1A: Dt 14 - 1

Front 1

Which primary bone tumor:
Most common malignant primary bone tumor of children

Back 1

Osteosarcoma

Front 2

Which primary bone tumor:
Most common benign bone tumor

Back 2

Osteochondroma

Front 3

Which primary bone tumor:
11 ;22 translocation

Back 3

Ewing Sarcoma

Front 4

Which primary bone tumor:
Soap-bubble appearance on X-ray

Back 4

Giant cell tumor of bone

Front 5

Which primary bone tumor:
Onion-skin appearance of bone

Back 5

Ewing Sarcoma of bone

Front 6

Which primary bone tumor:
Cadman's triangle on X-ray

Back 6

Osteosarcoma

Front 7

What are the most common causes of hypocalcemia?

Back 7

Deficiency of PTH
Deficiency of Ca2+
-Insufficient Ca2+ intake
-Vit D Def (more common than insuff Ca2+ intake)
-Chronic renal dz
-Parathyroidectomy

-Autoimmune destruction of parathyroid gland
-Pseudohypoparathyroidism--kidneys unresponsive to PTH, Ca2+ excreted
-DiGeorge Syndrome
-Acute pancreatitis

Front 8

What is the triad of symptoms of Wernicke's encephalopathy?

Back 8

Confusion
Ophthalmoplegia
Ataxia

Front 9

What is the triad of symptoms for Korsakoff syndrome?

Back 9

Memory loss
Confabulation
Personality changes

Front 10

Which drug:
AE: Agranulocytosis

Back 10

Clozapine
Carbamazepine
Colchicine
PTU (thyroid drug)
Methinazole (thyroid drug)

Front 11

Which drug:
AE: Osteoporosis

Back 11

Corticosteroids
LT heparin use

Front 12

Which drug:
AE: Pulmonary fibrosis

Back 12

Bleomycin
Busulfan
Amiodarone

Front 13

Which drug:
AE: Gyncomastia

Back 13

Some Drugs Create Awesome Knockers

Spironolactone
Digitalis
Cimetidine
Estrogen
Ketoconazole
Chronic EtOH
Marijuana

Front 14

Which drug:
AE: Photosensitivity

Back 14

SAT for a Photo
Sulfonamides
Amiodarine
Tetracycline

Front 15

Which drug:
AE: Drug-induced lupus

Back 15

SHIPP
Sulfonamides
Hydralazine
INH
Phenytoin
Procainamide

Front 16

What are the 4 cardinal features of Parkinson's disease?

How does Lewy body dementia differ?

Back 16

Tremore (pill rolling)
Rigidity--cogwheel
AKinesia
Postural instability

Lewy Body dementia:
-Visual hallucinations
-Repeated falls
-Syncope

Front 17

Describe how a mitral regurgitation murmur differs from an aortic regurgitation murmur.

Back 17

Mitral regurg:
-Holosystolic
-Heard best at apex
-Heard best in left lateral decubitus
-Enhanced by squat

Aortic regurg:
-Immediate diastolic murmur
-Assocd w/widening of pulse pressure

Front 18

What BP values mark the diagnosis of hypertension?

What values mark prehypertension?

Back 18

HTN: SBP≥140 OR DBP≥90

PreHTN: SBP 120-139 OR DBP 80-89

Front 19

What organisms cause endocarditis?

Back 19

Most common:
Staph aureus
Viridans streptococci
Enterococci
Staph epidermidis

Front 20

What are the most common locations for tophi in gout patients?

Back 20

External ear
Olecranon bursa
Achilles tendon

Front 21

Which autoimmune disorder:
Anti-TSH receptor antibodies

Back 21

Graves'

Front 22

Which autoimmune disorder:
Antimitochondrial antibodies

Back 22

Primary Biliary Cirrhosis

Front 23

Which autoimmune disorder:
Anticentromere antibodies

Back 23

CREST

Front 24

Which autoimmune disorder:
Antihistone antibodies

Back 24

Drug-induced lupus

Front 25

Which autoimmune disorder:
Anti-smooth muscle antibodies

Back 25

Autoimmune hepatitis

Front 26

Common site of mets from:
Stomach

Back 26

Celiac Nodes

Front 27

Common site of mets from:
Duodenum, jejunum

Back 27

Superior Mesenteric Nodes

Front 28

Common site of mets from:
Sigmoid colon

Back 28

Colic Nodes

Front 29

Common site of mets from:
Rectum

Back 29

Inferior iliac nodes-->Inferior mesenteric nodes

Front 30

Common site of mets from:
Testes

Back 30

Paraaortic LNs

Front 31

Common site of mets from:
Scrotum

Back 31

Superficial inguinal nodes

Front 32

Back 32

Front 33

Back 33

Front 34

Falciform ligament:
Connects
Structures contained
Derived from?

