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Gastrointestinal
Pathology: GI
| Question | Answer |
|---|---|
| What is responsible for biliary stones in a patient with a somatostatinoma? | reduced gallbladder contractility, due to decreased cholecystokinin secretion |
| 1. Recurrent aphthous ulcers, genital ulcerations and uveitis 2. What is the pathophysiology | 1. Behcet's syndrome 2. immune complex small vessel vasculitis |
| What are the characteristics of Peutz-Jeghers syndrome? | benign hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules on the lips and oral mucosa |
| Glossitis, dysphagia and anemia | Plummer-vinson syndrome due to iron deficiency - dysphagia due to esophageal webs |
| Where do the following usually present on the mouth: 1. squamous cell carcinoma 2. basal cell carcinoma | 1. lower lip 2. upper lip |
| 1. What does dysphagia for both solids and liquids suggest? 2. Dysphagia for solids alone? | 1. motility disorder 2. obstructive lesion |
| 1. What are common examples of upper esophageal motility disorders? 2. Lower esophageal dysphagia? | upper is striated muscle, lower is smooth muscle 1. dermatomyositis, myasthenia gravis, stroke 2. systemic sclerosis, CREST syndrome, achalasia |
| What problem does the following suggest in a newborn 1. abdominal distention, constant food regurgitation out of the mouth 2. projectile vomiting, mass in epigastrium 3. bilious vomiting | 1. Tracheoesophageal fistula 2. pyloric stenosis 3. duodenal atresia |
| 1. Most common diverticulum of the upper esophagus 2. Weakness of which muscle is seen? | 1. Zenker's diverticulum 2. cricopharyngeus muscle |
| What is Barrett's esophagus? | metaplasia of the lower esophageal epithelium from the normal squamous to columnar epithelium. Complication of GERD |
| 1. What is the cause of esophageal varices? 2. Mucosal tear in distal esophagus from retching 3. rupture of distal esophagus from retching | 1. portal htn → dilated left gastric veins → backup into esophageal vein 2. Mallory-Weiss syndrome 3. Boerhaave's syndrome |
| What is the difference between Mallory-Weiss tears and Boerhaave's syndrome? | Mallory-Weiss tears involve the mucosa and submucosa alone while Boerhaave's syndrome extends through the muscularis |
| Which cancer does Barrett's esophagus predispose to? | adenocarcinoma (GERD → metaplasia → Barret's → carcinoma) |
| 1. Dysphagia for solids with weight loss. 2. Most common cause of hematemesis | 1. Squamous cell carcinoma of the esophagus 2. Peptic ulcer disease |
| 1. Most common cause of death in cirrhosis 2. Vesicles around the oral mucosa that rupture into painful, red ulcers 3. Serum tumor marker to assess treatment response of colorectal carcinoma | 1. ruptured esophageal varices 2. HSV-1 3. CEA |
| What is the difference between leukoplakia and oral candidiasis on physical exam? | leukoplakia cannot be scraped away while candidiasis is easily scraped away |
| 1. leukoplakia is a precursor lesion of which neoplasm? 2. What causes hairy leukoplakia 3. Is hairy leukoplakia precancerous? | 1. squamous cell carcinoma 2. EBV 3. no |
| What are two causes of achalasia? | 1. inability to relax lower esophageal sphincter 2. damaged ganglion cells in myenteric plexus |
| 1. What is the most common type of esophageal carcinoma? 2. When can an adenocarcinoma be present? | 1. esophagus contain squamous cells so squamous cell carcinoma 2. metaplasia of squamous cells to columnar cells (Barrett's esophagus) |
| 1. congenital malformation of anterior abdominal wall leading to exposure of abdominal contents 2. persistent herniation of bowel into umbilical cord 3. Which congenital abnormality above is covered by peritoneum and amnion? | 1. gastroschisis 2. omphalocele 3. omphalocele |
| 1. Where is the obstruction in bililous vomiting as compared to nonbilious? 2. Which presents with yellow/green vomit? | 1. bilious occurs after bile as been added in the duodenum; nonbilious occurs before the pyloric sphincter 2. bilious |
| How can burns lead to a (acute gastritis) stomach ulcer? | hypovolemia leads to decreased blood supply to stomach = less nutrients to support mucosal cells and less blood flow removing the acid (Curling ulcer) |
| How can increased intracranial pressure lead to (acute gastritis) stomach ulcer? | increased stimulation of vagus nerve leads to increased acid production (Cushing ulcer) |
