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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. What does loss of APC cause
Uridine glucuronyl transferase
Mucosa - submucosa - muscularis externa - serosa/adventitia
Primary sclerosing cholangitis
Decreased intercellular adhesion and increased proliferation

2. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Above
Oligosaccharide digestion
Pancreatic head causing obstructive jaundice

3. What are the complications of duodenal PUD
Epithelium
Terminal ileum and colon
Bleeding - penetration into pancreas - perforation - obstruction
Duodenal atresia - Downs

4. conjugated hyperbilirubinemia due to defective liver excretion
HSV-1 - CMV - Candida
Dubin johnson
Duodenal atresia - Downs
Lye ingestion and acid reflux

5. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Necrotizing enterocolitis
Causes of gall stones
Left gastric vein and esophogeal vein - esophagus
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

6. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Krukenbergs tumor
Necrotizing enterocolitis
Lipase
Enterokinase/enteropeptidase from the duodenal mucosa

7. What is the most common esophageal cancer worldwide and in the US
Urobilin
Worldwide - SC - US - adeno
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

8. Gallstones that reach the common channel at ampulla can block which two ducts
True and most common congenital anomoly of GI tract
Pancreatic and bile
All 3 gut layers outpouch as in Meckels
Urobilin

9. What is the other name for GIP (gastric inhibitory peptide)
Stimulate intestinal persistalsis
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Hydrocele
Glucose dependent insulinotropic peptide

10. What happens to the short gastics if the splenic artery is blocked
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Left gastric vein and esophogeal vein - esophagus
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Poor anastamoses

11. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
External spermatic fascia only
L1
GERD - may also present with nocturnal cough and dyspnea
EtOH

12. What other condition can lead to acute gastritis - think renal
Elevated amylase - and lipase
Obstruction of the common bile duct
Uremia
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

13. What percentage of gall stones are cholesterol stones and What are the associations
Common hepatic - splenic - left gastric - main blood supply for stomach
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
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
Chronic gastritis and pernicious anemia

14. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
Muscularis mucosae
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

15. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lactase is located at the tips of intestinal villi
Left and right gastroepiploics - left and right gastrics
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Crohns = noncaseating granulomas - UC = crypt abscesses

16. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
L2

17. What is the mechanism for reyes syndrome
L2
Angiodysplasia
HSV-1 - CMV - Candida
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

18. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Adhesion
Glucouronate - water soluble (direct)
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

19. What makes a true diverticula
True and most common congenital anomoly of GI tract
All 3 gut layers outpouch as in Meckels
Alcoholic cirrhosis
L3

20. Transmural esophageal rupture due to violent retching

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21. secretin - source - action - regulation
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
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

22. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Fasting and stress
Dissaccharidase def - most commonly lactase
Alpha1 antitrypsin def - codominant trait
Gamma glutamyl transferase GGT

23. What are the four Fs of gallstones
Conj - inc - dec
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Female - fat - fertile - forty
Warthins' tumor

24. In what scenarios do pts with gilberts have inc bili
Diverticulum
Skip lesions =crohns - colon = UC
Fasting and stress
Bleeding - penetration into pancreas - perforation - obstruction

25. In PUD - with gastric ulcers - does pain inc or dec with meals?
Inc - weight loss
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Gilbert's
Inspiratory arrest on deep palpation due to pain

26. What are the histological findings in the duodenum

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27. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Chronic gastritis and pernicious anemia

28. What are the treatment options for uclerative colitis
Pleomorphic adenoma
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Closer to isotonic because of less time to reabsorb NaCl
Unconj - absent (acholuria) - inc

29. most common non - neoplastic polyp in colon
Via the middle colic
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Hyperplastic
Below

30. What are the foregut structures and what supplies their blood and PANS innvervation
Necrotizing enterocolitis
US and cholecystectomy
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
External spermatic fascia only

31. What is the prognosis of adenocarcinoma
IBS at least 2 with recurrent abdominal pain
Obstruction of the common bile duct
Averages 6 months - very aggressive - usually already metastasized at presentation
Neural muscarinic pathways

32. What are the complications of Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Zollinger Ellison - phenylalanine and tryptophan
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Antrum - H.pylori - inc risk of MALT lymphoma

33. What does bicab do in the mouth
Pertechnetate - study for uptake
Skip lesions =crohns - colon = UC
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Neutralizes oral bacertial acids and maintains dental health

34. How do NSAIDs cause acute gastritis
Crohns = maybe - UC= always
Angiodysplasia
Dec PGE2 leading to dec gastric mucosa protection
Pancreatic and bile

35. likely infectious form of malabsorption - responds to antibiotics
Stimulate intestinal persistalsis
Mucosa - submucosa - muscularis externa - serosa/adventitia
Hemolytic anemia
Tropical sprue

36. Why does indirect inguinal hernia happen in infacnts
Alk phos
Duodenum - 2nd - 3rd and 4th parts
Inc - weight loss
Failure of the processus vagainlis to close

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

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38. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
Hirschsprungs
Chagas disease
Ampulla of vater

39. trypsinogen is converted to trypsin via what enzyme
Pleuroperitoneal
90%
Enterokinase/enteropeptidase from the duodenal mucosa
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

40. In PUD with a duodenal ulcer does pain inc or dec with meals
Dilated esophagus with an area of distal stenosis - birds beak
Necrotizing enterocolitis
Decrease - weight gain
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

41. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
L3
Peyers patches
Reye's syndrome
Alcoholic cirrhosis

42. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Redness and tenderness on palpation of extremities
With albumin
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
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

43. What layer in the mucosa is repsonsible for motility
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Lamina propora and submucosa
Alk phos
Muscularis mucosae

44. How are all 3 monosaccharides transported to the blood
Portal HTN
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Striated and smooth
GLUT 2

45. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Reye's syndrome
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
HPNCC

46. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
FAP
Hyperplastic
Antrum - H.pylori - inc risk of MALT lymphoma

47. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Zollinger ellison - brunners glands

48. Where does copper accumulate in Wilsons and What are ABCD
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Turcot
Decrease - weight gain

49. What is contained in the gastrosplenic and What areas does it separate
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Short gastrics - left greater and lesser
Inc risk of CRC and other visceral malignancies
Complications of UC

50. What kind of lesions are characteristic of duodenal PUD vs cancer
True and most common congenital anomoly of GI tract
Stimulate the H/K ATPase
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Punched out - clean margins - carcinoma =raised irregular margins