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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. Malabsorption syndromes have what common clinical presentation
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Mucoepidermoid carcinoma
Diarrhea - steatorrhea - weight loss - weakness
Poor anastamoses

2. What causes nutmeg liver
Epithelium
AST >ALT - ration is usually 1.5
FAP
Backup of blood into the liver - RHF - budd chiari

3. In viral hepatitis - which liver enzyme is higher
Ischemic colitis
ALT>AST
Pleomorphic adenoma
CHF and inc risk of HCC

4. what percentage of colonic polyps are non - neoplastic
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Juvenille polyps - no risk if single
90%
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

5. What histological findings are present in the stomach
Internal thoracic to superior epigastric to inferior epigastric
Krukenbergs tumor
Gastric glands
Oligosaccharide digestion

6. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
T12

7. Gallstones that reach the common channel at ampulla can block which two ducts
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Juvenille polyps - no risk if single
Pancreatic and bile

8. Is there any structural abnl with IBS - What is the course of disease and presentation
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Oral glucose
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

9. What is the main symptom if a VIPoma
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Complications of UC
Femoral hernia
Copious diarrhea - non alpha - non beta cell pancreatic tumor

10. Who gets Whipple disease and How do they present
Chagas disease
Oral glucose
Old men - arthralgias - cardiac and neuro sx
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

11. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Phenobarbital - inc liver enzyme synthesis

12. inflammatino of gallbadder
Skip lesions =crohns - colon = UC
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Redness and tenderness on palpation of extremities
HPNCC

13. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Repeated phlebotomy - deferoxamine - HLA- A3
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Hyperpigmented mouth - lips - hands - genitalia
Diarrhea - steatorrhea - weight loss - weakness

14. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Adhesion
IBS at least 2 with recurrent abdominal pain

15. Why are most diverticula considered false
HSV-1 - CMV - Candida
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Left gastric vein and esophogeal vein - esophagus
Lack or have an attenuated muscularis externa - often in the sigmoid colon

16. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Cystic dilation of the viteline duct
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

17. What are the signs of peutz jehgers
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Left and right gastroepiploics - left and right gastrics
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Hyperpigmented mouth - lips - hands - genitalia

18. What enzyme is necessary to create conjugated bilirubin
Pancreatic and bile
Hirschsprungs
Uridine glucuronyl transferase
Oligosaccharide digestion

19. Gastrin - source - action - regulation
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Appendicitis
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
Epigastric abdominal pain radiating to back - anorexia - nausea

20. What is indirect bilirubin
Unconjugated - water insoluble
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
Femoral hernia
Reye's syndrome

21. Where is B12 absorbed
Hirschsprungs
ALT>AST
In the ileum with bile acids - requires IF
Via the middle colic

22. What are additional risk factors for CRC
Striated
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

23. What are the results of hemochromatosis
CHF and inc risk of HCC
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Hemolytic anemia

24. What structures feed into the common hepatic duct
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Right and left hepatic duct
Volvulus
Hypotonic because of more time to reabsorb NaCl

25. What layer in the mucosa is responsible for absorption
Inc lower esphogeal tone leading to achalasia
Turcot
Epithelium
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

26. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Glucose dependent insulinotropic peptide
Corticosteroids - infliximab
Superior rectal
Causes of gall stones

27. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Uridine glucuronyl transferase
Conj - inc - dec
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

28. What is the leading cause of bowel incarceration
T cell lymphoma
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Zollinger ellison - brunners glands
Femoral hernia

29. What congenital birth defect is associated with Hirschsprung
Hydrocele
Downs
Fe2+ in the duod
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

30. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Alk phos
90%
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Black - rotors syndrome

31. What are the branches of the celiac trunk and What do they supply
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Common hepatic - splenic - left gastric - main blood supply for stomach
Myenteric nerve plexus - aurbach
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

32. GIP - source - action regulation
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Krukenbergs tumor
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
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

33. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Superior rectal
Angiodysplasia
The entire
Copious diarrhea - non alpha - non beta cell pancreatic tumor

34. How does gastrin increase acid secretion?
Primary sclerosing cholangitis
Primarly through ECL leading to histamine release
Neutralizes oral bacertial acids and maintains dental health
All 3

35. In PUD - with gastric ulcers - does pain inc or dec with meals?
Inc - weight loss
VZV and influenza B treated with salicylates
Old men - arthralgias - cardiac and neuro sx
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

36. What does high flow rate mean
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Stimulate intestinal persistalsis
Closer to isotonic because of less time to reabsorb NaCl
Goes through deep inguinal ring - external inguinal ring and into the scrotum

37. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Around the central vein (zone III)
Centrilobular leading to congestive liver disease
Peyers patches
Fe2+ in the duod

38. How is bilirubin carried in the blood
With albumin
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Hypercoaguability - polycythemia vera - pregnancy - HCC
Stimulate the H/K ATPase

39. What is the omphalomesenteric cyst
Dermatitis herpetiformis
Heme metabolism
Colonic polyps
Cystic dilation of the viteline duct

40. Where are peyers patches found
Lamina propora and submucosa
Right and left hepatic duct
Epigastric abdominal pain radiating to back - anorexia - nausea
Smooth

41. What does GET SMASHED stand for in acute pancreatitis
Hyperpigmented mouth - lips - hands - genitalia
Alcoholic hepatitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Gastrohepatic ligament

42. in carcinoid tumors - What is seen on EM
Dilated esophagus with an area of distal stenosis - birds beak
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Oral glucose
Dense core bodies

43. What gives urine its characteristic color
Glucouronate - water soluble (direct)
Jewish and African American men
Around the central vein (zone III)
Urobilin

44. What are motilin receptor agonists used for clinically
Cholesterol - 10-20% opaque due to calcifications
L2
Epigastric abdominal pain radiating to back - anorexia - nausea
Stimulate intestinal persistalsis

45. Where is the pectinate line
In the ileum with bile acids - requires IF
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Jewish and African American men
Where hindgut meets ectoderm

46. How does hirschsprung present and appear on imaging
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Sphincter of oddi
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
Mallory bodies

47. What is the mechanism for reyes syndrome
Epigastric abdominal pain radiating to back - anorexia - nausea
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Decrease - weight gain
Sister mary joseph nodule

48. What pancreatic proteases are secreted as zymogens
Krukenbergs tumor
Trypsin - chymotrypsin - elastase - carboxypeptidases
Hepatic steatosis
Warthins' tumor

49. What serum enzyme is decreased in wilsons disease
Ceruplasmin
Right and left hepatic duct
Gilbert's
Female - fat - fertile - forty

50. What are the four Fs of gallstones
Turcot
Closer to isotonic because of less time to reabsorb NaCl
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Female - fat - fertile - forty