Back 34

Connects liver to anterior abdominal wall

Contains ligamentum teres

Derived from fetal umbilical vein

Front 35

Hepatoduodenal ligament:
Connects
Structures contained

Back 35

Liver to duodenum

Contains hepatic artery, portal vein, common bile duct (PORTAL TRIAD)

Front 36

Gastrohepatic ligament:
Connects
Structures contained

Back 36

Connects liver to lesser curvature of stomach

Contains gastric aa

Front 37

Gastrocolic ligament:
Connects
Structures contained

Back 37

Greater curvature and transverse colon

Contains gastroepiploic aa

Front 38

Gastrosplenic ligament:
Connects
Structures contained

Back 38

Connects greater curvature and spleen

Contains short gastrics

Front 39

Splenorenal ligament:
Connects
Structures contained

Back 39

Connects spleen to posterior abdominal wall

Contains splenic artery and vein

Front 40

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

What are the contents of each layer?

Back 40

Mucosa--epithelium (absorption), lamina propria (support), muscularis mucosae (motility)

Submucosa - Includes Submucosal nerve plexus (Meissner's!)

Muscularis externa - includes Myenteric nerve plexus (Auerbach's!)

Serosa/adventitis

Front 41

Submucosal plexus:
AKA
Role

Back 41

Meissner's Plexus = Submucosal

Regulates local secretions, blood flow, and absorption

Front 42

Myenteric plexus:
AKA
Role

Back 42

AKA Auerbach's Plexus

Coordinates gut motility along entire gut wall; located between inner and outer layers of SM of GI tract wall

Front 43

What are the frequencies of basal electric rhythm (slow waves) for the stomach and small intestine?

Back 43

Stomach - 3 waves/min
Duodenum - 12 waves/min
Ileum - 8-9 waves/min

Front 44

Brunner's glands:
Role
Location
Associated disease

Back 44

Secrete alkaline mucus to neutralize acid contents entering duodenum from stomach

Located in duodenal submucosa

Hypertrophy of Brunner's glands seen in Peptic Ulcer Dz

Front 45

Peyer's patches:
Role
Location

Back 45

Unencapsulated lymphoid tissue found in lamina propria and submucosa of small intestine

Contain M cells that take up antigen

B cells stimulated in germinal centers of Peyer's patches differentiate into IgA_secreting plasma cells, which ultimately reside in lamina propria

Front 46

Describe the muscle types of the esophagus.

Back 46

Upper 1/3: Striated muscle
Middle 1/3: Striated and smooth muscle
Lower 1/3: Smooth muscle

Front 47

Draw and label the branches of the abdominal aorta.

Back 47

Front 48

Foregut:
Structures
Arterial supply

Back 48

Celiac artery--stomach to proximal duodenum

Liver, gallbladder, pancreas, spleen

Front 49

Midgut:
Structures
Arterial supply

Back 49

SMA--distal duodenum to proximal 2/3 transverse colon

Front 50

Hindgut:
Structures
Arterial supply

Back 50

IMA--distal 1/3 transverse colon to upper portion of rectum; splenic flexure = watershed region

Front 51

What area of the gut is most sensitive to hypoxia?

Back 51

Splenic flexure--during times of hypoperfusion (hypotension); it's a watershed area

Front 52

What is a watershed area?

Back 52

Regions of the body that receive dual blood supply from the most distal branches of two large arteries; during atherosclerotic blockage are resistant to ischemia due to dual supply

However, during hypoperfusion (hypotension), most sensitive to hypoxia

Front 53

Draw and label celiac trunk.

