohn’s disease- histology

A

lymphoid aggregates, non-caseating granulomas

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13
Q

Crohn’s disease- gross and radiological findings

A

cobblestone mucosa, creeping fat, strictures (string-sign with barium)

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14
Q

Crohn’s disease- complications

A

malabsorption, vitamin D and B12 deficiency, calcium oxalate nephrolithiasis, fistulas, cancer

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15
Q

Crohn’s disease- associated disorders

A

ankylosing spondylitis, sacroiliitis, migratory polyarthritis, erythema nodosum, uveitis

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16
Q

Duodenal atresia- etiology

A

failure of canalization in the duodenum

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17
Q

Duodenal atresia- association

A

Down Syndrome

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18
Q

Duodenal atresia- presentation

A

polyhydramnios, bilious emesis, “double-bubble” sign

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19
Q

Meckel diverticulum- etiology

A

failure of vitelline duct to invaginate

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20
Q

Meckel diverticulum- presentation

A

Symptoms: Often asymptomatic, or bleeding, volvulus, intussusception, or obstruction during first 2 years of life.
Clinical: stool-like feeling in area of umbilicus. 2 inches long in the small bowel within 2 feet of the ileocecal valve.

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21
Q

Volvulus- etiology

A

Twisting of bowel along its mesentery, leading to obstruction and infarction

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22
Q

Volvulus- location

A

Sigmoid in elderly; cecum in young adults

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23
Q

Intussusception sign

A

Currant jelly stool (due to infarction)

