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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 is one potential precipitating factor for intussusception
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Parietal cells in the stomach - B12 binding protein
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

2. With internal hemorrhoids Where is the anastomoses and Where is it
The gastroduodenal
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Unconjugated - water insoluble
Superior rectal and middle and inferior rectal - rectum

3. What is charcot triad of cholangitis
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Turcot
Decrease - weight gain
Jaundice - fever - RUQ

4. What are motilin receptor agonists used for clinically
Lateral
NAV = nerve artery vein - venous near the penis (NAVEL)
Stimulate intestinal persistalsis
Juvenile polyposis syndrome - inc risk of adenocarcinoma

5. What is Trousseau's sign
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Redness and tenderness on palpation of extremities
Inferior rectal nerve
Mucoepidermoid carcinoma

6. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Intussusception
Crohns = noncaseating granulomas - UC = crypt abscesses
Pyoderma gangrenosum - primary sclerosing cholangitis
Gut bacteria

7. In PUD - with gastric ulcers - does pain inc or dec with meals?
Inc - weight loss
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
Alfatoxin in peanuts
8-9 waves/min

8. Transmural esophageal rupture due to violent retching

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9. occlusion of IVC or hepatic veins
Budd chiari syndrome
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
Small intestine

10. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Zenkers - halitosis - dysphagia and obstruction
Hirschsprungs
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

11. What causes nutmeg liver
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
T cell lymphoma
Neural muscarinic pathways
Backup of blood into the liver - RHF - budd chiari

12. What histological findings are present in the esophagus
Dense core bodies
Cholesterol
Nonkeritinized stratified sqamous epithelium
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

13. Which serum enzyme increases with heavy EtOH consumption
Amylase
Acute pancreatitis
Gamma glutamyl transferase GGT
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

14. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Cimetidine
Lipase
Pancreatic head causing obstructive jaundice
Brunners

15. HCC is associated with what other conditions
Jewish and African American men
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
Mallory bodies
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

16. rare - often fatal childhood hepatoencephalopathy

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17. In what scenarios do pts with gilberts have inc bili
Fasting and stress
Positive urease test
Parietal cells in the stomach - B12 binding protein
Trypsin - chymotrypsin - elastase - carboxypeptidases

18. 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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19. What source of salivary secretion is the most serous and What is the most mucinous
HSV-1 - CMV - Candida
Serous on the sides parotids - mucinous in the middle sublingual
Spleen to posterior abdominal wall - splenic artery and vein
Alpha1 antitrypsin def - codominant trait

20. What pancreatic proteases are secreted as zymogens
Alpha amylase
Stimulate the H/K ATPase
L4
Trypsin - chymotrypsin - elastase - carboxypeptidases

21. What does bicab do in the mouth
Neutralizes oral bacertial acids and maintains dental health
Oral glucose
12 waves/min
Cystic duct and common hepatic duct

22. Where does copper accumulate in Wilsons and What are ABCD
Early childhood - neuro sx and malabsorption
Peyers patches
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

23. Bilirubin is the product of what?
Ceruplasmin
Lateral to the inferior epigastric artery
Heme metabolism
Bleeding - penetration into pancreas - perforation - obstruction

24. conjugated hyperbilirubinemia due to defective liver excretion
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
Where hindgut meets ectoderm
Dubin johnson
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

25. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Esophageal cancer
Failure of neural crest migration
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Diverticulum

26. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Mallory bodies
Old men - arthralgias - cardiac and neuro sx
Duodenal atresia - Downs
Myenteric nerve plexus - aurbach

27. What reaction does salivary amylase catalyze
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Squamous - upper 1/3 - adeno - lower 1/3
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

28. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Upregulated intracellular signal transduction
Repeated phlebotomy - deferoxamine - HLA- A3
In the mucus that covers the gastric epithelium
Alpha amylase

29. Which patients have pigment stones
Centrilobular leading to congestive liver disease
Neural muscarinic pathways
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Unconjugated - water insoluble

30. What does the splenorenal ligament connect - and What does it contain
Inc smooth muscle relaxation - including lower esophageal sphincter
PAS- positive globules in liver -
Spleen to posterior abdominal wall - splenic artery and vein
H2 receptor - inc cAMP

31. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Femoral hernia
True and most common congenital anomoly of GI tract
Dilated esophagus with an area of distal stenosis - birds beak

32. What is the other name for GIP (gastric inhibitory peptide)
Hernia
Glucose dependent insulinotropic peptide
Squamous - upper 1/3 - adeno - lower 1/3
Tropical sprue

33. What is the path of an indirect inguinal hernia
US and cholecystectomy
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Hepatic steatosis
Jaundice - fever - RUQ

34. What is the most common diaphragmatic hernia and What are the two types
Menetriers disease
Diarrhea - steatorrhea - weight loss - weakness
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Below

35. How does abetalipoproteinemia lead to malabsorption
Amylase
Upregulated intracellular signal transduction
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Bleeding - penetration into pancreas - perforation - obstruction

36. What does TOASTED with alcoholic hepatitis stand for
Adhesion
Mucoepidermoid carcinoma
AST >ALT - ration is usually 1.5
Alcoholic cirrhosis

37. People of what decent are associated with celiac sprue and what findings/antibodies are present
Lubricate food (glycoprotiens)
Crigler - najjar type 1
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

38. likely infectious form of malabsorption - responds to antibiotics
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Tropical sprue
Above
Gardner's syndrome

39. 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
External spermatic fascia only
Muscularis mucosae
Cystic duct and common hepatic duct

40. What is contained in the gastrosplenic and What areas does it separate
Averages 6 months - very aggressive - usually already metastasized at presentation
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Duodenal atresia - Downs
Short gastrics - left greater and lesser

41. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Erosive - disruption of mucosal barrier leading to inflammation
Hypercoaguability - polycythemia vera - pregnancy - HCC
Gilbert's

42. Why are most diverticula considered false
3 waves/min
Brunners
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Alk phos

43. Diaphragmatic hernias occur in infants because of defective development of which membrane
Gilbert's
Chronic gastritis and pernicious anemia
H pylori (almost 100%)
Pleuroperitoneal

44. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Crohns = maybe - UC= always
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Lamina propora and submucosa
FAP

45. What does autoimmune destruction of parietal cells lead to...
Diarrhea - steatorrhea - weight loss - weakness
Dec PGE2 leading to dec gastric mucosa protection
Omeprazole
Chronic gastritis and pernicious anemia

46. What type of insults result in micronodular cirrhosis
ALT>AST
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
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
Right and left hepatic duct

47. What are the histological findings in the jejunum
Zollinger ellison - brunners glands
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
L/R renal artery around L1
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

48. What are the barium swallow findings of achalasia
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Dilated esophagus with an area of distal stenosis - birds beak

49. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Meconium ileus
Inc risk of CRC and other visceral malignancies
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

50. What is the frequency of basal electric rhythm of the stomach
3 waves/min
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)