Unit 3 - Formative 5 D1

Front 1

What anatomical location distinguishes the upper GI tract (esophagus, estomach, duodenum) from the lower GI tract (distal small bowel, colon)

Back 1

Ligament of Treitz

Front 2

What is the name of blood loss which is vomited and is fresh, bright red or with coffee ground appearance?

Back 2

Hematemesis

Front 3

What is the name for black, tarry, foul smelling stools?

Back 3

Melena

Front 4

What produces melena?

Back 4

Degradation of blood by bacteria; indicates the blood has been in the GI tract for at least 14 hrs

Front 5

What is the name for the passage of bright red blood or maroon stool from the rectum?

Back 5

Hematochezia

Front 6

What test is used to detect occult blood?

Back 6

Guaiac testing

Front 7

How can you differentiate between blood originating from the left colon vs blood originating from the right colon?

Back 7

LC: bright red
RC: dark or maroon and may be mixed with stool (since it's been sitting in there longer)

Front 8

What does hepatomegaly, splenomegaly, ascites and spider angiomata suggest?

Back 8

Liver disease

Front 9

What does a negative lavage with bilious fluid indicate about upper GI bleeding?

Back 9

that there is no upper GI bleeding

Front 10

A patient complains of epigastric pain after being admitted to the intensive care unit.

Back 10

Stress related peptic ulcer

Front 11

A patient taking NSAIDs for chronic lower back pain complains of epigastric pain.

Back 11

Peptic ulcer

Front 12

A patient presents with hematemesis and epigastric pain. What is the differential?

Back 12

Peptic ulcer dx secondary to h. pylori, NSAIDs, stress (ICU setting), gastric acid hypersecretion

Front 13

What is the tumor most likely to cause an acute upper GI bleed?

Back 13

Adenocarcinoma

Front 14

An alcoholic presents with vomiting and retching prior ot hematemesis. The bleeding usually stops spontaneously. The patient has a history of alcoholism. You rule out liver disease or peptic ulcers. Likely dx?

Back 14

Mallory-Weiss tear

Front 15

What is the most common cause of lower GI bleeding?

Back 15

Colonic diverticula

Front 16

How does visceral pain transmission differ from somatic?

Back 16

Visceral pathways demonstrate significant branching to I, II, V, and X

Front 17

What is epicritic pain?

Back 17

Pain which is precisely localized to a somatic structure

Front 18

Which cortical area is visceral sensation primarily represented in?

Back 18

Secondary somatosensory cortex; representation is vague which may account for poor localization

There's also projects to insular, amygdala, ingulate cortex as well as frontal lobe (emotional aspects of pain sensation)

Front 19

Does the GI tract respond more to cutting or distension?

Back 19

Distention; you can cut all you want and won't feel it

Front 20

When is sensitivity to pain greatest in females?

Back 20

Perimenstrual period;

(dropping progesterone (tranquilizing effect), increasing estrogen levels (arousing effect)

Front 21

What is significant about the sacral dermatones relative to referred pain?

Back 21

There's a high degree of sloping

Front 22

Why would the anterior wall of the stomach be able to project pain in the same dermatomal region but in the posterior projection it appears higher?

Back 22

T6-9 are in the same anatomical area as the stomach anterioally, but posterially the dermatones are higher due to the sloping of the T6-9 intercostal nerves

Front 23

What is the difference between the parietal and visceral peritoneum?

Back 23

Parietal; attached to the outer abdominal wall
Visceral; lines the inside of the abdomen

Front 24

Where would back pain radiating from the head or uncinate of the pancreas produce back pain?

Back 24

to the right of the midline; same as pancreatic anatomical location

Front 25

where would back pain radiating from the tail of the pancreas produce back pain?

Back 25

Left of the midline; same as pancreatic anatomical location

Front 26

What is causing 'loin and groin' pain?

Back 26

Pain radiating along L1 and L2 from the ureter

The Kidney radiates directly posteriorly to the back

Front 27

Where is the pelvic pain line?

Back 27

For GI viscera, it is in the middle of the sigmoid colon
Afferents are derived from T6-L2 above the pelvic pain line and from S2-S4 below the line

Front 28

A patient presents with inferior scapular pain. What might be happening?

Back 28

Cholecystisis (gallbladder inflammation); (kidney stone)

Front 29

A patient eats a fatty pizza and gets colicky cramping 30 minutes later under their right armpit. What's happening?

Back 29

Biliary colic; crampy pain right after eating due to large gallstones in the body of the gallbladder

Front 30

What is choledochocystiis?

Back 30

Gallbladders in the actual bile duct system

Front 31

Where are the dorsal root ganglia do the sensory nerve cell bodies associated with the phrenic nerve?

Back 31

C3, C4, C5; pain radiating to shoulder

Front 32

The phrenic nerve innervation of the gall bladder, when activated, will also caused referred pain where?

