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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 type of insults result in micronodular cirrhosis
Adhesion
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
GERD - may also present with nocturnal cough and dyspnea

2. What enzyme is necessary to create conjugated bilirubin
Centrilobular congestion and necrosis - cardiac cirrhosis
Uridine glucuronyl transferase
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Muscularis mucosae

3. Where is there sclerosis in alcoholic cirrohosis
Hyperplastic
Parietal cells in the stomach - B12 binding protein
Femoral hernia
Around the central vein (zone III)

4. What is the classic triad of hemochromatosis

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5. What are the longterm sequelae of nutmeg liver
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Centrilobular congestion and necrosis - cardiac cirrhosis
Alcoholic hepatitis
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

6. What is contained within the submucosa

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7. What causes carcinoid syndrome amd What are the symptoms
Unconj - absent (acholuria) - inc
Left gastric vein and esophogeal vein - esophagus
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Smooth

8. What complication can arise from indirect inguinal hernias
Inc smooth muscle relaxation - including lower esophageal sphincter
L/R renal artery around L1
Hydrocele
Amylase

9. What is the risk with peutz jehgers
Cystic dilation of the viteline duct
Inc risk of CRC and other visceral malignancies
Failure of the processus vagainlis to close
Normal

10. What can hemochromatosis be secondary to...
Crohns = noncaseating granulomas - UC = crypt abscesses
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Dissaccharidase def - most commonly lactase
Turcot

11. What is one potential precipitating factor for intussusception
Menetriers disease
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Inguninal ligament - sartorius muscle - adductor longus
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

12. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Crigler - najjar type 1
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

13. What are the effects of atropine on parietal cells and G cells
Mallory bodies
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Alcoholic hepatitis

14. What is the frequency of basal electric rhythm of the ilieum
Skip lesions =crohns - colon = UC
Lactase is located at the tips of intestinal villi
8-9 waves/min
AR

15. Progressive dyshphage beginning with solids and moving to liquids and weight loss
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
Penicillinamine - AR inheritance
Esophageal cancer
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

16. What can fistula between the gallbladder and small intestine create and how can you tell
Crohns = noncaseating granulomas - UC = crypt abscesses
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Left gastric vein and esophogeal vein - esophagus

17. What makes a true diverticula
Turcot
Lack or have an attenuated muscularis externa - often in the sigmoid colon
All 3 gut layers outpouch as in Meckels
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

18. What reaction does salivary amylase catalyze
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Inguninal ligament - sartorius muscle - adductor longus

19. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Lipase
Esophageal varices

20. What other condition can lead to acute gastritis - think renal
Early childhood - neuro sx and malabsorption
Penicillinamine - AR inheritance
Uremia
Bleeding - intussusception - volvulus - obstruction near terminal ileum

21. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Serous on the sides parotids - mucinous in the middle sublingual
Ischemic colitis
In the ileum with bile acids - requires IF

22. What is the characteristic histo finding in alcoholic hepatitis
Inc risk of CRC and other visceral malignancies
Mallory bodies
Primarly through ECL leading to histamine release
Upregulated intracellular signal transduction

23. Gallstones that reach the common channel at ampulla can block which two ducts
Portal HTN
Pancreatic and bile
AR
Below

24. What is the sphincter of the pancreatic duct
CHF and inc risk of HCC
Sphincter of oddi
Celiac sprue
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

25. What are the treatmet options for crohns
Fasting and stress
Corticosteroids - infliximab
Duodenal atresia - Downs
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

26. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Epigastric abdominal pain radiating to back - anorexia - nausea
Internal thoracic to superior epigastric to inferior epigastric
Cirrhosis

27. What does loss of APC cause
Diverticulum
Zollinger ellison - brunners glands
Warthins' tumor
Decreased intercellular adhesion and increased proliferation

28. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Gamma glutamyl transferase GGT
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

29. What parts of the small bowel can tropical sprue effect
The entire
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
Turcot
Sister mary joseph nodule

30. likely infectious form of malabsorption - responds to antibiotics
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
GERD - may also present with nocturnal cough and dyspnea
Tropical sprue
Stercobilin

31. What are the histological findings in the jejunum
T12
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

32. Where is the deep inguinal ring relative to the inferior epigastric vessels
Stimulate intestinal persistalsis
Hepatic steatosis
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Lateral

33. Cholecytsokinin - source - action - regulation
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
Causes of gall stones
Cystic dilation of the viteline duct
Centrilobular leading to congestive liver disease

34. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Redness and tenderness on palpation of extremities
Gardner's syndrome
Superior rectal
Mucoepidermoid carcinoma

35. How do you DX and TX gallstones
Lack or have an attenuated muscularis externa - often in the sigmoid colon
US and cholecystectomy
12 waves/min
Female - fat - fertile - forty

36. What does a gastrinoma cause
Omeprazole
Fe2+ in the duod
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Inc lower esphogeal tone leading to achalasia

37. What skin condition is associated with celiac sprue
Zenkers - halitosis - dysphagia and obstruction
Cirrhosis
Dermatitis herpetiformis
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

38. bilateral mets to ovaries with abundant mucus - signet ring cells
Hydrocele
Unconj - absent (acholuria) - inc
Krukenbergs tumor
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

39. What are the borders of Hesselbach's triangle
Downs
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Urobilin

40. What do tumors that arise in the head of the pancreas cause
Elevated amylase - and lipase
Obstruction of the common bile duct
Neutralizes oral bacertial acids and maintains dental health
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

41. Where are tumors commonly in pancreatic adenocarcinoma
Low pressure proximal to LES
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Alcoholic cirrhosis
Pancreatic head causing obstructive jaundice

42. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Squamous - upper 1/3 - adeno - lower 1/3
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

43. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Superior rectal
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Erosive - disruption of mucosal barrier leading to inflammation
With albumin

44. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
Urobilin
Oligosaccharide digestion
Appendicitis

45. People of what decent are associated with celiac sprue and what findings/antibodies are present
Unconj - absent (acholuria) - inc
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Appendicitis
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

46. What infection causes Whipple disease and What can you see on LM
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Black - rotors syndrome
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
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

47. What does histo show for alpha1 antitrypsin def
PAS- positive globules in liver -
Bleeding - penetration into pancreas - perforation - obstruction
Crohns = maybe - UC= always
Mallory bodies

48. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Oligosaccharide digestion
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Complications of crohns

49. secretin - source - action - regulation
Redness and tenderness on palpation of extremities
Dermatitis herpetiformis
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
Ceruplasmin

50. How does loss of NO secretion affect the esophagus and what results
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Fe2+ in the duod
Inc lower esphogeal tone leading to achalasia
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus