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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. Between what structures do strong anastamoses exist
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
Inc - weight loss
CCK8 receptor - Gq inc IP3/Ca
Left and right gastroepiploics - left and right gastrics

2. What reaction does salivary amylase catalyze
L2
Averages 6 months - very aggressive - usually already metastasized at presentation
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Copious diarrhea - non alpha - non beta cell pancreatic tumor

3. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Meckels
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

4. In alchoholic hepatitis which liver enzyme is higher
AST>ALT
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
FAP
Mitochondrial abnl - fatty liver - hypoglycemia - coma

5. What do you treat Wilsons disease with and What is the inheritance
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Penicillinamine - AR inheritance
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

6. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Worldwide - SC - US - adeno
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Zollinger ellison - brunners glands

7. What causes primary biliary cirrhosis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Small intestine
Left and right gastroepiploics - left and right gastrics
Pleuroperitoneal

8. What does histo show for alpha1 antitrypsin def
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Lateral to the inferior epigastric artery
Failure of the processus vagainlis to close
PAS- positive globules in liver -

9. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Left gastric vein and esophogeal vein - esophagus
Antrum - H.pylori - inc risk of MALT lymphoma
Pancreatic head causing obstructive jaundice
Meconium ileus

10. What are the signs of peutz jehgers
Hyperpigmented mouth - lips - hands - genitalia
2ndary biliary cirrhosis
90%
Gilbert's

11. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Pleomorphic adenoma
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Mitochondrial abnl - fatty liver - hypoglycemia - coma

12. How does gastrin increase acid secretion?
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Lipase - phospholipase A - colipase
Primarly through ECL leading to histamine release
Diverticulum

13. At what level of the spine does the IM exit the aorta
Sphincter of oddi
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Parietal cells in the stomach - B12 binding protein
L3

14. Malabsorption syndromes have what common clinical presentation
Gut bacteria
Diarrhea - steatorrhea - weight loss - weakness
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Gilbert's

15. What does the splenorenal ligament connect - and What does it contain
L3
Spleen to posterior abdominal wall - splenic artery and vein
Positive
Zollinger ellison - brunners glands

16. What are the tumor markers for pancreatic adenocarcinoma
CEA - CA-19-9
Hirschsprungs
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Inferior rectal nerve

17. To what substance is bilirubin conjugated and why
Ceruplasmin
Primary sclerosing cholangitis
Epithelium
Glucouronate - water soluble (direct)

18. Which serum enzyme increases with heavy EtOH consumption
Juvenille polyps - no risk if single
Gamma glutamyl transferase GGT
Female - fat - fertile - forty
Hemolytic anemia

19. What are the results of hemochromatosis
With albumin
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
AST >ALT - ration is usually 1.5
CHF and inc risk of HCC

20. What are the complications of Meckels
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Upregulated intracellular signal transduction
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Bleeding - intussusception - volvulus - obstruction near terminal ileum

21. somatostatin - source - action - regulation
VZV and influenza B treated with salicylates
Inspiratory arrest on deep palpation due to pain
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
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

22. What histological findings are present in the stomach
Lamina propora and submucosa
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Gastric glands
Uridine glucuronyl transferase

23. Diaphragmatic hernias occur in infants because of defective development of which membrane
Black - rotors syndrome
Pleuroperitoneal
Duodenal atresia - Downs
Phenobarbital - inc liver enzyme synthesis

24. motilin - source - action - regulation
Sister mary joseph nodule
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

25. What does GET SMASHED stand for in acute pancreatitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Cigarettes and chronic pancreatitis - not EtOH
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Zollinger Ellison - phenylalanine and tryptophan

26. What are the foregut structures and what supplies their blood and PANS innvervation
Zenkers - halitosis - dysphagia and obstruction
Serous on the sides parotids - mucinous in the middle sublingual
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Smooth

27. How is bilirubin carried in the blood
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
True and most common congenital anomoly of GI tract
With albumin
Redness and tenderness on palpation of extremities

28. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Falciform - ligamentum teres - fetal umbilical vein
Enterokinase/enteropeptidase from the duodenal mucosa
Stimulate the H/K ATPase
...

29. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
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
Ampulla of vater
Via the middle colic

30. Where does type B chronic gastritis occur and What causes it
Phototherapy
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Antrum - H.pylori - inc risk of MALT lymphoma
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

31. Who gets gastric ulcers
Dec PGE2 leading to dec gastric mucosa protection
So hypertrophied they look like brain gyri
Older patients
Achalasia due to loss of myenteric plexus (auberach)

32. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Backup of blood into the liver - RHF - budd chiari
3 waves/min
FAP

33. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Normal
Alpha1 antitrypsin def - codominant trait
Unconjugated - water insoluble
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

34. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Hirschsprungs
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

35. what kind of fistula is associated with diverticulitis
Corticosteroids - infliximab
Cholesterol
Colovesical leading to pneumaturia
Paraumbilical and superficial and inferior epigastric - umbilicus

36. What is the most common esophageal cancer worldwide and in the US
Pancreatic and bile
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Worldwide - SC - US - adeno

37. What is the mechanism for reyes syndrome
CHF and inc risk of HCC
Omeprazole
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

38. How does brain injury lead to acute gastritis and What is it called
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Conj/unconj - inc - nl to dec
Oral glucose

39. What does a low flow rate mean for saliva
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Antrum - H.pylori - inc risk of MALT lymphoma
Hypotonic because of more time to reabsorb NaCl

40. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Unconj - absent (acholuria) - inc
Pleomorphic adenoma
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Closer to isotonic because of less time to reabsorb NaCl

41. What factors increase risk of malignancy of adenomatous polyps
CCK8 receptor - Gq inc IP3/Ca
Superior rectal and middle and inferior rectal - rectum
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

42. 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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43. What are the complications of acute pancreatitis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
L3
Hernia

44. What does TOASTED with alcoholic hepatitis stand for
Lateral
AST >ALT - ration is usually 1.5
Jewish and African American men
Can lead to hematemesis - found in EtOHics and bulimics

45. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Female - fat - fertile - forty
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Conj - inc - dec

46. GIP - source - action regulation
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Chagas disease
Crypts but not villi

47. Where is IgA shuttled
Decrease - weight gain
Striated and smooth
Bleeding - intussusception - volvulus - obstruction near terminal ileum
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

48. If the hemochromatosis is primary - What is the pattern of inheritance
AR
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Dubin johnson
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

49. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
PAS- positive globules in liver -
The gastroduodenal
Squamous - upper 1/3 - adeno - lower 1/3
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

50. What cells make pepsin - What does it do - and what regulates it
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Paraumbilical and superficial and inferior epigastric - umbilicus