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24
Q

Intussusception causes

A

Lymphoid hyperplasia in children (e.g. virus); tumor in adults

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25
Transmural small bowel infarction- causes
Embolism/thrombosis of superior mesenteric artery or thrombosis of superior mesenteric vein
26
Mucosal small bowel infarction- causes
Marked hypotension
27
Small bowel infarction- presentation
Abdominal pain, bloody diarrhea, decreased bowel sounds
28
Causes of lactose intolerance
Congenital (rare), aging, post-infectious (transient)
29
Test to rule out celiac
(Negative for) HLA-DQ2 and HLA-DQ8
30
Celiac- laboratory testing
IgA to tTG, gliadin, endomysium. If IgA is low (common in celiac), check IgG.
31
Celiac- histology findings
Flattening of villi, hyperplasia of crypts, and intraepithelial lymphocytes. Mostly in the duodenum.
32
Celiac- complications
Small bowel carcinoma, enteropathy-associated T cell lymphoma (EATL)
33
Tropical sprue- key differences with celiac sprue
Caused by an unknown organism, follows infectious diarrhea, primarily affects jejunum and ileum (rather than duodenum), and responds to antibiotics
34
Whipple disease-etiology
Systemic tissue damage. Tropheryma whipplei bacteria are incorporated into macrophages in the lamina propria. These macrophages compress the lacteals and cause fat malabsorption.
35
Whipple disease- locations outside of GI system
synovium, cardiac valves, lymph nodes, CNS
36
Abetalipoproteinemia- inheritance and etiology
autosomal recessive deficiency of apolipoproteins B-48 and B-100. B-48 is needed to make chylomicrons, leading to fat malabsorption. B-100 is needed to make VLDL and LDL, so these are absent.
37
Carcinoid tumor- cell type
neuroendocrine cells
38
Carcinoid tumor- stain
chromogranin, synaptophysin, cytokeratin
39
Carcinoid tumor- most common GI location
small bowel
40
Why isn't there carcinoid syndrome if it is confined to the small intestine?
5-HT is metabolized to by 5-HIAA by MAO in the liver after going through portal circulation.
41
Carcinoid syndrome- symptoms
Bronchospasm, diarrhea, flushing
42
Carcinoid syndrome- aggravating factors
Emotional stress and alcohol
43
Carcinoid syndrome- cardiac effects and tumor location if these are present
Fibrosis, deposition of collagen within valves of right heart. Tricuspid regurgitation, pulmonary stenosis. Left side unaffected due to MAO in lungs. Tumor located in liver (hepatic vein drains to IVC).
44
Rovsing's sign and significance
Pushing on left side of abdomen hurts right side of abdomen; appendicitis (severe)
45
McBurney's point and significance
2/3 laterally on imaginary line from umbilicus to ASIS; appendicitis
46
Murphy's sign significance
Gallbladder (or liver) inflammation
47
Hinchey stages and their use
Diverticulitis. 1) small abscess 2) large abscess 3) gaseous release outside colon wall 4) fecal discharge outside colon wall
48
Diverticulitis- antibiotic combinations
1) metronidazole + quinolone 2) metronidazole + 3rd generation cephalosporin 3) Beta-lactam + beta-lactamase inhibitor (Augmentin)
49
Paralytic ileus causes
iatrogenic/surgery, narcotics, calcium channel blockers, hypokalemia
50
Inflammatory pseudopolyps- histology
granulation tissue, inflammatory infiltrate
51
Hamartomatous polyps- histology
"arborizing" smooth muscle divides glands and crypts
52
Juvenile/retention polyps- histology
cystic glands, stromal edema, inflammation, surface ulceration
53
Juvenile polyposis syndrome- genes and inheritance
Autosomal dominant; usually SMAD4 or BMPR1A, sometimes PTEN
54
Juvenile polyposis syndrome- associations
pulmonary arteriovenous malformation
55
Cronkite-Canada syndrome- presentation
Like juvenile polyposis in older individual. Abnormal intervening mucosa (unlike JP), diarrhea, weight loss, and symptoms with hair, skin, and nails.
56
Peutz-Jeghers syndrome- presentation
Hamartomatous polyps throughout GI tract, mucocutaneous hyperpigmentation on buccal mucosa and genitals
57
Peutz-Jeghers syndrome- genes and inheritance
Autosomal dominant; LKB1/STK11
58
Cowden syndrome- genes and inheritance
Autosomal dominant; PTEN (chromosome 10)
59
Cowden syndrome- associations
Macrocephaly, Lhermitte-Duclos disease, benign skin tumors, thyroid tumors, breast tumors, endometrial tumors, Bannayan-Ravulcaba-Riley syndrome
60
Bannayan-Ravulcaba-Riley syndrome
Cowden syndrome + developmental delay
61
Familial adenomatous polyposis- genes and inheritance
APC (autosomal dominant) or MUTYH (autosomal recessive)
62
Familal adenomatous polyposis- associations
Gardner syndrome, Turcot syndrome, congenital retinal pigment epithelial hypertrophy
63
Gardner syndrome
FAP + fibromatosis + osteomas
64
Turcot syndrome
FAP + CNS tumors (medulloblastoma and glial tumors)
65
Hereditary non-polyposis colon cancer (Lynch) syndrome- genes and inheritance. What do the respective proteins do?
Autosomal dominant; usually MSH2 or MLH1 (DNA mismatch repair genes)
66
Adenoma-adenocarcinoma sequence (GI)- steps
1) APC mutation increases the risk of polyps. 2) KRAS mutation allows formations allow of polyps 3) p53 mutation and increased COX expression cause cancer
67
APC chromosome location
Chromosome 5
68
Hereditary non-polyposis colon cancer (Lynch) syndrome- presentation
Fewer polyps that familial adenomatous polyposis, colorectal cancer on the RIGHT side at a young age, sometimes Turcot syndrome
69
Adenoma-adenocarcinoma sequence (GI)- side
Usually causes left side tumors
70
Colonic carcinoma is associated with an increased risk of what infection?
Streptococcus bovis endocarditis
71
Left side colorectal cancer- symptoms
"Napkin ring" lesion causes reduced stool caliber, LLQ pain, blood streaking on stool
72
Right side colorectal cancer- symptoms
Iron deficiency anemia (slow bleeding), vague pain
73
What is CEA good for in colorectal cancer?
Monitoring treatment response and recurrence.
74
What is CEA NOT good for in colorectal cancer?
Screening for colorectal cancer
75
Right side colorectal cancer- cause
Microsatellite instability sequence
76
Left side colorectal cancer- cause
Adenoma-adenocarcinoma sequence
77
Simplified colorectal cancer staging
Stage 1: small tumor Stage 2: big tumor Stage 3: regional lymph node involvement Stage 4: metastasis
78
Carcinoid tumor- appearance
non-pedunculated bumps with yellow cut surface
79
Mucus-associated lymphoid tissue (MALT) lymphoma- risk factors
H. pylori infection, chronic inflammation
80
Mucus-associated lymphoid tissue (MALT) lymphoma- complications
De novo change to diffuse B cell lymphoma
81
Mucus-associated lymphoid tissue (MALT) lymphoma- cell markers
CD20+, CD5-, CD10-
82
Gastrointestinal stromal tumor (GIST)- origin
Interstiitial cells of Cajal
83
Gastrointestinal stromal tumor (GIST)- targeted treatment
Imatinib if c-kit+ (CD117) or PGDFRA+
84
Pancreatic cancer- metastastis mechanism
Epithelial-to-mesenchymal transition (EMT)
85
When is ectopic gastric or pancreatic tissue observed?
Meckel (ilieal) diverticulum
86
Mechanism of osteoporosis in celiac sprue
1) Decreased small bowel absorption of calcium and vitamin D cause osteomalacia 2) Cross-reacting antibodies to osteoprotegerin result in increased osteoclast activation via RANKL
87
Plummer vinson syndrome triad
Iron-deficiency anemia, atrophic glossitis, esophageal web
88
Plummer vinson syndrome association
increased risk of squamous cell carcinoma of the esophagus

USMLE STEP 1 (24 decks)

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