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COMLEX STEP 1 2017 > GI > Flashcards

GI Flashcards

1
Q

T cell lymphoma is related to which GI disease?

A

Celiac disease

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2
Q

What substance is the drug Octreotide most similar to? which diseases is it used for?

A

Somatostatin

-Acromegaly, carcinoid tumor, VIPoma

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3
Q

What GI disease is associated with Fistulas, Noncaseating granulomas, Skip lesions, Transmural inflammation?

A

Crohn’s disease

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4
Q

what GI disease is related to Crypt abscesses?

A

Ulcerative colitis

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5
Q

Which nerve is responsible for the taste in the anterior 2/3rds of tongue?

A

Facial nerve (CN VII)

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6
Q

What nerve is responsible for sensation in the anterior 2/3rds of tongue?

A

Mandibular N (CN V3) - from trigeminal N.

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7
Q

What nerve is responsible for taste and sensation in the posterior 1/3 of tongue?

A

Glossopharyngeal N (CN IX)

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8
Q

What is the most common benign tumor of the parotid gland?

A

pleomorphic adenoma

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9
Q

What Abs are associated with Celiac disease?

A

Anti-endomysial Abs
Anti-Transglutaminase Abs
Anti-deamidated gliadin peptide antibodies

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10
Q

What microbial colonization is associated with Colon cancer?

A

Streptococcus bovis

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11
Q

What is the activity of Vasoactive intestinal peptide?

A
  • smooth muscle relaxation
  • water secretion into pancreatic juice/bile
  • inhibits gastric acid secretion and absorption from intestinal lumen
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12
Q

What is a Sudan III stain used for?

A

identify unabsorbed fat and confirm malabsorption

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13
Q

identify:

extensive lymphocyte infiltration and granulomatous destruction of interlobular bile ducts

A

Primary biliary cirrhosis

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14
Q 
identify:
Middle aged woman
Fatigue and pruritus (worse at night)
Hepatosplenomegaly, cholestasis (jaundice, pale stool, dark urine)
Malabsorption of ADEK
xanthelasma formation
A

Primary Biliary cirrhosis

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15
Q

What is the first line treatment for Ulcerative Colitis?

A

5-aminosalicylic acid (5-ASA)

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16
Q

What renal dysfunction is associated with Crohn’s?

A

Calcium oxalate stones

-gut cant absorb all fats, so fat binds to calcium in stomach, leaves oxalate free to deposit in kidney

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17
Q

What are gastric ulcers most commonly found in the stomach?

A

Lesser curvature

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18
Q

What are liver biopsy finding early in Wilson Disease?

A

Macrovesicular steatosis

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19
Q

How is the diagnosis of Acute diverticulitis made?

A

CT of abdomen

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20
Q

What is the most common GI disorder associated with Down Syndrome?

A

Duodenal Atresia - failure of recanalization

  • double bubble sign
  • bilious emesis
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21
Q

35 year old woman present with severe heartburn
has facial telangiectasias
ulcers on tips of fingers
small calcium deposits in the soft tissues of hands and elbows

What is causing her heartburn?
underlying disease?

A

Fibrous replacement of the muscularis in the LES

CREST Syndrome
Calcinosis
Raynauds
Esophageal Dysmotility (atrophy, fibrous replacement)
Sclerodactyly
Telangiectasia

finger ulcers are from chronic inflammation, vascular injury - ischemia

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22
Q

55 year old male present with worsening indigestion. epigastric tenderness
firm rubbery, mobile mass over left clavicle
pt has lost 25lbs since last appointment

what is most likely diagnosis?

