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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 are the common causes of gastric ulcers - What causes gastric ulcer
Budd chiari syndrome
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Lubricate food (glycoprotiens)
Amylase

2. What intervention will intervention will relieve portal HTN
Femoral hernia
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

3. What gives urine its characteristic color
Celiac sprue
Krukenbergs tumor
Dubin johnson
Urobilin

4. How does hirschsprung present and appear on imaging
Squamous - upper 1/3 - adeno - lower 1/3
Chronic gastritis and pernicious anemia
L/R renal artery around L1
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

5. Where is bicarb trapped
Where hindgut meets ectoderm
Lamina propora and submucosa
In the mucus that covers the gastric epithelium
Alpha amylase

6. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Esophageal cancer
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

7. What histological findings are present in the stomach
Squamous - upper 1/3 - adeno - lower 1/3
Gastric glands
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

8. What are the foregut structures and what supplies their blood and PANS innvervation
Mallory bodies
Crohns = noncaseating granulomas - UC = crypt abscesses
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

9. Through which aspect of the inguinal canal does a direct inguinal go
Paraumbilical and superficial and inferior epigastric - umbilicus
Carcinoid syndrome
Closer to isotonic because of less time to reabsorb NaCl
External (superficial) ring only

10. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Positive

11. Which IBD is autoimmune and which may be a disordered response to bacteria
Failure of the processus vagainlis to close
Left gastric vein and esophogeal vein - esophagus
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Colonic polyps

12. What does bicab do in the mouth
Neutralizes oral bacertial acids and maintains dental health
Chagas disease
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Closer to isotonic because of less time to reabsorb NaCl

13. Malabsorption syndromes have what common clinical presentation
Pancreatic and bile
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Diarrhea - steatorrhea - weight loss - weakness

14. What are additional risk factors for CRC
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
When diffusely infiltrative - thickened rigid appearance like a leather bottle
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Lipase

15. How do you DX and TX gallstones
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Worldwide - SC - US - adeno
Uridine glucuronyl transferase
US and cholecystectomy

16. What cells make pepsin - What does it do - and what regulates it
ALT>AST
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
HSV-1 - CMV - Candida
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

17. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Internal thoracic to superior epigastric to inferior epigastric
Budd chiari syndrome

18. What are the signs and symptoms of budd chiari
Oligosaccharide digestion
M3 - Gq - inc IP3/Ca
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Volvulus

19. People of what decent are associated with celiac sprue and what findings/antibodies are present
Downs
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
90%

20. Where is folate absorbed
Stimulate intestinal persistalsis
Fe2+ in the duod
The jejunum
90%

21. Gastrin - source - action - regulation
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
Neural muscarinic pathways
Upregulated intracellular signal transduction
Acute pancreatitis

22. If the abdominal aorta is blocked - How does blood get to the left colic artery
Tropical sprue
Necrotizing enterocolitis
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Via the middle colic

23. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
The gastroduodenal
Small intestine
Alpha amylase
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

24. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Unconjugated - water insoluble
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
HSV-1 - CMV - Candida
Lye ingestion and acid reflux

25. In what scenarios do pts with gilberts have inc bili
All 3 gut layers outpouch as in Meckels
Fasting and stress
Mucoepidermoid carcinoma
Upregulated intracellular signal transduction

26. How many layers of spermatic fascia are covers an indirect inguinal hernia
All 3
Begins starch digestion - inactivated by low pH upon reaching the stomach
Short gastrics - left greater and lesser
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

27. What is contained within the muscularis externa
Complications of UC
Appendicitis
Myenteric nerve plexus - aurbach
Lack or have an attenuated muscularis externa - often in the sigmoid colon

28. What is Trousseau's sign
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Muscularis mucosae
Primary sclerosing cholangitis
Redness and tenderness on palpation of extremities

29. What does loss of APC cause
Unconjugated - water insoluble
Decreased intercellular adhesion and increased proliferation
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

30. Dysphagia in achalasia results from
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Peyers patches
Neutralizes oral bacertial acids and maintains dental health
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

31. What are the structures of the femoral triangle and how are they organized
NAV = nerve artery vein - venous near the penis (NAVEL)
Cystic dilation of the viteline duct
Worldwide - SC - US - adeno
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

32. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Alpha1 antitrypsin def - codominant trait
EtOH
Cigarettes and chronic pancreatitis - not EtOH

33. What does primary sclerosing cholangitis lead to...
Pancreatic and bile
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Neutralizes gastric acid allowing pancreatic enzymes to fxn

34. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Normal
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Squamous - upper 1/3 - adeno - lower 1/3

35. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Conj - inc - dec
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Angiodysplasia

36. What is the epi for CRC
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
In the mucus that covers the gastric epithelium
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Peyers patches

37. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Inspiratory arrest on deep palpation due to pain
Cirrhosis
Diverticulum
No - chronic - can present with diarrhea or constipation or alternation - treat sx

38. Why are most diverticula considered false
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
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Lack or have an attenuated muscularis externa - often in the sigmoid colon

39. What do you treat Wilsons disease with and What is the inheritance
Fasting and stress
Lipase - phospholipase A - colipase
Hydrocele
Penicillinamine - AR inheritance

40. vasoactive intestinal polypeptide (VIP) - source - action - regulation
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
Positive urease test
Jewish and African American men
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

41. 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
AST >ALT - ration is usually 1.5
Spleen to posterior abdominal wall - splenic artery and vein
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

42. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Low pressure proximal to LES
Squamous - upper 1/3 - adeno - lower 1/3
Black - rotors syndrome
MSI (15%) and APC/beta catenin chromosomal instability (85%)

43. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Zenkers - halitosis - dysphagia and obstruction
Alcoholic hepatitis
Elevated amylase - and lipase

44. What does TOASTED with alcoholic hepatitis stand for
Pyoderma gangrenosum - primary sclerosing cholangitis
AST >ALT - ration is usually 1.5
Superior rectal
Complications of crohns

45. What does bicarb do in the duodenum
Brush border of intestine - produce monosaccharides from oligo and di
Ampulla of vater
The proximal small bowel
Neutralizes gastric acid allowing pancreatic enzymes to fxn

46. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Fasting and stress
Hemosiderosis - hemochromatosis

47. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
With albumin
Hyperplastic
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

48. What gives stool its characteristic color
M3 - Gq - inc IP3/Ca
Gardner's syndrome
Stercobilin
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

49. What do the rugae of stomach look like in menetriers disease
So hypertrophied they look like brain gyri
Colovesical leading to pneumaturia
Terminal ileum and colon
Omeprazole

50. most common non - neoplastic polyp in colon
Hyperplastic
HSV-1 - CMV - Candida
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Reye's syndrome