| What type A and B chronic gastritis? Which section of the stomach is involved? | 1. Type A: autoimmune gastritis leading to destruction of gastric parietal cells - fundus/body 2. Type B: H pylori induced - antrum |
| Which gastric adenocarcinoma: 1. solid mass that projects into the stomach lumen 2. infiltrates stomach wall; signet cells | 1. intestinal type 2. diffuse type |
| This lady presenting with new onset of diabetes. What diagnosis should you be thinking? | pancreatic carcinoma |
| 1. Diffuse gastric adenocarcinoma that spreads to the ovaries 2. Inflammation of the salivary gland from obstruction or infection | 1. Kruckenberg tumor 2. Sialadenitis |
| 1. Painless, mobile mass at the angle of the jaw. 2. Most common malignant tumor of the salivary gland 3. Mass in parotid with many lymphocytes on biopsy | 1. Pleomorphic adenoma (in parotid) 2. Mucoepidermoid carcinoma 3. Warthin tumor |
| 1. What causes a Meckel Diverticulum 2. Twisting of the bowel along its mesentery resulting in infarction | 1. failure of the vitelline duct to involute 2. volvulus |
| 1. telescoping of proximal segment of bowel forward into distal segment 2. Episode of hypotension. Now patient is having abdnominal pain and bloody diarrhea with ↓ bowel sounds | 1. Intussusception 2. small bowel mucosal infarction |
| 1. Tranmural infarction of the small bowel usually occurs with thrombosis of which artery? 2. What is the pathogenic component of gluten seen in celiac disease? | 1. superior mesenteric 2. gliadin |
| 1. Small vesicles arising on skin associated with celiac disease 2. What is the pathological cause? | 1. dermatitis herpetiformis 2. IgA deposition at the tips of dermal papillae |
| 1. Steatorrhea and arthritis with organisms present in macrophages on PAS stain 2. What is the pathophysiology of the steatorrhea? | 1. Tropheryma whippelii 2. microphages move into enteric villi and compress lacteals; resulting in fat malabsorption |
| Where does a carcinoid tumor have to be present for carcinoid syndrome to present? | liver; if tumor is elsewhere, serotonin secreted from the neoplasm will be metabolized from the liver |
| Patient with hx of recurrent diarrhea and flushing now presenting with right sided valvular fibrosis leading to tricuspid regurgitation | carcinoid heart syndrome |
| What is the difference in bowel wall involvement between: 1. Ulcerative colitis 2. Crohn disease | 1. mucusal and submucosal ulcers 2. transmural inflamamtion |
| Ulcerative colitis vs Crohn disease 1. right lower quadrant pain 2. left lower quadrant pain 3. malabsorption 4. loss of haustra 5. bloody diarrhea 6. confined to colon 7. presents anywhere in the alimentary canal 8. toxic megacolon | 1. Crohn's disease (usually ileum) 2. Ulcerative colitis (usually rectum) 3. Crohn's disease 4. Ulcerative colitis 5. Ulcerative colitis 6. Ulcerative colitis 7. Crohn's disease 8. Ulcerative colitis |
| 1. Most common site for diverticula formation 2. Relapsing abdominal pain with bloating, flatulence that improves with defecation | 1. sigmoid colon 2. irritable bowel syndrome |
| Polyp 1. benign, no malignancy potential 2. benign, but premalignant | 1. hyperplastic polyp 2. adenomatous polyp |
| How do the following effect formation of colonic polyps: 1. APC mutation 2. K-ras mutation 3. p53 mutation | 1. increases risk for polyp formation 2. ↑ polyp size 3. increases expression of COX allowing for progression to carcinoma |
| What mutation results in: 1. Familial Adenomatous Polyposis? 2. Hereditary nonpolyposis colorectal cancer (Lynch syndrome) | 1. APC gene mutation involved in cell attachment 2. DNA mismatch repair gene mutation |
| 1. Familial adenomatous polyposis with fibromatosis and osteomas 2. Familial adenomatous polyposis with CNS tumors | 1. Gardner syndrome 2. Turcot syndrome |
| Most common cause for iron deficiency anemia | colorectal carcinoma |
| 1. If patient presents with melena, where must the bleed be? 2. What is the pathophysiologic cause of melena? 3. What is the cause of gastroparesis in diabetes? | 1. Before the ligament of trietz (duodenojejunal junction) 2. hemoglobin is converted to hematin by acid 3. autonomic neuropathy |
| Ulcers: 1. epigastric pain aggravated by eating 2. epigastric pain relieved by eating 3. pre-cancerous | 1. gastric ulcer 2. duodenal ulcer 3. gastric ulcer |
| Multiple ulcers that are resistant to antibiotic therapy and no history of NSAID use may suggest... | Zollinger-Ellison syndrome |
| How is absorption of fat, proteins and carbohydrates effected in pancreatic insufficiency? | 1. fat absorption is decreased from diminished lipase activity 2. protein digestion is decreased from diminished trypsin 3. carbohydrate digestion is not affected (intact salivary amylase and disaccharidases in brush border) |
| 1. What is the cause of ascites and pitting edema seen with malabsorption 2. Left-sided abdominal cramping, blood diarrhea and p-ANCA | 1. hypoproteinemia 2. ulcerative colitis |
| 1. Dilation of mucosal venules in the cecum that can occassionally lead to hematochezia 2. Why do they typically occur in the cecum? | 1. Angiodysplasia 2. largest diameter of the GI tract creates increased stress on vasculature |
| Developmental malformation in which the ventral pancreatic bud forms a ring around the duodenum | annular pancreas |
| How does alcohol lead to pancreatitis | alcohol causes contraction of the sphincter of oddi at the ampulla of vater (entrance to duodenum) causes backup of pancreatic enzymes |
| How does hypercalcemia lead to pancreatitis | calcium activates trypsin prematurely |
| Major risk factor for pancreatic carcinoma | smoking and chronic pancreatitis |
| 1. sudden onset of multiple seborrheic keratosis is called 2. What is it suggestive of? | 1. sign of Leser-Trelat 2. gastric adenocarcinoma |
| What is the whipple procedure used to surgically resect pancreatic carcinoma? | removal of the head and neck of pancreas, proximal duodenum and gallbladder |
| What are the risk factors for cholelithiasis? | gallstones: 1. forties 2. estrogen (female, obese, oral contraceptives) |
| Two infectious agents that can cause cholelithiasis | 1. Ascaris lumbricoides 2. Clonorchis sinensis |
| Herniation of the gallbladder mucosa into its muscular wall creating diverticula | Rokitanski-Aschoff sinus (associated with cholecystitis) |
| 1. Ascending cholangitis occurs from gallstone obstruction of... 2. Shrunken, hard gallbladder due to chronic inflammation, fibrosis and dystrophic calcification | 1. common bile duct 2. Porcelain gallbladder from chronic cholecystitis (associated with gallbladder adenocarcinoma) |
| Elderly woman with new onset cholecystitis. What should you consider as the diagnosis? | gallbladder adenocarcinoma (because it's usually 40 year old females) |
| 1. What is the cause of jaundice. 2. Which form of bilirubin is water soluble and excreted in the urine? | 1. increase bilirubin 2. conjugated |
| Hereditary condition with: 1. mildly low uridine glucuronyl transferase (UGT) levels 2. absence UGT in hepatocytes | 1. Gilbert syndrome 2. Crigler-Najjar syndrome |
| 1. Which two hereditary defects lead to increased conjugated bilirubin 2. In which disorder does the liver appear dark on histological examination? | 1. Dubin-Johnson syndrome and Rotor syndrome 2. Dubin-Johnson |
| 1. What are the levels of conjugated and unconjugated bilirubin in viral hepatitis? 2. Presence of which serum marker indicated hepatitis A immunization? | 1. both are increased 2. anti-hepatitis A IgG |
| What is the cause of the following in liver cirrhosis: 1. asterixis, mental status changes 2. spider angioma, gynecomastia 3. jaundice 4. edema | 1. ↑ ammonia 2. ↑ estrogen 3. ↑ unconjugated bilirubin 4. hypoalbuminemia |
| 1. What are Mallory bodies found within the liver? 2. Triad of liver cirrhosis, diabetes mellitus and bronze skin | 1. damaged cytokeratin filaments within hepatocytes (hepatitis) 2. hemachromatosis |
| What defect leads to primary hemochromatosis? | mutation in HFE gene leads to defect in enterocyte iron regulation so that iron is constantly uptaken |
| 1. Liver infarction from hepatic vein obstruction 2. organism associated with hepatocellular carcinoma | 1. Budd-Chiari syndrome 2. aflatoxin from aspergillus |
| 1. Serum tumor marker for hepatocellular carcinoma 2. Defect in Wilson's disease | 1. alpha-fetoprotein 2. defect hepatocyte transport of copper into bile and ceruloplasmin |
| Inflammation and fibrosis of bile duct leading out to the liver. | primary sclerosing cholangitis -associated with ulcerative colitis |
