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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 layer in the mucosa is responsible for support
AST>ALT
Alfatoxin in peanuts
Zollinger Ellison - phenylalanine and tryptophan
Lamina propria

2. What are the foregut structures and what supplies their blood and PANS innvervation
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
All 3
Cholesterol
Alk pho

3. Gq and inc cAMP both work to do what in parietal cells
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Stimulate the H/K ATPase
Where hindgut meets ectoderm
Neural muscarinic pathways

4. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
The entire
The submucosal nerve plexus - meissner's
AST >ALT - ration is usually 1.5

5. What is the characteristic histo finding in alcoholic hepatitis
Neutralizes oral bacertial acids and maintains dental health
Mallory bodies
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Stimulate intestinal persistalsis

6. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
FAP
So hypertrophied they look like brain gyri
GERD - may also present with nocturnal cough and dyspnea

7. Through which aspect of the inguinal canal does a direct inguinal go
Warthins' tumor
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
External (superficial) ring only

8. What do tumors that arise in the head of the pancreas cause
Achalasia due to loss of myenteric plexus (auberach)
Obstruction of the common bile duct
90%
Inguninal ligament - sartorius muscle - adductor longus

9. What are the midgut structures and what supplies their blood and PANS innervation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
AST >ALT - ration is usually 1.5

10. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Meconium ileus
AST>ALT
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

11. What is the clinical presentation of acute pancreatitis
Spleen to posterior abdominal wall - splenic artery and vein
US and cholecystectomy
Epigastric abdominal pain radiating to back - anorexia - nausea
Black - rotors syndrome

12. What is the most common indication of emergent abdominal surgery in children
Appendicitis
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Conj - inc - dec
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

13. secretin - source - action - regulation
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
Above
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Carcinoid syndrome

14. What layer in the mucosa is responsible for absorption
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Closer to isotonic because of less time to reabsorb NaCl
Hyperplastic
Epithelium

15. What are the labs in acute pancreatitis
Elevated amylase - and lipase
Celiac sprue
L/R renal artery around L1
2ndary biliary cirrhosis

16. What transforms conjugated bilirubin to urobilinogen
VZV and influenza B treated with salicylates
Gardner's syndrome
Short gastrics - left greater and lesser
Gut bacteria

17. what kind of fistula is associated with diverticulitis
External spermatic fascia only
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Colovesical leading to pneumaturia
Jaundice - fever - RUQ

18. At what level do the testicular/ovarian arteries exit the aorta
L2
IBS at least 2 with recurrent abdominal pain
Hepatic steatosis
Celiac sprue

19. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Alpha1 antitrypsin def - codominant trait
Upregulated intracellular signal transduction
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Intussusception

20. What are the layers of the gut wall from inside out
Intussusception
Crigler - najjar type 1
Mucosa - submucosa - muscularis externa - serosa/adventitia
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

21. Which serum enzyme increases with heavy EtOH consumption
Diverticulum
Gamma glutamyl transferase GGT
Uridine glucuronyl transferase
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

22. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
Causes of gall stones
The jejunum
US and cholecystectomy

23. What does bicab do in the mouth
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Hirschsprungs
Pertechnetate - study for uptake
Neutralizes oral bacertial acids and maintains dental health

24. What kind of anemia is in Wilsons
Hemolytic anemia
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
L3
Goes through deep inguinal ring - external inguinal ring and into the scrotum

25. malnutrition - toxic megacolon - colorectal carcinoma
Complications of UC
Cigarettes and chronic pancreatitis - not EtOH
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

26. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
Krukenbergs tumor
Necrotizing enterocolitis
Glucouronate - water soluble (direct)

27. What infection causes Whipple disease and What can you see on LM
Black - rotors syndrome
Positive
Enterokinase/enteropeptidase from the duodenal mucosa
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

28. What cells secrete bicarb - What does it do - and what regulates it
Penicillinamine - AR inheritance
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

29. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Left gastric vein and esophogeal vein - esophagus
Complications of UC
Repeated phlebotomy - deferoxamine - HLA- A3
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

30. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
All 3
Crohns = maybe - UC= always

31. In viral hepatitis - which liver enzyme is higher
The jejunum
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Bleeding - penetration into pancreas - perforation - obstruction
ALT>AST

32. What drug inhibits the H/K ATPase
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Omeprazole
Punched out - clean margins - carcinoma =raised irregular margins
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

33. What artery passes around the duodenum
Primarly through ECL leading to histamine release
Budd chiari syndrome
The gastroduodenal
Complications of UC

34. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Old men - arthralgias - cardiac and neuro sx
Pancreatic and bile
Cirrhosis

35. What is the ddx associated with appendicitis
Below
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

36. Acute gastritis is caused By what process
Alpha amylase
Primary sclerosing cholangitis
Centrilobular congestion and necrosis - cardiac cirrhosis
Erosive - disruption of mucosal barrier leading to inflammation

37. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Lamina propria
Increase tumorigenesis
Inguninal ligament - sartorius muscle - adductor longus
Peutz jeghers

38. What do you use to diagnose meckels
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Pertechnetate - study for uptake
Via the superior pancreaticduodenal
Femoral hernia

39. How does loss of NO secretion affect the esophagus and what results
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Inc lower esphogeal tone leading to achalasia
Antrum - H.pylori - inc risk of MALT lymphoma
Hyperplastic

40. What are the tumor markers for pancreatic adenocarcinoma
Fe2+ in the duod
Gilbert's
Cimetidine
CEA - CA-19-9

41. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Hemosiderosis - hemochromatosis
Internal thoracic to superior epigastric to inferior epigastric
Can lead to hematemesis - found in EtOHics and bulimics
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

42. What are the hindgut structures and what supplies their blood and PANS innvervation
US and cholecystectomy
Erosive - disruption of mucosal barrier leading to inflammation
Glucouronate - water soluble (direct)
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

43. What pancreatic proteases are secreted as zymogens
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Trypsin - chymotrypsin - elastase - carboxypeptidases
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Neural muscarinic pathways

44. somatostatin - source - action - regulation
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
HSV-1 - CMV - Candida
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Acute pancreatitis

45. What type of insults result in micronodular cirrhosis
Small intestine
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

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

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47. What are the complications of Meckels
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
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Sphincter of oddi

48. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Short gastrics - left greater and lesser
True and most common congenital anomoly of GI tract
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

49. In an MI - which liver enzyme is elevated
Gilbert's
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
With albumin
AST

50. GIP - source - action regulation
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Mallory bodies
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Phenobarbital - inc liver enzyme synthesis