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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. crigler - najjar type II responds to which therapy and How does it work
Poor anastamoses
Boerhaave's Syndrome - Been heaving syndrome
Phenobarbital - inc liver enzyme synthesis
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

2. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Primary sclerosing cholangitis
IgA secreting plasma cells - ultimately reside in the lamina proporia
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

3. What are the histological findings in the ileum

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4. 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
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Striated and smooth
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

5. How is salivary secretion stimulated
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Mallory bodies
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

6. How many layers of spermatic fascia are covers an indirect inguinal hernia
All 3
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
CHF and inc risk of HCC
Redundant mesentary

7. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Meckels
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

8. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Worldwide - SC - US - adeno
HSV-1 - CMV - Candida
Cholesterol - 10-20% opaque due to calcifications
Duodenum - 2nd - 3rd and 4th parts

9. What serum enzyme is elevated inacute pancreatitis
Lipase
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Left and right gastroepiploics - left and right gastrics

10. With internal hemorrhoids Where is the anastomoses and Where is it
Complications of UC
Superior rectal and middle and inferior rectal - rectum
Glucose dependent insulinotropic peptide
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

11. Which kind of hemorrhoids are painful and why
Spleen to posterior abdominal wall - splenic artery and vein
No
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Left and right gastroepiploics - left and right gastrics

12. What do you use to diagnose meckels
Pertechnetate - study for uptake
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Failure of the processus vagainlis to close
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

13. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Necrotizing enterocolitis
Normal
Right and left hepatic duct

14. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Centrilobular leading to congestive liver disease
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

15. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Lipase
IBS at least 2 with recurrent abdominal pain
8-9 waves/min

16. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Hemolytic anemia
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

17. What is the action of NO as a GI hormone
Decreased intercellular adhesion and increased proliferation
Inc smooth muscle relaxation - including lower esophageal sphincter
L4
Lye ingestion and acid reflux

18. In alchoholic hepatitis which liver enzyme is higher
Smooth
Brush border of intestine - produce monosaccharides from oligo and di
Crypts but not villi
AST>ALT

19. What can fistula between the gallbladder and small intestine create and how can you tell
Urobilin
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
H+

20. What makes a true diverticula
Duodenum - 2nd - 3rd and 4th parts
All 3 gut layers outpouch as in Meckels
3 waves/min
T12

21. Where and How is iron absorbed
L3
Fasting and stress
Fe2+ in the duod
Downs

22. What carcinogens are associated with HCC
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
The submucosal nerve plexus - meissner's
Alfatoxin in peanuts
Where hindgut meets ectoderm

23. What does TOASTED with alcoholic hepatitis stand for
CHF and inc risk of HCC
AST >ALT - ration is usually 1.5
Uremia
Unconj - absent (acholuria) - inc

24. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Falciform - ligamentum teres - fetal umbilical vein
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Trypsin - chymotrypsin - elastase - carboxypeptidases
Muscularis mucosae

25. What are the histological findings in the duodenum

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26. What enzyme is necessary to create conjugated bilirubin
Superior rectal
Uridine glucuronyl transferase
Portal HTN
8-9 waves/min

27. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
HSV-1 - CMV - Candida
Cirrhosis
8-9 waves/min
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

28. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Lipase
3 waves/min
Esophageal cancer
Mitochondrial abnl - fatty liver - hypoglycemia - coma

29. Is there any structural abnl with IBS - What is the course of disease and presentation
IBS at least 2 with recurrent abdominal pain
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
No - chronic - can present with diarrhea or constipation or alternation - treat sx
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

30. Where is IgA shuttled
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Redness and tenderness on palpation of extremities
Portal HTN
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

31. in carcinoid tumors - What is seen on EM
Dense core bodies
AST >ALT - ration is usually 1.5
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Cirrhosis

32. What layer in the mucosa is responsible for absorption
Decreased intercellular adhesion and increased proliferation
Epithelium
Pyoderma gangrenosum - primary sclerosing cholangitis
Short gastrics - left greater and lesser

33. most common non - neoplastic polyp in colon
Right and left hepatic duct
Hyperplastic
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Stercobilin

34. Dysphagia in achalasia results from
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Liver metabolizes 5HT
Glucose dependent insulinotropic peptide
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

35. What structure is Not contained in the femoral sheath
Juvenille polyps - no risk if single
Centrilobular congestion and necrosis - cardiac cirrhosis
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Conj/unconj - inc - nl to dec

36. Acute gastritis is caused By what process
Phenobarbital - inc liver enzyme synthesis
AR
Erosive - disruption of mucosal barrier leading to inflammation
Budd chiari syndrome

37. How do you DX and TX gallstones
Ampulla of vater
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
HSV-1 - CMV - Candida
US and cholecystectomy

38. What are the effects of atropine on parietal cells and G cells
Parietal cells in the stomach - B12 binding protein
Spleen to posterior abdominal wall - splenic artery and vein
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

39. To what substance is bilirubin conjugated and why
Hemolytic anemia
Glucouronate - water soluble (direct)
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Complications of UC

40. What do mucins do?
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Low pressure proximal to LES
Lubricate food (glycoprotiens)
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

41. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
CEA - CA-19-9
HPNCC
Myenteric nerve plexus - aurbach
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

42. concentric onion skin bile duct fibrosis
Primary sclerosing cholangitis
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
PAS- positive globules in liver -
Juvenile polyposis syndrome - inc risk of adenocarcinoma

43. What is the frequency of basal electric rhythm in the duodenum
Low pressure proximal to LES
12 waves/min
Glucose dependent insulinotropic peptide
The submucosal nerve plexus - meissner's

44. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Brunners
Antrum - H.pylori - inc risk of MALT lymphoma
Juvenille polyps - no risk if single
NAV = nerve artery vein - venous near the penis (NAVEL)

45. What kind of pancreatitis is associated with EtOH and smoking
Cystic dilation of the viteline duct
US and cholecystectomy
Chronic calcifying pancreatitis - inc risk of panreatic cancer
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

46. Gq and inc cAMP both work to do what in parietal cells
Lipase
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Mucosa - submucosa - muscularis externa - serosa/adventitia
Stimulate the H/K ATPase

47. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Centrilobular congestion and necrosis - cardiac cirrhosis
Neural muscarinic pathways
Carcinoid syndrome
Tropical sprue

48. In what clinical scenarior do you see portosystemic anastomoses
Portal HTN
Mallory bodies
Positive urease test
In the ileum with bile acids - requires IF

49. What is the leading cause of bowel incarceration
Femoral hernia
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Nonkeritinized stratified sqamous epithelium
Budd chiari syndrome

50. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
The jejunum
Short gastrics - left greater and lesser
Crigler - najjar type 1