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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. List the clinical findings of HCC
Copious diarrhea - non alpha - non beta cell pancreatic tumor
2ndary biliary cirrhosis
Cirrhosis
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

2. Liver cell failure can lead to multisystem signs including
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Epigastric abdominal pain radiating to back - anorexia - nausea
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
US and cholecystectomy

3. milk intolerance
Dissaccharidase def - most commonly lactase
H pylori (almost 100%)
Duodenal atresia - Downs
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

4. What structure is Not contained in the femoral sheath
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
AST
Esophageal carcinoma
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

5. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Alpha amylase
Falciform - ligamentum teres - fetal umbilical vein
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Mitochondrial abnl - fatty liver - hypoglycemia - coma

6. How does hirschsprung present and appear on imaging
Stimulate the H/K ATPase
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
Right and left hepatic duct
M3 - Gq - inc IP3/Ca

7. Where is B12 absorbed
Lateral
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Erosive - disruption of mucosal barrier leading to inflammation
In the ileum with bile acids - requires IF

8. Where is folate absorbed
The jejunum
Alcoholic hepatitis
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
Omeprazole

9. What is the TX of physiologic neonatal jaundice
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Can lead to hematemesis - found in EtOHics and bulimics
Hydrocele
Phototherapy

10. What conditions are associated with budd chiari
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Hypercoaguability - polycythemia vera - pregnancy - HCC
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Myenteric nerve plexus - aurbach

11. What transforms conjugated bilirubin to urobilinogen
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Inc conj bilirubin - inc cholesterol - inc alk phos
Crypts but not villi
Gut bacteria

12. What congenital birth defect is associated with Hirschsprung
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Downs
Internal thoracic to superior epigastric to inferior epigastric
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

13. What is the sphincter of the pancreatic duct
Sphincter of oddi
Repeated phlebotomy - deferoxamine - HLA- A3
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Phenobarbital - inc liver enzyme synthesis

14. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Low pressure proximal to LES
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Peyers patches

15. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
The jejunum
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Downs
Above

16. What is the characteristic histo finding in alcoholic hepatitis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Omeprazole
Mallory bodies

17. What are the treatmet options for crohns
Closer to isotonic because of less time to reabsorb NaCl
Phenobarbital - inc liver enzyme synthesis
Hirschsprungs
Corticosteroids - infliximab

18. What are the main components of bile
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Urobilin
Squamous - upper 1/3 - adeno - lower 1/3

19. Autoantibodies to gluten (gliadin) in wheat and other grains
Lack or have an attenuated muscularis externa - often in the sigmoid colon
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Celiac sprue

20. If the abdominal aorta is blocked - How does blood get to the left colic artery
US and cholecystectomy
Hydrocele
Via the middle colic
Uremia

21. Where are oligosaccharide hydrolases and What do they do
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
Brush border of intestine - produce monosaccharides from oligo and di
Small intestine
Decreased intercellular adhesion and increased proliferation

22. Where is there sclerosis in alcoholic cirrohosis
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Around the central vein (zone III)
Barrett's esophagus

23. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Duodenum - 2nd - 3rd and 4th parts
AST
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Adhesion

24. In what scenarios do pts with gilberts have inc bili
Via the middle colic
Fasting and stress
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

25. At what spinal level does the celiac trunk exit
T12
Right and left hepatic duct
Amylase
Sister mary joseph nodule

26. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Uridine glucuronyl transferase
Alcoholic hepatitis

27. vasoactive intestinal polypeptide (VIP) - source - action - regulation
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
Dec PGE2 leading to dec gastric mucosa protection
Alpha amylase
Parietal cells in the stomach - B12 binding protein

28. why infxn is implicated in duodenal PUD
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Phenobarbital - inc liver enzyme synthesis
H pylori (almost 100%)
M3 - Gq - inc IP3/Ca

29. What can fistula between the gallbladder and small intestine create and how can you tell
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

30. With caput medusaw - between what vessels is the anastomoses and Where is it
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Paraumbilical and superficial and inferior epigastric - umbilicus
Lipase
Warthins' tumor

31. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Hyperplastic
Crohns = maybe - UC= always

32. Where are carcinoid tumors most commonly malignant
Muscularis mucosae
Mucoepidermoid carcinoma
Virchow's node
Small intestine

33. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lateral
Hyperpigmented mouth - lips - hands - genitalia
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Lamina propora and submucosa

34. What are additional risk factors for CRC
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Hypercoaguability - polycythemia vera - pregnancy - HCC
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

35. What causes pancreatic insuff and What does it cause
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Urobilin
Ampulla of vater
Alpha1 antitrypsin def - codominant trait

36. What is the lumen of the pancreatic duct
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Serous on the sides parotids - mucinous in the middle sublingual
The proximal small bowel
Ampulla of vater

37. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Colonic polyps
Lactase is located at the tips of intestinal villi

38. What cell produces IF and What does it do
Muscularis mucosae
Positive urease test
Urobilin
Parietal cells in the stomach - B12 binding protein

39. When and why is stomach cancer termed linitis plastica
Inc smooth muscle relaxation - including lower esophageal sphincter
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Jewish and African American men
Oligosaccharide digestion

40. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
So hypertrophied they look like brain gyri
Sphincter of oddi
Hernia

41. What is the clinical presentation of acute pancreatitis
HSV-1 - CMV - Candida
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Epigastric abdominal pain radiating to back - anorexia - nausea
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

42. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Peyers patches
FAP
Femoral hernia
Uridine glucuronyl transferase

43. What is contained within the submucosa

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44. How does CRC present in the distal and proximal colon
Erosive - disruption of mucosal barrier leading to inflammation
Celiac sprue
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Crypts but not villi

45. How is bilirubin carried in the blood
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
With albumin
Krukenbergs tumor
Lipase - phospholipase A - colipase

46. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Pertechnetate - study for uptake
Ampulla of vater
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

47. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Primarly through ECL leading to histamine release
Crypts but not villi
IgA secreting plasma cells - ultimately reside in the lamina proporia

48. What is the prognosis of adenocarcinoma
Terminal ileum and colon
Mucoepidermoid carcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Chronic calcifying pancreatitis - inc risk of panreatic cancer

49. What is the other name for GIP (gastric inhibitory peptide)
Complications of UC
Glucose dependent insulinotropic peptide
Peutz jeghers
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

50. What is one potential precipitating factor for intussusception
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Crypts but not villi
Downs
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia