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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. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

2. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Uridine glucuronyl transferase
Inc smooth muscle relaxation - including lower esophageal sphincter
Alk pho

3. What is the characteristic histo finding in alcoholic hepatitis
Alpha1 antitrypsin def - codominant trait
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Mallory bodies
Budd chiari syndrome

4. What are the layers of the gut wall from inside out
Mucosa - submucosa - muscularis externa - serosa/adventitia
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Phototherapy
Crigler - najjar type 1

5. What kind of diarrhea is produced from a disaccharide def
AR
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Can lead to hematemesis - found in EtOHics and bulimics
Osmotic

6. What are the results of hemochromatosis
...
Amylase
In the ileum with bile acids - requires IF
CHF and inc risk of HCC

7. What are the extraintestinal manifestations of ulcerative colitis
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Pyoderma gangrenosum - primary sclerosing cholangitis
Brush border of intestine - produce monosaccharides from oligo and di
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

8. Which IBD is autoimmune and which may be a disordered response to bacteria
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Dec PGE2 leading to dec gastric mucosa protection
Diverticulitis in elderly - ectopic pregs use hCG to rule out

9. How does abetalipoproteinemia lead to malabsorption
Around the central vein (zone III)
T cell lymphoma
Gastrohepatic ligament
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

10. What does a low flow rate mean for saliva
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Hypotonic because of more time to reabsorb NaCl
Peyers patches

11. What is the main symptom if a VIPoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Normal
GERD - may also present with nocturnal cough and dyspnea
L1

12. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Lipase - phospholipase A - colipase
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
Omeprazole

13. Where and How is iron absorbed
AST
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Fe2+ in the duod
Hypercoaguability - polycythemia vera - pregnancy - HCC

14. Where is the deep inguinal ring relative to the inferior epigastric vessels
GLUT 2
Unconj - absent (acholuria) - inc
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Lateral

15. Where are tumors commonly in pancreatic adenocarcinoma
Brunners
Oral glucose
Pancreatic head causing obstructive jaundice
Portal HTN

16. What are the tumor markers for pancreatic adenocarcinoma
PAS- positive globules in liver -
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Tropical sprue
CEA - CA-19-9

17. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Complications of crohns
Corticosteroids - infliximab
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

18. Where does crohns usually affect the GI tract
Fe2+ in the duod
Terminal ileum and colon
The proximal small bowel
Glucose dependent insulinotropic peptide

19. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
The gastroduodenal
Mucosa - submucosa - muscularis externa - serosa/adventitia

20. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Hirschsprungs
Lye ingestion and acid reflux
All 3 gut layers outpouch as in Meckels

21. What are the histological findings in the duodenum

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

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23. Where is the pectinate line
Pleuroperitoneal
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Inc - weight loss
Where hindgut meets ectoderm

24. What are the two molecular pathways that lead to CRC
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
Punched out - clean margins - carcinoma =raised irregular margins
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
MSI (15%) and APC/beta catenin chromosomal instability (85%)

25. What are the treatmet options for crohns
Esophageal carcinoma
Crohns = noncaseating granulomas - UC = crypt abscesses
Corticosteroids - infliximab
Phenobarbital - inc liver enzyme synthesis

26. What source of salivary secretion is the most serous and What is the most mucinous
Complications of UC
Boerhaave's Syndrome - Been heaving syndrome
Primarly through ECL leading to histamine release
Serous on the sides parotids - mucinous in the middle sublingual

27. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Spleen to posterior abdominal wall - splenic artery and vein
Zollinger Ellison - phenylalanine and tryptophan
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Early childhood - neuro sx and malabsorption

28. What does autoimmune destruction of parietal cells lead to...
Colonic polyps
Chronic gastritis and pernicious anemia
T cell lymphoma
Serous on the sides parotids - mucinous in the middle sublingual

29. What is the most common esophageal cancer worldwide and in the US
Glucose dependent insulinotropic peptide
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Inspiratory arrest on deep palpation due to pain
Worldwide - SC - US - adeno

30. How does hirschsprung present and appear on imaging
Striated
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Poor anastamoses
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

31. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Chronic gastritis and pernicious anemia
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Turcot

32. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Redness and tenderness on palpation of extremities
HSV-1 - CMV - Candida
Zollinger Ellison - phenylalanine and tryptophan
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

33. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Amylase
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Skip lesions =crohns - colon = UC
Gallbladder

34. Is there any structural abnl with IBS - What is the course of disease and presentation
Fasting and stress
No - chronic - can present with diarrhea or constipation or alternation - treat sx
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
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

35. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
NAV = nerve artery vein - venous near the penis (NAVEL)
Lye ingestion and acid reflux
Alcoholic cirrhosis
Skip lesions =crohns - colon = UC

36. What is the HLA association and treatment for hemochromatosis
Jaundice - fever - RUQ
Repeated phlebotomy - deferoxamine - HLA- A3
Gardner's syndrome
PAS- positive globules in liver -

37. What causes carcinoid syndrome amd What are the symptoms
Brunners
Left gastric vein and esophogeal vein - esophagus
Penicillinamine - AR inheritance
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

38. What are the four Fs of gallstones
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Adhesion
Female - fat - fertile - forty
Inferior rectal nerve

39. What is contained within the submucosa

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40. What does high flow rate mean
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Closer to isotonic because of less time to reabsorb NaCl
M3 - Gq - inc IP3/Ca
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

41. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Upregulated intracellular signal transduction
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

42. Why does indirect inguinal hernia happen in infacnts
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
L/R renal artery around L1
Failure of the processus vagainlis to close
...

43. How do villi appear in disaccharidease def
With albumin
Superior rectal
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Normal

44. What drug blocks the H2R
Cystic dilation of the viteline duct
8-9 waves/min
Cimetidine
Angiodysplasia

45. How do you DX and TX gallstones
Phenobarbital - inc liver enzyme synthesis
US and cholecystectomy
No
Brunners

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

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47. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Via the superior pancreaticduodenal
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
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

48. In PUD - with gastric ulcers - does pain inc or dec with meals?
Inc - weight loss
Cigarettes and chronic pancreatitis - not EtOH
Old men - arthralgias - cardiac and neuro sx
Penicillinamine - AR inheritance

49. B cells stimuated in the germinal centers of peyers patches differentiate into what?
IgA secreting plasma cells - ultimately reside in the lamina proporia
Adhesion
Cirrhosis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

50. What are the signs of peutz jehgers
Serous on the sides parotids - mucinous in the middle sublingual
L4
Hyperpigmented mouth - lips - hands - genitalia
Left and right gastroepiploics - left and right gastrics