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144 Cards in this Set
- Front
- Back
Derivative of fetal umbilical vein?
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Falciform ligament
- connects liver to anterior abdominal wall |
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Which ligament connects the greater and lesser sacs and contains the portal triad?
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Hepatoduodenal ligament
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The gastrosplenic ligament contains what vessels?
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Short gastrics
- also separates left greater and lesser sacs - connects greater curvature of stomach to spleen |
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Gastrosplenic ligament separates the L greater and lesser sacs. Which ligament separates the R side?
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Gastrohepatic
(contains gastric arteries) |
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Ligament that contains the gastroepiploic arteries?
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Gastrocolic
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Areas of the small intestine that have plicae circulares?
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Jejunum and proximal ileum
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Areas of the small intestine that have crypts of Lieberkuhn?
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All of the small intestine
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Area of the small intestine that have Brunner's glands?
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Submucosa of duodenum
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Area of the small intestine with the most goblet cells?
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Jejunum
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Parasympathetic innervation of foregut, midgut, and hindgut?
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Foregut and midgut: vagus nerve
Hindgut: pelvic |
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3 branches of celiac trunk?
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Common hepatic, splenic, and L gastric
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4 collateral circulations of GI system?
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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) |
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Innervation of external hemorrhoids?
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Inferior rectal nerve (branch of pudendal) - somatic innervation
- compare with internal hemorrhoids (visceral innervation) |
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Blood supply above vs below pectinate line?
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Above: superior rectal artery (IMA)
Below: inferior rectal artery (from internal pudendal artery) |
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Esophageal anastomosis?
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Left gastric (portal) and esophageal (systemic)
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Umbilicus anastomosis?
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Paraumbilical (portal) with superficial and inferior epigastric (systemic)
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Rectal anastomosis?
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Superior rectal (portal) with middle and inferior rectal (systemic)
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Femoral triangle vs femoral sheath?
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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.
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Order of fascias/muscles on lateral abdominal wall?
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Parietal peritoneum, transversalis fascia, transversus abdominis, internal oblique, external oblique
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What are the median and medial umbilical ligaments remnants of?
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Median: remnant of urachus
Medial: remnants of umbilical arteries |
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Where do congenital diaphragmatic hernias (Bochdalek hernia) usually occur?
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Left posterolateral.
Due to defective development of pleuroperitoneal membrane. |
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Sliding vs paraesophageal hernia?
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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. |
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Leading cause of bowel incarceration (especially in women)?
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Femoral hernia. Occur below the inguinal ligament, through femoral canal.
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Borders of Hesselbach's triangle?
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Inferior epigastric artery
Rectus abdominis Inguinal ligament |
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Division between direct and indirect inguinal hernias?
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Inferior epigastric artery/vessels.
Indirect: lateral Direct: medial |
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What kind of hernia do people with ascites, obesity, black newborns, or pregnant people get?
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Umbilical. Can lead to incarceration in adults, or often spontaneously close <2 yo in kids.
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What type of hernia occurs in an area weakened by previous surgery?
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Ventral hernia
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Which nerve can be damaged during parotid surgery?
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CN VII
- runs through parotid gland |
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Stimulation of salivary gland secretion?
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Sympathetics (T1-T3, superior cervical ganglion) and parasympathetics (facial, glossopharyngeal nerves)
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Prostaglandins, somatostatin, and histamine work through what mechanism on gastric parietal cells?
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cAMP
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ACh and gastrin work through what mechanism on parietal cells?
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Gq --> IP3/Ca
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What is the effect of atropine on parietal cells?
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It blocks direct vagal stimulation of parietal cells (M3 receptors) but NOT stimulation of G cells (where GRP transmitter is used).
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Hypertrophy of what is seen in peptic ulcer disease?
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Brunner's glands (duodenal submucosa)
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Carbohydrate absorption transporters?
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SGLT1: Glu/gal
GLUT-5: fructose GLUT-2: transports all monosaccharides to blood |
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Cells in Peyer's patches that take up antigen?
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M cells. Present it to B cells in germinal centers, which then differentiate into IgA secreting plasma cells (in lamina propria).
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Common benign tumor of the salivary gland?
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Pleomorphic adenoma
- more common F, painless, moveable |
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Common malignant tumor of the salivary gland?
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Mucoepidermoid carcinoma
- often in parotid gland - CN VII involvement is a sign of malignancy |
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Causes of macroglossia?
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Myxedema, Down syndrome, Acromegaly, Amyloidosis, MEN IIb/III
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What is Warthin's tumor?
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Benign salivary gland tumor
- heterotopic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue |
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What area of the bowel does celiac sprue affect?
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Primarily the proximal small bowel
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Findings in Whipple's disease?
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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 |
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"ABCDEF" risk factors for esophageal cancer?
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Alcohol/Achalasia, Barrett's, Cigarettes, Diverticula (Zenker's), Esophageal Web (Plummer-Vinson)/Esophagitis, Familial
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Tests of pancreatic insufficiency?
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Secretin stimulation test, trypsin levels, Bentiromide test (cleaved by chymotrypsin to PABA --> urine)
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Striated muscle vs smooth muscle causes of dysphagia?
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Upper (striated muscle): dermatomyositis, MG, stroke
Lower (smooth muscle): systemic sclerosis, CREST, achalasia |
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Nerve plexus lost in achalasia?
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Myenteric (Auerbach's) plexus (in esophageal body) --> failure of relaxation of LES
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3 infectious causes of esophagitis?
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HSV-1, CMV, and Candida
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What are Mallory-Weiss tears heavily associated with?
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Hiatal hernia
- tears: mucosal lacerations caused by severe vomiting |
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What can Boerhaave syndrome cause and what is the physical exam finding?
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Can cause pneumomediastinum.
- hear Hamman's crunch on auscultation |
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Pain with gastric vs duodenal ulcers?
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Gastric: Pain is Greater with meals
Duodenal: Pain Decreases with meals |
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Complications of duodenal ulcers?
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Bleeding (gastroduodenal artery), penetration into pancreas, perforation, obstruction
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Cause of gastric vs duodenal ulcer?
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Gastric: decreased mucosal protection against gastric acid
Duodenal: increased gastric acid secretion OR decreased mucosal protection |
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Malignancy risk with celiac sprue?
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T-cell lymphoma
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Dermatologic findings associated with gastric cancer?
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Acanthosis nigricans, sign of Leser-Trelat
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Associations/causes of gastric cancer?
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Chronic gastritis (H. pylori), achlorhydria, type A blood, dietary nitrosamines (smoked foods)
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Findings with Menetrier's disease?
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Gastric hypertrophy, protein loss, parietal cell atrophy, increased mucous cells
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Causes of acute erosive gastritis?
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NSAIDs, stress, alcohol, uremia, burns (Curling's ulcer), brain injury (Cushing's ulcer), Anisakis (worm)
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Types of chronic (non-erosive) gastritis?
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Type A (fundus/body): Autoimmune, Abs against parietal cells, pernicious anemia, achlorhydria
Type B (antrum): H. pylori, most common |
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Side effect of Infliximab (Ab to TNF-alpha)?
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Respiratory infection (including reactivation of latent TB)
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2 uses of misoprostol (PGE-1 analog) besides for peptic ulcers?
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1. Maintenance of patent ductus arteriosus
2. Induce labor |
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Drug interactions of metoclopramide?
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Digoxin and diabetic agents
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Sulfasalazine mechanism and uses?
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Sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory)
- activated by colonic bacteria - used for UC and CD |
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M1 and M3 blockers and use?
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Pirenzepine, propantheline
- used for peptic ulcers (but rarely) - block M1 on ECL cells and M3 on parietal cells |
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Side effects of overuse of aluminum hydroxide (antacid)?
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Constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures
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Side effects of overuse of magnesium hydroxide (antacid)?
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Diarrhea (also works as osmotic laxative), hyporeflexia, hypotension, cardiac arrest
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Are PPIs reversible or irreversible?
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IRREVERSIBLE
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Which H2 blockers decrease renal excretion of creatinine?
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Cimetidine and Ranitidine
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What is Courvoisier's sign?
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Palpable gallbladder.
Seen in obstructive jaundice (pancreatic adenocarcinoma) and cholangiocarcinoma. |
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What is the "C sign" seen in?
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Carcinoma of the head of the pancreas --> indents duodenum and forms "C" shape
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Risks of gallbladder adenocarcinoma?
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Cholelithiasis and porcelain gallbladder (dystrophic calcification)
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Black vs brown gallstones?
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Black: seen in chronic hemolysis
Brown: seen with biliary infection - both are pigmented and radiopaque |
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Ultrasound can diagnose gallstones in what location?
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US can only see stones still in the gallbladder, not in the common bile duct (need to use HIDA radionuc scan)
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What is the Grey-Turner sign?
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Flank hemorrhage (seen in retroperitoneal injury)
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What is Cullen's sign?
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Periumbilical hemorrhage (seen with necrotic pancreatitis)
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Complications of acute pancreatitis?
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DIC, ARDS, diffuse fat necrosis, hypocalcemia (FA soap deposits), pseudocyst formation, hemorrhage, infection, necrosis, multiorgan failure
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Causes of acute pancreatitis?
