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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 is the other name for GIP (gastric inhibitory peptide)
Gilbert's
Glucose dependent insulinotropic peptide
Conj/unconj - inc - nl to dec
Striated and smooth

2. What is the characteristic histo finding in alcoholic hepatitis
Redness and tenderness on palpation of extremities
Mallory bodies
Falciform - ligamentum teres - fetal umbilical vein
Complications of UC

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

4. What are the extraintestinal manifestations of ulcerative colitis
Pyoderma gangrenosum - primary sclerosing cholangitis
Necrotizing enterocolitis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
All 3 gut layers outpouch as in Meckels

5. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
T cell lymphoma
H2 receptor - inc cAMP
Omeprazole
Left gastric vein and esophogeal vein - esophagus

6. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
FAP
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Short gastrics - left greater and lesser

7. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Inc lower esphogeal tone leading to achalasia
Intussusception
Muscularis mucosae

8. Which IBD is autoimmune and which may be a disordered response to bacteria
Cystic dilation of the viteline duct
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Appendicitis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

9. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Turcot
External (superficial) ring only
Conj/unconj - inc - nl to dec
Crohns = noncaseating granulomas - UC = crypt abscesses

10. What are the histological findings in the ileum

11. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Common hepatic - splenic - left gastric - main blood supply for stomach
CCK8 receptor - Gq inc IP3/Ca
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Unconj - absent (acholuria) - inc

12. Where is B12 absorbed
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
In the ileum with bile acids - requires IF

13. signet ring cells - acanthosis nigracans - dz - character/association - spread
Decrease - weight gain
Mallory bodies
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

14. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Inc lower esphogeal tone leading to achalasia
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
Splenic flexure
Meckels

15. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Cholesterol - 10-20% opaque due to calcifications
Gut bacteria
Alcoholic cirrhosis

16. What artery passes around the duodenum
Inc - weight loss
Hemosiderosis - hemochromatosis
The gastroduodenal
Colovesical leading to pneumaturia

17. motilin - source - action - regulation
Jewish and African American men
Gallbladder
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Oral glucose

18. Who gets Whipple disease and How do they present
Old men - arthralgias - cardiac and neuro sx
Worldwide - SC - US - adeno
Colonic polyps
Meckels

19. What are the longterm sequelae of nutmeg liver
Epithelium
Centrilobular congestion and necrosis - cardiac cirrhosis
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Zollinger Ellison - phenylalanine and tryptophan

20. why infxn is implicated in duodenal PUD
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
H pylori (almost 100%)

21. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
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
Jaundice - fever - RUQ
Gallbladder
Adhesion

22. malnutrition - toxic megacolon - colorectal carcinoma
Complications of UC
Decrease - weight gain
Cirrhosis
Mucoepidermoid carcinoma

23. What causes carcinoid syndrome amd What are the symptoms
Goes through deep inguinal ring - external inguinal ring and into the scrotum
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
H pylori (almost 100%)
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

24. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Hirschsprungs
Cholesterol - 10-20% opaque due to calcifications
Dysphagia (due to esophageal web) - glossitis - iron def anemia

25. Autodigestion of pancreas by pancreatic enzymes
Conj - inc - dec
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Acute pancreatitis

26. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
The entire
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Inspiratory arrest on deep palpation due to pain
Carcinoid syndrome

27. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
T12
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Portal HTN
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

28. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
Decrease - weight gain
Internal thoracic to superior epigastric to inferior epigastric
L2

29. What is the most common indication of emergent abdominal surgery in children
External spermatic fascia only
Hydrocele
Alk pho
Appendicitis

30. What is the arterial supply and venous drainage below pectinate line
Normal
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Dissaccharidase def - most commonly lactase
The proximal small bowel

31. What portion of the bowel does sprue effect
The proximal small bowel
Lateral
Decreased intercellular adhesion and increased proliferation
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

32. what kind of muscle is in the upper 1/3 of esophagus
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Zenkers - halitosis - dysphagia and obstruction
Striated
Below

33. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Upregulated intracellular signal transduction
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Falciform - ligamentum teres - fetal umbilical vein

34. What does loss of APC cause
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Decreased intercellular adhesion and increased proliferation
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Closer to isotonic because of less time to reabsorb NaCl

35. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Colonic polyps
Angiodysplasia
Superior rectal and middle and inferior rectal - rectum
Primarly through ECL leading to histamine release

36. milk intolerance
Dissaccharidase def - most commonly lactase
Amylase
Left gastric vein and esophogeal vein - esophagus
Positive

37. What is indirect bilirubin
Lamina propora and submucosa
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Unconjugated - water insoluble
All 3 gut layers outpouch as in Meckels

38. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
Upregulated intracellular signal transduction
Esophageal cancer
Fasting and stress

39. What is the action of NO as a GI hormone
Pyoderma gangrenosum - primary sclerosing cholangitis
Inc smooth muscle relaxation - including lower esophageal sphincter
Normal
Squamous - upper 1/3 - adeno - lower 1/3

40. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
Uremia
Trypsin - chymotrypsin - elastase - carboxypeptidases
FAP

41. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
Budd chiari syndrome
Neutralizes oral bacertial acids and maintains dental health
Erosive - disruption of mucosal barrier leading to inflammation

42. What parts of the small bowel can tropical sprue effect
The entire
Positive
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
H+

43. What intervention will intervention will relieve portal HTN
Achalasia due to loss of myenteric plexus (auberach)
Stercobilin
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
NAV = nerve artery vein - venous near the penis (NAVEL)

44. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Boerhaave's Syndrome - Been heaving syndrome
Black - rotors syndrome
Volvulus
Averages 6 months - very aggressive - usually already metastasized at presentation

45. What structures feed into the common hepatic duct
Elevated amylase - and lipase
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Right and left hepatic duct

46. How do NSAIDs cause acute gastritis
Dec PGE2 leading to dec gastric mucosa protection
Crypts but not villi
Oral glucose
Juvenile polyposis syndrome - inc risk of adenocarcinoma

47. What do you use to diagnose meckels
Lamina propora and submucosa
Omeprazole
Averages 6 months - very aggressive - usually already metastasized at presentation
Pertechnetate - study for uptake

48. At what spinal level does the celiac trunk exit
T12
HSV-1 - CMV - Candida
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Lipase

49. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
PAS- positive globules in liver -
Dissaccharidase def - most commonly lactase
Neutralizes oral bacertial acids and maintains dental health

50. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Parietal cells in the stomach - B12 binding protein
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Esophageal varices
Inc conj bilirubin - inc cholesterol - inc alk phos