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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. Malabsorption syndromes have what common clinical presentation
Lipase
Esophageal cancer
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Diarrhea - steatorrhea - weight loss - weakness

2. What structures feed into the cystic duct
Gallbladder
Crohns = maybe - UC= always
Gastrohepatic ligament
Pertechnetate - study for uptake

3. What are the extraintestinal manifestations of ulcerative colitis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Increase tumorigenesis
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Pyoderma gangrenosum - primary sclerosing cholangitis

4. What are the complications of acute pancreatitis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
...
Diverticulitis in elderly - ectopic pregs use hCG to rule out

5. Where is B12 absorbed
Phototherapy
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
In the ileum with bile acids - requires IF
Stimulate intestinal persistalsis

6. 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
All 3 gut layers outpouch as in Meckels
Oral glucose
Old men - arthralgias - cardiac and neuro sx

7. What drug inhibits the H/K ATPase
Budd chiari syndrome
Omeprazole
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Positive urease test

8. What serum enzyme is elevated in acute pancreatitis and mumps
Backup of blood into the liver - RHF - budd chiari
Chagas disease
US and cholecystectomy
Amylase

9. What causes nutmeg liver
Lamina propria
The proximal small bowel
Mucoepidermoid carcinoma
Backup of blood into the liver - RHF - budd chiari

10. What is the HLA association and treatment for hemochromatosis
IBS at least 2 with recurrent abdominal pain
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Repeated phlebotomy - deferoxamine - HLA- A3
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

11. When and How does Abetalipoproteinemia present
The submucosal nerve plexus - meissner's
Phenobarbital - inc liver enzyme synthesis
Early childhood - neuro sx and malabsorption
Ampulla of vater

12. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Hirschsprungs
Adhesion
Zollinger ellison - brunners glands
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

13. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Duodenal atresia - Downs
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Female - fat - fertile - forty

14. what kind of muscle is in the upper 1/3 of esophagus
PAS- positive globules in liver -
CCK8 receptor - Gq inc IP3/Ca
Striated
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

15. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

16. What do you treat Wilsons disease with and What is the inheritance
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Penicillinamine - AR inheritance
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

17. What does bicarb do in the duodenum
Closer to isotonic because of less time to reabsorb NaCl
Superior rectal
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Neutralizes gastric acid allowing pancreatic enzymes to fxn

18. What is the other name for GIP (gastric inhibitory peptide)
CHF and inc risk of HCC
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Glucose dependent insulinotropic peptide
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

19. Which viral infxns/treatments are associated with reyes syndrome
Neutralizes gastric acid allowing pancreatic enzymes to fxn
VZV and influenza B treated with salicylates
Primarly through ECL leading to histamine release
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

20. At what level do the testicular/ovarian arteries exit the aorta
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Diarrhea - steatorrhea - weight loss - weakness
Cystic duct and common hepatic duct
L2

21. Bile is critical for exrection of what substance
Cholesterol
Elevated amylase - and lipase
The submucosal nerve plexus - meissner's
Jewish and African American men

22. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Poor anastamoses

23. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
L/R renal artery around L1
Gilbert's
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Zenkers - halitosis - dysphagia and obstruction

24. What kind of diarrhea is produced from a disaccharide def
Osmotic
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Redness and tenderness on palpation of extremities

25. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Hemolytic anemia
Duodenal atresia - Downs
2ndary biliary cirrhosis
FAP

26. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Dec PGE2 leading to dec gastric mucosa protection
Boerhaave's Syndrome - Been heaving syndrome
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

27. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Copious diarrhea - non alpha - non beta cell pancreatic tumor
True and most common congenital anomoly of GI tract
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Lye ingestion and acid reflux

28. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
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
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Left and right gastroepiploics - left and right gastrics

29. What do the rugae of stomach look like in menetriers disease
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
So hypertrophied they look like brain gyri
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
Copious diarrhea - non alpha - non beta cell pancreatic tumor

30. What causes hirschsprungs
Zollinger ellison - brunners glands
Failure of neural crest migration
Hypotonic because of more time to reabsorb NaCl
Alpha amylase

31. With caput medusaw - between what vessels is the anastomoses and Where is it
Terminal ileum and colon
Inc lower esphogeal tone leading to achalasia
Black - rotors syndrome
Paraumbilical and superficial and inferior epigastric - umbilicus

32. How does gastrin increase acid secretion?
Hernia
L4
Primarly through ECL leading to histamine release
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

33. 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
IBS at least 2 with recurrent abdominal pain
Inc risk of CRC and other visceral malignancies
Inferior rectal nerve

34. What is the frequency of basal electric rhythm of the ilieum
Sphincter of oddi
8-9 waves/min
The entire
Failure of the processus vagainlis to close

35. What arteries exit just below the SMA
L/R renal artery around L1
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Falciform - ligamentum teres - fetal umbilical vein

36. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Enterokinase/enteropeptidase from the duodenal mucosa
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
IBS at least 2 with recurrent abdominal pain
Meconium ileus

37. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Reye's syndrome

38. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Esophageal carcinoma
Diverticulum
Duodenal atresia - Downs
Dysphagia (due to esophageal web) - glossitis - iron def anemia

39. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Above
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Budd chiari syndrome

40. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Hemosiderosis - hemochromatosis
Redundant mesentary

41. Why are most diverticula considered false
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Mallory bodies
Lack or have an attenuated muscularis externa - often in the sigmoid colon

42. 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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43. why infxn is implicated in duodenal PUD
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
H pylori (almost 100%)
Fasting and stress
Parietal cells in the stomach - B12 binding protein

44. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
Inc - weight loss
Budd chiari syndrome
Dilated esophagus with an area of distal stenosis - birds beak

45. What is biliary colic
Colonic polyps
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Paraumbilical and superficial and inferior epigastric - umbilicus
Acute pancreatitis

46. What does histo show for alpha1 antitrypsin def
AST >ALT - ration is usually 1.5
Urobilin
PAS- positive globules in liver -
Positive urease test

47. What type of insults result in micronodular cirrhosis
Inc conj bilirubin - inc cholesterol - inc alk phos
True and most common congenital anomoly of GI tract
Phototherapy
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

48. In what scenarios do pts with gilberts have inc bili
Fasting and stress
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
GERD - may also present with nocturnal cough and dyspnea
Duodenum - 2nd - 3rd and 4th parts

49. People of what decent are associated with celiac sprue and what findings/antibodies are present
Splenic flexure
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Via the superior pancreaticduodenal
Necrotizing enterocolitis

50. likely infectious form of malabsorption - responds to antibiotics
Amylase
Tropical sprue
PAS- positive globules in liver -
Hypotonic because of more time to reabsorb NaCl