Usmle Step 1 Flashcards - Gi

Front 1

Derivative of fetal umbilical vein?

Back 1

Falciform ligament
- connects liver to anterior abdominal wall

Front 2

Which ligament connects the greater and lesser sacs and contains the portal triad?

Back 2

Hepatoduodenal ligament

Front 3

The gastrosplenic ligament contains what vessels?

Back 3

Short gastrics
- also separates left greater and lesser sacs
- connects greater curvature of stomach to spleen

Front 4

Gastrosplenic ligament separates the L greater and lesser sacs. Which ligament separates the R side?

Back 4

Gastrohepatic
(contains gastric arteries)

Front 5

Ligament that contains the gastroepiploic arteries?

Back 5

Gastrocolic

Front 6

Areas of the small intestine that have plicae circulares?

Back 6

Jejunum and proximal ileum

Front 7

Areas of the small intestine that have crypts of Lieberkuhn?

Back 7

All of the small intestine

Front 8

Area of the small intestine that have Brunner's glands?

Back 8

Submucosa of duodenum

Front 9

Area of the small intestine with the most goblet cells?

Back 9

Jejunum

Front 10

Parasympathetic innervation of foregut, midgut, and hindgut?

Back 10

Foregut and midgut: vagus nerve
Hindgut: pelvic

Front 11

3 branches of celiac trunk?

Back 11

Common hepatic, splenic, and L gastric

Front 12

4 collateral circulations of GI system?

Back 12

1.Internal thoracic/mammary (subclavian) w/ superior epigastric (internal thoracic) w/ inferior epigastric (external iliac)
2. Superior pancreaticoduodenal (celiac trunk) w/ inferior pancreaticoduodenal (SMA)
3. Middle colic (SMA) w/ left colic (IMA)
4. Superior rectal (IMA) w/ middle rectal (internal iliac)

Front 13

Innervation of external hemorrhoids?

Back 13

Inferior rectal nerve (branch of pudendal) - somatic innervation
- compare with internal hemorrhoids (visceral innervation)

Front 14

Blood supply above vs below pectinate line?

Back 14

Above: superior rectal artery (IMA)
Below: inferior rectal artery (from internal pudendal artery)

Front 15

Esophageal anastomosis?

Back 15

Left gastric (portal) and esophageal (systemic)

Front 16

Umbilicus anastomosis?

Back 16

Paraumbilical (portal) with superficial and inferior epigastric (systemic)

Front 17

Rectal anastomosis?

Back 17

Superior rectal (portal) with middle and inferior rectal (systemic)

Front 18

Femoral triangle vs femoral sheath?

Back 18

Femoral triangle contains femoral vein, artery, and nerve. Femoral SHEATH (fascial tube 3-4cm below inguinal ligament) contains femoral vein, artery, and canal (deep inguinal lymph nodes) but NOT nerve.

Front 19

Order of fascias/muscles on lateral abdominal wall?

Back 19

Parietal peritoneum, transversalis fascia, transversus abdominis, internal oblique, external oblique

Front 20

What are the median and medial umbilical ligaments remnants of?

Back 20

Median: remnant of urachus
Medial: remnants of umbilical arteries

Front 21

Where do congenital diaphragmatic hernias (Bochdalek hernia) usually occur?

Back 21

Left posterolateral.

Due to defective development of pleuroperitoneal membrane.

Front 22

Sliding vs paraesophageal hernia?

Back 22

Sliding: GE junction is displaced upward (get "hourglass stomach")

Paraesophageal: cardia of stomach moves into the thorax but GE junction is normal

Both are types of hiatal hernias.

Front 23

Leading cause of bowel incarceration (especially in women)?

Back 23

Femoral hernia. Occur below the inguinal ligament, through femoral canal.

Front 24

Borders of Hesselbach's triangle?

Back 24

Inferior epigastric artery
Rectus abdominis
Inguinal ligament

Front 25

Division between direct and indirect inguinal hernias?

Back 25

Inferior epigastric artery/vessels.

Indirect: lateral
Direct: medial

Front 26

What kind of hernia do people with ascites, obesity, black newborns, or pregnant people get?

Back 26

Umbilical. Can lead to incarceration in adults, or often spontaneously close <2 yo in kids.

Front 27

What type of hernia occurs in an area weakened by previous surgery?

Back 27

Ventral hernia

Front 28

Which nerve can be damaged during parotid surgery?

Back 28

CN VII
- runs through parotid gland

Front 29

Stimulation of salivary gland secretion?

