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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. In PUD with a duodenal ulcer does pain inc or dec with meals
Lateral
Decrease - weight gain
Gastrohepatic ligament
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

2. crigler - najjar type II responds to which therapy and How does it work
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Esophageal cancer
Phenobarbital - inc liver enzyme synthesis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

3. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Diarrhea - steatorrhea - weight loss - weakness
Corticosteroids - infliximab

4. What is Trousseau's sign
Gamma glutamyl transferase GGT
Redness and tenderness on palpation of extremities
AST >ALT - ration is usually 1.5
Cystic dilation of the viteline duct

5. How are all 3 monosaccharides transported to the blood
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Chronic gastritis and pernicious anemia
GLUT 2
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

6. What are the histological findings of the colon
Epithelium
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Peptic ulcer disease
Crypts but not villi

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

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8. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
With albumin
H+

9. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
H+
Sphincter of oddi
Angiodysplasia
Zenkers - halitosis - dysphagia and obstruction

10. likely infectious form of malabsorption - responds to antibiotics
Muscularis mucosae
Dec PGE2 leading to dec gastric mucosa protection
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Tropical sprue

11. How do villi appear in disaccharidease def
Hydrocele
Normal
Inguninal ligament - sartorius muscle - adductor longus
Alpha1 antitrypsin def - codominant trait

12. How does loss of NO secretion affect the esophagus and what results
Fe2+ in the duod
Inc lower esphogeal tone leading to achalasia
Inc conj bilirubin - inc cholesterol - inc alk phos
Downs

13. In an MI - which liver enzyme is elevated
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Hypercoaguability - polycythemia vera - pregnancy - HCC
Jaundice - fever - RUQ
AST

14. signet ring cells - acanthosis nigracans - dz - character/association - spread
Esophageal carcinoma
IBS at least 2 with recurrent abdominal pain
Above
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

15. What test and result confirms H pylori infxn
Positive urease test
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Carcinoid syndrome
Portal HTN

16. What are the branches of the celiac trunk and What do they supply
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Cholesterol - 10-20% opaque due to calcifications
Bleeding - penetration into pancreas - perforation - obstruction
Common hepatic - splenic - left gastric - main blood supply for stomach

17. 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
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Cirrhosis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

18. What conditions are associated with budd chiari
T12
Hypercoaguability - polycythemia vera - pregnancy - HCC
Right and left hepatic duct
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

19. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Unconj - absent (acholuria) - inc
Alk pho
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

20. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Colonic polyps
Gamma glutamyl transferase GGT

21. What is the cause of physiologic neonatal jaundice
Ceruplasmin
Complications of UC
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Alcoholic hepatitis

22. People of what decent are associated with celiac sprue and what findings/antibodies are present
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Lamina propria
GERD - may also present with nocturnal cough and dyspnea

23. What type of insults result in micronodular cirrhosis
Hepatic steatosis
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Neural muscarinic pathways
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

24. What kind of diarrhea is produced from a disaccharide def
Primary sclerosing cholangitis
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Osmotic
Older patients

25. What converts inactive pepsinogen to pepsin
H+
Jaundice - fever - RUQ
The gastroduodenal
Alfatoxin in peanuts

26. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
US and cholecystectomy
Superior rectal
Positive urease test
Small intestine

27. Scleroderma is associated with what kind of esophageal dysmotility
Low pressure proximal to LES
ALT>AST
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
L/R renal artery around L1

28. What does K- ras mutation cause
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Upregulated intracellular signal transduction
Amylase
Lactase is located at the tips of intestinal villi

29. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Portal HTN
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
FAP

30. What is the omphalomesenteric cyst
Above
With albumin
Neural muscarinic pathways
Cystic dilation of the viteline duct

31. What layer of fascia covers a direct inguinal hernia
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
External spermatic fascia only
Penicillinamine - AR inheritance

32. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Conj/unconj - inc - nl to dec
Hypercoaguability - polycythemia vera - pregnancy - HCC
Female - fat - fertile - forty

33. What are the main components of bile
2ndary biliary cirrhosis
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Gut bacteria
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

34. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Gastric glands
Above
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

35. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Conj - inc - dec
Decreased intercellular adhesion and increased proliferation
Crohns = maybe - UC= always

36. What kind of anemia is in Wilsons
Mucoepidermoid carcinoma
Crypts but not villi
Hemolytic anemia
Boerhaave's Syndrome - Been heaving syndrome

37. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Complications of crohns
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
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Cholesterol - 10-20% opaque due to calcifications

38. What are the complications of Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Femoral hernia
Neural muscarinic pathways

39. Where is the pectinate line
AST >ALT - ration is usually 1.5
L1
Where hindgut meets ectoderm
CHF and inc risk of HCC

40. Why are most diverticula considered false
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
CCK8 receptor - Gq inc IP3/Ca
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Lack or have an attenuated muscularis externa - often in the sigmoid colon

41. What are the ABCDEF of esophageal cancer
Reye's syndrome
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Lamina propria
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

42. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Where hindgut meets ectoderm
Alk pho
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Crohns = maybe - UC= always

43. involvement of left supraclavicular node by mets from stomach

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44. Why does carcinoid syndrome not occur if tumor is confined to GI system
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Gastrohepatic ligament
All 3
Liver metabolizes 5HT

45. What pancreatic enzymes are responsible for fat digestion
Diarrhea - steatorrhea - weight loss - weakness
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Lipase - phospholipase A - colipase
Begins starch digestion - inactivated by low pH upon reaching the stomach

46. How does hirschsprung present and appear on imaging
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
Ischemic colitis
Gardner's syndrome
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

47. What layer in the mucosa is responsible for absorption
Meconium ileus
Diverticulitis in elderly - ectopic pregs use hCG to rule out
8-9 waves/min
Epithelium

48. In alchoholic hepatitis which liver enzyme is higher
The submucosal nerve plexus - meissner's
AST>ALT
12 waves/min
Portal HTN

49. What histological findings are present in the esophagus
Complications of crohns
Nonkeritinized stratified sqamous epithelium
Crypts but not villi
90%

50. What can fistula between the gallbladder and small intestine create and how can you tell
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Lateral