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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. absent UDPGT - presents early in life - early mortality
90%
Peptic ulcer disease
Splenic flexure
Crigler - najjar type 1

2. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Virchow's node
Closer to isotonic because of less time to reabsorb NaCl
Conj - inc - dec
AST >ALT - ration is usually 1.5

3. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Uridine glucuronyl transferase
Causes of gall stones
Uremia
Begins starch digestion - inactivated by low pH upon reaching the stomach

4. What separates the right greater and lesser sacs
Acute pancreatitis
Gilbert's
Enterokinase/enteropeptidase from the duodenal mucosa
Gastrohepatic ligament

5. What source of salivary secretion is the most serous and What is the most mucinous
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Serous on the sides parotids - mucinous in the middle sublingual
Epithelium
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

6. what kind of muscle is in the upper 1/3 of esophagus
External spermatic fascia only
Primary sclerosing cholangitis
Striated
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

7. What does TOASTED with alcoholic hepatitis stand for
Antrum - H.pylori - inc risk of MALT lymphoma
AST >ALT - ration is usually 1.5
Positive
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

8. What does autoimmune destruction of parietal cells lead to...
Alfatoxin in peanuts
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Chronic gastritis and pernicious anemia
Pleomorphic adenoma

9. What does a gastrinoma cause
In the ileum with bile acids - requires IF
Serous on the sides parotids - mucinous in the middle sublingual
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Crypts but not villi

10. Who gets Whipple disease and How do they present
T12
Old men - arthralgias - cardiac and neuro sx
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
VZV and influenza B treated with salicylates

11. What is the clinical presentation of acute pancreatitis
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
Lamina propora and submucosa
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Epigastric abdominal pain radiating to back - anorexia - nausea

12. What are the common causes of gastric ulcers - What causes gastric ulcer
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

13. What are the foregut structures and what supplies their blood and PANS innvervation
Elevated amylase - and lipase
Dec PGE2 leading to dec gastric mucosa protection
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

14. When and How does Abetalipoproteinemia present
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Crypts but not villi
Low pressure proximal to LES
Early childhood - neuro sx and malabsorption

15. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Right and left hepatic duct
Juvenille polyps - no risk if single
Lactase is located at the tips of intestinal villi

16. What is the lumen of the pancreatic duct
Ampulla of vater
Spleen to posterior abdominal wall - splenic artery and vein
The gastroduodenal
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

17. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
...
L3
Hydrocele
Complications of UC

18. In PUD with a duodenal ulcer does pain inc or dec with meals
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Crohns = maybe - UC= always
Decrease - weight gain
Inc conj bilirubin - inc cholesterol - inc alk phos

19. Where is folate absorbed
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
The jejunum
Mallory bodies
Centrilobular congestion and necrosis - cardiac cirrhosis

20. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
HSV-1 - CMV - Candida
Trypsin - chymotrypsin - elastase - carboxypeptidases
H pylori (almost 100%)

21. What layer in the mucosa is responsible for absorption
Epithelium
IBS at least 2 with recurrent abdominal pain
Krukenbergs tumor
Begins starch digestion - inactivated by low pH upon reaching the stomach

22. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Striated and smooth
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Virchow's node
Necrotizing enterocolitis

23. Achalasia increases the risk For what complication
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Esophageal carcinoma
AST
HPNCC

24. What is biliary colic
Hyperpigmented mouth - lips - hands - genitalia
Copious diarrhea - non alpha - non beta cell pancreatic tumor
The proximal small bowel
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

25. What is the leading cause of bowel incarceration
Liver metabolizes 5HT
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Gamma glutamyl transferase GGT
Femoral hernia

26. rare - often fatal childhood hepatoencephalopathy

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27. Where are tumors commonly in pancreatic adenocarcinoma
Alpha1 antitrypsin def - codominant trait
T cell lymphoma
Pancreatic head causing obstructive jaundice
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

28. What is the characteristic histo finding in alcoholic hepatitis
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Mallory bodies
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

29. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

30. What are the tumor markers for pancreatic adenocarcinoma
Cholesterol
Ischemic colitis
H pylori (almost 100%)
CEA - CA-19-9

31. Where is there sclerosis in alcoholic cirrohosis
Around the central vein (zone III)
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
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Reye's syndrome

32. What are the ABCDEF of esophageal cancer
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Primarly through ECL leading to histamine release
Intussusception
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

33. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Nonkeritinized stratified sqamous epithelium
12 waves/min
Trypsin - chymotrypsin - elastase - carboxypeptidases

34. How does loss of NO secretion affect the esophagus and what results
Striated
ALT>AST
Inc lower esphogeal tone leading to achalasia
Left and right gastroepiploics - left and right gastrics

35. What are the effects of atropine on parietal cells and G cells
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Cholesterol
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

36. What structures feed into the common hepatic duct
Begins starch digestion - inactivated by low pH upon reaching the stomach
Uridine glucuronyl transferase
Right and left hepatic duct
ALT>AST

37. What does primary sclerosing cholangitis lead to...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Cimetidine
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Mitochondrial abnl - fatty liver - hypoglycemia - coma

38. What does histo show for alpha1 antitrypsin def
Gardner's syndrome
PAS- positive globules in liver -
Meconium ileus
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

39. What causes primary biliary cirrhosis
Centrilobular leading to congestive liver disease
Stimulate the H/K ATPase
Cholesterol - 10-20% opaque due to calcifications
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

40. What are the histological findings of the colon
Centrilobular congestion and necrosis - cardiac cirrhosis
Paraumbilical and superficial and inferior epigastric - umbilicus
Crypts but not villi
Striated

41. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
Muscularis mucosae
Primary sclerosing cholangitis
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

42. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Colonic polyps
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Dubin johnson
Myenteric nerve plexus - aurbach

43. Where does type A chronic gastritis occur and What causes it
Stercobilin
Celiac sprue
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
External (superficial) ring only

44. What is the cause of Barrett's and the assocaited complications
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

45. signet ring cells - acanthosis nigracans - dz - character/association - spread
Reye's syndrome
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
L3
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

46. What reaction does salivary amylase catalyze
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Inspiratory arrest on deep palpation due to pain
Right and left hepatic duct

47. What is the path of an indirect inguinal hernia
Pancreatic and bile
Goes through deep inguinal ring - external inguinal ring and into the scrotum
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Increase tumorigenesis

48. What carcinogens are associated with HCC
Crohns = noncaseating granulomas - UC = crypt abscesses
Gamma glutamyl transferase GGT
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Alfatoxin in peanuts

49. What does a low flow rate mean for saliva
Internal thoracic to superior epigastric to inferior epigastric
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Hypotonic because of more time to reabsorb NaCl
Epigastric abdominal pain radiating to back - anorexia - nausea

50. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Pleomorphic adenoma
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Neutralizes gastric acid allowing pancreatic enzymes to fxn