| Elevated liver enzymes, nausea/vomiting and encephalopathy in children with recent viral illness. What may be the cause? | Reye syndrome from aspirin |
| Which disorder is it safe to give children aspirin? | Kawasaki disease |
| ALT and AST 1. higher level is indicative of viral hepatitis 2. higher level is indicated of alcoholic hepatitis | 1. ALT > AST 2. AST > ALT |
| 1. Increased GGT and very high ALP 2. Increased GGT and mildly elevated ALP 3. Increased ALP and normal GGT | 1. liver cholestasis (bile duct blockage) 2. alcoholic hepatitis 3. source other than liver (bone) |
| What is the common cause of jaundice: 1. ↑ in both conjugated and unconjugated bilirubin 2. ↑ unconjugated 3. ↑ conjugated | 1. extravascular hemolysis 2. viral hepatitis 3. liver cholestasis (bile duct blockage) |
| 1. Jaundice with antimitochondrial antibodies and enlarged liver 2. Causes of Kayser-Fleischer rings | 1. Primary biliary cirrhosis 2. Wilson's disease, primary biliary cirrhosis, cholestasis |
| In hemachromatosis, what are the levels of: 1. serum iron 2. ferritin 3. total iron binding capacity (TIBC) | 1. ↑ 2. ↑ 3. ↓ (because transferrin is saturated) |
| Why is TIBC low in hemochromatosis? | iron stores are increased so transferrin synthesis is decreased (TIBC is the capacity to bind iron to transferrin) |
| Serum levels in Wilson's disease: 1. total serum copper 2. serum ceruloplasmin 3. free copper | 1. decreased 2. decreased 3. increased (total copper is decreased because of the decrease in ceruloplasmin) |
| Most common cause of liver cirrhosis in children | α1-antitrypsin deficiency |
| 1. Most common cause of liver cell adenoma in women 2. Most common cause of angiosarcoma | 1. oral contraceptives (estrogen) 2. vinyl chloride |
| 1. Most common malignancy of bile ducts 2. Most common cause | 1. Cholangiocarcinoma 2. Primary sclerosing cholangitis from ulcerative colitis |
| What are the most common bacterial species involved in cholecystitis? | E. coli, Bacteroides fragilis, Enterococci |
| What is the pathogenesis for acute pancreatitis from common bile duct obstruction | 1. increased back-pressure refluxes bile into the major pancreatic duct 2. bile activates pancreatic proenzymes causing acute pancreatitis |
| 1. What is Grey-turner sign and Cullen's sign? 2. What disorder exhibits these two signs? | 1. Grey-turner: flank hemorrhage; Cullen's sign: periumbilical hemorrhage 2. pancreatitis |
| In acute pancreatitis, what is the cause of the following: 1. ARDS 2. tetany 3. hypovolemic shock | 1. circulating pancreatic lipase destroys surfactant 2. hypocalcemia cause by enzymatic fat necrosis 3. peripancreatic fluid accumulation outside the vascular compartment (3rd space) |
| Persistent increase in serum amylase > 7 days after acute pancreatic episode may suggest | pancreatic pseudocyst |
| What causes oral candidiasis? | (thrush) candida albicans |
| Which congenital GI obstructions lead to polyhydramnios? | 1. duodenal atresia 2. tracheoesophagel fistula |
| What is swelling of the eye in an individuals with aquired toxic megacolon after a Reduviid bug bite? | Romana's sign from Chagas disease |
| What is the most common cause of hematechezia? | diverticulosis |
| Child with down syndrome has greater incidence of developing which two GI anomalies that lead to constipation? | 1. duodenal atresia 2. Hirschsprung's disease |
| Which section of the stomach does H. pylori preferentially effect? | pylorus and antrum |
| Why must a gastric ulcer be biopsied but not a duodenal? | gastric ulcers may become gastric adenocarcinoma while duodenal ulcers do not become malignant |
| Which lymph nodes drain abdominal organs and are the primary site for gastric adenocarcinoma metastasis? | left supraclavicular lymph nodes (Virchow's nodes) |
| What is the origin of malabsorption in patients with celiac sprue? | antibodies to gluten absorbed by enterocytes will cause inflamamtion and destruction of villi |
| Diarrhea caused by a partially acid-fast organism | Cryptosporidium parvi |
| 1. What is the most common cause of abdominal colicky pain in an adult? 2. Does cholelithiasis cause colicky pain? | 1. small bowel obstruction usually from an indirect inguinal hernia 2. no. gallbladder does not have peristalsis |