Back 29

Sympathetics (T1-T3, superior cervical ganglion) and parasympathetics (facial, glossopharyngeal nerves)

Front 30

Prostaglandins, somatostatin, and histamine work through what mechanism on gastric parietal cells?

Back 30

cAMP

Front 31

ACh and gastrin work through what mechanism on parietal cells?

Back 31

Gq --> IP3/Ca

Front 32

What is the effect of atropine on parietal cells?

Back 32

It blocks direct vagal stimulation of parietal cells (M3 receptors) but NOT stimulation of G cells (where GRP transmitter is used).

Front 33

Hypertrophy of what is seen in peptic ulcer disease?

Back 33

Brunner's glands (duodenal submucosa)

Front 34

Carbohydrate absorption transporters?

Back 34

SGLT1: Glu/gal
GLUT-5: fructose
GLUT-2: transports all monosaccharides to blood

Front 35

Cells in Peyer's patches that take up antigen?

Back 35

M cells. Present it to B cells in germinal centers, which then differentiate into IgA secreting plasma cells (in lamina propria).

Front 36

Common benign tumor of the salivary gland?

Back 36

Pleomorphic adenoma
- more common F, painless, moveable

Front 37

Common malignant tumor of the salivary gland?

Back 37

Mucoepidermoid carcinoma
- often in parotid gland
- CN VII involvement is a sign of malignancy

Front 38

Causes of macroglossia?

Back 38

Myxedema, Down syndrome, Acromegaly, Amyloidosis, MEN IIb/III

Front 39

What is Warthin's tumor?

Back 39

Benign salivary gland tumor
- heterotopic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue

Front 40

What area of the bowel does celiac sprue affect?

Back 40

Primarily the proximal small bowel

Front 41

Findings in Whipple's disease?

Back 41

Tropheryma whippelii (gm positive, PAS positive)
- macs in intestinal lamina propria & mesenteric nodes
- arthralgia, cardiac, neuro symptoms, fever, steatorrhea, lymphad, inc skin pigment
- older men

Front 42

"ABCDEF" risk factors for esophageal cancer?

Back 42

Alcohol/Achalasia, Barrett's, Cigarettes, Diverticula (Zenker's), Esophageal Web (Plummer-Vinson)/Esophagitis, Familial

Front 43

Tests of pancreatic insufficiency?

Back 43

Secretin stimulation test, trypsin levels, Bentiromide test (cleaved by chymotrypsin to PABA --> urine)

Front 44

Striated muscle vs smooth muscle causes of dysphagia?

Back 44

Upper (striated muscle): dermatomyositis, MG, stroke
Lower (smooth muscle): systemic sclerosis, CREST, achalasia

Front 45

Nerve plexus lost in achalasia?

Back 45

Myenteric (Auerbach's) plexus (in esophageal body) --> failure of relaxation of LES

Front 46

3 infectious causes of esophagitis?

Back 46

HSV-1, CMV, and Candida

Front 47

What are Mallory-Weiss tears heavily associated with?

Back 47

Hiatal hernia
- tears: mucosal lacerations caused by severe vomiting

Front 48

What can Boerhaave syndrome cause and what is the physical exam finding?

Back 48

Can cause pneumomediastinum.
- hear Hamman's crunch on auscultation

Front 49

Pain with gastric vs duodenal ulcers?

Back 49

Gastric: Pain is Greater with meals
Duodenal: Pain Decreases with meals

Front 50

Complications of duodenal ulcers?

Back 50

Bleeding (gastroduodenal artery), penetration into pancreas, perforation, obstruction

Front 51

Cause of gastric vs duodenal ulcer?

Back 51

Gastric: decreased mucosal protection against gastric acid
Duodenal: increased gastric acid secretion OR decreased mucosal protection

Front 52

Malignancy risk with celiac sprue?

Back 52

T-cell lymphoma

Front 53

Dermatologic findings associated with gastric cancer?

Back 53

Acanthosis nigricans, sign of Leser-Trelat

Front 54

Associations/causes of gastric cancer?

Back 54

Chronic gastritis (H. pylori), achlorhydria, type A blood, dietary nitrosamines (smoked foods)

Front 55

Findings with Menetrier's disease?

Back 55

Gastric hypertrophy, protein loss, parietal cell atrophy, increased mucous cells

Front 56

Causes of acute erosive gastritis?

Back 56

NSAIDs, stress, alcohol, uremia, burns (Curling's ulcer), brain injury (Cushing's ulcer), Anisakis (worm)

Front 57

Types of chronic (non-erosive) gastritis?

