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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. How does loss of NO secretion affect the esophagus and what results
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Inc lower esphogeal tone leading to achalasia
Dermatitis herpetiformis
The gastroduodenal

2. What infection causes Whipple disease and What can you see on LM
...
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Reye's syndrome

3. What drug inhibits the H/K ATPase
Lateral
Omeprazole
Pancreatic and bile
Falciform - ligamentum teres - fetal umbilical vein

4. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Squamous - upper 1/3 - adeno - lower 1/3
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Unconj - absent (acholuria) - inc

5. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Terminal ileum and colon
Crohns = maybe - UC= always
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
T12

6. What transforms conjugated bilirubin to urobilinogen
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Gut bacteria
Serous on the sides parotids - mucinous in the middle sublingual
Centrilobular congestion and necrosis - cardiac cirrhosis

7. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
True and most common congenital anomoly of GI tract
Upregulated intracellular signal transduction
Crohns = noncaseating granulomas - UC = crypt abscesses
Appendicitis

8. A protrusion of peritoneum through an opening - usually a site of weakness
Urobilin
Lateral to the inferior epigastric artery
Cimetidine
Hernia

9. What is biliary colic
Smooth
Crohns = maybe - UC= always
Boerhaave's Syndrome - Been heaving syndrome
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

10. What are causes of extrahepatic biliary obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Superior rectal and middle and inferior rectal - rectum
Zenkers - halitosis - dysphagia and obstruction
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

11. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Menetriers disease
Primary sclerosing cholangitis

12. What does autoimmune destruction of parietal cells lead to...
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Backup of blood into the liver - RHF - budd chiari
Colonic polyps
Chronic gastritis and pernicious anemia

13. What happens to the short gastics if the splenic artery is blocked
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Left and right gastroepiploics - left and right gastrics
Poor anastamoses

14. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Peptic ulcer disease
Juvenille polyps - no risk if single
Cystic duct and common hepatic duct
Hypotonic because of more time to reabsorb NaCl

15. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Small intestine
Dermatitis herpetiformis
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Oligosaccharide digestion

16. How does brain injury lead to acute gastritis and What is it called
Colonic polyps
Short gastrics - left greater and lesser
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
HPNCC

17. What are the hindgut structures and what supplies their blood and PANS innvervation
Crigler - najjar type 1
Where hindgut meets ectoderm
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

18. With internal hemorrhoids Where is the anastomoses and Where is it
3 waves/min
Superior rectal and middle and inferior rectal - rectum
Skip lesions =crohns - colon = UC
Hepatic steatosis

19. Between what structures do strong anastamoses exist
Superior rectal
Upregulated intracellular signal transduction
Left and right gastroepiploics - left and right gastrics
Nonkeritinized stratified sqamous epithelium

20. Where is B12 absorbed
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Penicillinamine - AR inheritance
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
In the ileum with bile acids - requires IF

21. What layer in the mucosa is responsible for absorption
Epithelium
The submucosal nerve plexus - meissner's
Appendicitis
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

22. What is charcot triad of cholangitis
Jaundice - fever - RUQ
Gamma glutamyl transferase GGT
Splenic flexure
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

23. What is the arterial supply and venous drainage below pectinate line
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Lamina propria
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

24. What are the structures of the femoral triangle and how are they organized
Alk pho
NAV = nerve artery vein - venous near the penis (NAVEL)
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Necrotizing enterocolitis

25. What cell produces IF and What does it do
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Parietal cells in the stomach - B12 binding protein
Failure of neural crest migration
Inspiratory arrest on deep palpation due to pain

26. What are the histological findings in the duodenum

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27. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Myenteric nerve plexus - aurbach
Sphincter of oddi
Alcoholic hepatitis
Alpha amylase

28. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
Alpha amylase
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

29. What is the cause of Barrett's and the assocaited complications
The jejunum
Stercobilin
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Below

30. What converts inactive pepsinogen to pepsin
H+
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
External (superficial) ring only
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

31. Which IBD is autoimmune and which may be a disordered response to bacteria
Chronic gastritis and pernicious anemia
Zollinger Ellison - phenylalanine and tryptophan
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Stimulate intestinal persistalsis

32. Where are carcinoid tumors most commonly malignant
Crigler - najjar type 1
Small intestine
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Serous on the sides parotids - mucinous in the middle sublingual

33. What are the complications of chronic pancreatitis
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Trypsin - chymotrypsin - elastase - carboxypeptidases
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Lateral

34. 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
Early childhood - neuro sx and malabsorption
Causes of gall stones
Ischemic colitis

35. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Pleomorphic adenoma
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Conj/unconj - inc - nl to dec
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

36. Which serum enzyme increases with heavy EtOH consumption
Muscularis mucosae
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Pleomorphic adenoma
Gamma glutamyl transferase GGT

37. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Necrotizing enterocolitis
Pertechnetate - study for uptake
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

38. Who gets Whipple disease and How do they present
Alcoholic cirrhosis
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Old men - arthralgias - cardiac and neuro sx
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

39. What complication can arise from indirect inguinal hernias
Hydrocele
Crohns = maybe - UC= always
Low pressure proximal to LES
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

40. What is the classic triad of hemochromatosis

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41. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Gardner's syndrome
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

42. What is the sphincter of the pancreatic duct
Sphincter of oddi
Decrease - weight gain
Neutralizes oral bacertial acids and maintains dental health
Punched out - clean margins - carcinoma =raised irregular margins

43. Bile is critical for exrection of what substance
Centrilobular leading to congestive liver disease
Cholesterol
Urobilin
Corticosteroids - infliximab

44. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
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
Inferior rectal nerve
L1

45. What test and result confirms H pylori infxn
Positive urease test
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
L/R renal artery around L1

46. What portion of the bowel does sprue effect
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Gastrohepatic ligament
Pancreatic head causing obstructive jaundice
The proximal small bowel

47. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Tropical sprue
Menetriers disease
Splenic flexure
Causes of gall stones

48. What receptors does gastrin bind on the parietal cell and What does it activate
Conj - inc - dec
CCK8 receptor - Gq inc IP3/Ca
Positive urease test
Diverticulum

49. What is the other name for GIP (gastric inhibitory peptide)
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Glucose dependent insulinotropic peptide
Phenobarbital - inc liver enzyme synthesis
Inc risk of CRC and other visceral malignancies

50. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
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
Gastric glands
Failure of neural crest migration
Ampulla of vater