Back 53

Front 54

Esophagus:
Anastamoses
Effect of portal hypertension

Back 54

Esophageal vein<--->Left gastric vein

Portal HTN-->backed up LGV-->esophageal varices

Front 55

Umbilicus:
Anastamoses
Effect of portal hypertension

Back 55

Superficial and inferior epigastric veins<---->Paraumbilical veins

Portal HTN-->Caput medusae

Front 56

Rectum:
Anastamoses
Effect of portal hypertension

Back 56

Superior Rectal vein<-->Middle and inferior rectal veins

Portal HTN-->Internal hemorrhoids

Front 57

Back 57

Sclerosed esophageal varix. Overlying esophageal mucosa is generally normal.

Front 58

Pectinate line:
What is it?
Abnormalities that occur above/below it
Arterial supply above/below it
Venous drainage above/below it

Back 58

Where hindgut (Distal 1/3 transverse colon to upper portion or rectum) meets ectoderm (striated squamous epithelium of rectum)

Above pectinate line:
Internal hemorrhoids, adenoca (endoderm derivation)
Arterial supply = superior rectal artery (branch of IMA)
VEnosu drainage to superior rectal vein-->inferior mesenteric vein-->portal system

Below pectinate:
External hemorrhoids; squamous cell carcinoma (ectoderm derivation)
Arterial supply: internal pudendal
Venous drainage to inferior rectal vein-->internal pudendal vein-->internal iliac vein-->IVC

Front 59

Internal vs External Hemorrhoids:
Innervation

Back 59

Internal: visceral innervation, not painful; can be sign of portal HTN

External: somatic innervation, painful. Innervated by inferior rectal nerve (branch of pudendal nerve)

Front 60

Describe RBC breakdown and bilirubin excretion.

Back 60

Front 61

Gilbert's Syndrome:
Pathophys
Presentation

Back 61

Mildly dec'd UDP-glucoronyl transferase or dec'd bilirubin uptake.

Asyx.

Elevated unconj'd bilirubin without overt hemolysis. Bilirubin increases with fasting and stress.

In short, it's a problem with bilirubin uptake into hepatocytes-->unconj'd bilirubinemia

Front 62

Crigler-Najjar syndrome, type I:
Pathophys
Presentation

Back 62

Absent UDP-glucoronyl transferase; presents early in life with jaundice, kernicterus (bilirubin deposition in brain), inc'd unconj'd bilirubin

Patients die within a few years.

In short, = problem with bilirubin conjugation.

Front 63

Dubin-Johnson syndrome:
Pathophys
Presentation

Back 63

Conjugated hyperbilirubinemia due to defective liver excretion.

Grossly black liver.

Benign.

IN short, = problem w/excretion of conjugated bilirubin, resulting in conj'd bilirubinemia.

Front 64

The bile duct runs in close association with the ______.

Back 64

Hepatic artery and portal vein

Front 65

Describe the path bile takes beginning with its synthesis and ending with its release.

Back 65

Liver-->L/R hepatic ducts
-->Common hepatic duct
-->Cystic duct-->Gall Bladder

Gall bladder-->Cystic duct
-->Common bile duct
-->Ampulla of Vater
-->Sphincter of Oddi
-->Duodenum

Front 66

Describe the vascular/nerve contents of the femoral region, in order.

Back 66

Going from lateral to medial: NAVEL

Femoral Nerve-Artery-Vein-Empty Space-Lymphatics

VENOUS NEAR THE PENIS

Front 67

What is a hernia?

Back 67

Protrusion of peritoneum through opening, usually a site of weakness.

Front 68

Indirect vs Direct Inguinal Hernias:
Path taken
Relation to Inferior Epigastric Artery
Fascia Covering
Populations Affected

Back 68

Indirect IH: goes through INternal (deep) inguinal ring, external (superficial) inguinal ring, and INto the scrotum.
Lateral to inferior epigastric artery.

Occurs in infants owing to failure of processus vaginalis to close.

Note: follows path of descent of testes. Covered by all 3 layers of spermatic fascia.

Direct IH: Protrudes through inguinal triangle. Bulges through abdominal wall medial to inferior epigastric artery. Goes through external (superficial inguinal ring only). Covered by external spermatic fascia.

Occurs in older men.

MDs don't LIe:
Medial to inferior epigastric = Direct; Lateral to inferior epigastric = Indirect

Front 69

Femoral hernia:
Path taken
Populations affected

Back 69

Protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle.

