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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. involvement of left supraclavicular node by mets from stomach

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2. What pancreatic enzymes are responsible for fat digestion
US and cholecystectomy
Lipase - phospholipase A - colipase
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Neutralizes gastric acid allowing pancreatic enzymes to fxn

3. What kind of insults results in macronodular cirrhosis
Hyperplastic
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Cystic duct and common hepatic duct
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

4. What are the complications of duodenal PUD
L4
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Gastrohepatic ligament
Bleeding - penetration into pancreas - perforation - obstruction

5. What converts inactive pepsinogen to pepsin
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Gilbert's
H+
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

6. What are the extraintestinal manifestations of crohns
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

7. What happens to the short gastics if the splenic artery is blocked
Jewish and African American men
Poor anastamoses
Serous on the sides parotids - mucinous in the middle sublingual
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

8. malnutrition - toxic megacolon - colorectal carcinoma
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Complications of UC
Hypotonic because of more time to reabsorb NaCl
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

9. Where are oligosaccharide hydrolases and What do they do
Glucouronate - water soluble (direct)
Carcinoid syndrome
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Brush border of intestine - produce monosaccharides from oligo and di

10. is meckels a true diverticulum and how common is it
Budd chiari syndrome
True and most common congenital anomoly of GI tract
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
External (superficial) ring only

11. conjugated hyperbilirubinemia due to defective liver excretion
Causes of gall stones
Dubin johnson
Phenobarbital - inc liver enzyme synthesis
Chronic calcifying pancreatitis - inc risk of panreatic cancer

12. Which serum enzyme increases with heavy EtOH consumption
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
No
Gamma glutamyl transferase GGT
Decrease - weight gain

13. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Alpha amylase
Portal HTN
Via the superior pancreaticduodenal

14. What kind of digestion is bile needed for
Hypercoaguability - polycythemia vera - pregnancy - HCC
Warthins' tumor
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Stercobilin

15. What causes nutmeg liver
Neural muscarinic pathways
Peyers patches
Lubricate food (glycoprotiens)
Backup of blood into the liver - RHF - budd chiari

16. What test and result confirms H pylori infxn
Meckels
Cirrhosis
Positive urease test
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

17. Which patients have pigment stones
Alcoholic hepatitis
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Punched out - clean margins - carcinoma =raised irregular margins

18. How are all 3 monosaccharides transported to the blood
GLUT 2
Bleeding - penetration into pancreas - perforation - obstruction
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

19. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
H pylori (almost 100%)
Colovesical leading to pneumaturia
Esophageal varices

20. Bile is critical for exrection of what substance
CHF and inc risk of HCC
Cholesterol
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Nonkeritinized stratified sqamous epithelium

21. What is the most common diaphragmatic hernia and What are the two types
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Intussusception
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Alpha amylase

22. Where are tumors commonly in pancreatic adenocarcinoma
12 waves/min
Striated and smooth
Pancreatic head causing obstructive jaundice
Mucoepidermoid carcinoma

23. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Complications of UC
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Dilated esophagus with an area of distal stenosis - birds beak
Juvenille polyps - no risk if single

24. What are the histological findings in the ileum

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25. What causes carcinoid syndrome amd What are the symptoms
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Positive
Paraumbilical and superficial and inferior epigastric - umbilicus
Hypercoaguability - polycythemia vera - pregnancy - HCC

26. Where is IgA shuttled
Penicillinamine - AR inheritance
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Decreased intercellular adhesion and increased proliferation

27. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
Parietal cells in the stomach - B12 binding protein
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Juvenile polyposis syndrome - inc risk of adenocarcinoma

28. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Meckels
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

29. What does alpha amylase do and what inactivates it
Inc lower esphogeal tone leading to achalasia
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Inc - weight loss
Begins starch digestion - inactivated by low pH upon reaching the stomach

30. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Causes of gall stones
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
IgA secreting plasma cells - ultimately reside in the lamina proporia

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

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32. Is there any structural abnl with IBS - What is the course of disease and presentation
Centrilobular congestion and necrosis - cardiac cirrhosis
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
No - chronic - can present with diarrhea or constipation or alternation - treat sx
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

33. How many layers of spermatic fascia are covers an indirect inguinal hernia
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Dense core bodies
All 3
Diarrhea - steatorrhea - weight loss - weakness

34. What are the extraintestinal manifestations of ulcerative colitis
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Alpha1 antitrypsin def - codominant trait
Pyoderma gangrenosum - primary sclerosing cholangitis

35. Bilirubin is the product of what?
Heme metabolism
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
HPNCC

36. How do villi appear in disaccharidease def
Normal
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
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
Decreased intercellular adhesion and increased proliferation

37. What layer of fascia covers a direct inguinal hernia
So hypertrophied they look like brain gyri
The submucosal nerve plexus - meissner's
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
External spermatic fascia only

38. Where is B12 absorbed
In the ileum with bile acids - requires IF
The gastroduodenal
Where hindgut meets ectoderm
Alcoholic cirrhosis

39. What serum enzyme is elevated in acute pancreatitis and mumps
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Inc lower esphogeal tone leading to achalasia
Amylase
Adhesion

40. Where does type B chronic gastritis occur and What causes it
Antrum - H.pylori - inc risk of MALT lymphoma
Mucosa - submucosa - muscularis externa - serosa/adventitia
The proximal small bowel
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

41. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Conj - inc - dec

42. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
3 waves/min
Crohns = noncaseating granulomas - UC = crypt abscesses

43. What receptor does histamine bind on the parietal cell and What does it activate
Inspiratory arrest on deep palpation due to pain
Inc lower esphogeal tone leading to achalasia
H2 receptor - inc cAMP
Boerhaave's Syndrome - Been heaving syndrome

44. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Carcinoid syndrome
Lateral
8-9 waves/min

45. What serum markers increase in cholecystitis with bile duct involvement
Around the central vein (zone III)
Alk phos
Ampulla of vater
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

46. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Zenkers - halitosis - dysphagia and obstruction
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Conj/unconj - inc - nl to dec
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

47. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
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
3 waves/min

48. What separates the right greater and lesser sacs
In the mucus that covers the gastric epithelium
Ceruplasmin
Gastrohepatic ligament
True and most common congenital anomoly of GI tract

49. What are the complications of acute pancreatitis
Smooth
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
The submucosal nerve plexus - meissner's

50. What is contained in the gastrosplenic and What areas does it separate
Gilbert's
Via the middle colic
Short gastrics - left greater and lesser
Peyers patches