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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 the presentation of pancreatic adenocarcinoma
90%
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
FAP

2. What does a gastrinoma cause
Crohns = maybe - UC= always
Chagas disease
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
CCK8 receptor - Gq inc IP3/Ca

3. Which is used more quickly - an oral glucose load - or that by IV
Smooth
Alfatoxin in peanuts
ALT>AST
Oral glucose

4. What are the longterm sequelae of nutmeg liver
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
Left gastric vein and esophogeal vein - esophagus
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Centrilobular congestion and necrosis - cardiac cirrhosis

5. What is diverticulosis
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Crypts but not villi
HPNCC

6. Which patients have pigment stones
Spleen to posterior abdominal wall - splenic artery and vein
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Falciform - ligamentum teres - fetal umbilical vein

7. Where is IgA shuttled
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Neutralizes oral bacertial acids and maintains dental health
Glucouronate - water soluble (direct)
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

8. inflammatino of gallbadder
All 3 gut layers outpouch as in Meckels
Fe2+ in the duod
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
CCK8 receptor - Gq inc IP3/Ca

9. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Alfatoxin in peanuts
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

10. Which area of the hindgut is a watershed area
Superior rectal and middle and inferior rectal - rectum
Splenic flexure
The submucosal nerve plexus - meissner's
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

11. What causes carcinoid syndrome amd What are the symptoms
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Skip lesions =crohns - colon = UC

12. What does loss of p53 cause
Upregulated intracellular signal transduction
Increase tumorigenesis
Zollinger Ellison - phenylalanine and tryptophan
External spermatic fascia only

13. What does a low flow rate mean for saliva
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Hypotonic because of more time to reabsorb NaCl
Lactase is located at the tips of intestinal villi
Boerhaave's Syndrome - Been heaving syndrome

14. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Backup of blood into the liver - RHF - budd chiari
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Muscularis mucosae

15. What are the common causes of gastric ulcers - What causes gastric ulcer
Brush border of intestine - produce monosaccharides from oligo and di
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Glucose dependent insulinotropic peptide
Dermatitis herpetiformis

16. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Barrett's esophagus
90%
Brunners
Uremia

17. trypsinogen is converted to trypsin via what enzyme
Cimetidine
Stimulate the H/K ATPase
Enterokinase/enteropeptidase from the duodenal mucosa
Redness and tenderness on palpation of extremities

18. What is the most common esophageal cancer worldwide and in the US
Lye ingestion and acid reflux
Internal thoracic to superior epigastric to inferior epigastric
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Worldwide - SC - US - adeno

19. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
Pleomorphic adenoma
FAP
Dilated esophagus with an area of distal stenosis - birds beak

20. Malabsorption syndromes have what common clinical presentation
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Diarrhea - steatorrhea - weight loss - weakness
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
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

21. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
L3
Esophageal varices
Sphincter of oddi
Via the superior pancreaticduodenal

22. Achalasia increases the risk For what complication
Esophageal carcinoma
Inferior rectal nerve
Skip lesions =crohns - colon = UC
Left and right gastroepiploics - left and right gastrics

23. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Mallory bodies
Centrilobular leading to congestive liver disease
IBS at least 2 with recurrent abdominal pain
Omeprazole

24. What is one potential precipitating factor for intussusception
Alfatoxin in peanuts
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Inspiratory arrest on deep palpation due to pain

25. What does high flow rate mean
Pleuroperitoneal
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
Closer to isotonic because of less time to reabsorb NaCl
Duodenum - 2nd - 3rd and 4th parts

26. What makes a true diverticula
Alk phos
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
All 3 gut layers outpouch as in Meckels
ALT>AST

27. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Causes of gall stones
Squamous - upper 1/3 - adeno - lower 1/3
Phenobarbital - inc liver enzyme synthesis

28. If the abdominal aorta is blocked - How does blood get to the left colic artery
Via the middle colic
Sister mary joseph nodule
Striated
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

29. What portion of the bowel does sprue effect
FAP
The proximal small bowel
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Dermatitis herpetiformis

30. When and How does Abetalipoproteinemia present
Early childhood - neuro sx and malabsorption
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Internal thoracic to superior epigastric to inferior epigastric
Mucoepidermoid carcinoma

31. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
H+
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Worldwide - SC - US - adeno

32. What transforms conjugated bilirubin to urobilinogen
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Gut bacteria
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

33. crigler - najjar type II responds to which therapy and How does it work
Phenobarbital - inc liver enzyme synthesis
Conj - inc - dec
CHF and inc risk of HCC
MSI (15%) and APC/beta catenin chromosomal instability (85%)

34. signet ring cells - acanthosis nigracans - dz - character/association - spread
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Primary sclerosing cholangitis
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

35. What commonly leads to appendicity in kids vs adults
Oligosaccharide digestion
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Glucose dependent insulinotropic peptide

36. What do you treat Wilsons disease with and What is the inheritance
Common hepatic - splenic - left gastric - main blood supply for stomach
Penicillinamine - AR inheritance
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Inc smooth muscle relaxation - including lower esophageal sphincter

37. What histological findings are present in the esophagus
Cystic dilation of the viteline duct
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Nonkeritinized stratified sqamous epithelium
Common hepatic - splenic - left gastric - main blood supply for stomach

38. What is biliary colic
Nonkeritinized stratified sqamous epithelium
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Lamina propria
L4

39. What is the HLA association and treatment for hemochromatosis
Dermatitis herpetiformis
Inc smooth muscle relaxation - including lower esophageal sphincter
Repeated phlebotomy - deferoxamine - HLA- A3
Mucoepidermoid carcinoma

40. Why does indirect inguinal hernia happen in infacnts
Adhesion
IgA secreting plasma cells - ultimately reside in the lamina proporia
Failure of the processus vagainlis to close
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

41. bilateral mets to ovaries with abundant mucus - signet ring cells
Left and right gastroepiploics - left and right gastrics
Alpha amylase
Acute pancreatitis
Krukenbergs tumor

42. conjugated hyperbilirubinemia due to defective liver excretion
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Dubin johnson
Complications of crohns
Ceruplasmin

43. What kind of anemia is in Wilsons
Hemolytic anemia
Colovesical leading to pneumaturia
Inferior rectal nerve
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

44. What layer in the mucosa is responsible for absorption
Epithelium
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Decrease - weight gain

45. What is the most common diaphragmatic hernia and What are the two types
Brunners
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

46. likely infectious form of malabsorption - responds to antibiotics
Hydrocele
Superior rectal
Tropical sprue
Brush border of intestine - produce monosaccharides from oligo and di

47. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Hemosiderosis - hemochromatosis
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Gamma glutamyl transferase GGT
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

48. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
Epithelium
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Normal

49. Why does volvulus occur more at cecum and sigmoid colon
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Redundant mesentary
Mallory bodies
Inc lower esphogeal tone leading to achalasia

50. How does brain injury lead to acute gastritis and What is it called
Trypsin - chymotrypsin - elastase - carboxypeptidases
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion