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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 conditions are associated with budd chiari
Menetriers disease
Hypercoaguability - polycythemia vera - pregnancy - HCC
Primarly through ECL leading to histamine release
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

2. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Lye ingestion and acid reflux
FAP

3. How many layers of spermatic fascia are covers an indirect inguinal hernia
2ndary biliary cirrhosis
All 3
FAP
Falciform - ligamentum teres - fetal umbilical vein

4. Acute gastritis is caused By what process
Gardner's syndrome
Erosive - disruption of mucosal barrier leading to inflammation
Barrett's esophagus
GERD - may also present with nocturnal cough and dyspnea

5. What is the rule of 2s for meckels
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Gilbert's
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

6. What is Trousseau's sign
Oligosaccharide digestion
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
FAP
Redness and tenderness on palpation of extremities

7. What factors increase risk of malignancy of adenomatous polyps
Pyoderma gangrenosum - primary sclerosing cholangitis
Lipase
Diverticulum
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

8. What are the layers of the gut wall from inside out
Low pressure proximal to LES
...
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Mucosa - submucosa - muscularis externa - serosa/adventitia

9. Where are carcinoid tumors most commonly malignant
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Small intestine
Centrilobular leading to congestive liver disease
IBS at least 2 with recurrent abdominal pain

10. What makes a true diverticula
Duodenal atresia - Downs
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
The submucosal nerve plexus - meissner's
All 3 gut layers outpouch as in Meckels

11. HCC is associated with what other conditions
8-9 waves/min
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Cystic duct and common hepatic duct

12. What causes primary biliary cirrhosis
Hernia
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Dissaccharidase def - most commonly lactase
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

13. How do you DX and TX gallstones
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
US and cholecystectomy
Pleuroperitoneal
Glucouronate - water soluble (direct)

14. What are the complications of duodenal PUD
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Virchow's node
Duodenal atresia - Downs
Bleeding - penetration into pancreas - perforation - obstruction

15. What are the results of hemochromatosis
Terminal ileum and colon
CHF and inc risk of HCC
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Heme metabolism

16. What is the triad of Plummer - Vinson syndrome
IBS at least 2 with recurrent abdominal pain
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Antrum - H.pylori - inc risk of MALT lymphoma
Superior rectal and middle and inferior rectal - rectum

17. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Internal thoracic to superior epigastric to inferior epigastric
Around the central vein (zone III)

18. What histological findings are present in the stomach
Urobilin
Crohns = noncaseating granulomas - UC = crypt abscesses
Gastric glands
Mitochondrial abnl - fatty liver - hypoglycemia - coma

19. What serum enzyme is decreased in wilsons disease
Ceruplasmin
FAP
Older patients
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

20. What serum enzyme is elevated inacute pancreatitis
Where hindgut meets ectoderm
AST >ALT - ration is usually 1.5
Cystic duct and common hepatic duct
Lipase

21. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Superior rectal
Brunners
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Phototherapy

22. secretin - source - action - regulation
Duodenum - 2nd - 3rd and 4th parts
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
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Colovesical leading to pneumaturia

23. What are the extraintestinal manifestations of crohns
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Corticosteroids - infliximab
The entire
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

24. rare - often fatal childhood hepatoencephalopathy

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25. What serum enzyme is elevated in acute pancreatitis and mumps
Primary sclerosing cholangitis
Jewish and African American men
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Amylase

26. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Liver metabolizes 5HT
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Striated and smooth

27. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Parietal cells in the stomach - B12 binding protein
In the ileum with bile acids - requires IF
H+
Conj - inc - dec

28. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Above
Mallory bodies
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Cholesterol - 10-20% opaque due to calcifications

29. What are the longterm sequelae of nutmeg liver
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Common hepatic - splenic - left gastric - main blood supply for stomach
Centrilobular congestion and necrosis - cardiac cirrhosis
Striated

30. What drug inhibits the H/K ATPase
Pertechnetate - study for uptake
Cholesterol - 10-20% opaque due to calcifications
Omeprazole
Gut bacteria

31. What carcinogens are associated with HCC
Bleeding - penetration into pancreas - perforation - obstruction
Unconj - absent (acholuria) - inc
Alfatoxin in peanuts
Jewish and African American men

32. motilin - source - action - regulation
Alcoholic hepatitis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Ischemic colitis

33. Who gets gastric ulcers
Older patients
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

34. What receptors does gastrin bind on the parietal cell and What does it activate
M3 - Gq - inc IP3/Ca
CCK8 receptor - Gq inc IP3/Ca
Lamina propria
H pylori (almost 100%)

35. What does a gastrinoma cause
Dense core bodies
Cholesterol - 10-20% opaque due to calcifications
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Common hepatic - splenic - left gastric - main blood supply for stomach

36. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Barrett's esophagus
True and most common congenital anomoly of GI tract

37. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Hyperplastic
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
T12
AR

38. What kind of diarrhea is produced from a disaccharide def
Appendicitis
Osmotic
So hypertrophied they look like brain gyri
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

39. What is the most common esophageal cancer worldwide and in the US
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Worldwide - SC - US - adeno
Lactase is located at the tips of intestinal villi
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

40. What receptors does ACH bind on the parietal cells and What does it activate
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Cholesterol - 10-20% opaque due to calcifications
M3 - Gq - inc IP3/Ca
Complications of UC

41. What does alpha amylase do and what inactivates it
Begins starch digestion - inactivated by low pH upon reaching the stomach
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

42. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Epithelium
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
The proximal small bowel

43. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Lye ingestion and acid reflux
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Carcinoid syndrome
Above

44. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Downs
Diverticulum
With albumin

45. What structures feed into the common bile duct
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Cystic duct and common hepatic duct
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

46. What does histo show for alpha1 antitrypsin def
Complications of crohns
PAS- positive globules in liver -
Oligosaccharide digestion
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

47. If the hemochromatosis is primary - What is the pattern of inheritance
Alcoholic hepatitis
Backup of blood into the liver - RHF - budd chiari
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
AR

48. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Portal HTN
Pertechnetate - study for uptake
Volvulus
Gardner's syndrome

49. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Juvenille polyps - no risk if single
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Hemosiderosis - hemochromatosis
Alk phos

50. What are the effects of atropine on parietal cells and G cells
Pleomorphic adenoma
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Squamous - upper 1/3 - adeno - lower 1/3