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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 structures feed into the common hepatic duct
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Right and left hepatic duct
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

2. Achalasia increases the risk For what complication
Inc risk of CRC and other visceral malignancies
Esophageal carcinoma
Female - fat - fertile - forty
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

3. What are the treatmet options for crohns
Upregulated intracellular signal transduction
Corticosteroids - infliximab
Downs
Alk phos

4. How are all 3 monosaccharides transported to the blood
GLUT 2
Via the middle colic
Positive urease test
Hyperplastic

5. Which viral infxns/treatments are associated with reyes syndrome
Trypsin - chymotrypsin - elastase - carboxypeptidases
AST
VZV and influenza B treated with salicylates
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

6. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Brush border of intestine - produce monosaccharides from oligo and di
Causes of gall stones
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

7. What are the signs and symptoms of budd chiari
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
IBS at least 2 with recurrent abdominal pain
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Conj/unconj - inc - nl to dec

8. What pancreatic proteases are secreted as zymogens
Elevated amylase - and lipase
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Trypsin - chymotrypsin - elastase - carboxypeptidases
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

9. To what substance is bilirubin conjugated and why
Cholesterol
Glucouronate - water soluble (direct)
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Causes of gall stones

10. What does TOASTED with alcoholic hepatitis stand for
CHF and inc risk of HCC
Dubin johnson
AST >ALT - ration is usually 1.5
VZV and influenza B treated with salicylates

11. What is the cause of physiologic neonatal jaundice
Positive urease test
CHF and inc risk of HCC
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

12. conjugated hyperbilirubinemia due to defective liver excretion
Nonkeritinized stratified sqamous epithelium
Dubin johnson
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

13. What congenital birth defect is associated with Hirschsprung
HPNCC
Alcoholic hepatitis
Can lead to hematemesis - found in EtOHics and bulimics
Downs

14. What kind of anemia is in Wilsons
Hemolytic anemia
Hepatic steatosis
IgA secreting plasma cells - ultimately reside in the lamina proporia
Brush border of intestine - produce monosaccharides from oligo and di

15. Which serum enzyme increases with heavy EtOH consumption
Hernia
Smooth
Gamma glutamyl transferase GGT
Brunners

16. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Left gastric vein and esophogeal vein - esophagus
CEA - CA-19-9
Liver metabolizes 5HT
Pertechnetate - study for uptake

17. What do the rugae of stomach look like in menetriers disease
Turcot
Paraumbilical and superficial and inferior epigastric - umbilicus
Krukenbergs tumor
So hypertrophied they look like brain gyri

18. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Celiac sprue
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Esophageal varices

19. Cholecytsokinin - source - action - regulation
Carcinoid syndrome
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
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
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

20. What are the midgut structures and what supplies their blood and PANS innervation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Hirschsprungs
Centrilobular leading to congestive liver disease
Upregulated intracellular signal transduction

21. What receptors does gastrin bind on the parietal cell and What does it activate
Dubin johnson
8-9 waves/min
CCK8 receptor - Gq inc IP3/Ca
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

22. Where does type A chronic gastritis occur and What causes it
Gastrohepatic ligament
Redness and tenderness on palpation of extremities
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Stimulate the H/K ATPase

23. motilin - source - action - regulation
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Zenkers - halitosis - dysphagia and obstruction
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

24. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Peyers patches

25. What are the hindgut structures and what supplies their blood and PANS innvervation
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
NAV = nerve artery vein - venous near the penis (NAVEL)
Elevated amylase - and lipase

26. crigler - najjar type II responds to which therapy and How does it work
VZV and influenza B treated with salicylates
Phenobarbital - inc liver enzyme synthesis
Lye ingestion and acid reflux
HPNCC

27. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
H2 receptor - inc cAMP
Zollinger ellison - brunners glands
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

28. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Hernia
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Hepatic steatosis
L4

29. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Inc lower esphogeal tone leading to achalasia
Inc smooth muscle relaxation - including lower esophageal sphincter
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

30. What intervention will intervention will relieve portal HTN
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
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
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Cirrhosis

31. What are the histological findings in the jejunum
Failure of the processus vagainlis to close
FAP
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

32. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Poor anastamoses
Bleeding - penetration into pancreas - perforation - obstruction
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

33. What test and result confirms H pylori infxn
Gardner's syndrome
The entire
Positive urease test
Alcoholic hepatitis

34. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Glucose dependent insulinotropic peptide
Worldwide - SC - US - adeno

35. How does brain injury lead to acute gastritis and What is it called
Smooth
AST >ALT - ration is usually 1.5
Adhesion
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

36. Why does indirect inguinal hernia happen in infacnts
Redundant mesentary
Zollinger ellison - brunners glands
Failure of the processus vagainlis to close
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

37. In what clinical scenarior do you see portosystemic anastomoses
Portal HTN
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Intussusception
Necrotizing enterocolitis

38. GIP - source - action regulation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Below
Brush border of intestine - produce monosaccharides from oligo and di
Short gastrics - left greater and lesser

39. occlusion of IVC or hepatic veins
Redness and tenderness on palpation of extremities
Uremia
Budd chiari syndrome
Juvenille polyps - no risk if single

40. Where is the pectinate line
Where hindgut meets ectoderm
Early childhood - neuro sx and malabsorption
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Pancreatic head causing obstructive jaundice

41. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
AR
Smooth
Pancreatic head causing obstructive jaundice

42. is meckels a true diverticulum and how common is it
Glucose dependent insulinotropic peptide
Above
True and most common congenital anomoly of GI tract
IgA secreting plasma cells - ultimately reside in the lamina proporia

43. What are the common causes of gastric ulcers - What causes gastric ulcer
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
Achalasia due to loss of myenteric plexus (auberach)
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Spleen to posterior abdominal wall - splenic artery and vein

44. absent UDPGT - presents early in life - early mortality
Unconj - absent (acholuria) - inc
Crigler - najjar type 1
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Female - fat - fertile - forty

45. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
HSV-1 - CMV - Candida
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

46. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Muscularis mucosae
Striated and smooth
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

47. What layer in the mucosa is responsible for support
Lamina propria
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Diverticulum
IgA secreting plasma cells - ultimately reside in the lamina proporia

48. What skin condition is associated with celiac sprue
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Gardner's syndrome
Dermatitis herpetiformis

49. What is the arterial supply and venous drainage below pectinate line
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Femoral hernia
Positive urease test

50. Are single polyps malignant in peutz jehgers
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
No
Liver metabolizes 5HT
Bleeding - intussusception - volvulus - obstruction near terminal ileum