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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. absent UDPGT - presents early in life - early mortality
Phenobarbital - inc liver enzyme synthesis
Zollinger ellison - brunners glands
Crigler - najjar type 1
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

2. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
The entire
Redness and tenderness on palpation of extremities
Oligosaccharide digestion

3. Where does type B chronic gastritis occur and What causes it
HSV-1 - CMV - Candida
Low pressure proximal to LES
Antrum - H.pylori - inc risk of MALT lymphoma
Striated

4. What drug blocks the H2R
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Cimetidine
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
AR

5. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Colonic polyps
Mucoepidermoid carcinoma

6. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Hepatic steatosis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Conj/unconj - inc - nl to dec
IgA secreting plasma cells - ultimately reside in the lamina proporia

7. Where is IgA shuttled
Diverticulum
Common hepatic - splenic - left gastric - main blood supply for stomach
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

8. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Neural muscarinic pathways
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Copious diarrhea - non alpha - non beta cell pancreatic tumor

9. conjugated hyperbilirubinemia due to defective liver excretion
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Dubin johnson
Below
Averages 6 months - very aggressive - usually already metastasized at presentation

10. What congenital birth defect is associated with Hirschsprung
Lipase
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Diverticulum
Downs

11. What factors increase risk of malignancy of adenomatous polyps
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Omeprazole
FAP
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

12. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Duodenal atresia - Downs
Celiac sprue
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

13. What does autoimmune destruction of parietal cells lead to...
Gastric glands
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Chronic gastritis and pernicious anemia
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

14. Liver cell failure can lead to multisystem signs including
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Crohns = noncaseating granulomas - UC = crypt abscesses
PAS- positive globules in liver -
Dysphagia (due to esophageal web) - glossitis - iron def anemia

15. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
FAP
Myenteric nerve plexus - aurbach
Cigarettes and chronic pancreatitis - not EtOH
GLUT 2

16. What serum enzyme is elevated inacute pancreatitis
Via the superior pancreaticduodenal
Adhesion
Lipase
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

17. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Hypercoaguability - polycythemia vera - pregnancy - HCC
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
In the mucus that covers the gastric epithelium
Superior rectal

18. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Juvenille polyps - no risk if single
Muscularis mucosae
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
Causes of gall stones

19. What are the longterm sequelae of nutmeg liver
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
HPNCC
Centrilobular congestion and necrosis - cardiac cirrhosis

20. What cells secrete bicarb - What does it do - and what regulates it
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
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

21. What are the two molecular pathways that lead to CRC
Zollinger Ellison - phenylalanine and tryptophan
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Normal
MSI (15%) and APC/beta catenin chromosomal instability (85%)

22. why infxn is implicated in duodenal PUD
Gardner's syndrome
H pylori (almost 100%)
GLUT 2
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

23. What are the signs of peutz jehgers
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Oligosaccharide digestion
Hyperpigmented mouth - lips - hands - genitalia
PAS- positive globules in liver -

24. What does the splenorenal ligament connect - and What does it contain
Colovesical leading to pneumaturia
Diverticulum
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Spleen to posterior abdominal wall - splenic artery and vein

25. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
3 waves/min
Menetriers disease
Left and right gastroepiploics - left and right gastrics
Duodenal atresia - Downs

26. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Alpha1 antitrypsin def - codominant trait
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

27. What transforms conjugated bilirubin to urobilinogen
Conj/unconj - inc - nl to dec
Left gastric vein and esophogeal vein - esophagus
Gut bacteria
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

28. What is the main symptom if a VIPoma
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Gamma glutamyl transferase GGT
Old men - arthralgias - cardiac and neuro sx

29. At what spinal level does the SMA exit
True and most common congenital anomoly of GI tract
Alcoholic hepatitis
L1
Left and right gastroepiploics - left and right gastrics

30. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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31. bilateral mets to ovaries with abundant mucus - signet ring cells
The proximal small bowel
Neutralizes oral bacertial acids and maintains dental health
Krukenbergs tumor
Sister mary joseph nodule

32. What portion of the bowel does sprue effect
Penicillinamine - AR inheritance
AST >ALT - ration is usually 1.5
The proximal small bowel
Centrilobular leading to congestive liver disease

33. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
So hypertrophied they look like brain gyri
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Bleeding - intussusception - volvulus - obstruction near terminal ileum

34. How is salivary secretion stimulated
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Centrilobular leading to congestive liver disease
IgA secreting plasma cells - ultimately reside in the lamina proporia
The entire

35. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis

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36. What is the risk with peutz jehgers
Alcoholic cirrhosis
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
Smooth
Inc risk of CRC and other visceral malignancies

37. What are the structures of the femoral triangle and how are they organized
NAV = nerve artery vein - venous near the penis (NAVEL)
Increase tumorigenesis
Mucoepidermoid carcinoma
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

38. What gives stool its characteristic color
Splenic flexure
Increase tumorigenesis
Stercobilin
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

39. What histological findings are present in the esophagus
Nonkeritinized stratified sqamous epithelium
Hyperplastic
Fasting and stress
AST>ALT

40. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Low pressure proximal to LES
Juvenile polyposis syndrome - inc risk of adenocarcinoma
EtOH
Carcinoid syndrome

41. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Conj/unconj - inc - nl to dec
Redness and tenderness on palpation of extremities
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Pancreatic head causing obstructive jaundice

42. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Intussusception
Hydrocele
Alcoholic cirrhosis
Pancreatic head causing obstructive jaundice

43. What is one potential precipitating factor for intussusception
All 3 gut layers outpouch as in Meckels
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Gardner's syndrome
Jewish and African American men

44. What is the HLA association and treatment for hemochromatosis
Repeated phlebotomy - deferoxamine - HLA- A3
Diverticulitis in elderly - ectopic pregs use hCG to rule out
...
Gastric glands

45. In viral hepatitis - which liver enzyme is higher
Hirschsprungs
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
ALT>AST

46. What does a low flow rate mean for saliva
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Hypotonic because of more time to reabsorb NaCl
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Adhesion

47. Where and How is iron absorbed
Fe2+ in the duod
CHF and inc risk of HCC
Redness and tenderness on palpation of extremities
Inc lower esphogeal tone leading to achalasia

48. somatostatin - source - action - regulation
Uridine glucuronyl transferase
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
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

49. What does a gastrinoma cause
Cystic dilation of the viteline duct
Epigastric abdominal pain radiating to back - anorexia - nausea
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Chronic gastritis and pernicious anemia

50. What are the complications of Meckels
External spermatic fascia only
Barrett's esophagus
Bleeding - intussusception - volvulus - obstruction near terminal ileum
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