A

gastric adenocarcinoma

mobile mass = supraclavicular lymphadenopathy on left hand side - VIRCHOW’s NODE

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23
Q

Patient present with chronic gnawing abdominal pain. pain starts within a few hours after a meal. Epigastric tenderness. Urea breath positive.
Patient is prescribed a drug that improves Sx but darkens stool and tongue

identify drug

A

Bismuth subsalicylate

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24
Q

pt presents with constipation, says over past 8 months stools have become smaller and smaller
12 lb weight loss since last visit
Contrast imaging shows “apple core” lesion

identify disease and underlying mechanism

A

Adenocarcinoma of colon

loss of APC gene (tumor suppressor)

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25
Q

Neonate drools, chokes, and vomit with first feeding
cyanotic when baby is feeding
very round and full abdomen

identify dz and related intrauterine causes

A

Tracheoesophageal fistula

a/w polyhydramnios in utero

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26
Q

small bowel coming straight off cecum and twisted around a marginal artery or around left branch of ileocolic artery

identify dz and cause

A

Jejunal and ileal atresion

–disruption of mesenteric vessels = ischemic necrosis = segmental resorption

“APPLE PEEL ATRESIA”

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27
Q

infantile dysphagia - nonbilious projective vomiting
palpable olive mass in epigastric region

identify dz, associated cause, and resulting electrolyte disturbances

A

Pyloric stenosis

a/w Macrolide exposure

Hypokalemic, Hypochloremic metabolic alkalosis (secondary to vomiting)

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28
Q

what is the embryonic origin of the spleen, what is blood supply

A 
Mesoderm
foregut supply (celiac - splenic A)
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29
Q

What are the 3 structures contained in the hepatoduodenal ligament?

A

Proper hepatic artery
Portal Vein
Common bile duct

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30
Q

What are the layers of the gut wall? (from inside to outside)

which 2 layers are the 2 nervous supply located? what are their functions

A

MSMS

  1. Mucosa
  2. Submucoa - MeiSSner plexus - secretes fluid
  3. Muscularis externa - Auerbach - motility
  4. Serosa (intraperitoneal), Adventitia (retroperitoneal)
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31
Q

Skin hyper pigmentation
Diabetes Mellitus
hepatomegaly (MICROnodular cirrhosis)

what is the most effective treatment?

A

Hemochromatosis

abnormally high iron GI absorption

Tx: phlebotomy

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32
Q

What is the therapy for hepatic encephalopathy? what other drug (mechanism?) is this typically coupled with?

A

RIFAXIMIN (or neomycin) - nonabsorbable abx that alters GI flora to decrease production of ammonia

used in addition to LACTULOSE (increases conversion of ammonia to ammonium) - acidifies colon contents

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33
Q

Pt presents with bloating and multiple watery diarrhea w/o blood.
Had gastric bypass surgery 3 years ago
Jejunal aspirate shows bacterial count >10^5 (small intestinal bacterial overgrowth)
what is probably increased in the patients serum?

A

Small intestinal bacterial overgrowth (SIBO)
Increased: Vit K, Folate (produced by enteric bacteria)

Decreased: Cobalamin, Vit A,D,E, iron, zinc

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34
Q

What is the mechanism and use of Diphenoxylate, Loperamide?

A

opioid anti-diarrheal agent - Slows motility

used in IBS

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35
Q

A patient who has been losing weight for a movie role presents with severe nausea, recurrent bilious vomiting. Began as postprandial epigastric pain and early satiety. Angle between SMA and aorta is diminished. What is the problem?

A

Small bowel obstruction:

Transverse part of the duodenum is pinched between SMA and aorta due to low visceral fat

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36
Q

pt has pmh of recurrent respiratory infections and chronic diarrhea. current meds: pancreatic enzyme therapy and dietary supplements:

Presents with decreased lower extremity proprioception and hyporeflexia. Labs shows mild hemolytic anemia
What is deficient in the patient

A

PMH: probably has CF w exocrine pancreatic insufficiency (malabsorption of ADEK)

Vit E deficiency = neuromuscular dz, hemolytic anemia
–cell membranes are predisposed to oxidative injury. long axons (large surface area) are easily damaged

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37
Q

Where is a Zenker diverticulum located? What is the underlying cause?

