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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 findings are associated with reyes
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Mitochondrial abnl - fatty liver - hypoglycemia - coma
When diffusely infiltrative - thickened rigid appearance like a leather bottle

2. secretin - source - action - regulation
90%
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
Bleeding - penetration into pancreas - perforation - obstruction
Alpha1 antitrypsin def - codominant trait

3. Abuse of what substance leads to acute gastritis
EtOH
Female - fat - fertile - forty
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
H+

4. What causes carcinoid syndrome amd What are the symptoms
AST >ALT - ration is usually 1.5
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

5. If the abdominal aorta is blocked - How does blood get to the left colic artery
Inguninal ligament - sartorius muscle - adductor longus
Inc lower esphogeal tone leading to achalasia
Via the middle colic
Cystic duct and common hepatic duct

6. What is the ddx associated with appendicitis
Liver metabolizes 5HT
90%
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

7. vasoactive intestinal polypeptide (VIP) - source - action - regulation
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
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Splenic flexure
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

8. why infxn is implicated in duodenal PUD
Bleeding - intussusception - volvulus - obstruction near terminal ileum
H pylori (almost 100%)
PAS- positive globules in liver -
Cholesterol

9. What are the treatment options for uclerative colitis
Cimetidine
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Celiac sprue
Lactase is located at the tips of intestinal villi

10. What does loss of APC cause
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Stimulate the H/K ATPase
Decreased intercellular adhesion and increased proliferation

11. What does autoimmune destruction of parietal cells lead to...
Female - fat - fertile - forty
Esophageal varices
Chronic gastritis and pernicious anemia
Complications of crohns

12. What kind of pathways do CCK act on to cause pancreatic secretion
Decreased intercellular adhesion and increased proliferation
Pancreatic head causing obstructive jaundice
Inc lower esphogeal tone leading to achalasia
Neural muscarinic pathways

13. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Dec PGE2 leading to dec gastric mucosa protection
Carcinoid syndrome
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

14. What does extrahepatic biliary obstruction cause
Lipase
Hirschsprungs
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Peptic ulcer disease

15. What is the most common cause of gallstones
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Causes of gall stones
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

16. Scleroderma is associated with what kind of esophageal dysmotility
AST>ALT
Low pressure proximal to LES
Female - fat - fertile - forty
L/R renal artery around L1

17. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Meckels
Left gastric vein and esophogeal vein - esophagus
US and cholecystectomy
Causes of gall stones

18. At what level do the testicular/ovarian arteries exit the aorta
L2
HSV-1 - CMV - Candida
Pyoderma gangrenosum - primary sclerosing cholangitis
Carcinoid syndrome

19. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
...
Alcoholic cirrhosis
Pleomorphic adenoma
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

20. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Alcoholic hepatitis
Falciform - ligamentum teres - fetal umbilical vein

21. Cholecytsokinin - source - action - regulation
Dissaccharidase def - most commonly lactase
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
Inc conj bilirubin - inc cholesterol - inc alk phos
Striated

22. What is the path of an indirect inguinal hernia
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Goes through deep inguinal ring - external inguinal ring and into the scrotum
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Angiodysplasia

23. What does alpha amylase do and what inactivates it
Myenteric nerve plexus - aurbach
With albumin
Hyperplastic
Begins starch digestion - inactivated by low pH upon reaching the stomach

24. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
HPNCC
Fe2+ in the duod

25. How does abetalipoproteinemia lead to malabsorption
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Chronic calcifying pancreatitis - inc risk of panreatic cancer
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
Below

26. What structure is Not contained in the femoral sheath
Goes through deep inguinal ring - external inguinal ring and into the scrotum
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Mucosa - submucosa - muscularis externa - serosa/adventitia
Above

27. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Lactase is located at the tips of intestinal villi
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
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

28. What kind of insults results in macronodular cirrhosis
Enterokinase/enteropeptidase from the duodenal mucosa
Bleeding - intussusception - volvulus - obstruction near terminal ileum
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

29. What percentage of gall stones are cholesterol stones and What are the associations
Inc - weight loss
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Urobilin
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

30. Is there any structural abnl with IBS - What is the course of disease and presentation
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Failure of the processus vagainlis to close
No - chronic - can present with diarrhea or constipation or alternation - treat sx
PAS- positive globules in liver -

31. What serum enzyme is elevated in acute pancreatitis and mumps
Glucouronate - water soluble (direct)
Hyperpigmented mouth - lips - hands - genitalia
Amylase
When diffusely infiltrative - thickened rigid appearance like a leather bottle

32. likely infectious form of malabsorption - responds to antibiotics
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Tropical sprue
Brush border of intestine - produce monosaccharides from oligo and di
Parietal cells in the stomach - B12 binding protein

33. Where is B12 absorbed
Warthins' tumor
The proximal small bowel
Portal HTN
In the ileum with bile acids - requires IF

34. How do NSAIDs cause acute gastritis
HSV-1 - CMV - Candida
Lateral
Brunners
Dec PGE2 leading to dec gastric mucosa protection

35. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
US and cholecystectomy
Alcoholic hepatitis
Worldwide - SC - US - adeno
Hemosiderosis - hemochromatosis

36. What are the borders of Hesselbach's triangle
Pleuroperitoneal
Stimulate the H/K ATPase
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Trypsin - chymotrypsin - elastase - carboxypeptidases

37. At what level of the spine does the IM exit the aorta
Brush border of intestine - produce monosaccharides from oligo and di
L3
M3 - Gq - inc IP3/Ca
Cirrhosis

38. In PUD - with gastric ulcers - does pain inc or dec with meals?
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Inc - weight loss
Duodenum - 2nd - 3rd and 4th parts

39. What cells secrete bicarb - What does it do - and what regulates it
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Inc lower esphogeal tone leading to achalasia
Striated and smooth
Downs

40. involvement of left supraclavicular node by mets from stomach

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41. What makes a true diverticula
IBS at least 2 with recurrent abdominal pain
Inc lower esphogeal tone leading to achalasia
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
All 3 gut layers outpouch as in Meckels

42. How do you DX and TX gallstones
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
Hernia
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
US and cholecystectomy

43. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Ampulla of vater
Primarly through ECL leading to histamine release
No - chronic - can present with diarrhea or constipation or alternation - treat sx

44. Which is used more quickly - an oral glucose load - or that by IV
L4
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Oral glucose
Inc lower esphogeal tone leading to achalasia

45. B cells stimuated in the germinal centers of peyers patches differentiate into what?
H pylori (almost 100%)
Dilated esophagus with an area of distal stenosis - birds beak
IgA secreting plasma cells - ultimately reside in the lamina proporia
Smooth

46. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Primarly through ECL leading to histamine release
12 waves/min
Black - rotors syndrome

47. What does TOASTED with alcoholic hepatitis stand for
Alfatoxin in peanuts
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
AST >ALT - ration is usually 1.5
The jejunum

48. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
External spermatic fascia only
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

49. What is contained within the submucosa

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50. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Conj/unconj - inc - nl to dec
Zollinger Ellison - phenylalanine and tryptophan
Cholesterol
Urobilin