Back 32

Right shoulder (C3, C4, C5 dermatomes)

Front 33

What is Murphy's sign?

Back 33

When palpating the liver along the costal margin, the patient takes a sharp intake o fbreath and then stops breathing; sign of gallbladder disease

Front 34

What is the reason for Murphy's sign?

Back 34

The palpating pressure on the abdomen causes the parietal peritoneum to contact the inflammed gall bladder, producing pain sufficient to stop respiration

Front 35

What are the F's of the gallbaldder

Back 35

Fair (european/light skinned origin/blonde), female, fertile (younger women in 40s), flatulent (due to not enough bile and malabsorption of fat), forty, febrile (bile is an excellent growth medium for bacteria)

Front 36

What is colicky character of pain?

Back 36

Spasmodic, comes in waves due to peristalsis

Front 37

What other referred pain might you see with choledochocysitis?

Back 37

Blockage of common bile duct may produce acute pancreatitis because the common bile duct joins with the main pancreatic duct at the ampulla Vater; pancreatic pain will radiate directly to the back

Front 38

Why does the localization of appendicitis pain shift from a periumbilical localization to right lower quadrant localization?

Back 38

Distension of the inflammed appendix touches the parietal peritoneum; same as gallbladder

Front 39

What is McBurney's point?

Back 39

2/3 distance between umbilicus and anterior superior iliac spine

Suggests involvement of parietal peritoneum secondary to appendicitis

Front 40

What is Rovsing's sign?

Back 40

Deep palpation in the left iliac fossa may elicit pain in the right iliac fossa; pressure over descending colon caues pain within the right lower qudrant of the abdomen due to bilateral feed from visceral pain neurons in the spinal cord

Front 41

What is the Psoas sign?

Back 41

Extension of the thight at the hip can detect a retroperitoneal appendix since it wil be touching the fascia of the psoas muscle

Front 42

What are some peritoneal signs of abdominal tenderness which may suggest the abdominal source?

Back 42

Shaking tenderness (pain when bed is bumped); tenderness to light percussion; rebound tenderness suggests aggravation of the parietal layer of peritoneum by stretching or moving; abdominal wall rigidity (involuntary guarding of abdominal musculature)

Front 43

What investigation is used to evaluate for pregnancy?

Back 43

Urine HCG

Front 44

Budd-Chiari Syndrome

Back 44

Obstruction of two or more major hepatic veins produces liver enlargement, pain and ascites

Front 45

Obstruction of two or more major hepatic veins produces liver enlargement, pain and ascites

Back 45

Budd-Chiari Syndrome

Front 46

Where would you expect to find Brunner glands?

Back 46

they're dense in proximal duodenum, decrease distally (they are not found in the jejunum or ileum)

Front 47

What is the broad name for the 3 longitudinal bands that contract to form haustra?

Back 47

Taenia coli

Front 48

Distinguishing characteristic of the appendix histology

Back 48

Large number and size of lymphatic nodules that fuse ande extend into the submucosa

Front 49

How to distinguish the ileum from the jejunum or duodenum histologically

Back 49

Villi in the ileum are shorter and more leaflike
PEYERS PATCHES

Front 50

Distinguishing features of the jejunum histologically

Back 50

Long finger like villi; Jejunum has the largest number of goblet cells; plicae circulares and crypts of Lieberkuhn

Front 51

Distinguishing features of the duodenum histologically

Back 51

Brunners glands, which secrete an alkaline mucus which helps to neutralize acidic chyme

Front 52

What is the difference in bonding structure between linked and branched glycogen bonds?

Back 52

Linear: alpha 1,4 glycosidic bonds

Branched: alpha 1,6 glycosidic bonds

Front 53

Differentiate the time frames between fed, fasting, and starved

Back 53

Fed: 2-4 hrs after eating meal
Fasting: 4-12 hrs after eating
Starved: occurs after 3-5 days of fasting

Front 54

How is glycogen utilized differently in the liver vs skeletal muscle?

Back 54

Liver: maintain blood glucose in a normal range

Skeletal: provides energy specifically for work

Front 55

Which two tissue types rely hejavily on glucose during the FASTING state?

Back 55

Brain and RBCs

Front 56

What is the primary glucose transporter in hepatocytes?

Back 56

GLUT-2

Front 57

What is the primary glucose transporter in adipose tissue, skeletal and cardiac muscle?

Back 57

GLUT-4

Front 58

Phosphorylation by which two enzymes in the liver and other tissues respectively prevents glucose from leaving the cell?

Back 58

Glucokinase (liver)
Hexokinase (other tissues)

Front 59

Why must glucokinase work at a much higher Km and Vmax relative to hexokinase?

