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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. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Alpha amylase
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Volvulus

2. What is the prognosis of adenocarcinoma
Complications of crohns
Lipase
Averages 6 months - very aggressive - usually already metastasized at presentation
Zollinger Ellison - phenylalanine and tryptophan

3. What do tumors that arise in the head of the pancreas cause
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Obstruction of the common bile duct
Juvenille polyps - no risk if single
With albumin

4. What are the signs of peutz jehgers
Diarrhea - steatorrhea - weight loss - weakness
Alcoholic hepatitis
Hyperpigmented mouth - lips - hands - genitalia
Redundant mesentary

5. What are the barium swallow findings of achalasia
Dilated esophagus with an area of distal stenosis - birds beak
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
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

6. What is the most common indication of emergent abdominal surgery in children
Appendicitis
Boerhaave's Syndrome - Been heaving syndrome
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Intussusception

7. Where does type A chronic gastritis occur and What causes it
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Squamous - upper 1/3 - adeno - lower 1/3
Inc risk of CRC and other visceral malignancies
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

8. absent UDPGT - presents early in life - early mortality
The gastroduodenal
Lamina propria
Cholesterol - 10-20% opaque due to calcifications
Crigler - najjar type 1

9. concentric onion skin bile duct fibrosis
Colonic polyps
Primary sclerosing cholangitis
IBS at least 2 with recurrent abdominal pain
Early childhood - neuro sx and malabsorption

10. Which is used more quickly - an oral glucose load - or that by IV
Angiodysplasia
M3 - Gq - inc IP3/Ca
Oral glucose
Appendicitis

11. What makes a true diverticula
12 waves/min
Early childhood - neuro sx and malabsorption
All 3 gut layers outpouch as in Meckels
Increase tumorigenesis

12. what kind of muscle is in the upper 1/3 of esophagus
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Falciform - ligamentum teres - fetal umbilical vein
Crypts but not villi
Striated

13. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
Elevated amylase - and lipase
Female - fat - fertile - forty
Ampulla of vater

14. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Internal thoracic to superior epigastric to inferior epigastric
Omeprazole
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

15. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Inc lower esphogeal tone leading to achalasia
Above
Hemosiderosis - hemochromatosis
Squamous - upper 1/3 - adeno - lower 1/3

16. Where are tumors commonly in pancreatic adenocarcinoma
GERD - may also present with nocturnal cough and dyspnea
Lipase
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Pancreatic head causing obstructive jaundice

17. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Superior rectal and middle and inferior rectal - rectum
Inc smooth muscle relaxation - including lower esophageal sphincter
Crohns = noncaseating granulomas - UC = crypt abscesses
NAV = nerve artery vein - venous near the penis (NAVEL)

18. What is the cause of physiologic neonatal jaundice
Copious diarrhea - non alpha - non beta cell pancreatic tumor
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

19. What is the TX of physiologic neonatal jaundice
Phototherapy
Hydrocele
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

20. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Stimulate intestinal persistalsis
Upregulated intracellular signal transduction
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Squamous - upper 1/3 - adeno - lower 1/3

21. What is the other name for GIP (gastric inhibitory peptide)
Dissaccharidase def - most commonly lactase
Glucose dependent insulinotropic peptide
Hyperpigmented mouth - lips - hands - genitalia
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

22. Why does carcinoid syndrome not occur if tumor is confined to GI system
Corticosteroids - infliximab
Liver metabolizes 5HT
Above
Crigler - najjar type 1

23. HCC is associated with what other conditions
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
External (superficial) ring only
Epigastric abdominal pain radiating to back - anorexia - nausea
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

24. How do you DX and TX gallstones
US and cholecystectomy
L4
Dissaccharidase def - most commonly lactase
Intussusception

25. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
2ndary biliary cirrhosis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

26. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Menetriers disease
Normal
Hirschsprungs
Cholesterol

27. Bilirubin is the product of what?
Old men - arthralgias - cardiac and neuro sx
Stercobilin
Heme metabolism
Left and right gastroepiploics - left and right gastrics

28. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
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
L4
Striated
Carcinoid syndrome

29. secretin - source - action - regulation
Lipase
Intussusception
Via the middle colic
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

30. What does primary sclerosing cholangitis lead to...
FAP
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

31. What drug inhibits the H/K ATPase
Zollinger ellison - brunners glands
Dubin johnson
Omeprazole
Lateral to the inferior epigastric artery

32. 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
When diffusely infiltrative - thickened rigid appearance like a leather bottle
L4
Glucose dependent insulinotropic peptide

33. inflammatino of gallbadder
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Failure of the processus vagainlis to close

34. At what spinal level does the SMA exit
Achalasia due to loss of myenteric plexus (auberach)
L1
All 3
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

35. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Conj/unconj - inc - nl to dec
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Hepatic steatosis

36. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Right and left hepatic duct
Mucosa - submucosa - muscularis externa - serosa/adventitia
Adhesion
Early childhood - neuro sx and malabsorption

37. What findings are associated with reyes
Cigarettes and chronic pancreatitis - not EtOH
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
The submucosal nerve plexus - meissner's
Mitochondrial abnl - fatty liver - hypoglycemia - coma

38. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
T12
Alcoholic cirrhosis
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
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

39. Which IBD is autoimmune and which may be a disordered response to bacteria
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Phototherapy
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

40. What kind of diarrhea is produced from a disaccharide def
Dissaccharidase def - most commonly lactase
Menetriers disease
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Osmotic

41. Where are peyers patches found
Lamina propora and submucosa
Inc - weight loss
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Phenobarbital - inc liver enzyme synthesis

42. motilin - source - action - regulation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Pancreatic and bile
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

43. What are the hindgut structures and what supplies their blood and PANS innvervation
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Achalasia due to loss of myenteric plexus (auberach)
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

44. Autodigestion of pancreas by pancreatic enzymes
IBS at least 2 with recurrent abdominal pain
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Acute pancreatitis
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

45. Is there any structural abnl with IBS - What is the course of disease and presentation
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Inc smooth muscle relaxation - including lower esophageal sphincter
Dense core bodies
No - chronic - can present with diarrhea or constipation or alternation - treat sx

46. Where and How is iron absorbed
Appendicitis
...
Fe2+ in the duod
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

47. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
CCK8 receptor - Gq inc IP3/Ca
Meckels
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Myenteric nerve plexus - aurbach

48. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Bleeding - penetration into pancreas - perforation - obstruction
...
Falciform - ligamentum teres - fetal umbilical vein

49. milk intolerance
The gastroduodenal
Dissaccharidase def - most commonly lactase
Cholesterol
H+

50. What is the frequency of basal electric rhythm of the ilieum
Phototherapy
90%
8-9 waves/min
Mallory bodies