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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. What conditions are associated with budd chiari
Epithelium
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Hypercoaguability - polycythemia vera - pregnancy - HCC
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

2. What transforms conjugated bilirubin to urobilinogen
Gut bacteria
Esophageal carcinoma
Crigler - najjar type 1
Striated

3. Is there any structural abnl with IBS - What is the course of disease and presentation
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Dilated esophagus with an area of distal stenosis - birds beak
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Angiodysplasia

4. What are the layers of the gut wall from inside out
Brush border of intestine - produce monosaccharides from oligo and di
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Mucosa - submucosa - muscularis externa - serosa/adventitia
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

5. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Erosive - disruption of mucosal barrier leading to inflammation
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
L3

6. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
Cholesterol
Brunners
Volvulus

7. Acute gastritis is caused By what process
Muscularis mucosae
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Centrilobular leading to congestive liver disease
Erosive - disruption of mucosal barrier leading to inflammation

8. What converts inactive pepsinogen to pepsin
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Crohns = noncaseating granulomas - UC = crypt abscesses
H+
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

9. What histological findings are present in the esophagus
AST >ALT - ration is usually 1.5
Centrilobular leading to congestive liver disease
Nonkeritinized stratified sqamous epithelium
Upregulated intracellular signal transduction

10. How do NSAIDs cause acute gastritis
Warthins' tumor
Dec PGE2 leading to dec gastric mucosa protection
Juvenille polyps - no risk if single
PAS- positive globules in liver -

11. What is the action of NO as a GI hormone
Alk phos
Inc smooth muscle relaxation - including lower esophageal sphincter
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

12. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
US and cholecystectomy
Carcinoid syndrome
H pylori (almost 100%)

13. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Pleomorphic adenoma
Alcoholic cirrhosis
Conj - inc - dec
Early childhood - neuro sx and malabsorption

14. What are the complications of duodenal PUD
M3 - Gq - inc IP3/Ca
Small intestine
Bleeding - penetration into pancreas - perforation - obstruction
Celiac sprue

15. What carcinogens are associated with HCC
Smooth
Alfatoxin in peanuts
Alcoholic hepatitis
Via the superior pancreaticduodenal

16. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
AST
3 waves/min

17. Where is there sclerosis in alcoholic cirrohosis
Superior rectal and middle and inferior rectal - rectum
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Around the central vein (zone III)
Esophageal varices

18. subQ peribumbilical metastasis
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Sister mary joseph nodule
Via the superior pancreaticduodenal
Upregulated intracellular signal transduction

19. crigler - najjar type II responds to which therapy and How does it work
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Phenobarbital - inc liver enzyme synthesis
Common hepatic - splenic - left gastric - main blood supply for stomach
Dissaccharidase def - most commonly lactase

20. At what spinal level does the celiac trunk exit
Brunners
T12
Alcoholic cirrhosis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

21. What layer in the mucosa is responsible for absorption
Turcot
Squamous - upper 1/3 - adeno - lower 1/3
Epithelium
L1

22. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
FAP
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Can lead to hematemesis - found in EtOHics and bulimics

23. What is pancreatic adenocarcinoma associated with
Punched out - clean margins - carcinoma =raised irregular margins
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
Complications of crohns
Cigarettes and chronic pancreatitis - not EtOH

24. Who gets gastric ulcers
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Older patients
H pylori (almost 100%)
Pleuroperitoneal

25. What is the other name for GIP (gastric inhibitory peptide)
Conj/unconj - inc - nl to dec
Glucose dependent insulinotropic peptide
Pyoderma gangrenosum - primary sclerosing cholangitis
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

26. How is salivary secretion stimulated
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
So hypertrophied they look like brain gyri
Pancreatic and bile
Chagas disease

27. What is the cause of physiologic neonatal jaundice
Jewish and African American men
Alcoholic cirrhosis
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

28. How do burns cause acute gastritis and What is it called

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29. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Hypotonic because of more time to reabsorb NaCl
Krukenbergs tumor
Alcoholic hepatitis
Decreased intercellular adhesion and increased proliferation

30. What drug inhibits the H/K ATPase
Increase tumorigenesis
Omeprazole
Gilbert's
Cholesterol - 10-20% opaque due to calcifications

31. What does bicab do in the mouth
Crohns = maybe - UC= always
Esophageal carcinoma
Neutralizes oral bacertial acids and maintains dental health
Cirrhosis

32. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
IgA secreting plasma cells - ultimately reside in the lamina proporia
Closer to isotonic because of less time to reabsorb NaCl
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Pancreatic head causing obstructive jaundice

33. What is the presenting course for appendicity

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34. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Uridine glucuronyl transferase
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Menetriers disease
Old men - arthralgias - cardiac and neuro sx

35. What are the results of hemochromatosis
...
Inc conj bilirubin - inc cholesterol - inc alk phos
Dilated esophagus with an area of distal stenosis - birds beak
CHF and inc risk of HCC

36. What cell produces IF and What does it do
Cystic dilation of the viteline duct
Parietal cells in the stomach - B12 binding protein
Pancreatic and bile
Necrotizing enterocolitis

37. concentric onion skin bile duct fibrosis
FAP
ALT>AST
Splenic flexure
Primary sclerosing cholangitis

38. Gq and inc cAMP both work to do what in parietal cells
Gilbert's
Hemolytic anemia
Stimulate the H/K ATPase
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

39. trypsinogen is converted to trypsin via what enzyme
Female - fat - fertile - forty
Colonic polyps
Enterokinase/enteropeptidase from the duodenal mucosa
Chronic gastritis and pernicious anemia

40. What is the main symptom if a VIPoma
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Hemosiderosis - hemochromatosis
Via the superior pancreaticduodenal

41. What are the complications of Meckels
Pancreatic and bile
Appendicitis
Striated and smooth
Bleeding - intussusception - volvulus - obstruction near terminal ileum

42. Where is IgA shuttled
No
Stercobilin
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Virchow's node

43. How is the diagonsis of CRC made
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
Squamous - upper 1/3 - adeno - lower 1/3
Amylase
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

44. At what spinal level does the is the bifurcation of aorta
L4
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Superior rectal and middle and inferior rectal - rectum
AST

45. occlusion of IVC or hepatic veins
Dense core bodies
Krukenbergs tumor
Budd chiari syndrome
Amylase

46. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Positive
HSV-1 - CMV - Candida
...
Cholesterol

47. rare - often fatal childhood hepatoencephalopathy

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48. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Enterokinase/enteropeptidase from the duodenal mucosa
Stercobilin
Hirschsprungs

49. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Zenkers - halitosis - dysphagia and obstruction
Left and right gastroepiploics - left and right gastrics
Pancreatic head causing obstructive jaundice
CCK8 receptor - Gq inc IP3/Ca

50. Through which aspect of the inguinal canal does a direct inguinal go
Menetriers disease
External (superficial) ring only
Gallbladder
Internal thoracic to superior epigastric to inferior epigastric