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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. Abuse of what substance leads to acute gastritis
EtOH
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Stimulate intestinal persistalsis

2. What gives stool its characteristic color
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
External spermatic fascia only
Pyoderma gangrenosum - primary sclerosing cholangitis
Stercobilin

3. Autodigestion of pancreas by pancreatic enzymes
Pertechnetate - study for uptake
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Acute pancreatitis

4. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Redness and tenderness on palpation of extremities

5. Is there any structural abnl with IBS - What is the course of disease and presentation
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Neutralizes oral bacertial acids and maintains dental health
Old men - arthralgias - cardiac and neuro sx
Small intestine

6. crigler - najjar type II responds to which therapy and How does it work
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Inc lower esphogeal tone leading to achalasia
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Phenobarbital - inc liver enzyme synthesis

7. What cells secrete bicarb - What does it do - and what regulates it
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
In the mucus that covers the gastric epithelium
The gastroduodenal
No

8. Where is the deep inguinal ring relative to the inferior epigastric vessels
2ndary biliary cirrhosis
Peyers patches
Muscularis mucosae
Lateral

9. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
External spermatic fascia only
Urobilin

10. What does autoimmune destruction of parietal cells lead to...
The jejunum
Neural muscarinic pathways
Chronic gastritis and pernicious anemia
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

11. How do NSAIDs cause acute gastritis
Turcot
Dec PGE2 leading to dec gastric mucosa protection
AR
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

12. To what substance is bilirubin conjugated and why
Glucouronate - water soluble (direct)
Gut bacteria
Primary sclerosing cholangitis
Diarrhea - steatorrhea - weight loss - weakness

13. What is the main symptom if a VIPoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Hepatic steatosis
...
Stimulate the H/K ATPase

14. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
FAP
Carcinoid syndrome
Glucouronate - water soluble (direct)
CCK8 receptor - Gq inc IP3/Ca

15. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Cimetidine
In the ileum with bile acids - requires IF
Skip lesions =crohns - colon = UC

16. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Intussusception
Redness and tenderness on palpation of extremities
Hirschsprungs
Epigastric abdominal pain radiating to back - anorexia - nausea

17. How does loss of NO secretion affect the esophagus and what results
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Inc lower esphogeal tone leading to achalasia
Volvulus
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

18. What drug inhibits the H/K ATPase
Gut bacteria
Chronic gastritis and pernicious anemia
Omeprazole
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

19. Which patients have pigment stones
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Gamma glutamyl transferase GGT
Pyoderma gangrenosum - primary sclerosing cholangitis
Complications of crohns

20. What pancreatic proteases are secreted as zymogens
Trypsin - chymotrypsin - elastase - carboxypeptidases
Female - fat - fertile - forty
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

21. Dysphagia in achalasia results from
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
HPNCC
Lactase is located at the tips of intestinal villi

22. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Around the central vein (zone III)
Carcinoid syndrome
Positive

23. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Complications of UC

24. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Lamina propria
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
In the ileum with bile acids - requires IF
Hirschsprungs

25. What is pancreatic adenocarcinoma associated with
Cigarettes and chronic pancreatitis - not EtOH
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Upregulated intracellular signal transduction
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

26. What are the signs of peutz jehgers
H pylori (almost 100%)
Boerhaave's Syndrome - Been heaving syndrome
Hyperpigmented mouth - lips - hands - genitalia
Ceruplasmin

27. Where are peyers patches found
Pleomorphic adenoma
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Meconium ileus
Lamina propora and submucosa

28. What does bicab do in the mouth
Liver metabolizes 5HT
Lateral to the inferior epigastric artery
Averages 6 months - very aggressive - usually already metastasized at presentation
Neutralizes oral bacertial acids and maintains dental health

29. Progressive dyshphage beginning with solids and moving to liquids and weight loss
AST
Older patients
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Esophageal cancer

30. Gallstones that reach the common channel at ampulla can block which two ducts
Averages 6 months - very aggressive - usually already metastasized at presentation
Brush border of intestine - produce monosaccharides from oligo and di
Pancreatic and bile
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

31. How are all 3 monosaccharides transported to the blood
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
GLUT 2
Heme metabolism

32. What portion of the bowel does sprue effect
Portal HTN
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Lamina propora and submucosa
The proximal small bowel

33. What are the histological findings in the duodenum

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34. What kind of diarrhea is produced from a disaccharide def
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
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
Osmotic
Gardner's syndrome

35. What causes carcinoid syndrome amd What are the symptoms
Unconj - absent (acholuria) - inc
Primarly through ECL leading to histamine release
Worldwide - SC - US - adeno
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

36. What are the complications of duodenal PUD
Inspiratory arrest on deep palpation due to pain
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Zollinger ellison - brunners glands
Bleeding - penetration into pancreas - perforation - obstruction

37. What structures feed into the common hepatic duct
Right and left hepatic duct
Jaundice - fever - RUQ
Gastric glands
Pancreatic and bile

38. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Peutz jeghers
Adhesion

39. What is the most common cause of gallstones
Adhesion
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Right and left hepatic duct
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

40. What does a low flow rate mean for saliva
Cholesterol - 10-20% opaque due to calcifications
Stimulate the H/K ATPase
Pertechnetate - study for uptake
Hypotonic because of more time to reabsorb NaCl

41. Malabsorption syndromes have what common clinical presentation
Uridine glucuronyl transferase
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
Mallory bodies
Diarrhea - steatorrhea - weight loss - weakness

42. What pancreatic enzymes are responsible for fat digestion
Centrilobular leading to congestive liver disease
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Dec PGE2 leading to dec gastric mucosa protection
Lipase - phospholipase A - colipase

43. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Esophageal cancer
Mucosa - submucosa - muscularis externa - serosa/adventitia
Carcinoid syndrome

44. What are the common causes of gastric ulcers - What causes gastric ulcer
Decrease - weight gain
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Positive
Esophageal varices

45. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
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
Dense core bodies
Mallory bodies

46. What cell produces IF and What does it do
Lubricate food (glycoprotiens)
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Parietal cells in the stomach - B12 binding protein

47. What is the frequency of basal electric rhythm in the duodenum
Striated
12 waves/min
Volvulus
Peutz jeghers

48. what kind of muscle is in the upper 1/3 of esophagus
Striated
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Paraumbilical and superficial and inferior epigastric - umbilicus
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

49. What is diverticulosis
Paraumbilical and superficial and inferior epigastric - umbilicus
Barrett's esophagus
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

50. Where does an indirect inguinal hernia enter the deep inguinal ring
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Parietal cells in the stomach - B12 binding protein
Lateral to the inferior epigastric artery
Glucouronate - water soluble (direct)