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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 are causes of extrahepatic biliary obstruction
Myenteric nerve plexus - aurbach
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

2. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Ampulla of vater
Striated
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
Colonic polyps

3. multiple juvenil polyps in GI tract - risk
Juvenile polyposis syndrome - inc risk of adenocarcinoma
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Alfatoxin in peanuts
Phototherapy

4. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
L1
Cystic duct and common hepatic duct
Can lead to hematemesis - found in EtOHics and bulimics

5. What source of salivary secretion is the most serous and What is the most mucinous
Boerhaave's Syndrome - Been heaving syndrome
Serous on the sides parotids - mucinous in the middle sublingual
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Ceruplasmin

6. What can hemochromatosis be secondary to...
Terminal ileum and colon
Esophageal carcinoma
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

7. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Crohns = transmural (cobblestone mucosa - creeping fat - string sign - linear ulcers fissures - fistulas) UC = mucosal and submucosal (friable mucosal pseudopolyps with freely hanging mesentary - loss of haustra - lead pipe appearance on imaging

8. Where is B12 absorbed
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
H pylori (almost 100%)
Muscularis mucosae
In the ileum with bile acids - requires IF

9. Between what structures do strong anastamoses exist
L3
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Left and right gastroepiploics - left and right gastrics

10. What are the layers of the gut wall from inside out
Gut bacteria
Mucosa - submucosa - muscularis externa - serosa/adventitia
Via the superior pancreaticduodenal
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

11. what kind of muscle is in the upper 1/3 of esophagus
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Striated
Menetriers disease
Osmotic

12. malnutrition - toxic megacolon - colorectal carcinoma
Complications of UC
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
CHF and inc risk of HCC
Dysphagia (due to esophageal web) - glossitis - iron def anemia

13. Who gets gastric ulcers
Bleeding - penetration into pancreas - perforation - obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Older patients
Dysphagia (due to esophageal web) - glossitis - iron def anemia

14. What is the classic triad of hemochromatosis

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15. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
3 waves/min
CHF and inc risk of HCC
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

16. Which IBD is autoimmune and which may be a disordered response to bacteria
Antrum - H.pylori - inc risk of MALT lymphoma
So hypertrophied they look like brain gyri
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Positive urease test

17. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
So hypertrophied they look like brain gyri
Inc conj bilirubin - inc cholesterol - inc alk phos
Paraumbilical and superficial and inferior epigastric - umbilicus
L/R renal artery around L1

18. What drug blocks the H2R
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
True and most common congenital anomoly of GI tract
Cimetidine
L2

19. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Jaundice - fever - RUQ
The entire
Juvenille polyps - no risk if single
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

20. trypsinogen is converted to trypsin via what enzyme
Dec PGE2 leading to dec gastric mucosa protection
Hepatic steatosis
Enterokinase/enteropeptidase from the duodenal mucosa
Stercobilin

21. Liver cell failure can lead to multisystem signs including
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Osmotic
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

22. What is the TX of physiologic neonatal jaundice
Phototherapy
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Esophageal carcinoma
Squamous - upper 1/3 - adeno - lower 1/3

23. What does primary sclerosing cholangitis lead to...
Krukenbergs tumor
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Sphincter of oddi
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

24. What does loss of p53 cause
Urobilin
Increase tumorigenesis
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

25. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Ampulla of vater
...
Dubin johnson

26. What does GET SMASHED stand for in acute pancreatitis
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Osmotic
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Parietal cells in the stomach - B12 binding protein

27. Who gets Whipple disease and How do they present
2ndary biliary cirrhosis
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
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
Old men - arthralgias - cardiac and neuro sx

28. What kind of pathways do CCK act on to cause pancreatic secretion
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Neutralizes oral bacertial acids and maintains dental health
Neural muscarinic pathways

29. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
H2 receptor - inc cAMP
Sphincter of oddi
Myenteric nerve plexus - aurbach

30. In alchoholic hepatitis which liver enzyme is higher
Above
AST>ALT
In the mucus that covers the gastric epithelium
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

31. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Averages 6 months - very aggressive - usually already metastasized at presentation
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

32. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Repeated phlebotomy - deferoxamine - HLA- A3

33. What causes carcinoid syndrome amd What are the symptoms
Heme metabolism
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Lubricate food (glycoprotiens)

34. Dysphagia in achalasia results from
Stercobilin
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Stimulate the H/K ATPase
Crypts but not villi

35. vasoactive intestinal polypeptide (VIP) - source - action - regulation
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
Dissaccharidase def - most commonly lactase
L/R renal artery around L1
Intussusception

36. What is the clinical presentation of acute pancreatitis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Epigastric abdominal pain radiating to back - anorexia - nausea
Volvulus

37. What are the complications of duodenal PUD
Oligosaccharide digestion
Closer to isotonic because of less time to reabsorb NaCl
Bleeding - penetration into pancreas - perforation - obstruction
The submucosal nerve plexus - meissner's

38. What does loss of APC cause
Below
Decreased intercellular adhesion and increased proliferation
Black - rotors syndrome
Hyperplastic

39. What is the presentation of pancreatic adenocarcinoma
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Complications of crohns

40. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Esophageal cancer
Cirrhosis
True and most common congenital anomoly of GI tract
Complications of crohns

41. What histological findings are present in the esophagus
Black - rotors syndrome
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Nonkeritinized stratified sqamous epithelium
Lamina propria

42. What are the signs and symptoms of budd chiari
AST>ALT
Angiodysplasia
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Short gastrics - left greater and lesser

43. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
In the ileum with bile acids - requires IF
Hypotonic because of more time to reabsorb NaCl
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

44. Who is at risk for pancreatic adenocarcinoma
Jewish and African American men
H2 receptor - inc cAMP
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Zenkers - halitosis - dysphagia and obstruction

45. How do villi appear in disaccharidease def
Normal
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Positive

46. why infxn is implicated in duodenal PUD
H pylori (almost 100%)
Failure of neural crest migration
Decreased intercellular adhesion and increased proliferation
AST

47. What do mucins do?
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Gardner's syndrome
Lubricate food (glycoprotiens)

48. Why are most diverticula considered false
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
CEA - CA-19-9
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Inc - weight loss

49. What kind of lesions are characteristic of duodenal PUD vs cancer
Worldwide - SC - US - adeno
Punched out - clean margins - carcinoma =raised irregular margins
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Backup of blood into the liver - RHF - budd chiari

50. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
EtOH
Oral glucose
Squamous - upper 1/3 - adeno - lower 1/3