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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. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Esophageal cancer
Pleuroperitoneal
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Lateral to the inferior epigastric artery

2. Gastrin - source - action - regulation
Via the superior pancreaticduodenal
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
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Urobilin

3. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Inferior rectal nerve
Lye ingestion and acid reflux
HPNCC

4. What is Trousseau's sign
Positive
Juvenille polyps - no risk if single
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Redness and tenderness on palpation of extremities

5. What is charcot triad of cholangitis
Jaundice - fever - RUQ
Dubin johnson
Pleomorphic adenoma
Complications of UC

6. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Lateral
Internal thoracic to superior epigastric to inferior epigastric
Crohns = noncaseating granulomas - UC = crypt abscesses
Cigarettes and chronic pancreatitis - not EtOH

7. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Inc conj bilirubin - inc cholesterol - inc alk phos
Cystic duct and common hepatic duct
Fe2+ in the duod
IgA secreting plasma cells - ultimately reside in the lamina proporia

8. malnutrition - toxic megacolon - colorectal carcinoma
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
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Complications of UC

9. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Lamina propria
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Volvulus

10. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Alfatoxin in peanuts
Inc lower esphogeal tone leading to achalasia
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

11. Autodigestion of pancreas by pancreatic enzymes
Acute pancreatitis
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
PAS- positive globules in liver -

12. What serum enzyme is elevated inacute pancreatitis
VZV and influenza B treated with salicylates
No
Lipase
Enterokinase/enteropeptidase from the duodenal mucosa

13. What is the frequency of basal electric rhythm of the ilieum
Ischemic colitis
8-9 waves/min
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Terminal ileum and colon

14. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Right and left hepatic duct
GERD - may also present with nocturnal cough and dyspnea
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

15. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
Via the middle colic
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Mallory bodies

16. What is the frequency of basal electric rhythm of the stomach
Positive
3 waves/min
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Colovesical leading to pneumaturia

17. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Ischemic colitis
Alcoholic cirrhosis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

18. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Lubricate food (glycoprotiens)
Uremia
Nonkeritinized stratified sqamous epithelium
Esophageal varices

19. What do mucins do?
US and cholecystectomy
Lubricate food (glycoprotiens)
Closer to isotonic because of less time to reabsorb NaCl
Hyperplastic

20. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
L/R renal artery around L1
Hemosiderosis - hemochromatosis
Low pressure proximal to LES
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

21. What causes hirschsprungs
Carcinoid syndrome
Portal HTN
Failure of neural crest migration
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

22. Scleroderma is associated with what kind of esophageal dysmotility
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Low pressure proximal to LES
IBS at least 2 with recurrent abdominal pain
Alpha amylase

23. in carcinoid tumors - What is seen on EM
Dense core bodies
FAP
Budd chiari syndrome
Osmotic

24. List the clinical findings of HCC
Cystic duct and common hepatic duct
Inguninal ligament - sartorius muscle - adductor longus
Backup of blood into the liver - RHF - budd chiari
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

25. What is the most common esophageal cancer worldwide and in the US
Worldwide - SC - US - adeno
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Cirrhosis
Skip lesions =crohns - colon = UC

26. What is diverticulosis
Centrilobular leading to congestive liver disease
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Esophageal carcinoma
Decrease - weight gain

27. What are the effects of atropine on parietal cells and G cells
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Necrotizing enterocolitis
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Conj - inc - dec

28. What are the four Fs of gallstones
Female - fat - fertile - forty
Alcoholic hepatitis
Uremia
Pancreatic head causing obstructive jaundice

29. signet ring cells - acanthosis nigracans - dz - character/association - spread
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Gardner's syndrome
L2
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

30. What is the cause of Barrett's and the assocaited complications
CHF and inc risk of HCC
Pleomorphic adenoma
Peutz jeghers
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

31. multiple juvenil polyps in GI tract - risk
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Gamma glutamyl transferase GGT

32. What nerve innervates the external hemorrhoids
Striated and smooth
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Inferior rectal nerve
Colovesical leading to pneumaturia

33. Where does crohns usually affect the GI tract
8-9 waves/min
Terminal ileum and colon
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
AST>ALT

34. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Krukenbergs tumor
Causes of gall stones
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

35. What is the most common cause of gallstones
Gastric glands
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Inguninal ligament - sartorius muscle - adductor longus

36. What is the TX of physiologic neonatal jaundice
GERD - may also present with nocturnal cough and dyspnea
Phototherapy
Lipase
Necrotizing enterocolitis

37. What are the extraintestinal manifestations of ulcerative colitis
Barrett's esophagus
Common hepatic - splenic - left gastric - main blood supply for stomach
Positive
Pyoderma gangrenosum - primary sclerosing cholangitis

38. somatostatin - source - action - regulation
Primary sclerosing cholangitis
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
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Heme metabolism

39. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inspiratory arrest on deep palpation due to pain
Inc conj bilirubin - inc cholesterol - inc alk phos
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Conj - inc - dec

40. most common non - neoplastic polyp in colon
Small intestine
Carcinoid syndrome
Hyperplastic
Diverticulitis in elderly - ectopic pregs use hCG to rule out

41. What artery passes around the duodenum
Krukenbergs tumor
The gastroduodenal
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Fe2+ in the duod

42. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Causes of gall stones
L1
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

43. What intervention will intervention will relieve portal HTN
Squamous - upper 1/3 - adeno - lower 1/3
Urobilin
Dense core bodies
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

44. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Turcot
The submucosal nerve plexus - meissner's
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
IgA secreting plasma cells - ultimately reside in the lamina proporia

45. What are the complications of duodenal PUD
Epithelium
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Bleeding - penetration into pancreas - perforation - obstruction
Failure of the processus vagainlis to close

46. What is the most important mechanism in gastric acid secretion
Closer to isotonic because of less time to reabsorb NaCl
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
VZV and influenza B treated with salicylates
Virchow's node

47. trypsinogen is converted to trypsin via what enzyme
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Enterokinase/enteropeptidase from the duodenal mucosa
Chagas disease
Above

48. If the hemochromatosis is primary - What is the pattern of inheritance
Volvulus
Crigler - najjar type 1
AR
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

49. How is the diagonsis of CRC made
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Esophageal varices
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
So hypertrophied they look like brain gyri

50. Which IBD is autoimmune and which may be a disordered response to bacteria
Mallory bodies
Epigastric abdominal pain radiating to back - anorexia - nausea
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Older patients