Back 57

Type A (fundus/body): Autoimmune, Abs against parietal cells, pernicious anemia, achlorhydria

Type B (antrum): H. pylori, most common

Front 58

Side effect of Infliximab (Ab to TNF-alpha)?

Back 58

Respiratory infection (including reactivation of latent TB)

Front 59

2 uses of misoprostol (PGE-1 analog) besides for peptic ulcers?

Back 59

1. Maintenance of patent ductus arteriosus
2. Induce labor

Front 60

Drug interactions of metoclopramide?

Back 60

Digoxin and diabetic agents

Front 61

Sulfasalazine mechanism and uses?

Back 61

Sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory)
- activated by colonic bacteria
- used for UC and CD

Front 62

M1 and M3 blockers and use?

Back 62

Pirenzepine, propantheline
- used for peptic ulcers (but rarely)
- block M1 on ECL cells and M3 on parietal cells

Front 63

Side effects of overuse of aluminum hydroxide (antacid)?

Back 63

Constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures

Front 64

Side effects of overuse of magnesium hydroxide (antacid)?

Back 64

Diarrhea (also works as osmotic laxative), hyporeflexia, hypotension, cardiac arrest

Front 65

Are PPIs reversible or irreversible?

Back 65

IRREVERSIBLE

Front 66

Which H2 blockers decrease renal excretion of creatinine?

Back 66

Cimetidine and Ranitidine

Front 67

What is Courvoisier's sign?

Back 67

Palpable gallbladder.
Seen in obstructive jaundice (pancreatic adenocarcinoma) and cholangiocarcinoma.

Front 68

What is the "C sign" seen in?

Back 68

Carcinoma of the head of the pancreas --> indents duodenum and forms "C" shape

Front 69

Risks of gallbladder adenocarcinoma?

Back 69

Cholelithiasis and porcelain gallbladder (dystrophic calcification)

Front 70

Black vs brown gallstones?

Back 70

Black: seen in chronic hemolysis
Brown: seen with biliary infection
- both are pigmented and radiopaque

Front 71

Ultrasound can diagnose gallstones in what location?

Back 71

US can only see stones still in the gallbladder, not in the common bile duct (need to use HIDA radionuc scan)

Front 72

What is the Grey-Turner sign?

Back 72

Flank hemorrhage (seen in retroperitoneal injury)

Front 73

What is Cullen's sign?

Back 73

Periumbilical hemorrhage (seen with necrotic pancreatitis)

Front 74

Complications of acute pancreatitis?

Back 74

DIC, ARDS, diffuse fat necrosis, hypocalcemia (FA soap deposits), pseudocyst formation, hemorrhage, infection, necrosis, multiorgan failure

Front 75

Causes of acute pancreatitis?

Back 75

Gallstone, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hyperlipidemia/hypertriglyceridemia, ERCP, Drugs (sulfa)
"GETSMASHED"

Front 76

Differences in iron location between primary and secondary hemochromatosis?

Back 76

Primary: more parenchymal Fe
Secondary: more in Kupffer cells (macs)

Front 77

Lab values in hemochromatosis?

Back 77

High ferritin, high iron, Low TIBC, high transferrin saturation

Front 78

Risks for cholangiocarcinoma?

Back 78

PSC, Clonorchis sinensis, thorotrast (thorium dioxide), choledochal cyst, Caroli disease

Front 79

"Onion skin" bile duct fibrosis?

Back 79

Primary sclerosing cholangitis (PSC)
- "beading" of intra and extra hepatic bile ducts on ERCP

Front 80

Special findings in PBC?

Back 80

- granulomas and lymphocytic infiltrate
- F > M
- pruritis BEFORE jaundice
- Kayser-Fleischer rings

Front 81

Appearance of alpha-1 antitrypsin deficiency on histology?

Back 81

PAS-positive red cytoplasmic granules/globules in liver

Front 82

Where does copper accumulate in Wilson's disease?

Back 82

Liver, brain, cornea, kidneys, and joints

Front 83

Findings in Wilson's disease?

Back 83

Asterixis, Basal ganglia degeneration (PD sx, hemiballismus), Cirrhosis, Corneal deposits (Descemet's membrane), Copper accum, Carcinoma, Dec ceruloplasmin, Dementia, Dyskinesia, Dysarthria, Hemolytic anemia

Front 84

Two types of Crigler-Najjar syndrome?

Back 84

Type 1: absent UDP-glucuronyl transferase
Type 2: less severe, responds to phenobarbital (inc liver enzyme synthesis)

Front 85

Dubin-Johnson vs Rotor syndrome?

