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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 jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Conj - inc - dec
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
Epithelium
Lipase - phospholipase A - colipase

2. What are the common causes of gastric ulcers - What causes gastric ulcer
AST>ALT
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Inspiratory arrest on deep palpation due to pain
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

3. Is there any structural abnl with IBS - What is the course of disease and presentation
Gallbladder
No - chronic - can present with diarrhea or constipation or alternation - treat sx
NAV = nerve artery vein - venous near the penis (NAVEL)
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

4. What does bicarb do in the duodenum
Short gastrics - left greater and lesser
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Above

5. What complication can arise from indirect inguinal hernias
Failure of neural crest migration
Hydrocele
Penicillinamine - AR inheritance
Inferior rectal nerve

6. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Via the superior pancreaticduodenal
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Mallory bodies
Conj/unconj - inc - nl to dec

7. What are the complications of chronic pancreatitis
Zenkers - halitosis - dysphagia and obstruction
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

8. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Hernia
Penicillinamine - AR inheritance
Warthins' tumor
Zollinger Ellison - phenylalanine and tryptophan

9. In alchoholic hepatitis which liver enzyme is higher
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
AST>ALT
Mitochondrial abnl - fatty liver - hypoglycemia - coma
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

10. What serum enzyme is elevated inacute pancreatitis
Intussusception
Lipase
Turcot
Squamous - upper 1/3 - adeno - lower 1/3

11. What are the signs of peutz jehgers
Hyperpigmented mouth - lips - hands - genitalia
Fe2+ in the duod
Cigarettes and chronic pancreatitis - not EtOH
90%

12. Where are oligosaccharide hydrolases and What do they do
Via the middle colic
Brush border of intestine - produce monosaccharides from oligo and di
T cell lymphoma
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

13. What is the most common esophageal cancer worldwide and in the US
Peyers patches
Worldwide - SC - US - adeno
Dubin johnson
Corticosteroids - infliximab

14. what kind of fistula is associated with diverticulitis
Hepatic steatosis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Colovesical leading to pneumaturia
Oligosaccharide digestion

15. What drug blocks the H2R
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Chronic gastritis and pernicious anemia
Cimetidine
Ischemic colitis

16. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Hypotonic because of more time to reabsorb NaCl
Stimulate the H/K ATPase
Jewish and African American men
Black - rotors syndrome

17. B cells stimuated in the germinal centers of peyers patches differentiate into what?
IgA secreting plasma cells - ultimately reside in the lamina proporia
Oral glucose
Corticosteroids - infliximab
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

18. What portion of the bowel does sprue effect
Centrilobular congestion and necrosis - cardiac cirrhosis
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
Striated and smooth
The proximal small bowel

19. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Fasting and stress
Source - S cells (duod) - action - inc pancreatic bicarb secretion - dec gastric acid secretin - inc bile secretion - regulation - inc by acid - fatty acids in lumen of duod

20. What are causes of extrahepatic biliary obstruction
Liver metabolizes 5HT
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Duodenal atresia - Downs
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

21. How many layers of spermatic fascia are covers an indirect inguinal hernia
Uremia
All 3
Failure of neural crest migration
Reye's syndrome

22. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Falciform - ligamentum teres - fetal umbilical vein
Can lead to hematemesis - found in EtOHics and bulimics
Worldwide - SC - US - adeno
Above

23. What is the cause of Barrett's and the assocaited complications
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
L/R renal artery around L1
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

24. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Primary sclerosing cholangitis
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Pleomorphic adenoma
Gallbladder

25. What pancreatic enzymes are responsible for fat digestion
CHF and inc risk of HCC
Inspiratory arrest on deep palpation due to pain
Increase tumorigenesis
Lipase - phospholipase A - colipase

26. What kind of diarrhea is produced from a disaccharide def
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Osmotic
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Juvenille polyps - no risk if single

27. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

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28. What is the most common indication of emergent abdominal surgery in children
HPNCC
Appendicitis
Gilbert's
Sphincter of oddi

29. What does a low flow rate mean for saliva
Hypotonic because of more time to reabsorb NaCl
Punched out - clean margins - carcinoma =raised irregular margins
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
The jejunum

30. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
T12
CHF and inc risk of HCC
Centrilobular leading to congestive liver disease
Hirschsprungs

31. What does high flow rate mean
Fe2+ in the duod
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
Redness and tenderness on palpation of extremities
Closer to isotonic because of less time to reabsorb NaCl

32. What gives stool its characteristic color
Corticosteroids - infliximab
Tropical sprue
...
Stercobilin

33. What are the treatment options for uclerative colitis
Liver metabolizes 5HT
In the mucus that covers the gastric epithelium
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

34. What does autoimmune destruction of parietal cells lead to...
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Conj/unconj - inc - nl to dec
Neutralizes oral bacertial acids and maintains dental health
Chronic gastritis and pernicious anemia

35. How is salivary secretion stimulated
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
HSV-1 - CMV - Candida
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

36. What is indirect bilirubin
Primarly through ECL leading to histamine release
Adhesion
Peutz jeghers
Unconjugated - water insoluble

37. HCC is associated with what other conditions
Cystic duct and common hepatic duct
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Chagas disease
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

38. what kind of muscle is in the upper 1/3 of esophagus
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Striated
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

39. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Spleen to posterior abdominal wall - splenic artery and vein
The gastroduodenal
Right and left hepatic duct

40. When and How does Abetalipoproteinemia present
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
H+
Early childhood - neuro sx and malabsorption
Increase tumorigenesis

41. What are the complications of acute pancreatitis
GLUT 2
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Phenobarbital - inc liver enzyme synthesis
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

42. What are the two molecular pathways that lead to CRC
MSI (15%) and APC/beta catenin chromosomal instability (85%)
US and cholecystectomy
Fasting and stress
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

43. Where is bicarb trapped
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Early childhood - neuro sx and malabsorption
In the mucus that covers the gastric epithelium
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

44. What are the hindgut structures and what supplies their blood and PANS innvervation
Increase tumorigenesis
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Inc conj bilirubin - inc cholesterol - inc alk phos
Inferior rectal nerve

45. What does extrahepatic biliary obstruction cause
Phototherapy
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Pancreatic and bile

46. What carcinogens are associated with HCC
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Positive urease test
Alfatoxin in peanuts
Cholesterol - 10-20% opaque due to calcifications

47. What infection causes Whipple disease and What can you see on LM
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Causes of gall stones
Old men - arthralgias - cardiac and neuro sx
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

48. What layer in the mucosa is repsonsible for motility
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Cystic dilation of the viteline duct
L2
Muscularis mucosae

49. How are all 3 monosaccharides transported to the blood
GLUT 2
Female - fat - fertile - forty
Failure of neural crest migration
Urobilin

50. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Lateral to the inferior epigastric artery
Diarrhea - steatorrhea - weight loss - weakness
Peptic ulcer disease