More common in women.

Front 70

Diaphragmantic hernia:
Path
Sliding vs Paraesophageal

Back 70

Abdominal structures enter thorax

Most commonly a sliding hernia (GE junction is displaced; "hourglass stomach")

Paraesophageal hernia--GE jn normal. Cardia moves into thorax.

Front 71

G cells:
Function
Stimulators

Back 71

Gastrin (pro-gastric)

Stimulated by hypercalcemia, phenylalanine, tryptophan

Front 72

I cells:
Function

Back 72

CCK (pro-duodenum, anti-gastric)

Front 73

S cells:
Function

Back 73

Secretin (pro-HCO3, antacid)

Front 74

D cells:
Function

Back 74

Somatostatin (inhibits all)

Front 75

Intrinsic factor:
Source
Function

Back 75

Source: parietal cells (stomach)

Vitamin B12 binding protein required for B12 uptake in terminal ileum

Front 76

Gastric acid:
Source
Regulation

Back 76

Parietal cells (stomach)--
Inc'd by histamine, ACh, gastrin

Dec'd by SMS, GIP, PG, secretin

Front 77

H2 Blockers:
Prefix/Suffix
MOA
Use
AE

Back 77

-idines (Cimetidine)

MOA: Reversible block of H2 receptors to dec H+ secretion by parietal cells

Use: Peptic ulcer, gastritis, GERD

Cimetidine = potent inhibitor of cyt p450; it also has anti-androgen effects (prolactin release, gynecomastic, impotence, dec'd libido)

Front 78

Proton Pump Inhibitors:
Prefix/Suffix
MOA
Use

Back 78

-prazole (omeprazole)
MOA: Irreversibly inhibit H/K-ATPase in stomach parietal cells.

Use: Peptic ulcer, gastricits, GERD, Zollinger-Ellison syndrome

Front 79

Bismuth:
MOA

Back 79

Binds ulcer base, provides physical protection, allows HCO3- secretion to reestablish pH gradient in mucus layer

Front 80

Sucralfate:
MOA

Back 80

Binds ulcer base, provides physical protection, allows HCO3- secretion to reestablish pH gradient in mucus layer

Front 81

Misoprostol:
MOA
Uses

Back 81

PGE1 analog; inc'd production and secretion of gastric mucus barrier, dec'd acid production

Use: Prevention of NSAID-induced peptic ulcers, maintenace of PDA, used to induce labor

Front 82

Enterochromaffin-like cells:
Role

Back 82

Produce histamine

Front 83

Aluminum hydroxide:
Drug Class
AE

Back 83

Antacid

Constipation and hypophosphatemia; aluMINIMUM amount of feces.

Proximal muscle weakness, osteodystrophy, seizures.

Front 84

Magnesium hydroxide:
Drug Class
AE

Back 84

Antacid

Diarrhea, hporeflexia, hypotn, cardiac arrest

Mg = Must Go to bathroom

Front 85

Calcium carbonate:
Drug Class
AE

Back 85

Antacid

HyperCa2+
Rebound acid

Front 86

Salivary secretions:
Source
Function

Back 86

Source: parotid (most serous), submandibular and sublingual (most mucinous) glands

Function:
1) alpha-amylase--beings starch digestion, inact'd by low pH on reaching stomach

2) Bicarbonate neutralizes oral bacterial acids, maintains dental health

3) Mucins (glycoproteins) lubricate food

4) Antibacterial secretory products

5) Growth factors promote epithelial renewal

Front 87

What is the most common location of salivary gland tumors?

Back 87

Parotid gland

Front 88

What is the most common salivary gland tumor?

What is the histologic appearance of this tumor?

Back 88

Pleomorphic adenoma

Histo: pleomorphic--both epithelial and mesenchymal differentiation

Front 89

What is the second most common benign salivary gland tumor?

Back 89

Warthin's tumor

Front 90

What is the most common malignant salivary gland tumor?

Back 90

Mucoepidermoid carcinoma (second most common overall salivary gland tumor)

Front 91

What is the likelihood that a salivary gland tumor will be malignant based on the gland it is located in?

Back 91

Parotid gland: <30% chance malignancy

Sublingual: >70% change malignancy

Front 92

What is the biggest risk factor of salivary gland tumor malignancy?