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Gallstone, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hyperlipidemia/hypertriglyceridemia, ERCP, Drugs (sulfa)
"GETSMASHED" |
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Differences in iron location between primary and secondary hemochromatosis?
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Primary: more parenchymal Fe
Secondary: more in Kupffer cells (macs) |
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Lab values in hemochromatosis?
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High ferritin, high iron, Low TIBC, high transferrin saturation
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Risks for cholangiocarcinoma?
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PSC, Clonorchis sinensis, thorotrast (thorium dioxide), choledochal cyst, Caroli disease
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"Onion skin" bile duct fibrosis?
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Primary sclerosing cholangitis (PSC)
- "beading" of intra and extra hepatic bile ducts on ERCP |
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Special findings in PBC?
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- granulomas and lymphocytic infiltrate
- F > M - pruritis BEFORE jaundice - Kayser-Fleischer rings |
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Appearance of alpha-1 antitrypsin deficiency on histology?
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PAS-positive red cytoplasmic granules/globules in liver
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Where does copper accumulate in Wilson's disease?
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Liver, brain, cornea, kidneys, and joints
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Findings in Wilson's disease?
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Asterixis, Basal ganglia degeneration (PD sx, hemiballismus), Cirrhosis, Corneal deposits (Descemet's membrane), Copper accum, Carcinoma, Dec ceruloplasmin, Dementia, Dyskinesia, Dysarthria, Hemolytic anemia
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Two types of Crigler-Najjar syndrome?
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Type 1: absent UDP-glucuronyl transferase
Type 2: less severe, responds to phenobarbital (inc liver enzyme synthesis) |
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Dubin-Johnson vs Rotor syndrome?
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Both involve defective excretion of conjugated bilirubin.
Rotor is LESS severe. Dubin-Johnson: grossly black liver |
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Post-viral hepatoencephalopathy with microvesicular steatosis, mitochondrial abnormalities, and hypoglycemia?
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Reye's syndrome
- often follows VZV or influenza B infection |
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Key histo finding of hepatocellular carcinoma?
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Bile in neoplastic cell
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What do Mallory bodies look like and what are they seen with?
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Intracytoplasmic eosinophilic inclusions. Seen in alcoholic hepatitis.
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Findings in alcoholic cirrhosis?
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Micronodular shrunken liver ("hobnail" appearance). Sclerosis around central vein (zone III). Manifestations of chronic liver disease.
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EM finding of carcinoid tumor?
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Dense core bodies.
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Series of gene mutations in APC pathway of colon cancer?
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Loss of APC gene --> K-ras mutation --> loss of p53 (& DCC)
- chromosomal instability pathway accounts for 85% of colon cancer |
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Micronodular vs macronodular regeneration: which has greater HCC risk?
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MACRO. Seen with significant hepatic necrosis (postinfectious or drug-induced hepatitis)
- Micronodular: seen with metabolic insult (alcohol, hemochromatosis, Wilson's disease) |
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Physical exam findings in appendicitis?
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Psoas sign, Blumberg's (rebound tenderness), and Rovsing's sign
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Locations of volvulus?
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Cecum in young people
Sigmoid colon in older |
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Most commonly involved area in necrotizing enterocolitis?
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Mucosa of colon but can involve entire GI tract
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Common location of ischemic colitis?
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Splenic flexure (watershed area) and distal colon
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Tubular vs villous polyps?
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Tubular: often stalked
Villous: often sessile, more likely to be malignant |
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Most common non-neoplastic polyp in colon?
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Hyperplastic
- 50% in rectosigmoid colon - "sawtooth" appearance |
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Peutz Jeghers syndrome?
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Aut dom, multiple nonmalignant hamartomas throughout GI tract (esp sml intestine)
- hyperpigmented mouth, lips, hands, genitalia - inc risk CRC and other visceral malignancies |
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Presentation of R vs L colon cancer?
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L: obstruction, colicky pain, hematochezia
R: dull pain, iron deficiency anemia, fatigue |
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Gardner's and Turcot's syndrome?
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Gardner's = FAP + osseous and soft tissue tumors, retinal hyperplasia (aut dom)
Turcot's = FAP + malignant CNS tumor (astrocytoma, medulloblastoma) (aut recess) |
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Level that testicular/ovarian arteries exit aorta?
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L2
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Structures supplied by celiac artery?
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Stomach to proximal duodenum
Liver Gallbladder Pancreas Spleen (mesoderm origin) |
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Histology of colon?
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Crypts but no villi
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Location of 2 nerve plexuses?
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Submucosal nerve plexus (Meissner's): in submucosa
Myenteric nerve plexus (Auerbach's): in muscularis externa |
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What does the pectinate line divide?
