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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 abetalipoproteinemia lead to malabsorption
Inc lower esphogeal tone leading to achalasia
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Pertechnetate - study for uptake
Esophageal varices

2. Which viral infxns/treatments are associated with reyes syndrome
Common hepatic - splenic - left gastric - main blood supply for stomach
Dissaccharidase def - most commonly lactase
Lamina propora and submucosa
VZV and influenza B treated with salicylates

3. In an MI - which liver enzyme is elevated
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
AST
Dissaccharidase def - most commonly lactase
Striated

4. bilateral mets to ovaries with abundant mucus - signet ring cells
Hypercoaguability - polycythemia vera - pregnancy - HCC
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Krukenbergs tumor
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

5. Where is the pectinate line
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Inc conj bilirubin - inc cholesterol - inc alk phos
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Where hindgut meets ectoderm

6. What is the classic triad of hemochromatosis

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7. If trypsin activates more trypsinogen - what kind of feedback loop is established
The proximal small bowel
AST >ALT - ration is usually 1.5
Gut bacteria
Positive

8. What kind of lesions are characteristic of duodenal PUD vs cancer
Volvulus
Pyoderma gangrenosum - primary sclerosing cholangitis
Punched out - clean margins - carcinoma =raised irregular margins
Hypotonic because of more time to reabsorb NaCl

9. signet ring cells - acanthosis nigracans - dz - character/association - spread
True and most common congenital anomoly of GI tract
Oligosaccharide digestion
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Boerhaave's Syndrome - Been heaving syndrome

10. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Bleeding - penetration into pancreas - perforation - obstruction
Peptic ulcer disease
IgA secreting plasma cells - ultimately reside in the lamina proporia
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

11. What are the treatment options for uclerative colitis
Black - rotors syndrome
Dermatitis herpetiformis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Dec PGE2 leading to dec gastric mucosa protection

12. How does CRC present in the distal and proximal colon
Alcoholic cirrhosis
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Colonic polyps
Source - I cells (duod - jej - action - inc pancreative secretion - inc gallbladder contraction - dec gastric emptying - sphincter of Oddi relaxation - regulation - inc by fatty acids and amino acids

13. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Lipase
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Alpha amylase

14. What layer of fascia covers a direct inguinal hernia
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
External spermatic fascia only
Centrilobular leading to congestive liver disease
H2 receptor - inc cAMP

15. Abuse of what substance leads to acute gastritis
Black - rotors syndrome
Left gastric vein and esophogeal vein - esophagus
EtOH
Celiac sprue

16. How are all 3 monosaccharides transported to the blood
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Decreased intercellular adhesion and increased proliferation
GLUT 2
VZV and influenza B treated with salicylates

17. in carcinoid tumors - What is seen on EM
Dense core bodies
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Low pressure proximal to LES
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

18. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

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19. What nerve innervates the external hemorrhoids
Lye ingestion and acid reflux
Inferior rectal nerve
Alcoholic hepatitis
Bleeding - penetration into pancreas - perforation - obstruction

20. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Neural muscarinic pathways
Peutz jeghers
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

21. What is the most common indication of emergent abdominal surgery in children
Appendicitis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Gamma glutamyl transferase GGT

22. crigler - najjar type II responds to which therapy and How does it work
3 waves/min
Failure of neural crest migration
Chagas disease
Phenobarbital - inc liver enzyme synthesis

23. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Liver metabolizes 5HT
Jewish and African American men
Hemolytic anemia
Unconj - absent (acholuria) - inc

24. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Complications of UC
Alcoholic hepatitis
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Above

25. What does bicab do in the mouth
Fe2+ in the duod
True and most common congenital anomoly of GI tract
Neutralizes oral bacertial acids and maintains dental health
Peutz jeghers

26. What portion of the bowel does sprue effect
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Reye's syndrome
Virchow's node
The proximal small bowel

27. 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
MSI (15%) and APC/beta catenin chromosomal instability (85%)
L3
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

28. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Diverticulum
Common hepatic - splenic - left gastric - main blood supply for stomach
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

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

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30. FAP + malignant CNS tumor
Primarly through ECL leading to histamine release
Turcot
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

31. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Krukenbergs tumor
Reye's syndrome
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
FAP

32. What is indirect bilirubin
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Decreased intercellular adhesion and increased proliferation
Increase tumorigenesis
Unconjugated - water insoluble

33. What causes nutmeg liver
Osmotic
Failure of the processus vagainlis to close
Backup of blood into the liver - RHF - budd chiari
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

34. What is the arterial supply and venous drainage below pectinate line
Obstruction of the common bile duct
Primary sclerosing cholangitis
Cholesterol - 10-20% opaque due to calcifications
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

35. What intervention will intervention will relieve portal HTN
Inc risk of CRC and other visceral malignancies
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
L/R renal artery around L1

36. How many layers of spermatic fascia are covers an indirect inguinal hernia
Peutz jeghers
Ampulla of vater
...
All 3

37. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Meconium ileus
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Primary sclerosing cholangitis

38. What is the omphalomesenteric cyst
Above
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Cystic dilation of the viteline duct

39. What kind of muscle is in the lower 1/3 of the esophagus
Smooth
Closer to isotonic because of less time to reabsorb NaCl
Gallbladder
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

40. With caput medusaw - between what vessels is the anastomoses and Where is it
Menetriers disease
Paraumbilical and superficial and inferior epigastric - umbilicus
Backup of blood into the liver - RHF - budd chiari
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

41. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

42. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Complications of UC
Increase tumorigenesis
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
PAS- positive globules in liver -

43. What are esophageal strictures associated with
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Dissaccharidase def - most commonly lactase
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Lye ingestion and acid reflux

44. What happens to the short gastics if the splenic artery is blocked
Poor anastamoses
FAP
Dubin johnson
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

45. Who gets Whipple disease and How do they present
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Old men - arthralgias - cardiac and neuro sx
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Alcoholic hepatitis

46. What is the frequency of basal electric rhythm in the duodenum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
12 waves/min

47. What is biliary colic
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Pertechnetate - study for uptake

48. What kind of muscle is in the middle 1/3 of esophagus
The jejunum
Striated and smooth
Intussusception
Cirrhosis

49. What are the hindgut structures and what supplies their blood and PANS innvervation
The submucosal nerve plexus - meissner's
90%
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Stimulate the H/K ATPase

50. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Colonic polyps
Alk phos
Barrett's esophagus
CHF and inc risk of HCC