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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. How is bilirubin carried in the blood
Backup of blood into the liver - RHF - budd chiari
Uridine glucuronyl transferase
With albumin
When diffusely infiltrative - thickened rigid appearance like a leather bottle

2. Autodigestion of pancreas by pancreatic enzymes
Begins starch digestion - inactivated by low pH upon reaching the stomach
Acute pancreatitis
Amylase
Positive

3. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Pertechnetate - study for uptake
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Terminal ileum and colon

4. Where are carcinoid tumors most commonly malignant
Lubricate food (glycoprotiens)
Chronic gastritis and pernicious anemia
Small intestine
Averages 6 months - very aggressive - usually already metastasized at presentation

5. What is the prognosis of adenocarcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Alk phos
Jaundice - fever - RUQ

6. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
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
Backup of blood into the liver - RHF - budd chiari
Black - rotors syndrome
Copious diarrhea - non alpha - non beta cell pancreatic tumor

7. To what substance is bilirubin conjugated and why
Glucouronate - water soluble (direct)
VZV and influenza B treated with salicylates
Turcot
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

8. What causes pancreatic insuff and What does it cause
PAS- positive globules in liver -
Low pressure proximal to LES
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
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

9. What is contained within the submucosa

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10. How does hirschsprung present and appear on imaging
Below
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
Skip lesions =crohns - colon = UC
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

11. why infxn is implicated in duodenal PUD
H pylori (almost 100%)
The jejunum
Hydrocele
Normal

12. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
H+
VZV and influenza B treated with salicylates
Alcoholic hepatitis

13. What is the other name for GIP (gastric inhibitory peptide)
Hypercoaguability - polycythemia vera - pregnancy - HCC
Inc lower esphogeal tone leading to achalasia
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Glucose dependent insulinotropic peptide

14. Which kind of hemorrhoids are painful and why
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Pleomorphic adenoma
Inc smooth muscle relaxation - including lower esophageal sphincter

15. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Colonic polyps
CCK8 receptor - Gq inc IP3/Ca
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

16. Diaphragmatic hernias occur in infants because of defective development of which membrane
Above
12 waves/min
Primarly through ECL leading to histamine release
Pleuroperitoneal

17. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Duodenum - 2nd - 3rd and 4th parts
Via the middle colic

18. Where does type A chronic gastritis occur and What causes it
Worldwide - SC - US - adeno
HSV-1 - CMV - Candida
HPNCC
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

19. Where is B12 absorbed
Duodenal atresia - Downs
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
In the ileum with bile acids - requires IF
Lye ingestion and acid reflux

20. What are the histological findings in the jejunum
Intussusception
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Inc - weight loss
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

21. What pancreatic proteases are secreted as zymogens
Increase tumorigenesis
Trypsin - chymotrypsin - elastase - carboxypeptidases
Sister mary joseph nodule
EtOH

22. What is the cause of Barrett's and the assocaited complications
Unconj - absent (acholuria) - inc
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Muscularis mucosae

23. Which IBD is autoimmune and which may be a disordered response to bacteria
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Ampulla of vater
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Inferior rectal nerve

24. How does gastrin increase acid secretion?
Can lead to hematemesis - found in EtOHics and bulimics
Below
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Primarly through ECL leading to histamine release

25. Acute gastritis is caused By what process
PAS- positive globules in liver -
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Oral glucose
Erosive - disruption of mucosal barrier leading to inflammation

26. What are the extraintestinal manifestations of ulcerative colitis
Meconium ileus
Pyoderma gangrenosum - primary sclerosing cholangitis
Reye's syndrome
Causes of gall stones

27. What kind of muscle is in the lower 1/3 of the esophagus
Smooth
Hyperpigmented mouth - lips - hands - genitalia
CHF and inc risk of HCC
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

28. What causes hirschsprungs
T cell lymphoma
Bleeding - penetration into pancreas - perforation - obstruction
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Failure of neural crest migration

29. What is the HLA association and treatment for hemochromatosis
AST >ALT - ration is usually 1.5
Old men - arthralgias - cardiac and neuro sx
Repeated phlebotomy - deferoxamine - HLA- A3
Warthins' tumor

30. Which serum enzyme increases with heavy EtOH consumption
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Gardner's syndrome
FAP
Gamma glutamyl transferase GGT

31. What receptors does gastrin bind on the parietal cell and What does it activate
CCK8 receptor - Gq inc IP3/Ca
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Primary sclerosing cholangitis

32. What are the labs in acute pancreatitis
Barrett's esophagus
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Gilbert's
Elevated amylase - and lipase

33. What gives urine its characteristic color
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Urobilin
90%
3 waves/min

34. What is Trousseau's sign
Alcoholic hepatitis
Redness and tenderness on palpation of extremities
Via the superior pancreaticduodenal
Stercobilin

35. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Skip lesions =crohns - colon = UC
Brunners
In the mucus that covers the gastric epithelium
FAP

36. With internal hemorrhoids Where is the anastomoses and Where is it
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Superior rectal and middle and inferior rectal - rectum
...
Alk phos

37. What are the borders of the femoral triangle
Dec PGE2 leading to dec gastric mucosa protection
Tropical sprue
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Inguninal ligament - sartorius muscle - adductor longus

38. Bilirubin is the product of what?
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Phenobarbital - inc liver enzyme synthesis
Heme metabolism
Alk phos

39. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Paraumbilical and superficial and inferior epigastric - umbilicus
Warthins' tumor
Dissaccharidase def - most commonly lactase
Via the superior pancreaticduodenal

40. Gallstones that reach the common channel at ampulla can block which two ducts
Nonkeritinized stratified sqamous epithelium
Pancreatic head causing obstructive jaundice
Pancreatic and bile
Uridine glucuronyl transferase

41. What kind of cancer to celiac sprue put you as inc risk for
Crohns = maybe - UC= always
Skip lesions =crohns - colon = UC
US and cholecystectomy
T cell lymphoma

42. occlusion of IVC or hepatic veins
Chronic gastritis and pernicious anemia
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Budd chiari syndrome
Hypotonic because of more time to reabsorb NaCl

43. What structures feed into the common bile duct
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
T cell lymphoma
Cystic duct and common hepatic duct
Complications of UC

44. What is the omphalomesenteric cyst
Decrease - weight gain
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Cystic dilation of the viteline duct
Dubin johnson

45. At what spinal level does the is the bifurcation of aorta
Lactase is located at the tips of intestinal villi
PAS- positive globules in liver -
CCK8 receptor - Gq inc IP3/Ca
L4

46. What is diverticulosis
Liver metabolizes 5HT
Inguninal ligament - sartorius muscle - adductor longus
Ischemic colitis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

47. What does a gastrinoma cause
Left gastric vein and esophogeal vein - esophagus
L4
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Closer to isotonic because of less time to reabsorb NaCl

48. What are additional risk factors for CRC
EtOH
Angiodysplasia
Nonkeritinized stratified sqamous epithelium
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

49. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Via the superior pancreaticduodenal
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
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Pleomorphic adenoma

50. 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
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Left and right gastroepiploics - left and right gastrics
Crohns = noncaseating granulomas - UC = crypt abscesses