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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. In what scenarios do pts with gilberts have inc bili
Fasting and stress
Meconium ileus
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Acute pancreatitis

2. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
HPNCC
Left gastric vein and esophogeal vein - esophagus

3. What gives stool its characteristic color
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
L4
Barrett's esophagus
Stercobilin

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

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5. What causes hirschsprungs
Zollinger ellison - brunners glands
Femoral hernia
HSV-1 - CMV - Candida
Failure of neural crest migration

6. What is the HLA association and treatment for hemochromatosis
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Trypsin - chymotrypsin - elastase - carboxypeptidases
Repeated phlebotomy - deferoxamine - HLA- A3
Female - fat - fertile - forty

7. What complication can arise from indirect inguinal hernias
L/R renal artery around L1
Omeprazole
Budd chiari syndrome
Hydrocele

8. What is the TX of physiologic neonatal jaundice
Budd chiari syndrome
Jewish and African American men
Phototherapy
Mitochondrial abnl - fatty liver - hypoglycemia - coma

9. If the abdominal aorta is blocked - How does blood get to the left colic artery
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Via the middle colic
Sphincter of oddi

10. What are the histological findings in the duodenum

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11. How is salivary secretion stimulated
Failure of neural crest migration
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Above
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

12. In alchoholic hepatitis which liver enzyme is higher
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Tropical sprue
AST>ALT
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

13. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
AR
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Jaundice - fever - RUQ
AST

14. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Duodenal atresia - Downs
Peutz jeghers
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
FAP

15. What are the results of hemochromatosis
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
The gastroduodenal
Osmotic
CHF and inc risk of HCC

16. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
Hirschsprungs
IgA secreting plasma cells - ultimately reside in the lamina proporia
Superior rectal

17. What are the extraintestinal manifestations of ulcerative colitis
L2
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Pyoderma gangrenosum - primary sclerosing cholangitis
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

18. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Gardner's syndrome
Liver metabolizes 5HT
Fe2+ in the duod

19. 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
Decreased intercellular adhesion and increased proliferation
Acute pancreatitis
Bleeding - intussusception - volvulus - obstruction near terminal ileum

20. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Older patients
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Adhesion
Conj - inc - dec

21. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
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
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Crohns = noncaseating granulomas - UC = crypt abscesses
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

22. What do tumors that arise in the head of the pancreas cause
Femoral hernia
Hypotonic because of more time to reabsorb NaCl
3 waves/min
Obstruction of the common bile duct

23. What causes primary biliary cirrhosis
Dermatitis herpetiformis
Mallory bodies
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
CCK8 receptor - Gq inc IP3/Ca

24. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Alcoholic cirrhosis
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Failure of the processus vagainlis to close
Cirrhosis

25. Dysphagia in achalasia results from
Striated
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Chagas disease
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

26. Failure of relaxation of lower esophageal sphincter - Name and etiology
Portal HTN
H+
Achalasia due to loss of myenteric plexus (auberach)
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

27. in carcinoid tumors - What is seen on EM
Ischemic colitis
Dense core bodies
Hemosiderosis - hemochromatosis
Early childhood - neuro sx and malabsorption

28. What do mucins do?
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Lubricate food (glycoprotiens)
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Sphincter of oddi

29. What kind of cancer to celiac sprue put you as inc risk for
External spermatic fascia only
Barrett's esophagus
T cell lymphoma
With albumin

30. What is the presentation of pancreatic adenocarcinoma
Diverticulum
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Copious diarrhea - non alpha - non beta cell pancreatic tumor

31. Where is there sclerosis in alcoholic cirrohosis
Epithelium
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Around the central vein (zone III)
FAP

32. Malabsorption syndromes have what common clinical presentation
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Ischemic colitis
Diarrhea - steatorrhea - weight loss - weakness

33. most common malignant salivary gland tumor
Early childhood - neuro sx and malabsorption
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Mucoepidermoid carcinoma
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

34. What are additional risk factors for CRC
Oligosaccharide digestion
Cystic dilation of the viteline duct
Esophageal carcinoma
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

35. What is the rule of 2s for meckels
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Stimulate the H/K ATPase
Black - rotors syndrome
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

36. 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
Ischemic colitis
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
Dense core bodies

37. What does TOASTED with alcoholic hepatitis stand for
AST >ALT - ration is usually 1.5
Oral glucose
So hypertrophied they look like brain gyri
AST

38. With internal hemorrhoids Where is the anastomoses and Where is it
Gardner's syndrome
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Superior rectal and middle and inferior rectal - rectum
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

39. What nerve innervates the external hemorrhoids
Lipase
Inferior rectal nerve
Virchow's node
The gastroduodenal

40. What are the midgut structures and what supplies their blood and PANS innervation
L4
Lubricate food (glycoprotiens)
The jejunum
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

41. Where is the pectinate line
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Older patients
Where hindgut meets ectoderm
Duodenum - 2nd - 3rd and 4th parts

42. What is the frequency of basal electric rhythm of the ilieum
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
8-9 waves/min
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

43. When do you see hypertrophy of brunners glands
Colonic polyps
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Peptic ulcer disease

44. What are the treatmet options for crohns
Antrum - H.pylori - inc risk of MALT lymphoma
The jejunum
Corticosteroids - infliximab
AST>ALT

45. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Redundant mesentary
H pylori (almost 100%)
3 waves/min

46. Which is used more quickly - an oral glucose load - or that by IV
Dubin johnson
Common hepatic - splenic - left gastric - main blood supply for stomach
Oral glucose
Decrease - weight gain

47. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Worldwide - SC - US - adeno
Dubin johnson
The submucosal nerve plexus - meissner's
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

48. Where is folate absorbed
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
The jejunum
Conj/unconj - inc - nl to dec
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

49. What serum enzyme is elevated inacute pancreatitis
Redundant mesentary
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Lipase
Lactase is located at the tips of intestinal villi

50. What findings are associated with reyes
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Inc - weight loss
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis