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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 intervention will intervention will relieve portal HTN
All 3
GLUT 2
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

2. What is the frequency of basal electric rhythm of the ilieum
Penicillinamine - AR inheritance
8-9 waves/min
Zollinger ellison - brunners glands
Mallory bodies

3. Where does type A chronic gastritis occur and What causes it
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Cystic duct and common hepatic duct
CEA - CA-19-9
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

4. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Zollinger Ellison - phenylalanine and tryptophan
Alpha1 antitrypsin def - codominant trait
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker

5. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Osmotic
Diverticulum
Meconium ileus
Hernia

6. why infxn is implicated in duodenal PUD
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
The jejunum
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
H pylori (almost 100%)

7. What causes nutmeg liver
Backup of blood into the liver - RHF - budd chiari
Hemosiderosis - hemochromatosis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Complications of UC

8. In an MI - which liver enzyme is elevated
AST
Turcot
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
Goes through deep inguinal ring - external inguinal ring and into the scrotum

9. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Crohns = maybe - UC= always
Peptic ulcer disease
M3 - Gq - inc IP3/Ca
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

10. If trypsin activates more trypsinogen - what kind of feedback loop is established
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Positive
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Angiodysplasia

11. What is the characteristic histo finding in alcoholic hepatitis
Mallory bodies
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
With albumin

12. What are the labs in acute pancreatitis
Primarly through ECL leading to histamine release
Striated and smooth
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Elevated amylase - and lipase

13. Who is at risk for pancreatic adenocarcinoma
Primary sclerosing cholangitis
Decrease - weight gain
CEA - CA-19-9
Jewish and African American men

14. What layer in the mucosa is responsible for support
Serous on the sides parotids - mucinous in the middle sublingual
Pleomorphic adenoma
Lamina propria
Antrum - H.pylori - inc risk of MALT lymphoma

15. GIP - source - action regulation
Unconj - absent (acholuria) - inc
L4
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

16. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
CEA - CA-19-9
Barrett's esophagus
Femoral hernia

17. involvement of left supraclavicular node by mets from stomach

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18. Through which aspect of the inguinal canal does a direct inguinal go
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Cimetidine
12 waves/min
External (superficial) ring only

19. At what spinal level does the is the bifurcation of aorta
L4
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
...
Pleuroperitoneal

20. what kind of muscle is in the upper 1/3 of esophagus
Striated
Parietal cells in the stomach - B12 binding protein
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Lack or have an attenuated muscularis externa - often in the sigmoid colon

21. What is the main symptom if a VIPoma
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Falciform - ligamentum teres - fetal umbilical vein
The proximal small bowel

22. 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
Older patients
Serous on the sides parotids - mucinous in the middle sublingual
Adhesion

23. What are the effects of atropine on parietal cells and G cells
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Obstruction of the common bile duct
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

24. What structure is Not contained in the femoral sheath
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Unconjugated - water insoluble

25. What kind of insults results in macronodular cirrhosis
With albumin
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Neutralizes oral bacertial acids and maintains dental health
When diffusely infiltrative - thickened rigid appearance like a leather bottle

26. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
AR
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Neutralizes oral bacertial acids and maintains dental health
Zenkers - halitosis - dysphagia and obstruction

27. Bile is critical for exrection of what substance
AST >ALT - ration is usually 1.5
Gut bacteria
Cholesterol
Elevated amylase - and lipase

28. Where is IgA shuttled
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Meckels
Black - rotors syndrome

29. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Above
H pylori (almost 100%)
Inc conj bilirubin - inc cholesterol - inc alk phos
Ischemic colitis

30. What is the most common esophageal cancer worldwide and in the US
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
Worldwide - SC - US - adeno
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Erosive - disruption of mucosal barrier leading to inflammation

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

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32. What kind of muscle is in the middle 1/3 of esophagus
Inc smooth muscle relaxation - including lower esophageal sphincter
Striated and smooth
Muscularis mucosae
Female - fat - fertile - forty

33. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Primary sclerosing cholangitis
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Esophageal varices
Hypercoaguability - polycythemia vera - pregnancy - HCC

34. motilin - source - action - regulation
All 3
Lateral to the inferior epigastric artery
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

35. Cholecytsokinin - source - action - regulation
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
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
Esophageal varices
Where hindgut meets ectoderm

36. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Muscularis mucosae
Left gastric vein and esophogeal vein - esophagus

37. What is indirect bilirubin
External (superficial) ring only
Phototherapy
Unconjugated - water insoluble
8-9 waves/min

38. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Skip lesions =crohns - colon = UC
Repeated phlebotomy - deferoxamine - HLA- A3
Dec PGE2 leading to dec gastric mucosa protection
So hypertrophied they look like brain gyri

39. What is the most important mechanism in gastric acid secretion
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Myenteric nerve plexus - aurbach
Crohns = maybe - UC= always

40. What are the borders of the femoral triangle
Hyperpigmented mouth - lips - hands - genitalia
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Inguninal ligament - sartorius muscle - adductor longus
Lipase - phospholipase A - colipase

41. Progressive dyshphage beginning with solids and moving to liquids and weight loss
The gastroduodenal
Esophageal cancer
Inc conj bilirubin - inc cholesterol - inc alk phos
Neutralizes oral bacertial acids and maintains dental health

42. What causes hirschsprungs
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Failure of neural crest migration
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Urobilin

43. Which serum enzyme increases with heavy EtOH consumption
HPNCC
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
Gamma glutamyl transferase GGT
L2

44. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Hemosiderosis - hemochromatosis
Cirrhosis
Complications of UC
Neutralizes gastric acid allowing pancreatic enzymes to fxn

45. What is contained within the submucosa

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46. What is the HLA association and treatment for hemochromatosis
Redness and tenderness on palpation of extremities
Repeated phlebotomy - deferoxamine - HLA- A3
Urobilin
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

47. What is biliary colic
Pleuroperitoneal
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Old men - arthralgias - cardiac and neuro sx
Hyperplastic

48. What are the main components of bile
Duodenal atresia - Downs
External spermatic fascia only
M3 - Gq - inc IP3/Ca
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

49. What commonly leads to appendicity in kids vs adults
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Diarrhea - steatorrhea - weight loss - weakness
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
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

50. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Dubin johnson
Cirrhosis
Striated and smooth
In the mucus that covers the gastric epithelium