GI

Question 1

Where does iron absorption predominantly occur?

Answer 1

Duodenum and proximal jejunum

Question 2

Malabsorption of which substances can occur after gastrojejunostomy?

Answer 2

Iron, Vit B12, folate, fat soluble vitamins, and calcium

Question 3

Brown pigment stones

Answer 3

Associated with billiary tract infections

Question 4

Black pigment stones

Answer 4

Chronic hemolysis (sickle cell, beta thalassemia, hereditary spherocytosis)

Question 5

Cause of pigment stones

Answer 5

Conditions that increase the amount of unconjugated bilirubin in bile, which promotes calcium bilirubinate precipitation

Question 6

What time of patients typically get acute acalculous cholecystitis?

Answer 6

Critically ill patients (sepsis, severe burns, trauma, immunosuppression)

Question 7

Describe right sided colon adenocarcinoma

Answer 7

More likely to bleed and cause iron deficiency anemia

Question 8

Describe left sided colon adenocarcinoma

Answer 8

Present with obstructing symptoms such as altered bowel habits, constipation, abdominal distension, nausea and vomiting

Question 9

Describe the mechanism of the Shiga-like toxin in EHEC

Answer 9

Inactivates the 60s ribosomal subunit in human cells, leading to inhibition of protein synthesis and eventual cell death

Question 10

Lynch syndrome

Answer 10

Autosomal dominant disease caused by abnormal nucleotide mismatch repair, including genes MSHS and MLH1

Question 11

Derivatives of the dorsal pancreatic bud

Answer 11

Pancreatic tail, body, most of the head, and the small accessory pancreatic duct

Question 12

Derivatives of the ventral pancreatic bud

Answer 12

Uncinate process, a portion of the pancreatic head, and the proximal portion of the main pancreatic duct

Question 13

Pathophysiology of pancreatic divisum

Answer 13

Dorsal and ventral pancreatic buds fail to fuse

Question 14

Polyethylene glycol

Answer 14

Osmotic laxative

Question 15

Describe the cause of Hirschsprung diease

Answer 15

A result of abnormal migration of neural crest cells during embryogenesis

Question 16

IL-8

Answer 16

Chemokine produced by macrophages that induces chemotaxis and phagocytosis in neutrophila

Question 17

What are the 3 main causes of HIV-associated esophagitis?

Answer 17

Candida, CMV, HSV

Question 18

How is CMV esophagitis characterized endoscopically?

Answer 18

Large, shallow linear ulcerations with intranuclear and cytoplasmic inclusions seen microscopically

Question 19

List the retroperitoneal abdominal organs

Answer 19

Suprarenal (adrenal) glands, aorta and inferior vena cava, duodenum (except 1st part), pancreas (head and body), ureters and bladder, kidneys, esophagus, rectum (mid-distal)

Question 20

What is the adenoma to carcinoma sequence is most cases of sporadic colon adenocarcinoma arising from a preexisting polyp?

Answer 20

Mutation of the APC tumor suppressor gene allows for the initial appearance of small adenomatous polyps.

Mutation of the KRAS protoocogene facilitates that increase in size of the adenoma

Malignant transformation requires TP53 mutation

Question 21

Systemic mastocytosis

Answer 21

Abnormal proliferation of mast cells and increased histamine release. Histamine causes hypersecretion of gastric acid by parietal cells in the stomach as well as hypotension, flushing, pruritus, etc.

Question 22

“Watershed areas”

Answer 22

In the left colon at the splenic flexure and rectosigmoid junction

Question 23

Periodic, simultaneous, and non-peristaltic contractions of the esophagus

Answer 23

Diffuse esophageal spasm

Question 24

What causes diffuse esophageal spasm?

Answer 24

Impaired inhibitory innervation within the esophageal myenteric plexus

Question 25

How does diffuse esophageal spasm present?

Answer 25

Liquid/solid dysphagia and chest pain due to inefficient propulsion of food into the stomach

Question 26

What are 3 well known risk factors for gallbladder disease?

Answer 26

"40, fat, female"

Question 27

Which hormone is responsible for gallbladder contraction? Where is it made?

Answer 27

Cholecystokinin. Made in the duodenum and jejunum in response to fatty acids and amino acids

Question 28

What is the most important characteristic that correlates with malignancy risk in colonic polyps?

Answer 28

Increasing polyp size

Question 29

Are villous adenomas or tubular adenomas more likely to undergo malignant transformation?

Answer 29

Villous

Question 30

Common findings with a gallstoneileus

Answer 30

Pneumobilia = air in the biliary tract

Question 31

Describe diffuse gastric adenocarcinoma

Answer 31

Infiltrates the stomach wall and displays signet-ring cells on light microscopy

Question 32

Describe intestinal type of gastric adenocarcinoma

Answer 32

Forms a solid mass that projects into the stomach lumen and is composed of glandular-forming cuboidal or columnar cells

Question 33

What is a manifestation of galactokinase deficiency?

Answer 33

Cataracts

Question 34

What is accumulating and causing cataracts with a galactokinase deficiency?

Answer 34

Lenticular accumulation of galactitol

Question 35

What is the cause of pernicious anemia?

Answer 35

Autoimmune disorder caused by the cell-mediated destruction of parietal cells in the superficial upper glandular layer of the gastric body and fundus

Question 36

What is the difference in immune responses between the live attenuated oral (Sabin) poliovirus vaccine and the inactivated poliovirus (Salk) vaccine?

Answer 36

Live attenuated oral vaccine produces a stronger mucosal secretory IgA immune response

Question 37

What can prolonged cholestatic liver disease cause?

Answer 37

Malabsorption and nutritional deficiencies of fat-soluble vitamins (A, D, E, and K)

Question 38

What kind of kidney stones are seen in Crohn disease?

Answer 38

Oxalate kidney stones

Question 39

Mechanism of gallstones in Crohn disease

Answer 39

Decreased bile acid reabsorption by the inflamed terminal ileum promotes cholesterol supersaturation of the bile

Question 40

Meckel diverticulum

Answer 40

Results from failed obliteration of the vitelline duct. Presents with spontaneous but painless lower GI bleeding

Question 41

Where does iron absorption predominantly occur?

Answer 41

In the duodenum and proximal jejunum

Question 42

What kind of kidney stones are associated with Crohn disease?

Answer 42

Oxalate kidney stones