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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. Are single polyps malignant in peutz jehgers
Below
Gardner's syndrome
...
No

2. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Complications of UC
Unconj - absent (acholuria) - inc
Inc smooth muscle relaxation - including lower esophageal sphincter
Gamma glutamyl transferase GGT

3. involvement of left supraclavicular node by mets from stomach

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4. Which area of the hindgut is a watershed area
Splenic flexure
Uremia
Inc - weight loss
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

5. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Elevated amylase - and lipase
Inguninal ligament - sartorius muscle - adductor longus
Pertechnetate - study for uptake
Above

6. What retroperitoneal structure flanks both sides of the pancreas on CT
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Portal HTN
Hyperplastic
Duodenum - 2nd - 3rd and 4th parts

7. What serum enzyme is decreased in wilsons disease
Ceruplasmin
T cell lymphoma
Uridine glucuronyl transferase
AST>ALT

8. What drug inhibits the H/K ATPase
Omeprazole
Neural muscarinic pathways
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Colonic polyps

9. Which serum enzyme increases with heavy EtOH consumption
Gamma glutamyl transferase GGT
Meconium ileus
Centrilobular congestion and necrosis - cardiac cirrhosis
Small intestine

10. How is salivary secretion stimulated
Uridine glucuronyl transferase
Oral glucose
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Nonkeritinized stratified sqamous epithelium

11. What cells make pepsin - What does it do - and what regulates it
Elevated amylase - and lipase
Backup of blood into the liver - RHF - budd chiari
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
L1

12. What does histo show for alpha1 antitrypsin def
Redness and tenderness on palpation of extremities
Averages 6 months - very aggressive - usually already metastasized at presentation
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
PAS- positive globules in liver -

13. What artery passes around the duodenum
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
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
The gastroduodenal
Below

14. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Conj - inc - dec
Superior rectal and middle and inferior rectal - rectum

15. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Increase tumorigenesis
Femoral hernia
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
The gastroduodenal

16. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Ischemic colitis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
EtOH
Gastric glands

17. What serum enzyme is elevated inacute pancreatitis
Lactase is located at the tips of intestinal villi
Lipase
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
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

18. What are the treatmet options for crohns
Corticosteroids - infliximab
M3 - Gq - inc IP3/Ca
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

19. Gallstones that reach the common channel at ampulla can block which two ducts
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Pancreatic and bile
Osmotic
Causes of gall stones

20. In viral hepatitis - which liver enzyme is higher
L2
ALT>AST
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Appendicitis

21. Cholecytsokinin - source - action - regulation
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Decrease - weight gain
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
Meconium ileus

22. Where is there sclerosis in alcoholic cirrohosis
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Increase tumorigenesis
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Around the central vein (zone III)

23. What does extrahepatic biliary obstruction cause
Neural muscarinic pathways
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Failure of the processus vagainlis to close
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

24. What serum enzyme is elevated in acute pancreatitis and mumps
IgA secreting plasma cells - ultimately reside in the lamina proporia
Amylase
Dermatitis herpetiformis
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

25. What are the layers of the gut wall from inside out
Right and left hepatic duct
Mucosa - submucosa - muscularis externa - serosa/adventitia
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

26. What test and result confirms H pylori infxn
Centrilobular congestion and necrosis - cardiac cirrhosis
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
HSV-1 - CMV - Candida
Positive urease test

27. What does bicab do in the mouth
Via the superior pancreaticduodenal
Neutralizes oral bacertial acids and maintains dental health
Adhesion
Heme metabolism

28. What intervention will intervention will relieve portal HTN
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Penicillinamine - AR inheritance
Urobilin

29. What skin condition is associated with celiac sprue
Jaundice - fever - RUQ
Warthins' tumor
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Dermatitis herpetiformis

30. What transforms conjugated bilirubin to urobilinogen
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Gut bacteria
Superior rectal and middle and inferior rectal - rectum
Punched out - clean margins - carcinoma =raised irregular margins

31. What is the other name for GIP (gastric inhibitory peptide)
Mucoepidermoid carcinoma
Carcinoid syndrome
Common hepatic - splenic - left gastric - main blood supply for stomach
Glucose dependent insulinotropic peptide

32. somatostatin - source - action - regulation
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
Volvulus
Inc lower esphogeal tone leading to achalasia
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

33. Which patients have pigment stones
Dysphagia (due to esophageal web) - glossitis - iron def anemia
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
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
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

34. At what spinal level does the SMA exit
L1
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Uremia
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

35. How do you DX and TX gallstones
Phenobarbital - inc liver enzyme synthesis
US and cholecystectomy
VZV and influenza B treated with salicylates
Left gastric vein and esophogeal vein - esophagus

36. Autoantibodies to gluten (gliadin) in wheat and other grains
H pylori (almost 100%)
Centrilobular leading to congestive liver disease
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Celiac sprue

37. What do you use to diagnose meckels
Zollinger Ellison - phenylalanine and tryptophan
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Falciform - ligamentum teres - fetal umbilical vein
Pertechnetate - study for uptake

38. Autodigestion of pancreas by pancreatic enzymes
M3 - Gq - inc IP3/Ca
Acute pancreatitis
L1
Lye ingestion and acid reflux

39. What are the histological findings in the duodenum

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40. What is the leading cause of bowel incarceration
Inguninal ligament - sartorius muscle - adductor longus
Phototherapy
Pleuroperitoneal
Femoral hernia

41. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
...
GERD - may also present with nocturnal cough and dyspnea
Inc risk of CRC and other visceral malignancies
Diarrhea - steatorrhea - weight loss - weakness

42. What does loss of APC cause
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Decreased intercellular adhesion and increased proliferation
Inc conj bilirubin - inc cholesterol - inc alk phos

43. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Intussusception
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

44. What is the rate limiting step of carbohydrate digestion
Oligosaccharide digestion
Paraumbilical and superficial and inferior epigastric - umbilicus
Pertechnetate - study for uptake
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

45. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Cigarettes and chronic pancreatitis - not EtOH
2ndary biliary cirrhosis
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Bleeding - penetration into pancreas - perforation - obstruction

46. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
Meckels
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Lubricate food (glycoprotiens)

47. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
L/R renal artery around L1
Causes of gall stones
Epigastric abdominal pain radiating to back - anorexia - nausea
Hemosiderosis - hemochromatosis

48. What congenital birth defect is associated with Hirschsprung
T12
Carcinoid syndrome
Downs
Inc risk of CRC and other visceral malignancies

49. What are the tumor markers for pancreatic adenocarcinoma
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
CEA - CA-19-9
Conj/unconj - inc - nl to dec
Fe2+ in the duod

50. Is there any structural abnl with IBS - What is the course of disease and presentation
Gamma glutamyl transferase GGT
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Closer to isotonic because of less time to reabsorb NaCl