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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. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Left gastric vein and esophogeal vein - esophagus
Via the superior pancreaticduodenal
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Superior rectal

2. Where does copper accumulate in Wilsons and What are ABCD
VZV and influenza B treated with salicylates
Increase tumorigenesis
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

3. What serum enzyme is decreased in wilsons disease
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Ceruplasmin
CCK8 receptor - Gq inc IP3/Ca
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

4. What is the most common esophageal cancer worldwide and in the US
Barrett's esophagus
In the ileum with bile acids - requires IF
Worldwide - SC - US - adeno
Inc smooth muscle relaxation - including lower esophageal sphincter

5. Why does indirect inguinal hernia happen in infacnts
Primary sclerosing cholangitis
Female - fat - fertile - forty
Failure of the processus vagainlis to close
Tropical sprue

6. multiple juvenil polyps in GI tract - risk
Chronic gastritis and pernicious anemia
Right and left hepatic duct
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Chagas disease

7. Where is there sclerosis in alcoholic cirrohosis
Osmotic
Around the central vein (zone III)
Peyers patches
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

8. With caput medusaw - between what vessels is the anastomoses and Where is it
Serous on the sides parotids - mucinous in the middle sublingual
Paraumbilical and superficial and inferior epigastric - umbilicus
Lack or have an attenuated muscularis externa - often in the sigmoid colon
The submucosal nerve plexus - meissner's

9. What are additional risk factors for CRC
Uridine glucuronyl transferase
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Alfatoxin in peanuts
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

10. How does brain injury lead to acute gastritis and What is it called
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
8-9 waves/min
External (superficial) ring only
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

11. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Via the superior pancreaticduodenal
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
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

12. What kind of cancer to celiac sprue put you as inc risk for
Corticosteroids - infliximab
T cell lymphoma
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Neutralizes gastric acid allowing pancreatic enzymes to fxn

13. Where is folate absorbed
Dermatitis herpetiformis
Juvenile polyposis syndrome - inc risk of adenocarcinoma
The jejunum
Cystic dilation of the viteline duct

14. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Goes through deep inguinal ring - external inguinal ring and into the scrotum
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
The proximal small bowel

15. A protrusion of peritoneum through an opening - usually a site of weakness
Portal HTN
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
So hypertrophied they look like brain gyri
Hernia

16. Which patients have pigment stones
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Superior rectal and middle and inferior rectal - rectum
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Sphincter of oddi

17. What carcinogens are associated with HCC
Tropical sprue
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
All 3
Alfatoxin in peanuts

18. GIP - source - action regulation
Decrease - weight gain
Complications of UC
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

19. bilateral mets to ovaries with abundant mucus - signet ring cells
Gastrohepatic ligament
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
CEA - CA-19-9
Krukenbergs tumor

20. most common malignant salivary gland tumor
Duodenum - 2nd - 3rd and 4th parts
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Mucoepidermoid carcinoma
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

21. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Complications of crohns
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Sphincter of oddi
Positive urease test

22. crigler - najjar type II responds to which therapy and How does it work
Sister mary joseph nodule
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Splenic flexure
Phenobarbital - inc liver enzyme synthesis

23. What is the cause of physiologic neonatal jaundice
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Crohns = maybe - UC= always
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Angiodysplasia

24. What is contained within the muscularis externa
M3 - Gq - inc IP3/Ca
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Myenteric nerve plexus - aurbach
IBS at least 2 with recurrent abdominal pain

25. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Closer to isotonic because of less time to reabsorb NaCl
Crypts but not villi

26. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Decreased intercellular adhesion and increased proliferation
L2
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

27. In PUD - with gastric ulcers - does pain inc or dec with meals?
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Peptic ulcer disease
Inc - weight loss
Neural muscarinic pathways

28. What are esophageal strictures associated with
Lye ingestion and acid reflux
H+
Omeprazole
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

29. 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
Female - fat - fertile - forty
External (superficial) ring only
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

30. What does TOASTED with alcoholic hepatitis stand for
AST >ALT - ration is usually 1.5
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Causes of gall stones
Increase tumorigenesis

31. What drug blocks the H2R
Cimetidine
The entire
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
90%

32. What are the layers of the gut wall from inside out
Hydrocele
Mucosa - submucosa - muscularis externa - serosa/adventitia
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
In the ileum with bile acids - requires IF

33. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
Gamma glutamyl transferase GGT
Urobilin
Pyoderma gangrenosum - primary sclerosing cholangitis

34. What is one potential precipitating factor for intussusception
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Glucouronate - water soluble (direct)
Lipase
Complications of crohns

35. What is the lumen of the pancreatic duct
Splenic flexure
Ampulla of vater
Stimulate intestinal persistalsis
Punched out - clean margins - carcinoma =raised irregular margins

36. What are the complications of chronic pancreatitis
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Neural muscarinic pathways
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
When diffusely infiltrative - thickened rigid appearance like a leather bottle

37. At what level do the testicular/ovarian arteries exit the aorta
Redundant mesentary
L2
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

38. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
Osmotic
Boerhaave's Syndrome - Been heaving syndrome
H pylori (almost 100%)

39. What does K- ras mutation cause
In the mucus that covers the gastric epithelium
Pleuroperitoneal
Upregulated intracellular signal transduction
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

40. Dysphagia in achalasia results from
Below
HPNCC
Alcoholic cirrhosis
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

41. With internal hemorrhoids Where is the anastomoses and Where is it
Gastric glands
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Meconium ileus
Superior rectal and middle and inferior rectal - rectum

42. What makes a true diverticula
Hyperpigmented mouth - lips - hands - genitalia
Internal thoracic to superior epigastric to inferior epigastric
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
All 3 gut layers outpouch as in Meckels

43. What are the signs of peutz jehgers
Zollinger ellison - brunners glands
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Hyperpigmented mouth - lips - hands - genitalia

44. What are causes of extrahepatic biliary obstruction
Stimulate the H/K ATPase
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
AST>ALT

45. Where are carcinoid tumors most commonly malignant
Jaundice - fever - RUQ
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Repeated phlebotomy - deferoxamine - HLA- A3
Small intestine

46. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Necrotizing enterocolitis
Crohns = maybe - UC= always
Dense core bodies

47. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Peyers patches
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
HSV-1 - CMV - Candida

48. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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49. What kind of pancreatitis is associated with EtOH and smoking
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
Alk phos
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Pleuroperitoneal

50. What do you treat Wilsons disease with and What is the inheritance
Inc conj bilirubin - inc cholesterol - inc alk phos
Centrilobular leading to congestive liver disease
Above
Penicillinamine - AR inheritance