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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. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Esophageal varices
Conj/unconj - inc - nl to dec
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

2. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Angiodysplasia
Superior rectal and middle and inferior rectal - rectum
Lateral to the inferior epigastric artery

3. what kind of muscle is in the upper 1/3 of esophagus
2ndary biliary cirrhosis
Striated
Chronic constipation early in life with dilated portion of the colon proximal to the aganglionic segment resulting in a transition zone - involves rectum - usually a failure to pass meconium
AST

4. What enzyme is necessary to create conjugated bilirubin
Uridine glucuronyl transferase
Hyperpigmented mouth - lips - hands - genitalia
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Low pressure proximal to LES

5. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Obstruction of the common bile duct
The gastroduodenal
Inc lower esphogeal tone leading to achalasia
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

6. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
Crohns = noncaseating granulomas - UC = crypt abscesses
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Esophageal cancer

7. What is the cause of physiologic neonatal jaundice
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Peptic ulcer disease
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
HSV-1 - CMV - Candida

8. What gives stool its characteristic color
Stercobilin
GLUT 2
Dermatitis herpetiformis
Cystic duct and common hepatic duct

9. What test and result confirms H pylori infxn
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Tropical sprue
HPNCC
Positive urease test

10. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
FAP
IgA secreting plasma cells - ultimately reside in the lamina proporia
Alcoholic cirrhosis

11. What cells secrete bicarb - What does it do - and what regulates it
Alk pho
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Can lead to hematemesis - found in EtOHics and bulimics
Conj - inc - dec

12. How many layers of spermatic fascia are covers an indirect inguinal hernia
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Decrease - weight gain
All 3
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

13. Scleroderma is associated with what kind of esophageal dysmotility
Urobilin
Common hepatic - splenic - left gastric - main blood supply for stomach
Juvenille polyps - no risk if single
Low pressure proximal to LES

14. Where does crohns usually affect the GI tract
Antrum - H.pylori - inc risk of MALT lymphoma
Alk phos
Lateral to the inferior epigastric artery
Terminal ileum and colon

15. Which kind of hemorrhoids are painful and why
AR
Trypsin - chymotrypsin - elastase - carboxypeptidases
Cystic duct and common hepatic duct
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

16. What are the results of hemochromatosis
Positive urease test
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
CHF and inc risk of HCC
Urobilin

17. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Alpha1 antitrypsin def - codominant trait
Short gastrics - left greater and lesser
Brunners
Unconjugated - water insoluble

18. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
NAV = nerve artery vein - venous near the penis (NAVEL)
...
Zenkers - halitosis - dysphagia and obstruction
Conj/unconj - inc - nl to dec

19. What histological findings are present in the stomach
Inc - weight loss
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Gastric glands
Nonkeritinized stratified sqamous epithelium

20. occlusion of IVC or hepatic veins
Budd chiari syndrome
Uremia
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
ALT>AST

21. in carcinoid tumors - What is seen on EM
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Dense core bodies
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
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

22. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Striated and smooth
EtOH
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
Heme metabolism

23. How are all 3 monosaccharides transported to the blood
Inferior rectal nerve
GLUT 2
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Neutralizes gastric acid allowing pancreatic enzymes to fxn

24. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Epithelium
Crohns = transmural (cobblestone mucosa - creeping fat - string sign - linear ulcers fissures - fistulas) UC = mucosal and submucosal (friable mucosal pseudopolyps with freely hanging mesentary - loss of haustra - lead pipe appearance on imaging
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Volvulus

25. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
T12
Failure of neural crest migration
Bleeding - penetration into pancreas - perforation - obstruction

26. What does TOASTED with alcoholic hepatitis stand for
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Budd chiari syndrome
AST >ALT - ration is usually 1.5
Colonic polyps

27. In PUD with a duodenal ulcer does pain inc or dec with meals
Where hindgut meets ectoderm
Decrease - weight gain
Lactase is located at the tips of intestinal villi
Cystic dilation of the viteline duct

28. In an MI - which liver enzyme is elevated
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Unconj - absent (acholuria) - inc
External (superficial) ring only
AST

29. What is the classic triad of hemochromatosis

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30. How does loss of NO secretion affect the esophagus and what results
Inc lower esphogeal tone leading to achalasia
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Normal
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

31. What does the splenorenal ligament connect - and What does it contain
Oligosaccharide digestion
Spleen to posterior abdominal wall - splenic artery and vein
Upregulated intracellular signal transduction
Decrease - weight gain

32. If trypsin activates more trypsinogen - what kind of feedback loop is established
Positive
Omeprazole
AST >ALT - ration is usually 1.5
Mallory bodies

33. What are the signs of peutz jehgers
Hyperpigmented mouth - lips - hands - genitalia
Boerhaave's Syndrome - Been heaving syndrome
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
AST >ALT - ration is usually 1.5

34. Where does copper accumulate in Wilsons and What are ABCD
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
GLUT 2
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

35. What is the main symptom if a VIPoma
True and most common congenital anomoly of GI tract
Warthins' tumor
Copious diarrhea - non alpha - non beta cell pancreatic tumor
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

36. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Pancreatic head causing obstructive jaundice
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Zollinger ellison - brunners glands
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

37. What gives urine its characteristic color
Parietal cells in the stomach - B12 binding protein
Urobilin
Corticosteroids - infliximab
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

38. secretin - source - action - regulation
Parietal cells in the stomach - B12 binding protein
Where hindgut meets ectoderm
Lye ingestion and acid reflux
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

39. HCC is associated with what other conditions
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Bleeding - penetration into pancreas - perforation - obstruction
HSV-1 - CMV - Candida
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

40. How do NSAIDs cause acute gastritis
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Dec PGE2 leading to dec gastric mucosa protection
Below
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

41. What are the main components of bile
L4
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Cholesterol
Necrotizing enterocolitis

42. What is the triad of Plummer - Vinson syndrome
Diarrhea - steatorrhea - weight loss - weakness
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Cimetidine

43. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Celiac sprue
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

44. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Closer to isotonic because of less time to reabsorb NaCl
Hypercoaguability - polycythemia vera - pregnancy - HCC

45. conjugated hyperbilirubinemia due to defective liver excretion
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Dubin johnson
Common hepatic - splenic - left gastric - main blood supply for stomach
Cirrhosis

46. When and How does Abetalipoproteinemia present
Skip lesions =crohns - colon = UC
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Early childhood - neuro sx and malabsorption
Osmotic

47. What are the longterm sequelae of nutmeg liver
Brush border of intestine - produce monosaccharides from oligo and di
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Centrilobular congestion and necrosis - cardiac cirrhosis

48. What are the treatmet options for crohns
Alpha1 antitrypsin def - codominant trait
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Corticosteroids - infliximab
Striated

49. Bile is critical for exrection of what substance
Hyperplastic
Cholesterol
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Common hepatic - splenic - left gastric - main blood supply for stomach

50. What arteries exit just below the SMA
Lubricate food (glycoprotiens)
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Hernia
L/R renal artery around L1