A

False diverticulum of upper esophagus

caused by Cricopharyngeal motor dysfunction

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38
Q

A mutation in which genes will cause a patients small early colon adenoma to:

  1. grow and develop late adenoma features
  2. transform into a carcinoma
A
  1. KRAS

2. TP53

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39
Q

65 year old presents with progressive weightloss, jaundice, anorexia for last 3 months
Urine has been dark, stools pale
Gallbladder is palpably large but nontender

what has happened?

A

palpable but nontender gallbladder = Courvoisier sign, weightloss, Painless Jaundice (pruritis, dark urine, pale stool) =
Adenocarcinoma at head of pancreas compressing common bile duct

40
Q

What is the venous drainage of the rectum above the pectinate line?

what is the lymphatic drainage?

A

Superior rectal vein, inferior mesenteric vein, portal system

Drains to internal iliac lymph nodes

41
Q

What is the venous drainage of the anus below the pectinate line?

what is the lymphatic drainage?

A

inferior rectal vein - internal pudenal vein - internal iliac vein - common iliac vein - IVC

drains to superficial inguinal lymph nodes

42
Q

How do the following Zones differ in the Liver: (from portal veins to central vein)

  1. Zone I
  2. Zone II
  3. Zone III
A
  1. periportal zone: first affected by viral hepatitis, ingested toxins (cocaine)
  2. intermediate zone: Yellow fever
  3. Centrilobular: 1st affected by ischemia, contains cytochromc P-450, most sensitive to metabolic toxins
    Site of ALCOHOLIC hepatitis
43
Q

What mechanism is the most responsible in down regulating gastric acid production after a meal?

A

Intestinal influences - ileum and colon release Peptide YY which bind on Enterchromaffin cells (ECLs) - this inhibits gastrin-stimulated histamine release from ECL’s

also: somatostatins and prostaglandin

44
Q

A patient with liver cirrhosis presents with gynecomastia, what other finding a/w liver cirrhosis is produced by the same mechanism causing his gynecomastia?

A

Spider Angiomata - occur in hyperestrogenic states (eg pregnancy)

Hyperestrinism (increased adrenal production of androstenedione with aromatization into estrone into estradiol)

45
Q

Increased activity of what enzyme is a/w many forms of colonic adenocarcinoma and in inherited polyposis syndromes?

A

COX-2

regular aspirin is a/w lower rates of colonic adenoma and adenocarcinoma

46
Q

Woman diagnosed with Crohns presents with dull RUQ abdominal pain that radiates to right shoulder. happens after fatty meals. Abd US shows multiple mobile calculi in gallbladder. What is causing the calculi formation?

A

Increase bile wasting (decreased absorption in the terminal ileum from Crohns)

Cholesterol/(Bile + Phosphatidylcholine)

  • –the higher the number gets the greater chance of gallstone formation
  • -in this case its DECREASED BILE
47
Q

Patient with fever, anorexia, nausea, myalgia, arthralgia, rash. Tender hepatomegaly jaundice. Elevated serum ALT. Recent history of surgery. What happened? what is an additional serum finding?

A 
Inhaled-anesthetic hepatotoxicity (Halothane)
prolonged PT (hepatic failure, deficiency of factor VII)

CENTRILOBULAR Necrosis, shrunken liver on autopsy

48
Q

What enzyme plays an important role in the formation of brown pigment stones?

A

Brown Stones are associated with biliary tract infection

microbes with B-GLUCURONIDASES break down direct bilirubin into INDIRECT BILIRUBIN

= calcium bilirubinate precipitation

49
Q

What surgical landmark is useful in identifying the appendix?

A

Taenia Coli - all 3 meet at the appendix

50
Q

What causes Meckels Diverticulum? what are the 4 “2’s” of Meckels diverticuli?

