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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 alchoholic hepatitis which liver enzyme is higher
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Hemolytic anemia
No - chronic - can present with diarrhea or constipation or alternation - treat sx
AST>ALT

2. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
No - chronic - can present with diarrhea or constipation or alternation - treat sx
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

3. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Meconium ileus
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Pleomorphic adenoma
Upregulated intracellular signal transduction

4. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Appendicitis
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Cimetidine

5. Acute gastritis is caused By what process
Meconium ileus
Superior rectal and middle and inferior rectal - rectum
Erosive - disruption of mucosal barrier leading to inflammation
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

6. When and How does Abetalipoproteinemia present
Cystic duct and common hepatic duct
HPNCC
Early childhood - neuro sx and malabsorption
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

7. What are the histological findings in the ileum

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8. trypsinogen is converted to trypsin via what enzyme
Gilbert's
Enterokinase/enteropeptidase from the duodenal mucosa
Redness and tenderness on palpation of extremities
Dysphagia (due to esophageal web) - glossitis - iron def anemia

9. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Neutralizes gastric acid allowing pancreatic enzymes to fxn
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Failure of the processus vagainlis to close
Around the central vein (zone III)

10. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Pleomorphic adenoma
Via the superior pancreaticduodenal
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

11. How does hirschsprung present and appear on imaging
Terminal ileum and colon
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
Paraumbilical and superficial and inferior epigastric - umbilicus
AST

12. involvement of left supraclavicular node by mets from stomach

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13. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
With albumin
Superior rectal

14. absent UDPGT - presents early in life - early mortality
Crigler - najjar type 1
Pertechnetate - study for uptake
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Trypsin - chymotrypsin - elastase - carboxypeptidases

15. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Spleen to posterior abdominal wall - splenic artery and vein
No - chronic - can present with diarrhea or constipation or alternation - treat sx

16. What are the labs in acute pancreatitis
Lateral to the inferior epigastric artery
Diarrhea - steatorrhea - weight loss - weakness
Elevated amylase - and lipase
VZV and influenza B treated with salicylates

17. What does histo show for alpha1 antitrypsin def
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
PAS- positive globules in liver -
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Zenkers - halitosis - dysphagia and obstruction

18. People of what decent are associated with celiac sprue and what findings/antibodies are present
Redundant mesentary
Repeated phlebotomy - deferoxamine - HLA- A3
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Carcinoid syndrome

19. What transforms conjugated bilirubin to urobilinogen
Gut bacteria
Carcinoid syndrome
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Lamina propora and submucosa

20. What drug inhibits the H/K ATPase
Krukenbergs tumor
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Omeprazole
All 3

21. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Brush border of intestine - produce monosaccharides from oligo and di
Cystic dilation of the viteline duct
Small intestine
Can lead to hematemesis - found in EtOHics and bulimics

22. When do you see hypertrophy of brunners glands
Upregulated intracellular signal transduction
Tropical sprue
Fe2+ in the duod
Peptic ulcer disease

23. What is the rate limiting step of carbohydrate digestion
Above
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Oligosaccharide digestion
Oral glucose

24. What kind of lesions are characteristic of duodenal PUD vs cancer
Dermatitis herpetiformis
Esophageal carcinoma
Punched out - clean margins - carcinoma =raised irregular margins
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

25. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Gastric glands
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
Conj - inc - dec
FAP

26. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
External (superficial) ring only
2ndary biliary cirrhosis
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
ALT>AST

27. What converts inactive pepsinogen to pepsin
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Lamina propora and submucosa
H+
Reye's syndrome

28. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Dermatitis herpetiformis
Conj/unconj - inc - nl to dec
Peutz jeghers
Begins starch digestion - inactivated by low pH upon reaching the stomach

29. 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
Black - rotors syndrome
Liver metabolizes 5HT
US and cholecystectomy

30. What complication can arise from indirect inguinal hernias
Sister mary joseph nodule
Hydrocele
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Enterokinase/enteropeptidase from the duodenal mucosa

31. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
Angiodysplasia
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Alk phos

32. Where is B12 absorbed
T12
Goes through deep inguinal ring - external inguinal ring and into the scrotum
L3
In the ileum with bile acids - requires IF

33. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
GERD - may also present with nocturnal cough and dyspnea
Pleuroperitoneal
Cirrhosis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

34. When and why is stomach cancer termed linitis plastica
Zenkers - halitosis - dysphagia and obstruction
Falciform - ligamentum teres - fetal umbilical vein
Volvulus
When diffusely infiltrative - thickened rigid appearance like a leather bottle

35. What structures feed into the common bile duct
Myenteric nerve plexus - aurbach
HPNCC
IgA secreting plasma cells - ultimately reside in the lamina proporia
Cystic duct and common hepatic duct

36. 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
Skip lesions =crohns - colon = UC
H+
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Pancreatic and bile

37. What are the histological findings in the jejunum
External (superficial) ring only
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

38. What is the frequency of basal electric rhythm of the ilieum
Striated
8-9 waves/min
Diverticulum
Gamma glutamyl transferase GGT

39. What histological findings are present in the stomach
Gastric glands
Diarrhea - steatorrhea - weight loss - weakness
Liver metabolizes 5HT
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

40. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
ALT>AST
Zollinger Ellison - phenylalanine and tryptophan
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Lubricate food (glycoprotiens)

41. What findings are associated with reyes
Meckels
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Hyperplastic
Muscularis mucosae

42. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Crohns = noncaseating granulomas - UC = crypt abscesses
CHF and inc risk of HCC
Causes of gall stones
Falciform - ligamentum teres - fetal umbilical vein

43. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
AR
Hirschsprungs
IgA secreting plasma cells - ultimately reside in the lamina proporia
Cystic duct and common hepatic duct

44. Where does crohns usually affect the GI tract
Short gastrics - left greater and lesser
Terminal ileum and colon
Lactase is located at the tips of intestinal villi
Hemolytic anemia

45. What is the risk with peutz jehgers
Inc risk of CRC and other visceral malignancies
Downs
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Dissaccharidase def - most commonly lactase

46. What separates the right greater and lesser sacs
Lamina propora and submucosa
The proximal small bowel
Gastrohepatic ligament
GLUT 2

47. What are the extraintestinal manifestations of crohns
Spleen to posterior abdominal wall - splenic artery and vein
Backup of blood into the liver - RHF - budd chiari
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

48. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Peptic ulcer disease
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

49. What serum enzyme is elevated inacute pancreatitis
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Jaundice - fever - RUQ
Lipase
GERD - may also present with nocturnal cough and dyspnea

50. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Poor anastamoses
Phototherapy
Spleen to posterior abdominal wall - splenic artery and vein
Unconj - absent (acholuria) - inc