Back 59

The liver has to be able to remove glucose quickly to minimize hyperglycemia

Front 60

What enzyme converts G6P to G1P

Back 60

Phosphoglucomutase

Front 61

What enzyme converts G1P to UDP-glucose

Back 61

UDO-glucose phosphorylase

Front 62

What enzyme, present in liver cells but not in skeletal muscle, hydrolyzes G6P to glucose?

Back 62

Glucose-6-Phosphatase; this enzyme releases glucose into the bloodstream, which is why liver glucose is used to maintain blood sugar levels while skeletal glucose only powers local tissue functions

Front 63

How does calcium calmodulin effect glycogen?

Back 63

Promotes glycogen degradation, raising blood sugar levels

Front 64

How does glucagon, epinephrine and insulin effect glycogen levels?

Back 64

Promotes glycogen degradation, raising blood sugar levels

Front 65

A patient presents with hepatomegaly, enlarged kidneys, failure to thrive, hypoglycemia, hyperlididemia, hyperlacticacidemia, hyperuricemia.

Back 65

Von Gierke's (Type I) Glycogen Storage Disorder; Glucose 6-phosphatase deficiency

Front 66

A patient presents with cardiac/respiratory failure, death before the age of 2

Back 66

Pompe's (Type II) Glycogen storage Disorder

alpha (1-4) glucosidase deficiency

Front 67

A patient presents with hepatomegaly, enlarged kidneys, failure to thrive, and hypoglycemia but without hyperlacticacidemia or hyperuricemia.

Back 67

Cori's (Type III) Glycogen storage disorder

Debranching Enzyme Deficiency

Front 68

A patient presents with painful muscle cramps with exercise.

Back 68

McArdle's (Type V) glycogen storage disorder

Glycogen phosphorylase (muscle) deficiency

Front 69

What happens biochemically with a deficiency in glucose-6-phosphatase?

Back 69

Inability to maintain blood glucose levels between meals; glucose that accumulates in hepatocytes is shunted towards glycogen and fat synthesis; DOES NOT EFFECT SKELETAL MUSCLE

Front 70

A 25 year-old male has arrived at the clinic with complaints of fatigue and muscle cramping after short periods of exercise at the gym. He remarks that he leads a relatively sedentary lifestyle and only recently has become interested in working out. His BMI falls within the healthy range and a review of his daily diet reveals generally healthy eating habits. In addition to a low threshold for exercise, the patient also mentions that his urine appears “dark” after his trips to the gym. You suspect that this individual may have an inherited glycogen storage disorder.

Back 70

McArdle's Type V (Glycogen Phosphorylase deficiency)

Front 71

A 3-year-old boy is brought to your pediatric clinic because of restlessness and fatigue. The mother is concerned that he becomes fidgety between meals. On physical examination, you notice that the child has very fat cheeks, making his face appear “doll-like,” and his abdomen is quite protuberant. The boy is short for his age, and his arms and legs are thin in comparison to his trunk. Laboratory findings include hypoglycemia, lactic acidosis, hyperuricemia, and hyperlipidemia. Based on the information given, which glycogen storage disorders is the most likely cause?

Back 71

Von Gierke's Type I (Glucose 6-phosphtase deficiency)

Front 72

A 3-month-old girl is brought to your pediatric clinic because she is not feeding well and has poor weight gain. On physical examination, you find that she has a large tongue and mild hepatomegaly. She is also significantly flaccid and hypotonic. Fearing an autosomal recessive glycogen storage disease, you order an ECG, which shows a short PR interval and wide QRS interval. You order a series of serum studies, expecting to see elevated creatine kinase, aspartate transaminase, and lactate dehydrogenase. You fear that the child has a poor prognosis, and will likely suffer cardiopulmonary failure and death before her first birthday. Which glycogen storage disorders is the most likely culprit?

Back 72

Cori's (Milder version of Type I)

Front 73

An 8-month-old boy is brought to the pediatrician by his parents because he has recently lost the ability to crawl or hold his toys. On examination the patient is tachypneic and breathing with considerable effort; the liver is palpable five finger widths below the right costal margin. X-rays of the chest reveals cardiomegaly. He has a difficult time sitting upright and cannot squeeze the physician’s fingers or the ring of his pacifier with any noticeable force. Despite a number of interventions, the child’s symptoms continue to worsen until his death 2 weeks later. On autopsy, it is likely that this patient’s cells will contain an accumulation of which substances?

Back 73

Glycogen

Front 74

A 7-year-old boy presents to your pediatric clinic complaining of muscle weakness of 1 year duration. His parents are concerned because he gets tired very quickly when playing with his classmates in the yard. He is an only child, and his mother’s pregnancy was full term with no complications and no known medical history. On physical exam, you note that he has moderate hepatosplenomegaly, is of short stature, and has marked muscle wasting. At his last clinic visit, serum studies revealed hypoglycemia, hyperlipidemia, a fasting ketosis, and elevated liver transaminases. Which glycogen storage disorders does this child likely have?

Back 74

Cori’s (Type III)