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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 does histo show for alpha1 antitrypsin def
Phenobarbital - inc liver enzyme synthesis
Penicillinamine - AR inheritance
Goes through deep inguinal ring - external inguinal ring and into the scrotum
PAS- positive globules in liver -

2. What are the extraintestinal manifestations of ulcerative colitis
Unconjugated - water insoluble
Pyoderma gangrenosum - primary sclerosing cholangitis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Pleuroperitoneal

3. What are the signs of peutz jehgers
Hyperpigmented mouth - lips - hands - genitalia
Intussusception
Lipase - phospholipase A - colipase
Phototherapy

4. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
HSV-1 - CMV - Candida
Lactase is located at the tips of intestinal villi
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

5. What is the action of NO as a GI hormone
Inc smooth muscle relaxation - including lower esophageal sphincter
Meckels
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Downs

6. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Pertechnetate - study for uptake
Crohns = maybe - UC= always

7. What are causes of extrahepatic biliary obstruction
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
The jejunum
Complications of crohns

8. Achalasia increases the risk For what complication
All 3
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Zollinger Ellison - phenylalanine and tryptophan
Esophageal carcinoma

9. How many layers of spermatic fascia are covers an indirect inguinal hernia
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
All 3
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

10. What are the four Fs of gallstones
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Failure of the processus vagainlis to close
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Female - fat - fertile - forty

11. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Esophageal carcinoma
Internal thoracic to superior epigastric to inferior epigastric
So hypertrophied they look like brain gyri
Bleeding - intussusception - volvulus - obstruction near terminal ileum

12. At what level of the spine does the IM exit the aorta
Repeated phlebotomy - deferoxamine - HLA- A3
L3
Left and right gastroepiploics - left and right gastrics
Angiodysplasia

13. What serum enzyme is decreased in wilsons disease
Ceruplasmin
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Crohns = maybe - UC= always
Appendicitis

14. What is the frequency of basal electric rhythm of the stomach
3 waves/min
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Failure of the processus vagainlis to close
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

15. inflammatino of gallbadder
Lack or have an attenuated muscularis externa - often in the sigmoid colon
The entire
Heme metabolism
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

16. What is the mechanism for reyes syndrome
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Crohns = maybe - UC= always

17. What is the other name for GIP (gastric inhibitory peptide)
Alk phos
...
The submucosal nerve plexus - meissner's
Glucose dependent insulinotropic peptide

18. Diaphragmatic hernias occur in infants because of defective development of which membrane
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Achalasia due to loss of myenteric plexus (auberach)
Pleuroperitoneal
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

19. How do burns cause acute gastritis and What is it called

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20. At what level do the testicular/ovarian arteries exit the aorta
Reye's syndrome
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
L1
L2

21. What is the presentation of pancreatic adenocarcinoma
M3 - Gq - inc IP3/Ca
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
True and most common congenital anomoly of GI tract
Boerhaave's Syndrome - Been heaving syndrome

22. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
Worldwide - SC - US - adeno
Parietal cells in the stomach - B12 binding protein
CHF and inc risk of HCC

23. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Boerhaave's Syndrome - Been heaving syndrome
Lactase is located at the tips of intestinal villi
Cirrhosis
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

24. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
GLUT 2
Tropical sprue
IBS at least 2 with recurrent abdominal pain
8-9 waves/min

25. What makes a true diverticula
Muscularis mucosae
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
All 3 gut layers outpouch as in Meckels
Penicillinamine - AR inheritance

26. What is contained within the muscularis externa
Superior rectal
Erosive - disruption of mucosal barrier leading to inflammation
Myenteric nerve plexus - aurbach
Dysphagia (due to esophageal web) - glossitis - iron def anemia

27. What kind of insults results in macronodular cirrhosis
Juvenille polyps - no risk if single
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Redundant mesentary
Internal thoracic to superior epigastric to inferior epigastric

28. What is the cause of physiologic neonatal jaundice
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
IgA secreting plasma cells - ultimately reside in the lamina proporia
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
So hypertrophied they look like brain gyri

29. Gallstones that reach the common channel at ampulla can block which two ducts
Worldwide - SC - US - adeno
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Celiac sprue
Pancreatic and bile

30. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Corticosteroids - infliximab
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Increase tumorigenesis

31. How does gastrin increase acid secretion?
Primarly through ECL leading to histamine release
Backup of blood into the liver - RHF - budd chiari
Lubricate food (glycoprotiens)
Hemolytic anemia

32. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
Hydrocele
CCK8 receptor - Gq inc IP3/Ca
Virchow's node

33. How does brain injury lead to acute gastritis and What is it called
Around the central vein (zone III)
Brunners
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
The entire

34. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Glucose dependent insulinotropic peptide
Terminal ileum and colon
Complications of crohns

35. What do the rugae of stomach look like in menetriers disease
Worldwide - SC - US - adeno
Decreased intercellular adhesion and increased proliferation
So hypertrophied they look like brain gyri
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

36. Transmural esophageal rupture due to violent retching

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37. What is contained within the submucosa

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38. What are the complications of acute pancreatitis
AST
Jaundice - fever - RUQ
Penicillinamine - AR inheritance
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

39. What causes carcinoid syndrome amd What are the symptoms
Gamma glutamyl transferase GGT
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Hyperpigmented mouth - lips - hands - genitalia
Downs

40. List the clinical findings of HCC
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Low pressure proximal to LES
In the mucus that covers the gastric epithelium
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

41. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Amylase
Zollinger Ellison - phenylalanine and tryptophan
In the mucus that covers the gastric epithelium
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

42. Which IBD is autoimmune and which may be a disordered response to bacteria
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Dec PGE2 leading to dec gastric mucosa protection
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

43. What receptors does ACH bind on the parietal cells and What does it activate
Achalasia due to loss of myenteric plexus (auberach)
M3 - Gq - inc IP3/Ca
Epigastric abdominal pain radiating to back - anorexia - nausea
Glucose dependent insulinotropic peptide

44. What cell produces IF and What does it do
Lateral to the inferior epigastric artery
Parietal cells in the stomach - B12 binding protein
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
M3 - Gq - inc IP3/Ca

45. Why are most diverticula considered false
Peptic ulcer disease
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Lipase
Hyperpigmented mouth - lips - hands - genitalia

46. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Zollinger Ellison - phenylalanine and tryptophan
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

47. Where is the pectinate line
Crohns = maybe - UC= always
3 waves/min
Where hindgut meets ectoderm
L/R renal artery around L1

48. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Inspiratory arrest on deep palpation due to pain
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Gut bacteria
Urobilin

49. What structures feed into the cystic duct
Menetriers disease
Cystic duct and common hepatic duct
Gallbladder
Penicillinamine - AR inheritance

50. What are esophageal strictures associated with
Brush border of intestine - produce monosaccharides from oligo and di
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
Chronic gastritis and pernicious anemia
Lye ingestion and acid reflux