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USMLE GI

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What is the other name for GIP (gastric inhibitory peptide)
Chagas disease
Glucose dependent insulinotropic peptide
Ampulla of vater
NAV = nerve artery vein - venous near the penis (NAVEL)

2. Where is there sclerosis in alcoholic cirrohosis
Centrilobular leading to congestive liver disease
CHF and inc risk of HCC
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Around the central vein (zone III)

3. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lactase is located at the tips of intestinal villi
Complications of UC
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Dense core bodies

4. What are the signs and symptoms of budd chiari
So hypertrophied they look like brain gyri
Lamina propria
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Left and right gastroepiploics - left and right gastrics

5. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Inguninal ligament - sartorius muscle - adductor longus
Alpha1 antitrypsin def - codominant trait
Ischemic colitis
Portal HTN

6. What are the treatment options for uclerative colitis
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Primarly through ECL leading to histamine release
Duodenal atresia - Downs

7. What receptors does ACH bind on the parietal cells and What does it activate
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
M3 - Gq - inc IP3/Ca
AST >ALT - ration is usually 1.5
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

8. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Pertechnetate - study for uptake
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Can lead to hematemesis - found in EtOHics and bulimics
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

9. What is the most common esophageal cancer worldwide and in the US
Pertechnetate - study for uptake
Worldwide - SC - US - adeno
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati

10. What intervention will intervention will relieve portal HTN
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Hypotonic because of more time to reabsorb NaCl
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Right and left hepatic duct

11. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Cigarettes and chronic pancreatitis - not EtOH
Femoral hernia
Lubricate food (glycoprotiens)

12. Gallstones that reach the common channel at ampulla can block which two ducts
Black - rotors syndrome
Pancreatic and bile
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
2ndary biliary cirrhosis

13. What gives urine its characteristic color
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
Oligosaccharide digestion
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Urobilin

14. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Diverticulitis in elderly - ectopic pregs use hCG to rule out
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Inc conj bilirubin - inc cholesterol - inc alk phos

15. Which area of the hindgut is a watershed area
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Internal thoracic to superior epigastric to inferior epigastric
Splenic flexure
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

16. What kind of anemia is in Wilsons
Hyperpigmented mouth - lips - hands - genitalia
Hemolytic anemia
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Redness and tenderness on palpation of extremities

17. What does bicab do in the mouth
Backup of blood into the liver - RHF - budd chiari
Neutralizes oral bacertial acids and maintains dental health
Diarrhea - steatorrhea - weight loss - weakness
H2 receptor - inc cAMP

18. why infxn is implicated in duodenal PUD
2ndary biliary cirrhosis
H pylori (almost 100%)
Liver metabolizes 5HT
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

19. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Squamous - upper 1/3 - adeno - lower 1/3
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Hypercoaguability - polycythemia vera - pregnancy - HCC
CEA - CA-19-9

20. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Hirschsprungs
Pyoderma gangrenosum - primary sclerosing cholangitis
Crohns = maybe - UC= always

21. what kind of fistula is associated with diverticulitis
HSV-1 - CMV - Candida
No
Pleomorphic adenoma
Colovesical leading to pneumaturia

22. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Inc risk of CRC and other visceral malignancies
IgA secreting plasma cells - ultimately reside in the lamina proporia

23. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Lubricate food (glycoprotiens)
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Meckels

24. What are the treatmet options for crohns
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Corticosteroids - infliximab
Glucouronate - water soluble (direct)

25. What do you treat Wilsons disease with and What is the inheritance
Phototherapy
Common hepatic - splenic - left gastric - main blood supply for stomach
Penicillinamine - AR inheritance
ALT>AST

26. FAP + osseous and soft tissue tumors - retinal hyperplasia

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27. Autodigestion of pancreas by pancreatic enzymes
Acute pancreatitis
Turcot
IgA secreting plasma cells - ultimately reside in the lamina proporia
AST>ALT

28. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
CHF and inc risk of HCC
Source - I cells (duod - jej - action - inc pancreative secretion - inc gallbladder contraction - dec gastric emptying - sphincter of Oddi relaxation - regulation - inc by fatty acids and amino acids
Zenkers - halitosis - dysphagia and obstruction
Skip lesions =crohns - colon = UC

29. How are all 3 monosaccharides transported to the blood
Ischemic colitis
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Begins starch digestion - inactivated by low pH upon reaching the stomach
GLUT 2

30. What is the action of NO as a GI hormone
Source - S cells (duod) - action - inc pancreatic bicarb secretion - dec gastric acid secretin - inc bile secretion - regulation - inc by acid - fatty acids in lumen of duod
Inc smooth muscle relaxation - including lower esophageal sphincter
Esophageal carcinoma
Pertechnetate - study for uptake

31. What is the TX of physiologic neonatal jaundice
Averages 6 months - very aggressive - usually already metastasized at presentation
Neutralizes oral bacertial acids and maintains dental health
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Phototherapy

32. How is the diagonsis of CRC made
Stimulate the H/K ATPase
FAP
Pertechnetate - study for uptake
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker

33. What does autoimmune destruction of parietal cells lead to...
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Pancreatic head causing obstructive jaundice
Chronic gastritis and pernicious anemia

34. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Old men - arthralgias - cardiac and neuro sx
Hypotonic because of more time to reabsorb NaCl
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Parietal cells in the stomach - B12 binding protein

35. What are the foregut structures and what supplies their blood and PANS innvervation
Begins starch digestion - inactivated by low pH upon reaching the stomach
Parietal cells in the stomach - B12 binding protein
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release

36. How do you DX and TX gallstones
Zollinger Ellison - phenylalanine and tryptophan
US and cholecystectomy
Portal HTN
Mucoepidermoid carcinoma

37. What structures feed into the cystic duct
Gallbladder
Lateral to the inferior epigastric artery
Dec PGE2 leading to dec gastric mucosa protection
Chronic gastritis and pernicious anemia

38. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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39. In viral hepatitis - which liver enzyme is higher
ALT>AST
Dubin johnson
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
AST >ALT - ration is usually 1.5

40. What portion of the bowel does sprue effect
GLUT 2
Conj - inc - dec
The proximal small bowel
M3 - Gq - inc IP3/Ca

41. Why does volvulus occur more at cecum and sigmoid colon
Gardner's syndrome
Smooth
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Redundant mesentary

42. Achalasia can be secondary to what infectious disease common in South America
With albumin
Chagas disease
Gallbladder
Inc conj bilirubin - inc cholesterol - inc alk phos

43. How is bilirubin carried in the blood
Ampulla of vater
Meckels
CHF and inc risk of HCC
With albumin

44. What arteries exit just below the SMA
L/R renal artery around L1
Chagas disease
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Phototherapy

45. Where and How is iron absorbed
Fe2+ in the duod
Penicillinamine - AR inheritance
Mallory bodies
L3

46. What is the mechanism for reyes syndrome
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
True and most common congenital anomoly of GI tract
With albumin
US and cholecystectomy

47. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Conj/unconj - inc - nl to dec
IgA secreting plasma cells - ultimately reside in the lamina proporia
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

48. Who gets gastric ulcers
Cholesterol
Older patients
The gastroduodenal
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

49. secretin - source - action - regulation
Lateral
Achalasia due to loss of myenteric plexus (auberach)
Source - S cells (duod) - action - inc pancreatic bicarb secretion - dec gastric acid secretin - inc bile secretion - regulation - inc by acid - fatty acids in lumen of duod
Femoral hernia

50. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Diarrhea - steatorrhea - weight loss - weakness
Lactase is located at the tips of intestinal villi
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Hirschsprungs