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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. Cholecytsokinin - source - action - regulation
Alfatoxin in peanuts
Reye's syndrome
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
Centrilobular congestion and necrosis - cardiac cirrhosis

2. Where is the deep inguinal ring relative to the inferior epigastric vessels
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Primarly through ECL leading to histamine release
Lateral
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

3. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Lateral to the inferior epigastric artery
Alpha1 antitrypsin def - codominant trait
Lipase - phospholipase A - colipase
GERD - may also present with nocturnal cough and dyspnea

4. What can hemochromatosis be secondary to...
Alfatoxin in peanuts
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
12 waves/min
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

5. Gallstones that reach the common channel at ampulla can block which two ducts
Diarrhea - steatorrhea - weight loss - weakness
Jewish and African American men
Pancreatic and bile
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

6. Where does type B chronic gastritis occur and What causes it
Punched out - clean margins - carcinoma =raised irregular margins
Right and left hepatic duct
Centrilobular leading to congestive liver disease
Antrum - H.pylori - inc risk of MALT lymphoma

7. What is the triad of Plummer - Vinson syndrome
Osmotic
Myenteric nerve plexus - aurbach
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

8. What are the foregut structures and what supplies their blood and PANS innvervation
Hemosiderosis - hemochromatosis
Dec PGE2 leading to dec gastric mucosa protection
Inc smooth muscle relaxation - including lower esophageal sphincter
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

9. Which area of the hindgut is a watershed area
Splenic flexure
Diarrhea - steatorrhea - weight loss - weakness
Mucoepidermoid carcinoma
Mallory bodies

10. In what scenarios do pts with gilberts have inc bili
Fasting and stress
Penicillinamine - AR inheritance
Left gastric vein and esophogeal vein - esophagus
Lipase - phospholipase A - colipase

11. What causes carcinoid syndrome amd What are the symptoms
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Zenkers - halitosis - dysphagia and obstruction
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

12. What are the branches of the celiac trunk and What do they supply
Inc lower esphogeal tone leading to achalasia
Complications of crohns
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Common hepatic - splenic - left gastric - main blood supply for stomach

13. Bilirubin is the product of what?
Heme metabolism
Hirschsprungs
CEA - CA-19-9
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

14. What causes hirschsprungs
Failure of neural crest migration
Heme metabolism
Causes of gall stones
Alfatoxin in peanuts

15. Which is used more quickly - an oral glucose load - or that by IV
Alcoholic hepatitis
Oral glucose
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
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

16. GIP - source - action regulation
AST>ALT
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Neutralizes gastric acid allowing pancreatic enzymes to fxn

17. occlusion of IVC or hepatic veins
Spleen to posterior abdominal wall - splenic artery and vein
Budd chiari syndrome
Appendicitis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

18. What transforms conjugated bilirubin to urobilinogen
Tropical sprue
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Gut bacteria
Diarrhea - steatorrhea - weight loss - weakness

19. What causes nutmeg liver
Lack or have an attenuated muscularis externa - often in the sigmoid colon
The jejunum
Backup of blood into the liver - RHF - budd chiari
Female - fat - fertile - forty

20. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Short gastrics - left greater and lesser
Volvulus
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

21. What structures feed into the common hepatic duct
Muscularis mucosae
Peyers patches
Liver metabolizes 5HT
Right and left hepatic duct

22. What is diverticulosis
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Esophageal carcinoma
Glucouronate - water soluble (direct)
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

23. What is the HLA association and treatment for hemochromatosis
Squamous - upper 1/3 - adeno - lower 1/3
Dermatitis herpetiformis
External (superficial) ring only
Repeated phlebotomy - deferoxamine - HLA- A3

24. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Smooth
Erosive - disruption of mucosal barrier leading to inflammation
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
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

25. What gives urine its characteristic color
VZV and influenza B treated with salicylates
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
Urobilin
Adhesion

26. what kind of fistula is associated with diverticulitis
Female - fat - fertile - forty
Repeated phlebotomy - deferoxamine - HLA- A3
H+
Colovesical leading to pneumaturia

27. What commonly leads to appendicity in kids vs adults
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Conj - inc - dec
Uridine glucuronyl transferase
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

28. What does loss of p53 cause
Female - fat - fertile - forty
Increase tumorigenesis
Brush border of intestine - produce monosaccharides from oligo and di
ALT>AST

29. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Pyoderma gangrenosum - primary sclerosing cholangitis
L2
Sister mary joseph nodule
FAP

30. What is the lumen of the pancreatic duct
Via the middle colic
Mitochondrial abnl - fatty liver - hypoglycemia - coma
IgA secreting plasma cells - ultimately reside in the lamina proporia
Ampulla of vater

31. What cells secrete bicarb - What does it do - and what regulates it
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Cirrhosis
True and most common congenital anomoly of GI tract

32. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
Juvenille polyps - no risk if single
Small intestine
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

33. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Cigarettes and chronic pancreatitis - not EtOH

34. What test and result confirms H pylori infxn
Gardner's syndrome
Right and left hepatic duct
Inc lower esphogeal tone leading to achalasia
Positive urease test

35. What histological findings are present in the esophagus
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Volvulus
Nonkeritinized stratified sqamous epithelium
NAV = nerve artery vein - venous near the penis (NAVEL)

36. How is the diagonsis of CRC made
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
HSV-1 - CMV - Candida
Lack or have an attenuated muscularis externa - often in the sigmoid colon
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

37. What do the rugae of stomach look like in menetriers disease
CCK8 receptor - Gq inc IP3/Ca
HSV-1 - CMV - Candida
Diarrhea - steatorrhea - weight loss - weakness
So hypertrophied they look like brain gyri

38. What does bicab do in the mouth
Gallbladder
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Failure of the processus vagainlis to close
Neutralizes oral bacertial acids and maintains dental health

39. 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
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Pancreatic and bile
Lubricate food (glycoprotiens)

40. Where is bicarb trapped
Skip lesions =crohns - colon = UC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Crypts but not villi
In the mucus that covers the gastric epithelium

41. What happens to the short gastics if the splenic artery is blocked
Poor anastamoses
Positive
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
With albumin

42. milk intolerance
Gamma glutamyl transferase GGT
Dissaccharidase def - most commonly lactase
Above
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

43. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Neural muscarinic pathways
Goes through deep inguinal ring - external inguinal ring and into the scrotum
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Alpha amylase

44. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Peyers patches
Skip lesions =crohns - colon = UC
So hypertrophied they look like brain gyri
Chronic gastritis and pernicious anemia

45. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Epigastric abdominal pain radiating to back - anorexia - nausea
Esophageal varices
Complications of crohns
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

46. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Boerhaave's Syndrome - Been heaving syndrome
Mucoepidermoid carcinoma
Cholesterol
Conj - inc - dec

47. What do tumors that arise in the head of the pancreas cause
AST
Via the middle colic
True and most common congenital anomoly of GI tract
Obstruction of the common bile duct

48. What is the presenting course for appendicity

49. How do you DX and TX gallstones
12 waves/min
Superior rectal and middle and inferior rectal - rectum
US and cholecystectomy
Carcinoid syndrome

50. What is the cause of physiologic neonatal jaundice
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Hypotonic because of more time to reabsorb NaCl
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Inc - weight loss