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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. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Alpha1 antitrypsin def - codominant trait
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

2. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Osmotic
Failure of neural crest migration
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
Angiodysplasia

3. Where is IgA shuttled
L3
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Cirrhosis
Volvulus

4. A protrusion of peritoneum through an opening - usually a site of weakness
Small intestine
Esophageal cancer
Ampulla of vater
Hernia

5. What is the frequency of basal electric rhythm of the ilieum
Trypsin - chymotrypsin - elastase - carboxypeptidases
Poor anastamoses
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
8-9 waves/min

6. How do you DX and TX gallstones
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Barrett's esophagus
US and cholecystectomy
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

7. What cells secrete bicarb - What does it do - and what regulates it
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
M3 - Gq - inc IP3/Ca
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Alk phos

8. multiple juvenil polyps in GI tract - risk
Crypts but not villi
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Crohns = maybe - UC= always

9. What histological findings are present in the stomach
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Redness and tenderness on palpation of extremities
Amylase
Gastric glands

10. What receptors does ACH bind on the parietal cells and What does it activate
Pancreatic and bile
M3 - Gq - inc IP3/Ca
Short gastrics - left greater and lesser
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

11. What is the main symptom if a VIPoma
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
GERD - may also present with nocturnal cough and dyspnea
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Unconjugated - water insoluble

12. In viral hepatitis - which liver enzyme is higher
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Warthins' tumor
Peptic ulcer disease
ALT>AST

13. Abuse of what substance leads to acute gastritis
T12
Splenic flexure
Complications of crohns
EtOH

14. malnutrition - toxic megacolon - colorectal carcinoma
Unconj - absent (acholuria) - inc
Complications of UC
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Spleen to posterior abdominal wall - splenic artery and vein

15. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
US and cholecystectomy
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
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

16. What does high flow rate mean
Meconium ileus
Closer to isotonic because of less time to reabsorb NaCl
Reye's syndrome
Pancreatic and bile

17. is meckels a true diverticulum and how common is it
Jaundice - fever - RUQ
Hepatic steatosis
True and most common congenital anomoly of GI tract
H+

18. What gives urine its characteristic color
Causes of gall stones
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Urobilin
Where hindgut meets ectoderm

19. Dysphagia in achalasia results from
Conj - inc - dec
GLUT 2
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

20. What are the signs of peutz jehgers
Elevated amylase - and lipase
Hyperpigmented mouth - lips - hands - genitalia
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Bleeding - penetration into pancreas - perforation - obstruction

21. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
The gastroduodenal
Alfatoxin in peanuts
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

22. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Enterokinase/enteropeptidase from the duodenal mucosa
Can lead to hematemesis - found in EtOHics and bulimics
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

23. What are the complications of chronic pancreatitis
Around the central vein (zone III)
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Elevated amylase - and lipase
Neutralizes oral bacertial acids and maintains dental health

24. What converts inactive pepsinogen to pepsin
Duodenal atresia - Downs
Hernia
H+
Alk pho

25. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Centrilobular leading to congestive liver disease
Adhesion
Dermatitis herpetiformis

26. What are the treatmet options for crohns
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Corticosteroids - infliximab
Diarrhea - steatorrhea - weight loss - weakness

27. What are the barium swallow findings of achalasia
Appendicitis
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
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Dilated esophagus with an area of distal stenosis - birds beak

28. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Alk pho
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Cimetidine
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

29. What happens to the short gastics if the splenic artery is blocked
Mallory bodies
Poor anastamoses
Epithelium
Right and left hepatic duct

30. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Alcoholic cirrhosis
8-9 waves/min
Appendicitis
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

31. absent UDPGT - presents early in life - early mortality
Centrilobular congestion and necrosis - cardiac cirrhosis
The proximal small bowel
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Crigler - najjar type 1

32. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Left and right gastroepiploics - left and right gastrics
Reye's syndrome
IgA secreting plasma cells - ultimately reside in the lamina proporia
Conj - inc - dec

33. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Around the central vein (zone III)
Epigastric abdominal pain radiating to back - anorexia - nausea
Ischemic colitis

34. Where is the arterial supply from above the pectinate line - and What is the venous drainage
No
Inc conj bilirubin - inc cholesterol - inc alk phos
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Lactase is located at the tips of intestinal villi

35. Failure of relaxation of lower esophageal sphincter - Name and etiology
Achalasia due to loss of myenteric plexus (auberach)
Inc lower esphogeal tone leading to achalasia
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Failure of neural crest migration

36. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Alpha1 antitrypsin def - codominant trait
FAP
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

37. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Above
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Alcoholic cirrhosis
Krukenbergs tumor

38. What is the action of NO as a GI hormone
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
Inc smooth muscle relaxation - including lower esophageal sphincter
Hernia
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

39. What nerve innervates the external hemorrhoids
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
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Brunners
Inferior rectal nerve

40. What is the HLA association and treatment for hemochromatosis
Adhesion
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Repeated phlebotomy - deferoxamine - HLA- A3
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

41. What cells make pepsin - What does it do - and what regulates it
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Upregulated intracellular signal transduction
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

42. What is the arterial supply and venous drainage below pectinate line
Primary sclerosing cholangitis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Duodenal atresia - Downs
Oligosaccharide digestion

43. What does TOASTED with alcoholic hepatitis stand for
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Heme metabolism
Paraumbilical and superficial and inferior epigastric - umbilicus
AST >ALT - ration is usually 1.5

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

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45. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Mucosa - submucosa - muscularis externa - serosa/adventitia
Unconj - absent (acholuria) - inc
Antrum - H.pylori - inc risk of MALT lymphoma
Neural muscarinic pathways

46. Cholecytsokinin - source - action - regulation
Below
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
Oligosaccharide digestion
Inc - weight loss

47. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
Via the middle colic
Phenobarbital - inc liver enzyme synthesis
Gastric glands

48. What do you treat Wilsons disease with and What is the inheritance
Carcinoid syndrome
Enterokinase/enteropeptidase from the duodenal mucosa
Failure of the processus vagainlis to close
Penicillinamine - AR inheritance

49. Where and How is iron absorbed
Fe2+ in the duod
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Achalasia due to loss of myenteric plexus (auberach)
Peutz jeghers

50. In PUD - with gastric ulcers - does pain inc or dec with meals?
Positive urease test
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Inc - weight loss
In the mucus that covers the gastric epithelium