A

Most common vitelline duct anomaly - partial closure

  • 2 FEET from ileocecal valve
  • 2 inches in length
  • 2% are symptomatic
  • males 2x more likely
51
Q

How do you distinguish GI mucosal damage from other causes of malabsorption?

A

D-xylose absorption test

  • -monosugar so should be able to be absorbed and detected in blood in enzyme deficiency (eg pancreas probs)
  • -no absorbed in diseases like Crohns, Whipples
52
Q

What is the most common type of malignant salivary gland tumor?

A

Mucoepidermoid carcinoma

53
Q

What is the cause of esophagitis (reflux, infection) in the immunocompromised with:

  1. white pseudomembrane
  2. punched out ulcers
  3. linear ulcers
A
  1. Candida
  2. HSV-1
  3. CMV
54
Q

What type of esophageal cancer is related to:

  1. alcohol, hot liquids, caustic strictures, smoking, achalasia
  2. Chronic GERD, Barret esophagus, obesity, smoking, achalasia
A
  1. Squamous Cell Carcinoma

2. Adenocarcinoma

55
Q

35 year old caucasian male with abdominal pains has a laparotomy
chalky white lesions are found in the mesentery. Histologic evaluation of the lesions reveals fat cell destruction and calcium deposits.

identify dz

A

Acute hemorrhagic pancreatitis

—pancreatic enzyme leak into retroperitoneum = fat necrosis

56
Q

Patient has endometrial thickening with dysplastic cells. colonoscopy also reveals two adenomas. Family history of endometrial cancer, colorectal cancer, and gastric cancer

what is happening?

A

Hereditary nonpolyposis colorectal cancer (HNPCC aka Lynch syndrome)

  • -genetic disorder with high rick of colorectal and endometrial cancer
  • -proximal colon is always involved
  • –mutation of DNA mismatch repair genes with subsequent microsatellite instability
57
Q

Patient presents with fever, jaundice, RUQ pain, has recent history of gallstones.
Leukocytosis, elevated Alkaline phosphatase, elevated GGT

A

Acute Cholangitis - infection of biliary tree

Charcots triad = Fever, Jaundice, RUQ pain

58
Q

Which HLA type are associated with Celiac disease?

A

HLA-DQ2, HLA-DQ8

59
Q

What is the molecular pathway of colorectal cancer? (gene mutation sequence)

A
  1. loss of APC gene - colon at risk
  2. KRAS mutation - adenoma
  3. loss of p53, DCC tumor suppressor - carcinoma
60
Q

Pt with acute cholecystitis presents with abdominal and shoulder pain. Which nerve is her shoulder pain most likely related to?

A

Phrenic N. - innervates diaphragm and shoulder dermatomes (C3, C4, C5)

61
Q

Through what mechanism does Salmonella Typhimurium cause diarrhea?

A

direct activation of the immune response resulting in intracellular cAMP

62
Q

Patient presents with abdominal pain, diarrhea, bilateral lower extemity edema, five pound weight loss. esophagogastroduodenoscopy is performed and cerebriform rugae are observed. Bx shows abundance of mucous cells forming glands in the shape of corkscrews. few parietal or chief cells. What is the dz and pathophyz.

A

Menetrier’s dz - significant loss of protein in the GI tract

63
Q

What are biopsy and lab findings of Non-alcoholic fatty liver disease?

What is the cause of this disease?

A

fatty infiltration of hepatocytes = cellular ballooning and eventual necrosis

  • —-can lead to cirrhosis and HCC
  • -ALT > AST (Lipids)

caused by Metabolic syndrome (insulin resistance)

64
Q

How does the hepatitis cirrhosis differ between alcohol and viral causes?

A

Macronodular - Viral

Micronodular - alcohol

65
Q

What is the mechanism of achalasia?

A

Loss of nitric oxide synthase producing neurons

66
Q

What are 3 criteria (2 out of 3 needed) to diagnose Acute pancreatitis

A
  1. Acute epigastric pain often radiating to the back
  2. increased serum amylase
  3. increased lipase
    - –to 3x upper limit of normal
67
Q

abdominal pain radiating to back
weightloss
Redness and tender on palpation of extremities

A

Pancreatic adenocarcinoma

-Migratory thrombophlebitis (Trousseau syndrome) - redness and tenderness on palpation of extremities

68
Q

What does stimulation of Beta-3 receptors do?

A

Beta-3 receptors are located in adipose tissue

–stimulation leads to fat breakdown

69
Q

What additional medication can be given to mitigate the abdominal pain caused by chronic NSAIDs?

A

chronic NSAIDs can cause gastric bleeding

use Misoprostol (stimulate prostaglandin receptors on gastric parietal cells = decrease acid secretion

70
Q

41 year old present with recurrent abdominal pain over the past few months, with eruptive xanthomas. Hepatosplenomegaly.
Serum: increase TG rich lipoproteins (chylomicrons, VLDL)
Reduction of LDL and HDL

identify dz and deficient factor? also what does this factor interact with?

A

Familial hypertriglyceridemia type 1

  • -mutation of Lipoprotein lipase (LPL)
  • —-responsible for removing TG and fatty acids from chylomicrons and VLDL

—apoC-II = major apolipoprotein found on chylomicrons, VLDL, and HDL

71
Q

18 year old female presents with multiple colonic polyps in distal colon and rectum. PMH of desmoid tumor two years ago. Fam hx: colon cancer in maternal grandfather, mother, brother.

identify dz, additional symptoms?

A

Gardner syndrome - type of familial adenomatous polyposis

  • may also have a history of supernumerary teeth
  • Congenital hypertrophy of the retinal pigment epithelium
72
Q

Pt is found unresponsive on floor. has black stool. drinks a 6 pack every night. abdominal fullness and distention. abdominal fluid wave present. Bilateral lower extremity edema, scleral icterus, and gynecomastia. Patient suddenly has dark brown emesis.

What is most likely responsible for presentation?

A

Portal hypertension from Cirrhosis

73
Q

What is the treatment for dermatitis herpetiformis in celiac disease?

A

Dapsone + gluten free diet

74
Q

What is a side effect associated with long term PPI use?

A

Hypomagnesemia

75
Q

A pt presents with abdominal pain from eating. + calf pain. Unintentional weight loss. BP 145/90. Livedo reticularis present bilaterally on lower extremities. What is the dz?

what test should be performed?

A

Polyarteritis nodosa
–affects skin, cardiovascular, renal/mesenteric, nervous system

–Derm: Levido reticularis, subq nodules, digital gangrene, ulcers
–HTN from renal artery involvement
positive p-ANCA

test for Hepatitis B

76
Q

A pt has FAP, which chromosome does he most likely have mutation on?

A

Chromsome 5 - APC gene

77
Q

What type of cells are seen in gastric adenocarcinomas?

A

Signet Ring cells (neoplastic cells filled with mucin)

78
Q

pt with PMH of gastric bypass surgery presents with sudden crampy abdominal pain shortly after eating. accompanied by nausea, vomiting, diarrhea, lightheadedness, palpitations. Labs normal.

what is happening?

A

Dumping syndrome - damage to pyloric sphincter from surgery

—damage allows rapid emptying of stomach into proximal small bowel. hyper osmolar fluid in duodenum activates sympathetic nervous system

79
Q

57 year old presents with new onset steatorrhea. weightloss. RUQ tenderness. Labs show increased plasma glucose. CT shows cholelithiasis and pancreatic mass. What dz is this? what cell is involved? (what is classic triad for this dz)

A

Somatostatinoma - Delta cell

  • Triad:
    1. Diabetes/glucose intolerance
    2. Cholelithiasis
    3. Steatorrhea
80
Q

40 year old female - fatigue and itching for three months. Scleral icterus, jaundice, hepatomegaly
labs show elevated ALP, antimitochondrial antibodies

what is dz and best therapy for pruritis?

A

Primary Biliary Cholangitis

  • -pruritis is a/w elevated bile acids
  • –Tx: cholestyramine
81
Q

How is Dubin-Johnson syndrome differentiated from Rotor syndrome?

A

Both are a/w elevated conjugated bilirubin

Rotor - elevated urinary coproporphyrin. liver is not pigmented

Dubin-Johnson - normal urinry coproporphyrin and black pigmented liver

82
Q

Pt complains of loss of taste in the entire tongue. what CNS structure is likely affected?

A

Nucleus Solitarius

  • -CN VII - ant tongue taste
  • -CN IX - post tongue taste
  • -CN X - epiglottis taste

lesion to CAUDAL nucleus solitarius - cause tachycardia
—BILATERAL = cardio collapse (b/c of CN IX innervation of carotid sinue

ROSTRAL lesion to NS = loss of taste

83
Q

What is the most common cause of small bowel obstruction?

A

most frequently from postoperative adhesions

not low fiber, fecalith, etc

84
Q

60 year old presents with sudden accumulation of numerous rough, brown, greasy, papules on chest and back.

what is the this called? what is a related pathology? what is histology?

A

Leser-Trelat sign
—rapid increase of seborrheic keratosis

–associated with GI ADENOCARCINOMA, other malignancy

histology: intraepidermal horn cysts filled with cornified cells containing melanin

85
Q

What are 2 visual truncal signs of acute pancreatitis?

A

Cullen’s sign = ecchymosis surrounding the umbilicus

Grey Turner’s sign = ecchymoses in the flank region

86
Q

what is the most common cause of acute pancreatitis

A

gallstones

alcohol is second most common

87
Q

What is the mechanism of hypocalcemia in acute pancreatitis?

A

Pancreatic inflammation causes lipase production = generates free fatty acids

free fatty acids chelate insoluble calcium salts present in the pancreas

88
Q

Where are gastrinomas, Zollinger-Ellison Syndrome most commonly located?

A

Duodenum

body of pancreas - neuroendocrine tumors (gastrinomas, insulinom, glucagonoma, carcinoid

89
Q

Where is the most common site of origin of Carcinoid tumors?

A

Ileum

90
Q

What is a pharm therapy for Crohn’s dz? what is a adverse side effect?

A

Infliximab - Ab against TNF-a

  • -can treat CD and UC.
  • -can reactivate latent tuberculosis
91
Q

What is the diagnostic test for achalasia?

what is the treatment of choice?

A

Manometry

Tx: Laparoscopic myotomy

92
Q

What is Ceruloplasmin? what are serum levels in Wilson dz?

A

Ceruloplamin = protein carrier for copper in blood

Wilson dz = copper decreased in blood because it is sequestered in liver and brain = lower ceruloplasmin

93
Q

pt w hx of alcohol abuse. complains of peripheral edema, diffuse abdominal swelling. Jaundice, ascited, 3+ pitting edema, coarse hand tremor.

What is dz, what is the serum calcium levels

A

Decreased total calcium
Normal ionized calcium

  • Liver Cirrhosis = decreased albumin production
  • –majority of calcium exists in inactive albumin bound form.
94
Q

Pt with Primary Sclerosing cholangitis has a skin lesion on let that is ulcerate with purulent base and surrounding erythema.

what is cause of skin lesion?

A

Pyoderma Gangrenosum

  • –PSC is related to Ulcerative Colitis
  • –Pyoderma Gangrenosum is related to UC
95
Q

Which artery is the source of a hemorrhageo of a large posterior duodenal ulcer?

A

Gastroduodenal artery

96
Q

what are liver biopsy findings of alcoholic hepatitis?

A

Mallory bodies = hepatocytes cell w accumulation of fat and cytokeratin intermediate filaments

COMLEX STEP 1 2017 (19 decks)

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