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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. milk intolerance
Dissaccharidase def - most commonly lactase
Left and right gastroepiploics - left and right gastrics
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Smooth

2. What are the complications of duodenal PUD
Elevated amylase - and lipase
Pancreatic head causing obstructive jaundice
Bleeding - penetration into pancreas - perforation - obstruction
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

3. What does high flow rate mean
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Centrilobular congestion and necrosis - cardiac cirrhosis
Closer to isotonic because of less time to reabsorb NaCl
Antrum - H.pylori - inc risk of MALT lymphoma

4. At what spinal level does the celiac trunk exit
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Lipase - phospholipase A - colipase
Internal thoracic to superior epigastric to inferior epigastric
T12

5. secretin - source - action - regulation
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
PAS- positive globules in liver -
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
90%

6. What is one potential precipitating factor for intussusception
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Lateral
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
Cirrhosis

7. Where does copper accumulate in Wilsons and What are ABCD
Sister mary joseph nodule
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Inferior rectal nerve
Juvenile polyposis syndrome - inc risk of adenocarcinoma

8. Where is the deep inguinal ring relative to the inferior epigastric vessels
Stimulate the H/K ATPase
Positive
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
Lateral

9. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
Duodenum - 2nd - 3rd and 4th parts
No
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

10. What cells make pepsin - What does it do - and what regulates it
Alpha1 antitrypsin def - codominant trait
Meconium ileus
In the mucus that covers the gastric epithelium
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

11. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Hepatic steatosis
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Dysphagia (due to esophageal web) - glossitis - iron def anemia

12. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Meconium ileus
AR

13. Which is used more quickly - an oral glucose load - or that by IV
Lye ingestion and acid reflux
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Oral glucose
Cimetidine

14. What causes nutmeg liver
Oral glucose
Epithelium
Backup of blood into the liver - RHF - budd chiari
The proximal small bowel

15. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Hemosiderosis - hemochromatosis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Stercobilin
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

16. What does loss of APC cause
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Decreased intercellular adhesion and increased proliferation
Via the middle colic
Meconium ileus

17. What gives urine its characteristic color
Urobilin
Nonkeritinized stratified sqamous epithelium
Averages 6 months - very aggressive - usually already metastasized at presentation
NAV = nerve artery vein - venous near the penis (NAVEL)

18. What is the prognosis of adenocarcinoma
Cimetidine
Averages 6 months - very aggressive - usually already metastasized at presentation
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Colovesical leading to pneumaturia

19. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Copious diarrhea - non alpha - non beta cell pancreatic tumor
HSV-1 - CMV - Candida
The proximal small bowel
Causes of gall stones

20. What enzyme is necessary to create conjugated bilirubin
Erosive - disruption of mucosal barrier leading to inflammation
Positive
Gamma glutamyl transferase GGT
Uridine glucuronyl transferase

21. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Backup of blood into the liver - RHF - budd chiari
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Striated and smooth
Lactase is located at the tips of intestinal villi

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

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23. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Mucoepidermoid carcinoma
Pancreatic head causing obstructive jaundice
Adhesion

24. likely infectious form of malabsorption - responds to antibiotics
Internal thoracic to superior epigastric to inferior epigastric
External spermatic fascia only
Tropical sprue
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

25. what kind of fistula is associated with diverticulitis
Black - rotors syndrome
Colovesical leading to pneumaturia
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

26. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
The gastroduodenal
Cirrhosis
Conj/unconj - inc - nl to dec
Krukenbergs tumor

27. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Epigastric abdominal pain radiating to back - anorexia - nausea
Epithelium
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Left gastric vein and esophogeal vein - esophagus

28. What kind of lesions are characteristic of duodenal PUD vs cancer
AR
L4
Punched out - clean margins - carcinoma =raised irregular margins
Alk phos

29. What is the cause of physiologic neonatal jaundice
Gilbert's
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Colovesical leading to pneumaturia
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

30. What are the effects of atropine on parietal cells and G cells
Lamina propora and submucosa
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Juvenille polyps - no risk if single
Portal HTN

31. Where and How is iron absorbed
Inc risk of CRC and other visceral malignancies
Fe2+ in the duod
Warthins' tumor
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

32. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Hypotonic because of more time to reabsorb NaCl
Sister mary joseph nodule
Chronic calcifying pancreatitis - inc risk of panreatic cancer

33. Achalasia increases the risk For what complication
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
PAS- positive globules in liver -
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Esophageal carcinoma

34. What makes a true diverticula
AST >ALT - ration is usually 1.5
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
All 3 gut layers outpouch as in Meckels
Serous on the sides parotids - mucinous in the middle sublingual

35. How do villi appear in disaccharidease def
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Normal
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

36. What histological findings are present in the esophagus
Small intestine
M3 - Gq - inc IP3/Ca
Nonkeritinized stratified sqamous epithelium
Spleen to posterior abdominal wall - splenic artery and vein

37. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Squamous - upper 1/3 - adeno - lower 1/3
Pancreatic head causing obstructive jaundice
AR
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

38. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
2ndary biliary cirrhosis
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

39. What are the two molecular pathways that lead to CRC
Heme metabolism
MSI (15%) and APC/beta catenin chromosomal instability (85%)
With albumin
Crohns = maybe - UC= always

40. What are the labs in acute pancreatitis
Crohns = noncaseating granulomas - UC = crypt abscesses
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Elevated amylase - and lipase
Striated

41. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Paraumbilical and superficial and inferior epigastric - umbilicus
Goes through deep inguinal ring - external inguinal ring and into the scrotum

42. What is indirect bilirubin
Unconjugated - water insoluble
T12
Hypotonic because of more time to reabsorb NaCl
AST

43. What kind of cancer to celiac sprue put you as inc risk for
Short gastrics - left greater and lesser
T cell lymphoma
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
IBS at least 2 with recurrent abdominal pain

44. What does loss of p53 cause
Increase tumorigenesis
Inc conj bilirubin - inc cholesterol - inc alk phos
Hemolytic anemia
No - chronic - can present with diarrhea or constipation or alternation - treat sx

45. What do the rugae of stomach look like in menetriers disease
So hypertrophied they look like brain gyri
Black - rotors syndrome
Ceruplasmin
Acute pancreatitis

46. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Above
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Falciform - ligamentum teres - fetal umbilical vein
Juvenille polyps - no risk if single

47. What is contained within the muscularis externa
Averages 6 months - very aggressive - usually already metastasized at presentation
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Myenteric nerve plexus - aurbach
Necrotizing enterocolitis

48. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Bleeding - intussusception - volvulus - obstruction near terminal ileum
PAS- positive globules in liver -
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

49. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Parietal cells in the stomach - B12 binding protein
Primarly through ECL leading to histamine release
Complications of crohns
Muscularis mucosae

50. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Colonic polyps
Omeprazole
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Hypercoaguability - polycythemia vera - pregnancy - HCC