Back 92

Smoking

Front 93

Trypsinogen:
Secreted by
Function

Back 93

Secreted by panccreas, converted to trypsin by enterokinase/enteropeptidase (secreted by duodenal mucosa)

Trypsin activates other proenzymes and more trypsinogen (positive feedback loop)

Front 94

What is the rate-limiting step of carbohydrate digestion?

Back 94

Oligosaccharide hydrolase at brush border of intestine; produce monosaccharides from oligo- and disaccharides

Front 95

Where in the GI tract is iron absorbed?

Back 95

Fe2+ absorbed in duodenum

Front 96

Where in the GI tract is folate absorbed?

Back 96

Jejunum

Front 97

Where in the GI tract is B12 absorbed?

Back 97

Ilieum; along with bile acids; requires INTRINSIC FACTOR from parietal cells

Front 98

What is a bile salt?

Role?

Back 98

Bile acid conjugated to glycine/taurine; makes bile water soluble

Needed for digestion of TGs and micelle formation (required for absorption of non-polar nutrients such as lipids) in small bowel

Front 99

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

Back 99

Oligosaccharide hydrolases at intestinal brush border

Front 100

What enzyme is responsible for the conjugation of bilirubin?

Back 100

UDP glucoronyl transferase; up-regulated by phenobarbital

Front 101

What important secretory products are secreted from:
G cells

Back 101

Gastrin

Front 102

What important secretory products are secreted from:
I cells

Back 102

CCK

Front 103

What important secretory products are secreted from:
S cells

Back 103

Secretin

Front 104

What important secretory products are secreted from:
D cells

Back 104

SMS

Front 105

What important secretory products are secreted from:
Parietal cells

Back 105

Acid, IF

Front 106

What important secretory products are secreted from:
Chief cells

Back 106

Pepsinogen

Front 107

Which GI ligament:
Contains portal triad and may be compressed to control bleeding

Back 107

Hepatoduodenal lig

Front 108

Which GI ligament:
Attaches spleen to posterior abdominal wall

Back 108

Splenorenal

Front 109

Which GI ligament:
Attaches spleen to stomach

Back 109

Gastrosplenic lig

Front 110

What drugs and endogenous hormones regulate the secretion of gastric acid?

Back 110

Secretory Hormones:
Histamine
ACh
Gastrin

Inhibitory hormones:
PGs
SMS
Secretin
GIP
----
PPIs
H2RAs
Anti-muscarinics

Front 111

Which hormones stimulate pancreatic secretion?

Back 111

ACh
CCK
Secretin

Front 112

What structures form Hesselbach's triangle?

Back 112

Inferior gastric artery
Lateral border of rectus abdominis
Inguinal ligament

Front 113

Which hereditary hyperbilirubinemia:
Mildly decreased UDPGT

Back 113

Gilbert's, Crigler-Najjar Type II

Front 114

Which hereditary hyperbilirubinemia:
Completely absent UDPGT

Back 114

Crigler-Najjar Type I

Front 115

Which hereditary hyperbilirubinemia:
Grossly black liver

Back 115

Dubin-Johnson Syndrome

Front 116

Which hereditary hyperbilirubinemia:
Responds to phenobarbital

Back 116

Crigler-Najjar Type II

Front 117

Which hereditary hyperbilirubinemia:
Treatment includes plasmapheresis and phototherapy

Back 117

Crigle-Najjar Type I

Front 118

Which hereditary hyperbilirubinemia:
Asymptomatic unless under physical stress (alcohol, infection)

Back 118

Gilbert's

Front 119

Which antacid:
May cause diarrhea

Back 119

Magnesium hydroxide

Front 120

Which antacid:
May cause constipation

Back 120

Aluminum hydroxide

Front 121

Which antacid:
May cause rebound hypercalcemia

Back 121

Calcium carbonate

Front 122

Which antacid:
May cause hypokalemia

Back 122

Mg(OH)2
Al(OH)3
CaCO3

Front 123

What enzyme is inhibited by PPIs?

Back 123

Hydrogen Potassium ATP-ase

Front 124

What is the arterial supply of the forgut?

Back 124

Celiac

Front 125

What is the arterial supply of the midgut?

Back 125

SMA

Front 126

What is the arterial supply of the rectum and distal third of the colon?

Back 126

IMA