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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 parts of the small bowel can tropical sprue effect
The entire
Necrotizing enterocolitis
Ampulla of vater
Punched out - clean margins - carcinoma =raised irregular margins

2. Achalasia increases the risk For what complication
Failure of neural crest migration
True and most common congenital anomoly of GI tract
Paraumbilical and superficial and inferior epigastric - umbilicus
Esophageal carcinoma

3. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Dubin johnson
ALT>AST
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

4. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
Common hepatic - splenic - left gastric - main blood supply for stomach
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Chronic calcifying pancreatitis - inc risk of panreatic cancer

5. What causes hirschsprungs
Esophageal cancer
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
AST>ALT
Failure of neural crest migration

6. FAP + malignant CNS tumor
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Peyers patches
Turcot
Barrett's esophagus

7. What does alpha amylase do and what inactivates it
Fasting and stress
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Begins starch digestion - inactivated by low pH upon reaching the stomach
Diverticulitis in elderly - ectopic pregs use hCG to rule out

8. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Stimulate the H/K ATPase
External spermatic fascia only
Alpha amylase
Crohns = noncaseating granulomas - UC = crypt abscesses

9. Where is bicarb trapped
Peyers patches
In the mucus that covers the gastric epithelium
Splenic flexure
Decreased intercellular adhesion and increased proliferation

10. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
All 3
ALT>AST
Esophageal varices
Cigarettes and chronic pancreatitis - not EtOH

11. Who gets Whipple disease and How do they present
Old men - arthralgias - cardiac and neuro sx
Downs
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
Complications of crohns

12. What is the arterial supply and venous drainage below pectinate line
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Dense core bodies
Brush border of intestine - produce monosaccharides from oligo and di

13. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Antrum - H.pylori - inc risk of MALT lymphoma
Dilated esophagus with an area of distal stenosis - birds beak
2ndary biliary cirrhosis
Meckels

14. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Alk pho
L4
True and most common congenital anomoly of GI tract
Diverticulitis in elderly - ectopic pregs use hCG to rule out

15. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Diverticulum
Upregulated intracellular signal transduction
Inc conj bilirubin - inc cholesterol - inc alk phos
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

16. What do you use to diagnose meckels
Phenobarbital - inc liver enzyme synthesis
Pertechnetate - study for uptake
Backup of blood into the liver - RHF - budd chiari
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

17. Which patients have pigment stones
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Hirschsprungs
Muscularis mucosae
Gardner's syndrome

18. What are the midgut structures and what supplies their blood and PANS innervation
Appendicitis
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Decrease - weight gain
Stimulate intestinal persistalsis

19. conjugated hyperbilirubinemia due to defective liver excretion
Lack or have an attenuated muscularis externa - often in the sigmoid colon
External (superficial) ring only
Dubin johnson
Penicillinamine - AR inheritance

20. What are the barium swallow findings of achalasia
Alk phos
GLUT 2
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Dilated esophagus with an area of distal stenosis - birds beak

21. What are the structures of the femoral triangle and how are they organized
Early childhood - neuro sx and malabsorption
Paraumbilical and superficial and inferior epigastric - umbilicus
NAV = nerve artery vein - venous near the penis (NAVEL)
Urobilin

22. What is the main symptom if a VIPoma
90%
Crypts but not villi
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Begins starch digestion - inactivated by low pH upon reaching the stomach

23. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
GERD - may also present with nocturnal cough and dyspnea
Chagas disease
Unconjugated - water insoluble
Stimulate the H/K ATPase

24. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Hirschsprungs
Dec PGE2 leading to dec gastric mucosa protection

25. subQ peribumbilical metastasis
Sister mary joseph nodule
Intussusception
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
VZV and influenza B treated with salicylates

26. What are the signs and symptoms of budd chiari
Gardner's syndrome
Common hepatic - splenic - left gastric - main blood supply for stomach
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Omeprazole

27. What receptors does gastrin bind on the parietal cell and What does it activate
Unconj - absent (acholuria) - inc
Elevated amylase - and lipase
CCK8 receptor - Gq inc IP3/Ca
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

28. With internal hemorrhoids Where is the anastomoses and Where is it
Brunners
Superior rectal and middle and inferior rectal - rectum
Closer to isotonic because of less time to reabsorb NaCl
Reye's syndrome

29. why infxn is implicated in duodenal PUD
Hypercoaguability - polycythemia vera - pregnancy - HCC
Complications of UC
H pylori (almost 100%)
AST

30. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Appendicitis
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Cirrhosis
Dense core bodies

31. Which is used more quickly - an oral glucose load - or that by IV
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Oral glucose
Trypsin - chymotrypsin - elastase - carboxypeptidases

32. What is the characteristic histo finding in alcoholic hepatitis
Meconium ileus
2ndary biliary cirrhosis
Mallory bodies
In the ileum with bile acids - requires IF

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

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34. What does primary sclerosing cholangitis lead to...
The proximal small bowel
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Low pressure proximal to LES
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

35. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Black - rotors syndrome
Dense core bodies

36. Scleroderma is associated with what kind of esophageal dysmotility
So hypertrophied they look like brain gyri
Virchow's node
Obstruction of the common bile duct
Low pressure proximal to LES

37. What serum markers increase in cholecystitis with bile duct involvement
Achalasia due to loss of myenteric plexus (auberach)
Alk phos
Parietal cells in the stomach - B12 binding protein
Sister mary joseph nodule

38. Malabsorption syndromes have what common clinical presentation
Left and right gastroepiploics - left and right gastrics
Internal thoracic to superior epigastric to inferior epigastric
Brush border of intestine - produce monosaccharides from oligo and di
Diarrhea - steatorrhea - weight loss - weakness

39. What gives stool its characteristic color
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Internal thoracic to superior epigastric to inferior epigastric
Budd chiari syndrome
Stercobilin

40. What is charcot triad of cholangitis
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Jaundice - fever - RUQ
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Punched out - clean margins - carcinoma =raised irregular margins

41. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Alpha amylase
Peutz jeghers
Downs
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

42. In what scenarios do pts with gilberts have inc bili
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
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Unconj - absent (acholuria) - inc
Fasting and stress

43. What does GET SMASHED stand for in acute pancreatitis
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Backup of blood into the liver - RHF - budd chiari
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Necrotizing enterocolitis

44. What is the rate limiting step of carbohydrate digestion
Oligosaccharide digestion
Nonkeritinized stratified sqamous epithelium
Dubin johnson
Lateral to the inferior epigastric artery

45. What serum enzyme is elevated in acute pancreatitis and mumps
Brunners
Striated and smooth
Lipase
Amylase

46. What does loss of APC cause
Diarrhea - steatorrhea - weight loss - weakness
Averages 6 months - very aggressive - usually already metastasized at presentation
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Decreased intercellular adhesion and increased proliferation

47. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Via the middle colic
Obstruction of the common bile duct
Alk phos
Intussusception

48. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Ceruplasmin
Serous on the sides parotids - mucinous in the middle sublingual
The entire

49. How does CRC present in the distal and proximal colon
AST >ALT - ration is usually 1.5
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
FAP
Diarrhea - steatorrhea - weight loss - weakness

50. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Stimulate intestinal persistalsis
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
MSI (15%) and APC/beta catenin chromosomal instability (85%)