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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 does loss of APC cause
Meckels
Black - rotors syndrome
Decreased intercellular adhesion and increased proliferation
Lamina propria

2. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Cholesterol - 10-20% opaque due to calcifications
Diverticulum
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Uremia

3. occlusion of IVC or hepatic veins
Pancreatic head causing obstructive jaundice
Closer to isotonic because of less time to reabsorb NaCl
Budd chiari syndrome
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

4. What converts inactive pepsinogen to pepsin
Bleeding - penetration into pancreas - perforation - obstruction
Hypotonic because of more time to reabsorb NaCl
H+
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

5. What kind of pancreatitis is associated with EtOH and smoking
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
CEA - CA-19-9
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Chronic calcifying pancreatitis - inc risk of panreatic cancer

6. 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
US and cholecystectomy
Skip lesions =crohns - colon = UC
Amylase
Begins starch digestion - inactivated by low pH upon reaching the stomach

7. What complication can arise from indirect inguinal hernias
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Hydrocele
Dissaccharidase def - most commonly lactase
Spleen to posterior abdominal wall - splenic artery and vein

8. What serum enzyme is elevated in acute pancreatitis and mumps
Increase tumorigenesis
Amylase
Lamina propora and submucosa
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

9. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
Primarly through ECL leading to histamine release
Bleeding - penetration into pancreas - perforation - obstruction
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

10. Which IBD is autoimmune and which may be a disordered response to bacteria
Unconj - absent (acholuria) - inc
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

11. Which area of the hindgut is a watershed area
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Hepatic steatosis
Splenic flexure
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

12. What histological findings are present in the esophagus
Positive urease test
Older patients
Nonkeritinized stratified sqamous epithelium
Smooth

13. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
CCK8 receptor - Gq inc IP3/Ca
Hypotonic because of more time to reabsorb NaCl
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

14. in carcinoid tumors - What is seen on EM
Inc lower esphogeal tone leading to achalasia
Epigastric abdominal pain radiating to back - anorexia - nausea
Via the middle colic
Dense core bodies

15. Where are peyers patches found
Lamina propora and submucosa
Around the central vein (zone III)
Erosive - disruption of mucosal barrier leading to inflammation
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

16. At what spinal level does the celiac trunk exit
Cystic dilation of the viteline duct
Achalasia due to loss of myenteric plexus (auberach)
T12
Corticosteroids - infliximab

17. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Diverticulum
Worldwide - SC - US - adeno
Cholesterol - 10-20% opaque due to calcifications
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

18. What are the complications of duodenal PUD
Adhesion
Liver metabolizes 5HT
Alcoholic hepatitis
Bleeding - penetration into pancreas - perforation - obstruction

19. How is bilirubin carried in the blood
Falciform - ligamentum teres - fetal umbilical vein
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
With albumin

20. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Juvenille polyps - no risk if single
Lipase
Black - rotors syndrome
Primary sclerosing cholangitis

21. What test and result confirms H pylori infxn
Striated and smooth
Positive urease test
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Antrum - H.pylori - inc risk of MALT lymphoma

22. What is the frequency of basal electric rhythm of the stomach
3 waves/min
Hyperplastic
Crigler - najjar type 1
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

23. What receptors does gastrin bind on the parietal cell and What does it activate
CCK8 receptor - Gq inc IP3/Ca
Superior rectal
Redness and tenderness on palpation of extremities
Early childhood - neuro sx and malabsorption

24. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Ampulla of vater
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Alpha amylase

25. What causes nutmeg liver
Jewish and African American men
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Closer to isotonic because of less time to reabsorb NaCl
Backup of blood into the liver - RHF - budd chiari

26. How does hirschsprung present and appear on imaging
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
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
No - chronic - can present with diarrhea or constipation or alternation - treat sx
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

27. What does alpha amylase do and what inactivates it
Cigarettes and chronic pancreatitis - not EtOH
Hernia
Falciform - ligamentum teres - fetal umbilical vein
Begins starch digestion - inactivated by low pH upon reaching the stomach

28. What layer in the mucosa is responsible for absorption
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Older patients
Epithelium
Ampulla of vater

29. What kind of anemia is in Wilsons
Hemolytic anemia
Striated and smooth
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
Gardner's syndrome

30. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
Left and right gastroepiploics - left and right gastrics
Hyperplastic
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

31. Where are tumors commonly in pancreatic adenocarcinoma
Spleen to posterior abdominal wall - splenic artery and vein
Right and left hepatic duct
Sphincter of oddi
Pancreatic head causing obstructive jaundice

32. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Zollinger Ellison - phenylalanine and tryptophan
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Lactase is located at the tips of intestinal villi

33. What is biliary colic
Complications of crohns
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
L1
Menetriers disease

34. What congenital birth defect is associated with Hirschsprung
Downs
Inc lower esphogeal tone leading to achalasia
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Dilated esophagus with an area of distal stenosis - birds beak

35. Where does copper accumulate in Wilsons and What are ABCD
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Stimulate intestinal persistalsis
Warthins' tumor
Juvenile polyposis syndrome - inc risk of adenocarcinoma

36. subQ peribumbilical metastasis
Zenkers - halitosis - dysphagia and obstruction
Female - fat - fertile - forty
Cystic duct and common hepatic duct
Sister mary joseph nodule

37. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Cholesterol - 10-20% opaque due to calcifications
Neural muscarinic pathways
Menetriers disease
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

38. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Sphincter of oddi
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
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
Unconj - absent (acholuria) - inc

39. How is the diagonsis of CRC made
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
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
CEA - CA-19-9
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

40. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Brunners
Duodenal atresia - Downs
Inspiratory arrest on deep palpation due to pain
Cystic duct and common hepatic duct

41. What is the arterial supply and venous drainage below pectinate line
Failure of the processus vagainlis to close
Hyperpigmented mouth - lips - hands - genitalia
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Spleen to posterior abdominal wall - splenic artery and vein

42. trypsinogen is converted to trypsin via what enzyme
Enterokinase/enteropeptidase from the duodenal mucosa
Colonic polyps
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
ALT>AST

43. What is the main symptom if a VIPoma
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Poor anastamoses
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

44. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Pertechnetate - study for uptake
Volvulus
Chronic calcifying pancreatitis - inc risk of panreatic cancer

45. What is the TX of physiologic neonatal jaundice
Phototherapy
Sphincter of oddi
FAP
Lubricate food (glycoprotiens)

46. What do you treat Wilsons disease with and What is the inheritance
ALT>AST
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Penicillinamine - AR inheritance
H+

47. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Hyperpigmented mouth - lips - hands - genitalia
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Complications of crohns

48. Where is bicarb trapped
Redundant mesentary
H+
Low pressure proximal to LES
In the mucus that covers the gastric epithelium

49. Gq and inc cAMP both work to do what in parietal cells
Via the middle colic
Hypercoaguability - polycythemia vera - pregnancy - HCC
Stimulate the H/K ATPase
Inspiratory arrest on deep palpation due to pain

50. What nerve innervates the external hemorrhoids
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Terminal ileum and colon
Superior rectal and middle and inferior rectal - rectum
Inferior rectal nerve