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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 pancreatic proteases are secreted as zymogens
Causes of gall stones
Trypsin - chymotrypsin - elastase - carboxypeptidases
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
L2

2. What is the omphalomesenteric cyst
CHF and inc risk of HCC
Cystic dilation of the viteline duct
Cimetidine
The gastroduodenal

3. Gallstones that reach the common channel at ampulla can block which two ducts
Failure of neural crest migration
Pancreatic and bile
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Celiac sprue

4. What are the effects of atropine on parietal cells and G cells
Esophageal varices
Dense core bodies
Neutralizes oral bacertial acids and maintains dental health
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

5. How are all 3 monosaccharides transported to the blood
ALT>AST
No - chronic - can present with diarrhea or constipation or alternation - treat sx
GLUT 2
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

6. What serum markers increase in cholecystitis with bile duct involvement
Tropical sprue
Alk phos
Where hindgut meets ectoderm
Hyperpigmented mouth - lips - hands - genitalia

7. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
Stimulate intestinal persistalsis
Liver metabolizes 5HT
Antrum - H.pylori - inc risk of MALT lymphoma

8. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Pertechnetate - study for uptake
Enterokinase/enteropeptidase from the duodenal mucosa
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

9. What is the most common esophageal cancer worldwide and in the US
Worldwide - SC - US - adeno
VZV and influenza B treated with salicylates
Menetriers disease
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

10. Achalasia increases the risk For what complication
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Esophageal carcinoma
Positive urease test
Older patients

11. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Via the middle colic
T12
Repeated phlebotomy - deferoxamine - HLA- A3
Lactase is located at the tips of intestinal villi

12. What transforms conjugated bilirubin to urobilinogen
Epigastric abdominal pain radiating to back - anorexia - nausea
Lubricate food (glycoprotiens)
Gut bacteria
The entire

13. What kind of muscle is in the lower 1/3 of the esophagus
Left gastric vein and esophogeal vein - esophagus
Cholesterol - 10-20% opaque due to calcifications
Fasting and stress
Smooth

14. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Menetriers disease
Achalasia due to loss of myenteric plexus (auberach)
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Chronic gastritis and pernicious anemia

15. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
Jewish and African American men
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Conj - inc - dec

16. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Esophageal varices
Hyperplastic

17. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Dermatitis herpetiformis
Alcoholic cirrhosis
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Necrotizing enterocolitis

18. A protrusion of peritoneum through an opening - usually a site of weakness
Hernia
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

19. What is the characteristic histo finding in alcoholic hepatitis
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Mallory bodies
Inc smooth muscle relaxation - including lower esophageal sphincter
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

20. How does hirschsprung present and appear on imaging
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
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
Pertechnetate - study for uptake
The jejunum

21. What histological findings are present in the stomach
Ampulla of vater
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Complications of crohns
Gastric glands

22. What parts of the small bowel can tropical sprue effect
Spleen to posterior abdominal wall - splenic artery and vein
The entire
Positive urease test
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

23. What are the treatmet options for crohns
Corticosteroids - infliximab
Osmotic
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

24. What receptors does ACH bind on the parietal cells and What does it activate
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Gastrohepatic ligament
M3 - Gq - inc IP3/Ca
Cholesterol

25. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Adhesion
Reye's syndrome
Unconj - absent (acholuria) - inc
Inferior rectal nerve

26. What is the path of an indirect inguinal hernia
T cell lymphoma
VZV and influenza B treated with salicylates
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Goes through deep inguinal ring - external inguinal ring and into the scrotum

27. What causes hirschsprungs
L/R renal artery around L1
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Failure of neural crest migration
Celiac sprue

28. What are the foregut structures and what supplies their blood and PANS innvervation
Bleeding - intussusception - volvulus - obstruction near terminal ileum
...
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
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

29. Cholecytsokinin - source - action - regulation
Intussusception
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
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Neutralizes gastric acid allowing pancreatic enzymes to fxn

30. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Fe2+ in the duod
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
IgA secreting plasma cells - ultimately reside in the lamina proporia

31. What are the histological findings in the ileum

32. crigler - najjar type II responds to which therapy and How does it work
Conj/unconj - inc - nl to dec
Phenobarbital - inc liver enzyme synthesis
Crohns = noncaseating granulomas - UC = crypt abscesses
Dermatitis herpetiformis

33. What factors increase risk of malignancy of adenomatous polyps
Heme metabolism
GLUT 2
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

34. What drug inhibits the H/K ATPase
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Omeprazole
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Mucoepidermoid carcinoma

35. What layer in the mucosa is repsonsible for motility
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Muscularis mucosae
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Chagas disease

36. motilin - source - action - regulation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Decrease - weight gain
Virchow's node
M3 - Gq - inc IP3/Ca

37. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Portal HTN
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Volvulus

38. With caput medusaw - between what vessels is the anastomoses and Where is it
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Crypts but not villi
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
Paraumbilical and superficial and inferior epigastric - umbilicus

39. What infection causes Whipple disease and What can you see on LM
GERD - may also present with nocturnal cough and dyspnea
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Alfatoxin in peanuts

40. When and why is stomach cancer termed linitis plastica
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Older patients
AST>ALT
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

41. When do you see hypertrophy of brunners glands
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Juvenille polyps - no risk if single
Centrilobular congestion and necrosis - cardiac cirrhosis
Peptic ulcer disease

42. somatostatin - source - action - regulation
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Early childhood - neuro sx and malabsorption
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

43. What kind of insults results in macronodular cirrhosis
Lubricate food (glycoprotiens)
Common hepatic - splenic - left gastric - main blood supply for stomach
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Alfatoxin in peanuts

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

45. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Meconium ileus
Meckels
Obstruction of the common bile duct

46. inflammatino of gallbadder
T cell lymphoma
Striated
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Pancreatic and bile

47. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
...
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Inc conj bilirubin - inc cholesterol - inc alk phos
External (superficial) ring only

48. What do mucins do?
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Lubricate food (glycoprotiens)
Gastric glands
Hirschsprungs

49. What is the rate limiting step of carbohydrate digestion
Oligosaccharide digestion
Repeated phlebotomy - deferoxamine - HLA- A3
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Amylase

50. What are the complications of Meckels
CCK8 receptor - Gq inc IP3/Ca
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Reye's syndrome
Hirschsprungs