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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 does TOASTED with alcoholic hepatitis stand for
Alk phos
Erosive - disruption of mucosal barrier leading to inflammation
Paraumbilical and superficial and inferior epigastric - umbilicus
AST >ALT - ration is usually 1.5

2. What kind of lesions are characteristic of duodenal PUD vs cancer
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
CCK8 receptor - Gq inc IP3/Ca
Necrotizing enterocolitis
Punched out - clean margins - carcinoma =raised irregular margins

3. trypsinogen is converted to trypsin via what enzyme
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Enterokinase/enteropeptidase from the duodenal mucosa
Lateral
Juvenile polyposis syndrome - inc risk of adenocarcinoma

4. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Boerhaave's Syndrome - Been heaving syndrome
GLUT 2
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

5. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
2ndary biliary cirrhosis
Sister mary joseph nodule
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Liver metabolizes 5HT

6. How does gastrin increase acid secretion?
Old men - arthralgias - cardiac and neuro sx
Alcoholic cirrhosis
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Primarly through ECL leading to histamine release

7. What is contained within the muscularis externa
HPNCC
Phototherapy
Myenteric nerve plexus - aurbach
H2 receptor - inc cAMP

8. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Urobilin
Cholesterol - 10-20% opaque due to calcifications
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Jewish and African American men

9. How many layers of spermatic fascia are covers an indirect inguinal hernia
All 3
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Mallory bodies

10. If trypsin activates more trypsinogen - what kind of feedback loop is established
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
AST >ALT - ration is usually 1.5
Positive
Peutz jeghers

11. What do you treat Wilsons disease with and What is the inheritance
Hyperplastic
The entire
The proximal small bowel
Penicillinamine - AR inheritance

12. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Cholesterol - 10-20% opaque due to calcifications
Dense core bodies

13. What does a gastrinoma cause
FAP
Antrum - H.pylori - inc risk of MALT lymphoma
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

14. What cell produces IF and What does it do
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Stimulate intestinal persistalsis
Parietal cells in the stomach - B12 binding protein
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

15. B cells stimuated in the germinal centers of peyers patches differentiate into what?
IgA secreting plasma cells - ultimately reside in the lamina proporia
HSV-1 - CMV - Candida
Crohns = noncaseating granulomas - UC = crypt abscesses
Budd chiari syndrome

16. What is the presentation of pancreatic adenocarcinoma
Jaundice - fever - RUQ
T cell lymphoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
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

17. What is charcot triad of cholangitis
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Jaundice - fever - RUQ
Pleomorphic adenoma
L1

18. What histological findings are present in the esophagus
Nonkeritinized stratified sqamous epithelium
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Ceruplasmin
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

19. bilateral mets to ovaries with abundant mucus - signet ring cells
Erosive - disruption of mucosal barrier leading to inflammation
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Krukenbergs tumor
AR

20. What cells make pepsin - What does it do - and what regulates it
Crohns = noncaseating granulomas - UC = crypt abscesses
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Pleuroperitoneal
Ceruplasmin

21. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
PAS- positive globules in liver -
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
L/R renal artery around L1

22. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Begins starch digestion - inactivated by low pH upon reaching the stomach
Gamma glutamyl transferase GGT
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

23. absent UDPGT - presents early in life - early mortality
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Crigler - najjar type 1
Paraumbilical and superficial and inferior epigastric - umbilicus

24. What is the path of an indirect inguinal hernia
Cholesterol
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Striated
Goes through deep inguinal ring - external inguinal ring and into the scrotum

25. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
Inc - weight loss
Via the middle colic
EtOH

26. What is the presenting course for appendicity

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27. What receptor does histamine bind on the parietal cell and What does it activate
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Pertechnetate - study for uptake
Chronic calcifying pancreatitis - inc risk of panreatic cancer
H2 receptor - inc cAMP

28. What is the epi for CRC
Normal
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
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
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

29. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Gastrohepatic ligament
Crohns = noncaseating granulomas - UC = crypt abscesses
Decrease - weight gain
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

30. What serum enzyme is elevated in acute pancreatitis and mumps
Hepatic steatosis
CCK8 receptor - Gq inc IP3/Ca
Brush border of intestine - produce monosaccharides from oligo and di
Amylase

31. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
AR
Pleomorphic adenoma
All 3 gut layers outpouch as in Meckels
Amylase

32. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
The proximal small bowel
Gilbert's
Stimulate the H/K ATPase
IBS at least 2 with recurrent abdominal pain

33. What does alpha amylase do and what inactivates it
Begins starch digestion - inactivated by low pH upon reaching the stomach
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Left gastric vein and esophogeal vein - esophagus

34. What is the most important mechanism in gastric acid secretion
Dense core bodies
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Hypotonic because of more time to reabsorb NaCl
Hemolytic anemia

35. How are all 3 monosaccharides transported to the blood
GLUT 2
Lipase
Gallbladder
Gilbert's

36. What does the splenorenal ligament connect - and What does it contain
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
Spleen to posterior abdominal wall - splenic artery and vein
PAS- positive globules in liver -
Around the central vein (zone III)

37. What are the labs in acute pancreatitis
Elevated amylase - and lipase
Stimulate intestinal persistalsis
AST >ALT - ration is usually 1.5
Unconj - absent (acholuria) - inc

38. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

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39. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Begins starch digestion - inactivated by low pH upon reaching the stomach
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

40. Where and How is iron absorbed
Fe2+ in the duod
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
CHF and inc risk of HCC
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

41. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Cholesterol
AST >ALT - ration is usually 1.5

42. In PUD with a duodenal ulcer does pain inc or dec with meals
Pyoderma gangrenosum - primary sclerosing cholangitis
Decrease - weight gain
Dec PGE2 leading to dec gastric mucosa protection
Mallory bodies

43. How does hirschsprung present and appear on imaging
Diverticulum
NAV = nerve artery vein - venous near the penis (NAVEL)
Colonic polyps
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

44. What kind of muscle is in the lower 1/3 of the esophagus
Lactase is located at the tips of intestinal villi
Parietal cells in the stomach - B12 binding protein
Myenteric nerve plexus - aurbach
Smooth

45. At what level of the spine does the IM exit the aorta
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Causes of gall stones
L3

46. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Meckels
The gastroduodenal
Alpha1 antitrypsin def - codominant trait

47. what percentage of colonic polyps are non - neoplastic
Internal thoracic to superior epigastric to inferior epigastric
Celiac sprue
Dec PGE2 leading to dec gastric mucosa protection
90%

48. What is the main symptom if a VIPoma
US and cholecystectomy
Pleomorphic adenoma
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Copious diarrhea - non alpha - non beta cell pancreatic tumor

49. In what scenarios do pts with gilberts have inc bili
Myenteric nerve plexus - aurbach
Fasting and stress
Stercobilin
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

50. How do villi appear in disaccharidease def
Normal
Adhesion
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis