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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 serum markers increase in cholecystitis with bile duct involvement
Alk phos
Ampulla of vater
Left and right gastroepiploics - left and right gastrics
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

2. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Spleen to posterior abdominal wall - splenic artery and vein
Splenic flexure
Alpha1 antitrypsin def - codominant trait
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

3. What are the extraintestinal manifestations of crohns
Alfatoxin in peanuts
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
The entire
Parietal cells in the stomach - B12 binding protein

4. Which serum enzyme increases with heavy EtOH consumption
Gamma glutamyl transferase GGT
Cystic duct and common hepatic duct
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

5. What are the signs and symptoms of budd chiari
Peutz jeghers
Small intestine
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

6. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Alk pho
Peptic ulcer disease
Complications of crohns
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

7. What cells secrete bicarb - What does it do - and what regulates it
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Inc smooth muscle relaxation - including lower esophageal sphincter
Failure of neural crest migration
Brunners

8. What is a positive murphy's sign
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
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
Inspiratory arrest on deep palpation due to pain
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

9. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
IBS at least 2 with recurrent abdominal pain
Smooth
All 3

10. What are the layers of the gut wall from inside out
Erosive - disruption of mucosal barrier leading to inflammation
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Alk pho
Mucosa - submucosa - muscularis externa - serosa/adventitia

11. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Cystic duct and common hepatic duct
Crigler - najjar type 1
HPNCC
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

12. Acute gastritis is caused By what process
Splenic flexure
Erosive - disruption of mucosal barrier leading to inflammation
Diverticulum
Goes through deep inguinal ring - external inguinal ring and into the scrotum

13. If trypsin activates more trypsinogen - what kind of feedback loop is established
Positive
Boerhaave's Syndrome - Been heaving syndrome
Striated and smooth
Volvulus

14. What artery passes around the duodenum
So hypertrophied they look like brain gyri
Oral glucose
The gastroduodenal
AR

15. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Alk phos
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

16. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Colonic polyps
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
The proximal small bowel

17. what percentage of colonic polyps are non - neoplastic
Inferior rectal nerve
Goes through deep inguinal ring - external inguinal ring and into the scrotum
90%
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

18. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Menetriers disease
Dysphagia (due to esophageal web) - glossitis - iron def anemia

19. What pancreatic proteases are secreted as zymogens
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Hydrocele
Trypsin - chymotrypsin - elastase - carboxypeptidases
Juvenille polyps - no risk if single

20. What gives urine its characteristic color
Spleen to posterior abdominal wall - splenic artery and vein
Urobilin
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
Jaundice - fever - RUQ

21. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Angiodysplasia
Ampulla of vater
Alpha amylase
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

22. How does abetalipoproteinemia lead to malabsorption
Pleomorphic adenoma
Begins starch digestion - inactivated by low pH upon reaching the stomach
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Epithelium

23. What is the other name for GIP (gastric inhibitory peptide)
Esophageal cancer
Dense core bodies
Glucose dependent insulinotropic peptide
Can lead to hematemesis - found in EtOHics and bulimics

24. Where are peyers patches found
Lamina propora and submucosa
Inspiratory arrest on deep palpation due to pain
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
Glucouronate - water soluble (direct)

25. When and How does Abetalipoproteinemia present
All 3
Early childhood - neuro sx and malabsorption
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Hypercoaguability - polycythemia vera - pregnancy - HCC

26. milk intolerance
Dissaccharidase def - most commonly lactase
Zollinger ellison - brunners glands
External (superficial) ring only
Via the superior pancreaticduodenal

27. involvement of left supraclavicular node by mets from stomach

28. What is the presentation of pancreatic adenocarcinoma
Pertechnetate - study for uptake
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Brunners

29. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lactase is located at the tips of intestinal villi
Ischemic colitis
Parietal cells in the stomach - B12 binding protein
CEA - CA-19-9

30. What do tumors that arise in the head of the pancreas cause
Obstruction of the common bile duct
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
VZV and influenza B treated with salicylates

31. Where does copper accumulate in Wilsons and What are ABCD
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Centrilobular congestion and necrosis - cardiac cirrhosis
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

32. What does bicarb do in the duodenum
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Positive
Neutralizes gastric acid allowing pancreatic enzymes to fxn
When diffusely infiltrative - thickened rigid appearance like a leather bottle

33. What is diverticulosis
Hemosiderosis - hemochromatosis
Older patients
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Ampulla of vater

34. How does loss of NO secretion affect the esophagus and what results
Paraumbilical and superficial and inferior epigastric - umbilicus
Inc lower esphogeal tone leading to achalasia
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

35. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Unconj - absent (acholuria) - inc
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Female - fat - fertile - forty
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

36. What factors increase risk of malignancy of adenomatous polyps
Left and right gastroepiploics - left and right gastrics
Peptic ulcer disease
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

37. malnutrition - toxic megacolon - colorectal carcinoma
Alk phos
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
Complications of UC
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

38. Failure of relaxation of lower esophageal sphincter - Name and etiology
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Achalasia due to loss of myenteric plexus (auberach)
With albumin

39. What causes primary biliary cirrhosis
Femoral hernia
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Gastric glands
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

40. FAP + malignant CNS tumor
Turcot
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Acute pancreatitis
Fe2+ in the duod

41. How do NSAIDs cause acute gastritis
Gallbladder
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Budd chiari syndrome
Dec PGE2 leading to dec gastric mucosa protection

42. What serum enzyme is decreased in wilsons disease
Ceruplasmin
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Zenkers - halitosis - dysphagia and obstruction
The entire

43. What kind of pancreatitis is associated with EtOH and smoking
Positive urease test
Angiodysplasia
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Dense core bodies

44. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Centrilobular leading to congestive liver disease
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

45. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Heme metabolism
Squamous - upper 1/3 - adeno - lower 1/3
All 3 gut layers outpouch as in Meckels

46. rare - often fatal childhood hepatoencephalopathy

47. What cell produces IF and What does it do
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Parietal cells in the stomach - B12 binding protein
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

48. If the abdominal aorta is blocked - How does blood get to the left colic artery
Unconjugated - water insoluble
Via the middle colic
Chronic gastritis and pernicious anemia
Elevated amylase - and lipase

49. What causes pancreatic insuff and What does it cause
Chagas disease
Erosive - disruption of mucosal barrier leading to inflammation
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Alk pho

50. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Increase tumorigenesis
Zollinger ellison - brunners glands
Uridine glucuronyl transferase
Old men - arthralgias - cardiac and neuro sx