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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 color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
L/R renal artery around L1
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Black - rotors syndrome
Above

2. What test and result confirms H pylori infxn
Boerhaave's Syndrome - Been heaving syndrome
Positive urease test
Hyperpigmented mouth - lips - hands - genitalia
Enterokinase/enteropeptidase from the duodenal mucosa

3. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Inc - weight loss
Esophageal cancer
Dilated esophagus with an area of distal stenosis - birds beak

4. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Portal HTN
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Colovesical leading to pneumaturia

5. What structures feed into the common bile duct
Neural muscarinic pathways
Increase tumorigenesis
Cystic duct and common hepatic duct
Peutz jeghers

6. Why does volvulus occur more at cecum and sigmoid colon
Redundant mesentary
Cirrhosis
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Epithelium

7. Which IBD is autoimmune and which may be a disordered response to bacteria
GERD - may also present with nocturnal cough and dyspnea
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Failure of neural crest migration
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

8. Who gets gastric ulcers
In the ileum with bile acids - requires IF
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Older patients

9. Why does carcinoid syndrome not occur if tumor is confined to GI system
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Alpha1 antitrypsin def - codominant trait
Liver metabolizes 5HT
Primarly through ECL leading to histamine release

10. Where is the pectinate line
Right and left hepatic duct
Epigastric abdominal pain radiating to back - anorexia - nausea
Where hindgut meets ectoderm
The gastroduodenal

11. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
External (superficial) ring only
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
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Lipase

12. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Lamina propria
Striated and smooth
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
IgA secreting plasma cells - ultimately reside in the lamina proporia

13. What causes nutmeg liver
L4
Omeprazole
Backup of blood into the liver - RHF - budd chiari
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

14. At what spinal level does the is the bifurcation of aorta
Stimulate the H/K ATPase
L4
Decrease - weight gain
Gamma glutamyl transferase GGT

15. What are the complications of Meckels
Phenobarbital - inc liver enzyme synthesis
Jewish and African American men
Cystic duct and common hepatic duct
Bleeding - intussusception - volvulus - obstruction near terminal ileum

16. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Ischemic colitis
Crigler - najjar type 1
Mallory bodies

17. What kind of diarrhea is produced from a disaccharide def
EtOH
Osmotic
Neutralizes oral bacertial acids and maintains dental health
M3 - Gq - inc IP3/Ca

18. What serum enzyme is elevated in acute pancreatitis and mumps
Alk phos
Goes through deep inguinal ring - external inguinal ring and into the scrotum
All 3
Amylase

19. What receptor does histamine bind on the parietal cell and What does it activate
Budd chiari syndrome
H2 receptor - inc cAMP
Myenteric nerve plexus - aurbach
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

20. What are the extraintestinal manifestations of ulcerative colitis
Colonic polyps
In the ileum with bile acids - requires IF
Pyoderma gangrenosum - primary sclerosing cholangitis
In the mucus that covers the gastric epithelium

21. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Uremia
Zollinger Ellison - phenylalanine and tryptophan
With albumin
Tropical sprue

22. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Brush border of intestine - produce monosaccharides from oligo and di
Sister mary joseph nodule
Via the middle colic

23. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Nonkeritinized stratified sqamous epithelium
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Esophageal varices

24. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Causes of gall stones
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

25. Where are carcinoid tumors most commonly malignant
Small intestine
Zollinger ellison - brunners glands
Primarly through ECL leading to histamine release
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

26. Which serum enzyme increases with heavy EtOH consumption
Glucouronate - water soluble (direct)
Hydrocele
Gamma glutamyl transferase GGT
Trypsin - chymotrypsin - elastase - carboxypeptidases

27. What does high flow rate mean
Dermatitis herpetiformis
Meconium ileus
Striated and smooth
Closer to isotonic because of less time to reabsorb NaCl

28. Transmural esophageal rupture due to violent retching

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29. At what level do the testicular/ovarian arteries exit the aorta
T12
Around the central vein (zone III)
Upregulated intracellular signal transduction
L2

30. What is the sphincter of the pancreatic duct
Hemosiderosis - hemochromatosis
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
Sphincter of oddi
Neural muscarinic pathways

31. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Adhesion
Duodenum - 2nd - 3rd and 4th parts
Serous on the sides parotids - mucinous in the middle sublingual

32. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Redundant mesentary
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
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

33. How does gastrin increase acid secretion?
The gastroduodenal
Primarly through ECL leading to histamine release
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

34. Where does type B chronic gastritis occur and What causes it
Antrum - H.pylori - inc risk of MALT lymphoma
T12
Hemosiderosis - hemochromatosis
Crigler - najjar type 1

35. Malabsorption syndromes have what common clinical presentation
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Repeated phlebotomy - deferoxamine - HLA- A3
Diarrhea - steatorrhea - weight loss - weakness
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

36. What are the four Fs of gallstones
Nonkeritinized stratified sqamous epithelium
Hemolytic anemia
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Female - fat - fertile - forty

37. Autodigestion of pancreas by pancreatic enzymes
Acute pancreatitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Lamina propora and submucosa
Centrilobular leading to congestive liver disease

38. What is the HLA association and treatment for hemochromatosis
AR
Repeated phlebotomy - deferoxamine - HLA- A3
Hepatic steatosis
Osmotic

39. What is the rate limiting step of carbohydrate digestion
Conj - inc - dec
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Oligosaccharide digestion
PAS- positive globules in liver -

40. 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
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
IBS at least 2 with recurrent abdominal pain
Decrease - weight gain

41. What does extrahepatic biliary obstruction cause
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Superior rectal and middle and inferior rectal - rectum
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

42. What is the most common diaphragmatic hernia and What are the two types
Omeprazole
GLUT 2
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

43. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Ampulla of vater
Lipase
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Causes of gall stones

44. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
EtOH
Fasting and stress
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Peyers patches

45. Who is at risk for pancreatic adenocarcinoma
Jewish and African American men
Glucouronate - water soluble (direct)
NAV = nerve artery vein - venous near the penis (NAVEL)
Barrett's esophagus

46. What does a gastrinoma cause
NAV = nerve artery vein - venous near the penis (NAVEL)
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

47. If the hemochromatosis is primary - What is the pattern of inheritance
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
AR
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Myenteric nerve plexus - aurbach

48. What is the other name for GIP (gastric inhibitory peptide)
Skip lesions =crohns - colon = UC
Crypts but not villi
Glucose dependent insulinotropic peptide
Pertechnetate - study for uptake

49. What is indirect bilirubin
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Erosive - disruption of mucosal barrier leading to inflammation
Primarly through ECL leading to histamine release
Unconjugated - water insoluble

50. What are the histological findings in the ileum

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