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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 do burns cause acute gastritis and What is it called

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2. With caput medusaw - between what vessels is the anastomoses and Where is it
All 3
Paraumbilical and superficial and inferior epigastric - umbilicus
Gallbladder
Right and left hepatic duct

3. What kind of muscle is in the middle 1/3 of esophagus
Phototherapy
True and most common congenital anomoly of GI tract
Striated and smooth
So hypertrophied they look like brain gyri

4. Gallstones that reach the common channel at ampulla can block which two ducts
Pancreatic and bile
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
The jejunum
Femoral hernia

5. Where is the deep inguinal ring relative to the inferior epigastric vessels
In the mucus that covers the gastric epithelium
Lateral
Hyperplastic
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

6. What is the path of an indirect inguinal hernia
Angiodysplasia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Peutz jeghers
Meconium ileus

7. What is biliary colic
Cirrhosis
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
With albumin
Poor anastamoses

8. Where does type A chronic gastritis occur and What causes it
All 3
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Begins starch digestion - inactivated by low pH upon reaching the stomach
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

9. What is the TX of physiologic neonatal jaundice
Phototherapy
Complications of UC
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Corticosteroids - infliximab

10. What are the main components of bile
External spermatic fascia only
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Epigastric abdominal pain radiating to back - anorexia - nausea
External (superficial) ring only

11. What cell produces IF and What does it do
Inguninal ligament - sartorius muscle - adductor longus
The submucosal nerve plexus - meissner's
Paraumbilical and superficial and inferior epigastric - umbilicus
Parietal cells in the stomach - B12 binding protein

12. When do you see hypertrophy of brunners glands
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Inc risk of CRC and other visceral malignancies
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Peptic ulcer disease

13. Which patients have pigment stones
...
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Copious diarrhea - non alpha - non beta cell pancreatic tumor
2ndary biliary cirrhosis

14. Autoantibodies to gluten (gliadin) in wheat and other grains
In the mucus that covers the gastric epithelium
Pleuroperitoneal
Glucose dependent insulinotropic peptide
Celiac sprue

15. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Turcot

16. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Sister mary joseph nodule
Crigler - najjar type 1
Penicillinamine - AR inheritance

17. To what substance is bilirubin conjugated and why
Fe2+ in the duod
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Glucouronate - water soluble (direct)
Can lead to hematemesis - found in EtOHics and bulimics

18. What is the prognosis of adenocarcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Brush border of intestine - produce monosaccharides from oligo and di
Centrilobular leading to congestive liver disease

19. involvement of left supraclavicular node by mets from stomach

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20. What is the lumen of the pancreatic duct
Ampulla of vater
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Upregulated intracellular signal transduction
Lipase - phospholipase A - colipase

21. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
Lamina propria
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Alcoholic cirrhosis

22. With internal hemorrhoids Where is the anastomoses and Where is it
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Cholesterol - 10-20% opaque due to calcifications
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Superior rectal and middle and inferior rectal - rectum

23. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
2ndary biliary cirrhosis
Zollinger ellison - brunners glands
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

24. What are causes of extrahepatic biliary obstruction
Esophageal cancer
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Epigastric abdominal pain radiating to back - anorexia - nausea
Hepatic steatosis

25. What does a gastrinoma cause
The jejunum
Epithelium
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

26. is meckels a true diverticulum and how common is it
Sphincter of oddi
HSV-1 - CMV - Candida
True and most common congenital anomoly of GI tract
Conj/unconj - inc - nl to dec

27. What does high flow rate mean
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Closer to isotonic because of less time to reabsorb NaCl
Fe2+ in the duod

28. What are the hindgut structures and what supplies their blood and PANS innvervation
IgA secreting plasma cells - ultimately reside in the lamina proporia
Dubin johnson
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Redundant mesentary

29. How is salivary secretion stimulated
Urobilin
The entire
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

30. What is Trousseau's sign
Omeprazole
Carcinoid syndrome
Alcoholic hepatitis
Redness and tenderness on palpation of extremities

31. How are all 3 monosaccharides transported to the blood
GLUT 2
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Black - rotors syndrome
Dermatitis herpetiformis

32. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Zenkers - halitosis - dysphagia and obstruction
Gardner's syndrome
Hypercoaguability - polycythemia vera - pregnancy - HCC

33. What are the results of hemochromatosis
Nonkeritinized stratified sqamous epithelium
Lactase is located at the tips of intestinal villi
Hypotonic because of more time to reabsorb NaCl
CHF and inc risk of HCC

34. subQ peribumbilical metastasis
8-9 waves/min
Hernia
Sister mary joseph nodule
Pleuroperitoneal

35. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Terminal ileum and colon
Zenkers - halitosis - dysphagia and obstruction
Peyers patches
H2 receptor - inc cAMP

36. What is contained in the gastrosplenic and What areas does it separate
Averages 6 months - very aggressive - usually already metastasized at presentation
Stimulate intestinal persistalsis
Short gastrics - left greater and lesser
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

37. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Uridine glucuronyl transferase
Phenobarbital - inc liver enzyme synthesis
Chronic gastritis and pernicious anemia

38. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Causes of gall stones
The jejunum
GERD - may also present with nocturnal cough and dyspnea

39. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
2ndary biliary cirrhosis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Inc - weight loss
Peutz jeghers

40. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Tropical sprue
Conj - inc - dec

41. What is the most important mechanism in gastric acid secretion
Volvulus
Reye's syndrome
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Hypercoaguability - polycythemia vera - pregnancy - HCC

42. Where does type B chronic gastritis occur and What causes it
Portal HTN
Black - rotors syndrome
Antrum - H.pylori - inc risk of MALT lymphoma
T12

43. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Averages 6 months - very aggressive - usually already metastasized at presentation
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
GERD - may also present with nocturnal cough and dyspnea

44. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Stimulate intestinal persistalsis
Dissaccharidase def - most commonly lactase

45. What is the characteristic histo finding in alcoholic hepatitis
Mallory bodies
Acute pancreatitis
Fasting and stress
Mucosa - submucosa - muscularis externa - serosa/adventitia

46. What is the clinical presentation of acute pancreatitis
Krukenbergs tumor
Pleuroperitoneal
Epigastric abdominal pain radiating to back - anorexia - nausea
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

47. If the hemochromatosis is primary - What is the pattern of inheritance
AR
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Where hindgut meets ectoderm
Hydrocele

48. In PUD - with gastric ulcers - does pain inc or dec with meals?
Chronic gastritis and pernicious anemia
Inc - weight loss
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Portal HTN

49. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
FAP
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
CHF and inc risk of HCC
Chagas disease

50. What causes pancreatic insuff and What does it cause
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Complications of UC
GERD - may also present with nocturnal cough and dyspnea
Stimulate the H/K ATPase