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Hindgut and ectoderm
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Venous drainage of external hemorrhoids (below pectinate line)?
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Inferior rectal vein
--> internal pudendal vein --> internal iliac vein --> IVC |
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Portal HTN affecting the anastomosis between the paraumbilical (portal) and superficial and inferior epigastric (systemic) arteries causes what?
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Caput medusae (at the umbilicus)
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What does the femoral sheath contain?
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Femoral artery
Femoral vein Canal (deep inguinal lymph nodes) Does NOT contain femoral nerve |
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What forms the boundaries of the femoral triangle?
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Inguinal ligament (top)
Sartorius (lateral) Adductor longus (medial) |
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Origin of cremasteric muscle and fascia?
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Internal oblique aponeurosis
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Site of protrusion of direct vs indirect hernia?
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Indirect: internal (deep) inguinal ring
Direct: abdominal wall (inguinal/Hesselbach's triangle) |
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Which hernias go through internal inguinal ring? External inguinal ring?
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Only indirect goes through internal inguinal ring.
Both direct and indirect go through external inguinal ring. |
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Where does a femoral hernia travel through?
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Through femoral canal
- below and lateral to pubic tubercle |
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5 components of saliva?
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1. Alpha-amylase (ptyalin)
2. HCO3 3. Mucins (glycoproteins) 4. Antibacterial products 5. Growth factors (for epithelial renewal) |
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Neurotransmitter released when vagus nerve innervates G cells and significance?
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GRP
- CANNOT be blocked by atropine |
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Strongest effect of gastrin is on what cells?
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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.
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Which of the pancreatic enzymes is secreted in its active form?
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Alpha amylase
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Mechanism of absorption of glucose vs fructose?
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Glucose: SGLT1 (Na+ dependent)
Fructose: GLUT5 (facilitated diffusion) |
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Salivary vs pancreatic amylase?
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Salivary: hydrolyzes alpha-1,4 linkages to yield disaccharides (maltose and alpha-limit dextrins)
Pancreatic: hydrolyzes starch to oligo and disaccharides |
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Tropical vs celiac sprue?
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Both are malabsorption syndromes.
Tropical sprue is similar to celiac but affects the entire small bowel and responds to antibiotics. |
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Complications of duodenal ulcers?
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Bleeding (gastroduodenal artery)
Penetration into pancreas Obstruction Perforation |
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Where can PAS-positive macrophages be found in Whipple's disease?
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Intestinal lamina propria and mesenteric nodes
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Cause of appendicitis in kids vs adults?
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Kids: lymphoid hyperplasia after viral infection
Adults: obstruction, fecalith |
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How does pneumaturia result from diverticulitis?
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Results from formation of a colovesical fistula (fistula with bladder)
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Zenker's diverticulum occurs at what junction?
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Junction between the pharynx and esophagus
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Bowel layers with inflammation in UC?
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Mucosal and submucosal only
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Histology of UC?
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Crypt abscesses and ulcers
Bleeding NO granulomas |
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Common locations of angiodysplasia?
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Cecum
Terminal ileum Ascending colon |
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"Double bubble" sign?
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Duodenal atresia.
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Reproductive AE of sulfasalazine?
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Reversible oligospermia
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Ocular effect of muscarinic antagonists?
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Difficulty focusing/accommodating
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What electrolyte abnormality can all antacids cause?
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Hypokalemia
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Which 2 drugs decrease renal excretion of creatinine?
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Cimetidine and Ranitidine
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Muscarinic receptor on ECL cell? Parietal cell?
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ECL cells: M1 receptor
Parietal cells: M3 receptor Both are cAMP mediated. |
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Associations of cholesterol stones?
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Obesity
Crohn's disease CF Advanced age Clofibrate Estrogens Multiparity Rapid weight loss Native American |
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Gross appearance of alcoholic cirrhosis?
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Micronodular, shrunken, "hobnail" appearance
Sclerosis around central vein |
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Source of motilin?
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Small intestine
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Source of VIP and its actions?
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Parasympathetic ganglia in sphincters, gallbladder, and small intestine.
Increases intestinal water/electrolyte secretion. Increases relaxation of intestinal smooth muscle and sphincters. |
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Potent amino acid stimulators of gastrin secretion?
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Phenylalanine and tryptophan
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Regulation of somatostatin secretion?
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Increased by acid.
Decreased by vagal stimulation. |
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2 actions of GIP?
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Exocrine: decreases gastric H+ secretion
Endocrine: increases insulin release |
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Regulation of VIP secretion?
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Increased by distention and vagal stimulation
Decreased by adrenergic input |
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In what state is motilin secretion increased?
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Fasting state
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