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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. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Neutralizes gastric acid allowing pancreatic enzymes to fxn
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

2. In PUD with a duodenal ulcer does pain inc or dec with meals
Female - fat - fertile - forty
Hemosiderosis - hemochromatosis
Decrease - weight gain
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

3. What do the rugae of stomach look like in menetriers disease
Mucosa - submucosa - muscularis externa - serosa/adventitia
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
So hypertrophied they look like brain gyri
The gastroduodenal

4. At what spinal level does the is the bifurcation of aorta
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
L4
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

5. What are the barium swallow findings of achalasia
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Dilated esophagus with an area of distal stenosis - birds beak
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Inguninal ligament - sartorius muscle - adductor longus

6. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Lipase - phospholipase A - colipase
Downs
Below

7. What is the risk with peutz jehgers
Crohns = noncaseating granulomas - UC = crypt abscesses
Positive urease test
Inc risk of CRC and other visceral malignancies
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

8. most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Low pressure proximal to LES
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Crigler - najjar type 1

9. Where is folate absorbed
The jejunum
Crohns = maybe - UC= always
Cholesterol
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

10. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Centrilobular congestion and necrosis - cardiac cirrhosis
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Dense core bodies
Hypotonic because of more time to reabsorb NaCl

11. What is the frequency of basal electric rhythm of the ilieum
L2
8-9 waves/min
Squamous - upper 1/3 - adeno - lower 1/3
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

12. What source of salivary secretion is the most serous and What is the most mucinous
Serous on the sides parotids - mucinous in the middle sublingual
Gilbert's
Centrilobular leading to congestive liver disease
Peptic ulcer disease

13. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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14. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Pancreatic head causing obstructive jaundice
Menetriers disease
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Meckels

15. What kind of diarrhea is produced from a disaccharide def
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Osmotic

16. What portion of the bowel does sprue effect
Falciform - ligamentum teres - fetal umbilical vein
Crohns = noncaseating granulomas - UC = crypt abscesses
The proximal small bowel
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

17. What cell produces IF and What does it do
Dense core bodies
Parietal cells in the stomach - B12 binding protein
Amylase
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

18. What is the action of NO as a GI hormone
Celiac sprue
Alfatoxin in peanuts
Repeated phlebotomy - deferoxamine - HLA- A3
Inc smooth muscle relaxation - including lower esophageal sphincter

19. Why does volvulus occur more at cecum and sigmoid colon
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Inc risk of CRC and other visceral malignancies
No
Redundant mesentary

20. What is the frequency of basal electric rhythm of the stomach
Trypsin - chymotrypsin - elastase - carboxypeptidases
Phototherapy
Lubricate food (glycoprotiens)
3 waves/min

21. What layer of fascia covers a direct inguinal hernia
Dermatitis herpetiformis
The gastroduodenal
Heme metabolism
External spermatic fascia only

22. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
Right and left hepatic duct
Penicillinamine - AR inheritance
Dermatitis herpetiformis

23. Where does type B chronic gastritis occur and What causes it
Oral glucose
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Antrum - H.pylori - inc risk of MALT lymphoma

24. What are the foregut structures and what supplies their blood and PANS innvervation
Peyers patches
Budd chiari syndrome
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
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

25. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
So hypertrophied they look like brain gyri
Brush border of intestine - produce monosaccharides from oligo and di
Lamina propria

26. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Failure of neural crest migration
Jaundice - fever - RUQ
HSV-1 - CMV - Candida
The entire

27. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Inguninal ligament - sartorius muscle - adductor longus
Dissaccharidase def - most commonly lactase
Hernia
Complications of crohns

28. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
External spermatic fascia only
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Alpha1 antitrypsin def - codominant trait
Hemolytic anemia

29. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Conj - inc - dec
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Terminal ileum and colon
FAP

30. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Barrett's esophagus
Hydrocele
Gallbladder

31. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
IBS at least 2 with recurrent abdominal pain
Dilated esophagus with an area of distal stenosis - birds beak

32. What is the rate limiting step of carbohydrate digestion
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
External (superficial) ring only
Glucose dependent insulinotropic peptide
Oligosaccharide digestion

33. Malabsorption syndromes have what common clinical presentation
Menetriers disease
Backup of blood into the liver - RHF - budd chiari
Diarrhea - steatorrhea - weight loss - weakness
Lipase

34. What test and result confirms H pylori infxn
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Positive urease test
Lateral
Punched out - clean margins - carcinoma =raised irregular margins

35. What conditions are associated with budd chiari
Neutralizes oral bacertial acids and maintains dental health
Dermatitis herpetiformis
Hypercoaguability - polycythemia vera - pregnancy - HCC
Glucouronate - water soluble (direct)

36. Where are carcinoid tumors most commonly malignant
T12
Uridine glucuronyl transferase
Cigarettes and chronic pancreatitis - not EtOH
Small intestine

37. What intervention will intervention will relieve portal HTN
Skip lesions =crohns - colon = UC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

38. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Epigastric abdominal pain radiating to back - anorexia - nausea

39. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Punched out - clean margins - carcinoma =raised irregular margins
IBS at least 2 with recurrent abdominal pain
Inc risk of CRC and other visceral malignancies
Normal

40. Where is the pectinate line
Centrilobular leading to congestive liver disease
Cholesterol
IgA secreting plasma cells - ultimately reside in the lamina proporia
Where hindgut meets ectoderm

41. secretin - source - action - regulation
Failure of neural crest migration
Centrilobular leading to congestive liver disease
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
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

42. What are additional risk factors for CRC
Corticosteroids - infliximab
Phototherapy
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

43. What does primary sclerosing cholangitis lead to...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Redness and tenderness on palpation of extremities
Smooth

44. What complication can arise from indirect inguinal hernias
L2
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Hydrocele
Left gastric vein and esophogeal vein - esophagus

45. FAP + osseous and soft tissue tumors - retinal hyperplasia

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46. Where is the deep inguinal ring relative to the inferior epigastric vessels
Pyoderma gangrenosum - primary sclerosing cholangitis
Lateral
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Adhesion

47. What is Trousseau's sign
IgA secreting plasma cells - ultimately reside in the lamina proporia
Epigastric abdominal pain radiating to back - anorexia - nausea
Zollinger Ellison - phenylalanine and tryptophan
Redness and tenderness on palpation of extremities

48. What does histo show for alpha1 antitrypsin def
Jewish and African American men
All 3
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
PAS- positive globules in liver -

49. What are the layers of the gut wall from inside out
Mucosa - submucosa - muscularis externa - serosa/adventitia
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
US and cholecystectomy
Angiodysplasia

50. blind pouch protruding from alimentary tract that communicates with lumen of the gut
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Acute pancreatitis
H+
Diverticulum