| What is meconium ileus and what is it a sign of? | thickened meconium that gets stuck in the ileum. sign of cystic fibrosis |
| What causes a fistula between the colon and the bladder? | diverticulosis, Crohn's disease |
| Colicky RLQ abdominal pain in a young person with diarrhea? | Crohn's - inflammation of terminal ileum and ascending colon leading to obstruction (peristalsis leads to colicky pain) |
| What vitamin deficiency can carcinoid syndrome lead to? | depletes tryptophan to create serotonin leading to niacin deficiency and pellagra |
| What is the pathogenesis for appendicitis and diverticulitis? | 1. fecalith formation (impacted stool) that compresses blood vessels 2. ischemia along the wall 3. mucosal breakdown and E coli infiltration |
| Serology for IgA signifies: 1. anti A IgM 2. anti A IgG | 1. have hepatitis A 2. had hepatitis A won't get it again |
| Hepatitis B serologies: 1. HB surface IgG 2. HB core IgM 3. HBc IgG and HBs IgG | 1. vaccinated 2. window phase 3. resolved infection |
| 2 y/o kid, with colicky pain and bloody stools | intussusception of ileum into cecum |
| Liver tumor that is associated with estrogen and anabolic steroid use | hepatic adenoma |
| What is sentinel's sign? | inflamamtion adjacent to the bowel (ex: pancreatitis) leads to ↓ peristalsis at that point with air retention |
| What is the difference between a true and false diverticulum? | 1. True - contains mucosa, submucosa and musculari 2. False - contains only mucosa and submucosa |
| Gastric hypertrophy with protein loss, parietal cell atrophy, and ↑ mucous cells | Menetrier's disease |
| Ulcerative colitis vs Crohn disease 1. rectal sparing 2. primary sclerosing cholangitis 3. Rx with sulfasalazine 4. ankylosing spondylitis 5. "string sign" on barium x-ray 6. HLA-DR2 | 1. Crohn's disease 2. Ulcerative colitis 3. Ulcerative colitis 4. Crohn's disease 5. Crohn's disease 6. Ulcerative colitis |
| What is pertechnetate used to detect? | presence of gastric mucosa as in Meckel's diverticulum |
| Cause of: 1. duodenal atresia 2. colonic atresia | 1. congenital malformation due to failure of recanalization 2. vascular accidents in utero |
| Is multiple intestinal polyps in a child of concern? A single polyp? | 1. juvenile polyposis syndrome has ↑ risk of adenocarcinoma 2. single polyps are not malignant |
| What is the cause of neonatal jaundice? | immature UDP-glucuronyl transferase at birth |
| What is the most likely cause of aquired hemochromatosis? | chronic blood transfusions leading to pathologic iron deposition |
| Gallstones with air seen in biliary tree on imaging | Gallstone ileus: fistula created between gallbladder and small intestine; large stone from gallbladder deposits in ileocecal valve |
| Episode of hypotension and now patient has abdominal pain and bloody diarrhea. Which portion of the large bowel is most likely to be affected? | Splenic flexure and distal sigmoid colon |
| Stomach cancer with cell nuclei pushed to periphery. | Signet ring cells - large amount of mucous in cell pushes nuclei aside |
| Distended macrophages in the intestinal lamina propria. | Whipple disease |
| Massive infiltration of intestinal lamina propria with atypical lymphocytes | Lymphoma (keyword is atypical lymphocytes) |
| What is the pathogenesis of H pylori induced: 1. gastric ulcer 2. duodenal ulcer | 1. breakdown of gastric mucosal barrier from inflammation 2. inflammation destroys somatostatin secretion from antral D cells and bicarb secretion in duodenum |
| Which organism causes cysts in the liver that may lead to anaphylaxis if damaged? | Echinococcus granulosus |
| Apoptotic hepatocytes that undergo fragmentation in acute hepatitis | Councilman bodies |
| 30 year old caucasian man with progressive eertional dyspnea and PAS-positive intracellular inclusions on liver biopsy. | α1-antitrypsin deficiency |
| How does left sided vs right sided colorectal cancer present? | 1. left sided - decreased stool caliber, LLQ pain 2. iron deficiency anemia and vague pain |
| What is the most likely course of events for an individual with a hepatitis C infection? | stable chronic hepatitis |
| Patient with malabsorption and flattening of intestinal villi upon biopsy. | celiac disease |
Created by:
amichael87
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