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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 layer in the mucosa is responsible for absorption
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Epithelium
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

2. Where is IgA shuttled
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
The submucosal nerve plexus - meissner's
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

3. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Cirrhosis
Complications of crohns

4. In PUD - with gastric ulcers - does pain inc or dec with meals?
Below
Inc - weight loss
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
H2 receptor - inc cAMP

5. What skin condition is associated with celiac sprue
Diarrhea - steatorrhea - weight loss - weakness
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Colonic polyps
Dermatitis herpetiformis

6. What is the TX of physiologic neonatal jaundice
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Dissaccharidase def - most commonly lactase
Older patients
Phototherapy

7. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Diarrhea - steatorrhea - weight loss - weakness
Acute pancreatitis

8. absent UDPGT - presents early in life - early mortality
Crigler - najjar type 1
Inferior rectal nerve
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Pertechnetate - study for uptake

9. What is pancreatic adenocarcinoma associated with
Pancreatic and bile
Zenkers - halitosis - dysphagia and obstruction
Cigarettes and chronic pancreatitis - not EtOH
Corticosteroids - infliximab

10. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Duodenum - 2nd - 3rd and 4th parts
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Hemosiderosis - hemochromatosis

11. What is the cause of physiologic neonatal jaundice
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Virchow's node
Gut bacteria

12. What receptors does ACH bind on the parietal cells and What does it activate
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
Crigler - najjar type 1
Lipase
M3 - Gq - inc IP3/Ca

13. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Colonic polyps
Uridine glucuronyl transferase
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Crohns = maybe - UC= always

14. What is the most common diaphragmatic hernia and What are the two types
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Omeprazole
Brush border of intestine - produce monosaccharides from oligo and di
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

15. What findings are associated with reyes
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Adhesion
Jaundice - fever - RUQ

16. What are the complications of chronic pancreatitis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
All 3 gut layers outpouch as in Meckels
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Celiac sprue

17. How are all 3 monosaccharides transported to the blood
Intussusception
Duodenal atresia - Downs
Alcoholic cirrhosis
GLUT 2

18. Achalasia can be secondary to what infectious disease common in South America
Neutralizes oral bacertial acids and maintains dental health
Chagas disease
Menetriers disease
Hyperpigmented mouth - lips - hands - genitalia

19. What can hemochromatosis be secondary to...
Hydrocele
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

20. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Begins starch digestion - inactivated by low pH upon reaching the stomach
Fasting and stress
Above
Achalasia due to loss of myenteric plexus (auberach)

21. GIP - source - action regulation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

22. What are the labs in acute pancreatitis
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Lubricate food (glycoprotiens)
Elevated amylase - and lipase
No - chronic - can present with diarrhea or constipation or alternation - treat sx

23. How does CRC present in the distal and proximal colon
Serous on the sides parotids - mucinous in the middle sublingual
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Mucoepidermoid carcinoma
H2 receptor - inc cAMP

24. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Falciform - ligamentum teres - fetal umbilical vein
Hemosiderosis - hemochromatosis
Muscularis mucosae
Redundant mesentary

25. Who gets Whipple disease and How do they present
Old men - arthralgias - cardiac and neuro sx
Terminal ileum and colon
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Via the middle colic

26. In viral hepatitis - which liver enzyme is higher
Averages 6 months - very aggressive - usually already metastasized at presentation
Osmotic
Gardner's syndrome
ALT>AST

27. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
ALT>AST
...
Below
Upregulated intracellular signal transduction

28. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Superior rectal
Failure of the processus vagainlis to close
Crigler - najjar type 1

29. How does abetalipoproteinemia lead to malabsorption
Complications of UC
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Serous on the sides parotids - mucinous in the middle sublingual
M3 - Gq - inc IP3/Ca

30. What is the main symptom if a VIPoma
Alpha amylase
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Copious diarrhea - non alpha - non beta cell pancreatic tumor
L3

31. Cholecytsokinin - source - action - regulation
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
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
Brunners
Neutralizes oral bacertial acids and maintains dental health

32. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Alpha amylase
Esophageal cancer
Osmotic
Adhesion

33. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
So hypertrophied they look like brain gyri
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Lipase - phospholipase A - colipase
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

34. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Lamina propora and submucosa
Below
IBS at least 2 with recurrent abdominal pain
Alpha1 antitrypsin def - codominant trait

35. How many layers of spermatic fascia are covers an indirect inguinal hernia
Conj/unconj - inc - nl to dec
AST>ALT
All 3
CEA - CA-19-9

36. What is the sphincter of the pancreatic duct
Hemosiderosis - hemochromatosis
Hydrocele
CEA - CA-19-9
Sphincter of oddi

37. what percentage of colonic polyps are non - neoplastic
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
L/R renal artery around L1
Female - fat - fertile - forty
90%

38. What causes nutmeg liver
Failure of the processus vagainlis to close
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Causes of gall stones
Backup of blood into the liver - RHF - budd chiari

39. What drug blocks the H2R
T cell lymphoma
Where hindgut meets ectoderm
Cimetidine
Lipase

40. What are the complications of Meckels
Jaundice - fever - RUQ
Hyperplastic
Bleeding - intussusception - volvulus - obstruction near terminal ileum
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

41. What is diverticulosis
Fe2+ in the duod
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
CCK8 receptor - Gq inc IP3/Ca

42. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Trypsin - chymotrypsin - elastase - carboxypeptidases
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

43. What structures feed into the common bile duct
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Begins starch digestion - inactivated by low pH upon reaching the stomach
Dermatitis herpetiformis
Cystic duct and common hepatic duct

44. What does high flow rate mean
Left and right gastroepiploics - left and right gastrics
Closer to isotonic because of less time to reabsorb NaCl
Liver metabolizes 5HT
In the mucus that covers the gastric epithelium

45. What is the most common indication of emergent abdominal surgery in children
Lipase
Appendicitis
The proximal small bowel
Hyperpigmented mouth - lips - hands - genitalia

46. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Stimulate the H/K ATPase
Alpha1 antitrypsin def - codominant trait
Superior rectal and middle and inferior rectal - rectum
Juvenille polyps - no risk if single

47. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Internal thoracic to superior epigastric to inferior epigastric
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Duodenal atresia - Downs

48. What is the prognosis of adenocarcinoma
Muscularis mucosae
Femoral hernia
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Averages 6 months - very aggressive - usually already metastasized at presentation

49. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Volvulus
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Elevated amylase - and lipase

50. Why does carcinoid syndrome not occur if tumor is confined to GI system
Primarly through ECL leading to histamine release
The entire
Right and left hepatic duct
Liver metabolizes 5HT