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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. In PUD with a duodenal ulcer does pain inc or dec with meals
90%
The submucosal nerve plexus - meissner's
Decrease - weight gain
Lack or have an attenuated muscularis externa - often in the sigmoid colon

2. What are the hindgut structures and what supplies their blood and PANS innvervation
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Terminal ileum and colon
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Lateral to the inferior epigastric artery

3. Which area of the hindgut is a watershed area
Splenic flexure
Hernia
Pleuroperitoneal
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

4. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Gastric glands
Ischemic colitis
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

5. Which viral infxns/treatments are associated with reyes syndrome
VZV and influenza B treated with salicylates
AR
Hypotonic because of more time to reabsorb NaCl
Achalasia due to loss of myenteric plexus (auberach)

6. Abuse of what substance leads to acute gastritis
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Ampulla of vater
EtOH
L/R renal artery around L1

7. What kind of diarrhea is produced from a disaccharide def
Stimulate the H/K ATPase
Myenteric nerve plexus - aurbach
Trypsin - chymotrypsin - elastase - carboxypeptidases
Osmotic

8. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
2ndary biliary cirrhosis

9. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Epithelium
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Stercobilin

10. In viral hepatitis - which liver enzyme is higher
Esophageal cancer
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
3 waves/min
ALT>AST

11. What is the leading cause of bowel incarceration
Gastric glands
Femoral hernia
Stercobilin
Appendicitis

12. What does histo show for alpha1 antitrypsin def
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
PAS- positive globules in liver -
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

13. What are the branches of the celiac trunk and What do they supply
Common hepatic - splenic - left gastric - main blood supply for stomach
Achalasia due to loss of myenteric plexus (auberach)
Left gastric vein and esophogeal vein - esophagus
Phenobarbital - inc liver enzyme synthesis

14. What pancreatic proteases are secreted as zymogens
Hyperplastic
Trypsin - chymotrypsin - elastase - carboxypeptidases
Carcinoid syndrome
All 3

15. What is the most common cause of gallstones
IgA secreting plasma cells - ultimately reside in the lamina proporia
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Duodenal atresia - Downs
Lamina propora and submucosa

16. What is the risk with peutz jehgers
Oligosaccharide digestion
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Inc risk of CRC and other visceral malignancies
Alfatoxin in peanuts

17. Bile is critical for exrection of what substance
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Cholesterol
Dermatitis herpetiformis
So hypertrophied they look like brain gyri

18. In what clinical scenarior do you see portosystemic anastomoses
Stercobilin
Complications of crohns
Smooth
Portal HTN

19. What is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Zenkers - halitosis - dysphagia and obstruction
Right and left hepatic duct
Cholesterol

20. How does gastrin increase acid secretion?
Primarly through ECL leading to histamine release
The gastroduodenal
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Brunners

21. What is pancreatic adenocarcinoma associated with
Amylase
Cigarettes and chronic pancreatitis - not EtOH
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Stimulate the H/K ATPase

22. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Redness and tenderness on palpation of extremities
Inc risk of CRC and other visceral malignancies
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

23. What artery passes around the duodenum
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
The gastroduodenal
Turcot

24. Liver cell failure can lead to multisystem signs including
Pyoderma gangrenosum - primary sclerosing cholangitis
Gastric glands
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Hypercoaguability - polycythemia vera - pregnancy - HCC

25. Where does type B chronic gastritis occur and What causes it
PAS- positive globules in liver -
Repeated phlebotomy - deferoxamine - HLA- A3
Alpha1 antitrypsin def - codominant trait
Antrum - H.pylori - inc risk of MALT lymphoma

26. What is the cause of Barrett's and the assocaited complications
Striated
L1
Heme metabolism
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

27. What are the extraintestinal manifestations of ulcerative colitis
Sphincter of oddi
Ischemic colitis
Pyoderma gangrenosum - primary sclerosing cholangitis
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

28. What structures feed into the cystic duct
Gallbladder
Stimulate the H/K ATPase
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Neural muscarinic pathways

29. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

30. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Unconjugated - water insoluble
Can lead to hematemesis - found in EtOHics and bulimics

31. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Alpha1 antitrypsin def - codominant trait
HPNCC
Falciform - ligamentum teres - fetal umbilical vein

32. What is contained within the muscularis externa
Lamina propora and submucosa
Myenteric nerve plexus - aurbach
Gut bacteria
Hypercoaguability - polycythemia vera - pregnancy - HCC

33. How are all 3 monosaccharides transported to the blood
L3
GLUT 2
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Goes through deep inguinal ring - external inguinal ring and into the scrotum

34. What are the complications of Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Dilated esophagus with an area of distal stenosis - birds beak
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

35. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Zenkers - halitosis - dysphagia and obstruction
Esophageal varices
Early childhood - neuro sx and malabsorption
IBS at least 2 with recurrent abdominal pain

36. Where is IgA shuttled
Decreased intercellular adhesion and increased proliferation
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Sister mary joseph nodule
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

37. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Alcoholic cirrhosis
Brunners
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
NAV = nerve artery vein - venous near the penis (NAVEL)

38. If the abdominal aorta is blocked - How does blood get to the left colic artery
Via the middle colic
Low pressure proximal to LES
Inc - weight loss
Worldwide - SC - US - adeno

39. What kind of digestion is bile needed for
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

40. If trypsin activates more trypsinogen - what kind of feedback loop is established
Pleomorphic adenoma
Chronic gastritis and pernicious anemia
Heme metabolism
Positive

41. What are the tumor markers for pancreatic adenocarcinoma
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Reye's syndrome
CEA - CA-19-9
Adhesion

42. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
Downs
Alpha1 antitrypsin def - codominant trait
Cystic dilation of the viteline duct

43. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Angiodysplasia
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Black - rotors syndrome
Pertechnetate - study for uptake

44. When do you see hypertrophy of brunners glands
Peptic ulcer disease
In the mucus that covers the gastric epithelium
Decrease - weight gain
Colonic polyps

45. How do burns cause acute gastritis and What is it called

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46. What findings are associated with reyes
True and most common congenital anomoly of GI tract
Hirschsprungs
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Uremia

47. secretin - source - action - regulation
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
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
Diarrhea - steatorrhea - weight loss - weakness

48. What serum enzyme is decreased in wilsons disease
Causes of gall stones
CEA - CA-19-9
Ceruplasmin
Juvenille polyps - no risk if single

49. What are causes of extrahepatic biliary obstruction
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
PAS- positive globules in liver -

50. What happens to the short gastics if the splenic artery is blocked
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Dissaccharidase def - most commonly lactase
Poor anastamoses
Internal thoracic to superior epigastric to inferior epigastric