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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. To what substance is bilirubin conjugated and why
Serous on the sides parotids - mucinous in the middle sublingual
Glucouronate - water soluble (direct)
Inc conj bilirubin - inc cholesterol - inc alk phos
Striated

2. What structures feed into the common hepatic duct
Hepatic steatosis
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Right and left hepatic duct
Obstruction of the common bile duct

3. In what clinical scenarior do you see portosystemic anastomoses
Sphincter of oddi
Early childhood - neuro sx and malabsorption
Portal HTN
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

4. What is the path of an indirect inguinal hernia
Juvenille polyps - no risk if single
Redundant mesentary
Uridine glucuronyl transferase
Goes through deep inguinal ring - external inguinal ring and into the scrotum

5. trypsinogen is converted to trypsin via what enzyme
Jaundice - fever - RUQ
Enterokinase/enteropeptidase from the duodenal mucosa
Decreased intercellular adhesion and increased proliferation
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

6. What is the rate limiting step of carbohydrate digestion
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Oligosaccharide digestion
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
12 waves/min

7. What is the epi for CRC
Gut bacteria
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Older patients
Chronic gastritis and pernicious anemia

8. What percentage of gall stones are cholesterol stones and What are the associations
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Pertechnetate - study for uptake
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Stimulate intestinal persistalsis

9. What is one potential precipitating factor for intussusception
Diarrhea - steatorrhea - weight loss - weakness
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Internal thoracic to superior epigastric to inferior epigastric
Alfatoxin in peanuts

10. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Juvenille polyps - no risk if single
Intussusception
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
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

11. What kind of cancer to celiac sprue put you as inc risk for
Stimulate intestinal persistalsis
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
T cell lymphoma
Diverticulum

12. What is contained within the muscularis externa
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Peyers patches
Myenteric nerve plexus - aurbach

13. How does brain injury lead to acute gastritis and What is it called
Chagas disease
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Enterokinase/enteropeptidase from the duodenal mucosa
Superior rectal and middle and inferior rectal - rectum

14. subQ peribumbilical metastasis
Normal
Sister mary joseph nodule
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
Mucoepidermoid carcinoma

15. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
IBS at least 2 with recurrent abdominal pain
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Cirrhosis
3 waves/min

16. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Intussusception
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Striated

17. What is the clinical presentation of acute pancreatitis
Epigastric abdominal pain radiating to back - anorexia - nausea
Spleen to posterior abdominal wall - splenic artery and vein
External spermatic fascia only
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

18. What type of insults result in micronodular cirrhosis
True and most common congenital anomoly of GI tract
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Sister mary joseph nodule
Common hepatic - splenic - left gastric - main blood supply for stomach

19. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
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
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Alpha amylase
Omeprazole

20. What can hemochromatosis be secondary to...
Epithelium
Alfatoxin in peanuts
Crohns = maybe - UC= always
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

21. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Meckels
Zollinger Ellison - phenylalanine and tryptophan
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Epigastric abdominal pain radiating to back - anorexia - nausea

22. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Common hepatic - splenic - left gastric - main blood supply for stomach
Diverticulum
IgA secreting plasma cells - ultimately reside in the lamina proporia
Spleen to posterior abdominal wall - splenic artery and vein

23. Gallstones that reach the common channel at ampulla can block which two ducts
Pancreatic and bile
Duodenal atresia - Downs
Stimulate the H/K ATPase
Glucose dependent insulinotropic peptide

24. What kind of pathways do CCK act on to cause pancreatic secretion
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Neural muscarinic pathways
Juvenile polyposis syndrome - inc risk of adenocarcinoma

25. In an MI - which liver enzyme is elevated
Lubricate food (glycoprotiens)
Hirschsprungs
Redness and tenderness on palpation of extremities
AST

26. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Unconj - absent (acholuria) - inc
The gastroduodenal
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Tropical sprue

27. What transforms conjugated bilirubin to urobilinogen
Gut bacteria
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Striated
Pleuroperitoneal

28. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
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
L3
Inc - weight loss

29. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Crohns = noncaseating granulomas - UC = crypt abscesses
Hydrocele

30. occlusion of IVC or hepatic veins
All 3
EtOH
Budd chiari syndrome
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

31. Where are peyers patches found
Hypotonic because of more time to reabsorb NaCl
Lamina propora and submucosa
Acute pancreatitis
CHF and inc risk of HCC

32. What kind of diarrhea is produced from a disaccharide def
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Osmotic
With albumin
The submucosal nerve plexus - meissner's

33. What are the main components of bile
Lactase is located at the tips of intestinal villi
Hypotonic because of more time to reabsorb NaCl
Alk phos
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

34. Which viral infxns/treatments are associated with reyes syndrome
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
VZV and influenza B treated with salicylates
Tropical sprue

35. What is Trousseau's sign
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Redness and tenderness on palpation of extremities
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Superior rectal and middle and inferior rectal - rectum

36. bilateral mets to ovaries with abundant mucus - signet ring cells
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Necrotizing enterocolitis
Bleeding - penetration into pancreas - perforation - obstruction
Krukenbergs tumor

37. What conditions are associated with budd chiari
Necrotizing enterocolitis
Alk phos
Gilbert's
Hypercoaguability - polycythemia vera - pregnancy - HCC

38. What kind of insults results in macronodular cirrhosis
T cell lymphoma
Squamous - upper 1/3 - adeno - lower 1/3
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Dermatitis herpetiformis

39. What kind of digestion is bile needed for
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
CHF and inc risk of HCC
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

40. inflammatino of gallbadder
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Omeprazole
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Barrett's esophagus

41. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

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42. If the hemochromatosis is primary - What is the pattern of inheritance
AR
Zollinger Ellison - phenylalanine and tryptophan
Gut bacteria
Lubricate food (glycoprotiens)

43. signet ring cells - acanthosis nigracans - dz - character/association - spread
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Complications of crohns
Hydrocele
Lye ingestion and acid reflux

44. What portion of the bowel does sprue effect
The proximal small bowel
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Meckels
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

45. is meckels a true diverticulum and how common is it
Terminal ileum and colon
Left and right gastroepiploics - left and right gastrics
True and most common congenital anomoly of GI tract
Epithelium

46. What gives urine its characteristic color
Urobilin
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Antrum - H.pylori - inc risk of MALT lymphoma
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

47. What is the ddx associated with appendicitis
External spermatic fascia only
Duodenal atresia - Downs
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Diverticulitis in elderly - ectopic pregs use hCG to rule out

48. What does histo show for alpha1 antitrypsin def
L4
Fasting and stress
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
PAS- positive globules in liver -

49. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Carcinoid syndrome
Bleeding - penetration into pancreas - perforation - obstruction
Hirschsprungs
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

50. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Bleeding - penetration into pancreas - perforation - obstruction
Inc conj bilirubin - inc cholesterol - inc alk phos
Alpha1 antitrypsin def - codominant trait
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis