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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. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
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
Centrilobular congestion and necrosis - cardiac cirrhosis
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

2. Which viral infxns/treatments are associated with reyes syndrome
Intussusception
Decreased intercellular adhesion and increased proliferation
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
VZV and influenza B treated with salicylates

3. In PUD - with gastric ulcers - does pain inc or dec with meals?
Omeprazole
True and most common congenital anomoly of GI tract
Inc - weight loss
In the ileum with bile acids - requires IF

4. Where does type B chronic gastritis occur and What causes it
Pleomorphic adenoma
Striated and smooth
CHF and inc risk of HCC
Antrum - H.pylori - inc risk of MALT lymphoma

5. What serum enzyme is decreased in wilsons disease
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
Ceruplasmin
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Alpha amylase

6. What are the treatment options for uclerative colitis
HPNCC
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Ampulla of vater
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

7. What structures feed into the cystic duct
Failure of neural crest migration
In the ileum with bile acids - requires IF
Gallbladder
Stercobilin

8. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
AST >ALT - ration is usually 1.5
Epigastric abdominal pain radiating to back - anorexia - nausea
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

9. How does loss of NO secretion affect the esophagus and what results
Inc lower esphogeal tone leading to achalasia
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
HSV-1 - CMV - Candida
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

10. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Duodenal atresia - Downs
Esophageal varices
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Internal thoracic to superior epigastric to inferior epigastric

11. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Oligosaccharide digestion
Dec PGE2 leading to dec gastric mucosa protection
Inc conj bilirubin - inc cholesterol - inc alk phos

12. What factors increase risk of malignancy of adenomatous polyps
Punched out - clean margins - carcinoma =raised irregular margins
Dense core bodies
FAP
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

13. Which is used more quickly - an oral glucose load - or that by IV
Urobilin
Stimulate the H/K ATPase
Cystic dilation of the viteline duct
Oral glucose

14. multiple juvenil polyps in GI tract - risk
Smooth
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

15. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Parietal cells in the stomach - B12 binding protein
Above
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

16. What is biliary colic
Duodenal atresia - Downs
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Terminal ileum and colon
Splenic flexure

17. What are the signs and symptoms of budd chiari
AR
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Primarly through ECL leading to histamine release
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

18. What causes primary biliary cirrhosis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Lamina propora and submucosa
Crigler - najjar type 1
Oligosaccharide digestion

19. What kind of lesions are characteristic of duodenal PUD vs cancer
Punched out - clean margins - carcinoma =raised irregular margins
Via the superior pancreaticduodenal
FAP
Alk phos

20. What is the prognosis of adenocarcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Oral glucose
Urobilin

21. What causes nutmeg liver
Backup of blood into the liver - RHF - budd chiari
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Urobilin
L3

22. subQ peribumbilical metastasis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Sister mary joseph nodule
Jaundice - fever - RUQ
Chagas disease

23. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
Brunners
Hyperpigmented mouth - lips - hands - genitalia
The entire

24. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Can lead to hematemesis - found in EtOHics and bulimics
Diverticulum
Zollinger Ellison - phenylalanine and tryptophan
Juvenille polyps - no risk if single

25. What commonly leads to appendicity in kids vs adults
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Reye's syndrome
Cholesterol
Urobilin

26. In what scenarios do pts with gilberts have inc bili
Meckels
Redness and tenderness on palpation of extremities
Fasting and stress
Elevated amylase - and lipase

27. What are the signs of peutz jehgers
Hyperpigmented mouth - lips - hands - genitalia
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Crypts but not villi
Unconjugated - water insoluble

28. motilin - source - action - regulation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Hydrocele
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Inspiratory arrest on deep palpation due to pain

29. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Inc lower esphogeal tone leading to achalasia
HSV-1 - CMV - Candida

30. What is contained in the gastrosplenic and What areas does it separate
Increase tumorigenesis
Short gastrics - left greater and lesser
Dec PGE2 leading to dec gastric mucosa protection
Inspiratory arrest on deep palpation due to pain

31. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
3 waves/min
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
VZV and influenza B treated with salicylates

32. likely infectious form of malabsorption - responds to antibiotics
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Fe2+ in the duod
Oligosaccharide digestion
Tropical sprue

33. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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34. What percentage of gall stones are cholesterol stones and What are the associations
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Inc lower esphogeal tone leading to achalasia
Crypts but not villi
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

35. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
Normal
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Budd chiari syndrome

36. Where are carcinoid tumors most commonly malignant
No - chronic - can present with diarrhea or constipation or alternation - treat sx
In the ileum with bile acids - requires IF
The entire
Small intestine

37. How does CRC present in the distal and proximal colon
Fasting and stress
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Antrum - H.pylori - inc risk of MALT lymphoma
Hyperplastic

38. What does autoimmune destruction of parietal cells lead to...
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Inc - weight loss
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Chronic gastritis and pernicious anemia

39. How is the diagonsis of CRC made
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
The submucosal nerve plexus - meissner's
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
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

40. How do NSAIDs cause acute gastritis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Hirschsprungs
Dec PGE2 leading to dec gastric mucosa protection
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

41. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Gastrohepatic ligament
Cigarettes and chronic pancreatitis - not EtOH
In the mucus that covers the gastric epithelium
Falciform - ligamentum teres - fetal umbilical vein

42. What receptors does gastrin bind on the parietal cell and What does it activate
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
CCK8 receptor - Gq inc IP3/Ca
Hyperpigmented mouth - lips - hands - genitalia
Terminal ileum and colon

43. Achalasia increases the risk For what complication
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Esophageal carcinoma
Around the central vein (zone III)
VZV and influenza B treated with salicylates

44. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Inc risk of CRC and other visceral malignancies
Inc smooth muscle relaxation - including lower esophageal sphincter
Short gastrics - left greater and lesser
Carcinoid syndrome

45. 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
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Mallory bodies
Lubricate food (glycoprotiens)

46. What separates the right greater and lesser sacs
Virchow's node
Gastrohepatic ligament
Obstruction of the common bile duct
So hypertrophied they look like brain gyri

47. What is the arterial supply and venous drainage below pectinate line
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
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
Positive urease test
Unconjugated - water insoluble

48. Who is at risk for pancreatic adenocarcinoma
Upregulated intracellular signal transduction
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Lye ingestion and acid reflux
Jewish and African American men

49. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Warthins' tumor
Unconj - absent (acholuria) - inc
Omeprazole
NAV = nerve artery vein - venous near the penis (NAVEL)

50. What does alpha amylase do and what inactivates it
Black - rotors syndrome
Glucouronate - water soluble (direct)
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Begins starch digestion - inactivated by low pH upon reaching the stomach