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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 are the histological findings in the ileum

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2. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Ischemic colitis
Hepatic steatosis
Elevated amylase - and lipase
Alcoholic cirrhosis

3. malnutrition - toxic megacolon - colorectal carcinoma
Dense core bodies
Complications of UC
Chronic calcifying pancreatitis - inc risk of panreatic cancer
L/R renal artery around L1

4. FAP + malignant CNS tumor
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
Diverticulum
Turcot
Epithelium

5. What causes hirschsprungs
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Lye ingestion and acid reflux
Failure of neural crest migration
Left gastric vein and esophogeal vein - esophagus

6. What are the treatment options for uclerative colitis
Gilbert's
Jewish and African American men
Failure of the processus vagainlis to close
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

7. somatostatin - source - action - regulation
Falciform - ligamentum teres - fetal umbilical vein
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
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Lipase - phospholipase A - colipase

8. GIP - source - action regulation
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Phototherapy
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
MSI (15%) and APC/beta catenin chromosomal instability (85%)

9. What kind of pathways do CCK act on to cause pancreatic secretion
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Phenobarbital - inc liver enzyme synthesis
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Neural muscarinic pathways

10. What are the four Fs of gallstones
Dec PGE2 leading to dec gastric mucosa protection
Female - fat - fertile - forty
Antrum - H.pylori - inc risk of MALT lymphoma
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

11. What is Trousseau's sign
Mucosa - submucosa - muscularis externa - serosa/adventitia
Redness and tenderness on palpation of extremities
Superior rectal and middle and inferior rectal - rectum
90%

12. What separates the right greater and lesser sacs
Glucose dependent insulinotropic peptide
Enterokinase/enteropeptidase from the duodenal mucosa
Mallory bodies
Gastrohepatic ligament

13. What is the mechanism for reyes syndrome
Diarrhea - steatorrhea - weight loss - weakness
Inc - weight loss
Reye's syndrome
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

14. How is bilirubin carried in the blood
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
With albumin
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

15. Which patients have pigment stones
Duodenal atresia - Downs
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
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

16. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Zollinger ellison - brunners glands
Cirrhosis
The entire
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

17. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
Lamina propria
Diverticulum
AST >ALT - ration is usually 1.5

18. What does the splenorenal ligament connect - and What does it contain
HPNCC
Diverticulum
Spleen to posterior abdominal wall - splenic artery and vein
Gallbladder

19. What is the cause of Barrett's and the assocaited complications
Superior rectal and middle and inferior rectal - rectum
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

20. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
US and cholecystectomy
Poor anastamoses
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

21. What does GET SMASHED stand for in acute pancreatitis
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Duodenum - 2nd - 3rd and 4th parts
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Glucose dependent insulinotropic peptide

22. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Volvulus
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Diverticulum
Enterokinase/enteropeptidase from the duodenal mucosa

23. What does extrahepatic biliary obstruction cause
CHF and inc risk of HCC
Pancreatic head causing obstructive jaundice
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Virchow's node

24. Esophagitis can result From which 3 infectious agents - or chemical ingestion
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
HSV-1 - CMV - Candida
90%

25. How do you DX and TX gallstones
Turcot
Urobilin
US and cholecystectomy
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

26. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Crohns = maybe - UC= always
Dissaccharidase def - most commonly lactase
Inferior rectal nerve

27. B cells stimuated in the germinal centers of peyers patches differentiate into what?
IgA secreting plasma cells - ultimately reside in the lamina proporia
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Worldwide - SC - US - adeno
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

28. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Angiodysplasia
Lipase - phospholipase A - colipase
Positive urease test
Positive

29. Where is IgA shuttled
Lactase is located at the tips of intestinal villi
Increase tumorigenesis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

30. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
8-9 waves/min
Cirrhosis
With albumin

31. What does histo show for alpha1 antitrypsin def
PAS- positive globules in liver -
Superior rectal
Glucose dependent insulinotropic peptide
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

32. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Inc conj bilirubin - inc cholesterol - inc alk phos
Esophageal carcinoma
Crohns = maybe - UC= always
Inguninal ligament - sartorius muscle - adductor longus

33. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
No
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
HPNCC

34. What are the signs of peutz jehgers
Lamina propria
Short gastrics - left greater and lesser
Alpha amylase
Hyperpigmented mouth - lips - hands - genitalia

35. What are the barium swallow findings of achalasia
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Uremia
Unconj - absent (acholuria) - inc
Dilated esophagus with an area of distal stenosis - birds beak

36. How is the diagonsis of CRC made
Meckels
External (superficial) ring only
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
Squamous - upper 1/3 - adeno - lower 1/3

37. What is the action of NO as a GI hormone
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
Inc conj bilirubin - inc cholesterol - inc alk phos
Inc smooth muscle relaxation - including lower esophageal sphincter
Hirschsprungs

38. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
CEA - CA-19-9
Cystic duct and common hepatic duct
Internal thoracic to superior epigastric to inferior epigastric

39. What serum enzyme is elevated inacute pancreatitis
CCK8 receptor - Gq inc IP3/Ca
Hemolytic anemia
Lipase
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

40. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Pertechnetate - study for uptake
Cimetidine
Upregulated intracellular signal transduction

41. What does a low flow rate mean for saliva
Female - fat - fertile - forty
EtOH
Can lead to hematemesis - found in EtOHics and bulimics
Hypotonic because of more time to reabsorb NaCl

42. What other condition can lead to acute gastritis - think renal
Older patients
Redundant mesentary
Uremia
Chronic calcifying pancreatitis - inc risk of panreatic cancer

43. What gives stool its characteristic color
Barrett's esophagus
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Stercobilin
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

44. involvement of left supraclavicular node by mets from stomach

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45. What is the presenting course for appendicity

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46. At what spinal level does the is the bifurcation of aorta
Mucosa - submucosa - muscularis externa - serosa/adventitia
Crypts but not villi
L4
Crohns = maybe - UC= always

47. What is one potential precipitating factor for intussusception
Gut bacteria
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Peptic ulcer disease
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

48. What happens to the short gastics if the splenic artery is blocked
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Poor anastamoses
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Sphincter of oddi

49. What arteries exit just below the SMA
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Colovesical leading to pneumaturia
L/R renal artery around L1
Nonkeritinized stratified sqamous epithelium

50. What are esophageal strictures associated with
Lye ingestion and acid reflux
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
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
Achalasia due to loss of myenteric plexus (auberach)