Back 85

Both involve defective excretion of conjugated bilirubin.
Rotor is LESS severe.
Dubin-Johnson: grossly black liver

Front 86

Post-viral hepatoencephalopathy with microvesicular steatosis, mitochondrial abnormalities, and hypoglycemia?

Back 86

Reye's syndrome
- often follows VZV or influenza B infection

Front 87

Key histo finding of hepatocellular carcinoma?

Back 87

Bile in neoplastic cell

Front 88

What do Mallory bodies look like and what are they seen with?

Back 88

Intracytoplasmic eosinophilic inclusions. Seen in alcoholic hepatitis.

Front 89

Findings in alcoholic cirrhosis?

Back 89

Micronodular shrunken liver ("hobnail" appearance). Sclerosis around central vein (zone III). Manifestations of chronic liver disease.

Front 90

EM finding of carcinoid tumor?

Back 90

Dense core bodies.

Front 91

Series of gene mutations in APC pathway of colon cancer?

Back 91

Loss of APC gene --> K-ras mutation --> loss of p53 (& DCC)
- chromosomal instability pathway accounts for 85% of colon cancer

Front 92

Micronodular vs macronodular regeneration: which has greater HCC risk?

Back 92

MACRO. Seen with significant hepatic necrosis (postinfectious or drug-induced hepatitis)
- Micronodular: seen with metabolic insult (alcohol, hemochromatosis, Wilson's disease)

Front 93

Physical exam findings in appendicitis?

Back 93

Psoas sign, Blumberg's (rebound tenderness), and Rovsing's sign

Front 94

Locations of volvulus?

Back 94

Cecum in young people
Sigmoid colon in older

Front 95

Most commonly involved area in necrotizing enterocolitis?

Back 95

Mucosa of colon but can involve entire GI tract

Front 96

Common location of ischemic colitis?

Back 96

Splenic flexure (watershed area) and distal colon

Front 97

Tubular vs villous polyps?

Back 97

Tubular: often stalked
Villous: often sessile, more likely to be malignant

Front 98

Most common non-neoplastic polyp in colon?

Back 98

Hyperplastic
- 50% in rectosigmoid colon
- "sawtooth" appearance

Front 99

Peutz Jeghers syndrome?

Back 99

Aut dom, multiple nonmalignant hamartomas throughout GI tract (esp sml intestine)
- hyperpigmented mouth, lips, hands, genitalia
- inc risk CRC and other visceral malignancies

Front 100

Presentation of R vs L colon cancer?

Back 100

L: obstruction, colicky pain, hematochezia
R: dull pain, iron deficiency anemia, fatigue

Front 101

Gardner's and Turcot's syndrome?

Back 101

Gardner's = FAP + osseous and soft tissue tumors, retinal hyperplasia (aut dom)

Turcot's = FAP + malignant CNS tumor (astrocytoma, medulloblastoma) (aut recess)

Front 102

Level that testicular/ovarian arteries exit aorta?

Back 102

L2

Front 103

Structures supplied by celiac artery?

Back 103

Stomach to proximal duodenum
Liver
Gallbladder
Pancreas
Spleen (mesoderm origin)

Front 104

Histology of colon?

Back 104

Crypts but no villi

Front 105

Location of 2 nerve plexuses?

Back 105

Submucosal nerve plexus (Meissner's): in submucosa

Myenteric nerve plexus (Auerbach's): in muscularis externa

Front 106

What does the pectinate line divide?

Back 106

Hindgut and ectoderm

Front 107

Venous drainage of external hemorrhoids (below pectinate line)?

Back 107

Inferior rectal vein
--> internal pudendal vein
--> internal iliac vein
--> IVC

Front 108

Portal HTN affecting the anastomosis between the paraumbilical (portal) and superficial and inferior epigastric (systemic) arteries causes what?

Back 108

Caput medusae (at the umbilicus)

Front 109

What does the femoral sheath contain?

Back 109

Femoral artery
Femoral vein
Canal (deep inguinal lymph nodes)

Does NOT contain femoral nerve

Front 110

What forms the boundaries of the femoral triangle?

Back 110

Inguinal ligament (top)
Sartorius (lateral)
Adductor longus (medial)

Front 111

Origin of cremasteric muscle and fascia?

Back 111

Internal oblique aponeurosis

Front 112

Site of protrusion of direct vs indirect hernia?

Back 112

Indirect: internal (deep) inguinal ring

Direct: abdominal wall (inguinal/Hesselbach's triangle)

Front 113

Which hernias go through internal inguinal ring? External inguinal ring?

Back 113

Only indirect goes through internal inguinal ring.

Both direct and indirect go through external inguinal ring.

Front 114

Where does a femoral hernia travel through?

Back 114

Through femoral canal

- below and lateral to pubic tubercle

Front 115

5 components of saliva?

Back 115

1. Alpha-amylase (ptyalin)
2. HCO3
3. Mucins (glycoproteins)
4. Antibacterial products
5. Growth factors (for epithelial renewal)

Front 116

Neurotransmitter released when vagus nerve innervates G cells and significance?

Back 116

GRP

- CANNOT be blocked by atropine

Front 117

Strongest effect of gastrin is on what cells?

Back 117

Strongest effect is on ECL cells (leading to histamine release) which has a greater influence on gastric acid secretion than gastrin's direct effect on parietal cells.

Front 118

Which of the pancreatic enzymes is secreted in its active form?

Back 118

Alpha amylase

Front 119

Mechanism of absorption of glucose vs fructose?

Back 119

Glucose: SGLT1 (Na+ dependent)

Fructose: GLUT5 (facilitated diffusion)

Front 120

Salivary vs pancreatic amylase?

Back 120

Salivary: hydrolyzes alpha-1,4 linkages to yield disaccharides (maltose and alpha-limit dextrins)

Pancreatic: hydrolyzes starch to oligo and disaccharides

Front 121

Tropical vs celiac sprue?

Back 121

Both are malabsorption syndromes.

Tropical sprue is similar to celiac but affects the entire small bowel and responds to antibiotics.

Front 122

Complications of duodenal ulcers?

Back 122

Bleeding (gastroduodenal artery)
Penetration into pancreas
Obstruction
Perforation

Front 123

Where can PAS-positive macrophages be found in Whipple's disease?

Back 123

Intestinal lamina propria and mesenteric nodes

Front 124

Cause of appendicitis in kids vs adults?

Back 124

Kids: lymphoid hyperplasia after viral infection

Adults: obstruction, fecalith

Front 125

How does pneumaturia result from diverticulitis?

Back 125

Results from formation of a colovesical fistula (fistula with bladder)

Front 126

Zenker's diverticulum occurs at what junction?

Back 126

Junction between the pharynx and esophagus

Front 127

Bowel layers with inflammation in UC?

Back 127

Mucosal and submucosal only

Front 128

Histology of UC?

Back 128

Crypt abscesses and ulcers
Bleeding
NO granulomas

Front 129

Common locations of angiodysplasia?

Back 129

Cecum
Terminal ileum
Ascending colon

Front 130

"Double bubble" sign?

Back 130

Duodenal atresia.

Front 131

Reproductive AE of sulfasalazine?

Back 131

Reversible oligospermia

Front 132

Ocular effect of muscarinic antagonists?

Back 132

Difficulty focusing/accommodating

Front 133

What electrolyte abnormality can all antacids cause?

Back 133

Hypokalemia

Front 134

Which 2 drugs decrease renal excretion of creatinine?

Back 134

Cimetidine and Ranitidine

Front 135

Muscarinic receptor on ECL cell? Parietal cell?

Back 135

ECL cells: M1 receptor

Parietal cells: M3 receptor

Both are cAMP mediated.

Front 136

Associations of cholesterol stones?

Back 136

Obesity
Crohn's disease
CF
Advanced age
Clofibrate
Estrogens
Multiparity
Rapid weight loss
Native American

Front 137

Gross appearance of alcoholic cirrhosis?

Back 137

Micronodular, shrunken, "hobnail" appearance
Sclerosis around central vein

Front 138

Source of motilin?

Back 138

Small intestine

Front 139

Source of VIP and its actions?

Back 139

Parasympathetic ganglia in sphincters, gallbladder, and small intestine.

Increases intestinal water/electrolyte secretion.
Increases relaxation of intestinal smooth muscle and sphincters.

Front 140

Potent amino acid stimulators of gastrin secretion?

Back 140

Phenylalanine and tryptophan

Front 141

Regulation of somatostatin secretion?

Back 141

Increased by acid.

Decreased by vagal stimulation.

Front 142

2 actions of GIP?

Back 142

Exocrine: decreases gastric H+ secretion

Endocrine: increases insulin release

Front 143

Regulation of VIP secretion?

Back 143

Increased by distention and vagal stimulation

Decreased by adrenergic input

Front 144

In what state is motilin secretion increased?

Back 144

Fasting state