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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. Why are most diverticula considered false
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

2. In PUD - with gastric ulcers - does pain inc or dec with meals?
Epithelium
Meckels
Pyoderma gangrenosum - primary sclerosing cholangitis
Inc - weight loss

3. What are the histological findings of the colon
Crypts but not villi
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
CCK8 receptor - Gq inc IP3/Ca

4. What kind of digestion is bile needed for
Obstruction of the common bile duct
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Sister mary joseph nodule
Failure of neural crest migration

5. At what level of the spine does the IM exit the aorta
L3
Angiodysplasia
IBS at least 2 with recurrent abdominal pain
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

6. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Pancreatic and bile
Juvenille polyps - no risk if single

7. What happens to the short gastics if the splenic artery is blocked
Pyoderma gangrenosum - primary sclerosing cholangitis
Poor anastamoses
Urobilin
Redness and tenderness on palpation of extremities

8. Acute gastritis is caused By what process
Via the superior pancreaticduodenal
Erosive - disruption of mucosal barrier leading to inflammation
Begins starch digestion - inactivated by low pH upon reaching the stomach
All 3 gut layers outpouch as in Meckels

9. Where is the pectinate line
Where hindgut meets ectoderm
T cell lymphoma
Appendicitis
Crypts but not villi

10. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Splenic flexure
Conj/unconj - inc - nl to dec
Dissaccharidase def - most commonly lactase
Uremia

11. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
EtOH
Inc smooth muscle relaxation - including lower esophageal sphincter
Hypotonic because of more time to reabsorb NaCl
Alpha1 antitrypsin def - codominant trait

12. subQ peribumbilical metastasis
Common hepatic - splenic - left gastric - main blood supply for stomach
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Sister mary joseph nodule
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

13. What does a low flow rate mean for saliva
Obstruction of the common bile duct
Hepatic steatosis
Hypotonic because of more time to reabsorb NaCl
Inc conj bilirubin - inc cholesterol - inc alk phos

14. Achalasia can be secondary to what infectious disease common in South America
Zollinger Ellison - phenylalanine and tryptophan
Chagas disease
Lipase
Normal

15. Where is folate absorbed
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
The jejunum
Dissaccharidase def - most commonly lactase
Hyperpigmented mouth - lips - hands - genitalia

16. What does autoimmune destruction of parietal cells lead to...
Chronic gastritis and pernicious anemia
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Centrilobular congestion and necrosis - cardiac cirrhosis
Old men - arthralgias - cardiac and neuro sx

17. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
All 3
Conj/unconj - inc - nl to dec
Myenteric nerve plexus - aurbach

18. What structures feed into the common hepatic duct
Right and left hepatic duct
12 waves/min
Decrease - weight gain
Poor anastamoses

19. What is the most common indication of emergent abdominal surgery in children
Dubin johnson
Appendicitis
Via the superior pancreaticduodenal
Complications of UC

20. What can fistula between the gallbladder and small intestine create and how can you tell
VZV and influenza B treated with salicylates
Carcinoid syndrome
Primarly through ECL leading to histamine release
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

21. What factors increase risk of malignancy of adenomatous polyps
Inc - weight loss
Dilated esophagus with an area of distal stenosis - birds beak
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

22. What are additional risk factors for CRC
Crohns = noncaseating granulomas - UC = crypt abscesses
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Cholesterol - 10-20% opaque due to calcifications
Bleeding - intussusception - volvulus - obstruction near terminal ileum

23. malnutrition - toxic megacolon - colorectal carcinoma
Complications of UC
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Lubricate food (glycoprotiens)
GLUT 2

24. What does bicarb do in the duodenum
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Chagas disease
Acute pancreatitis
Neutralizes gastric acid allowing pancreatic enzymes to fxn

25. Who is at risk for pancreatic adenocarcinoma
Pertechnetate - study for uptake
Juvenille polyps - no risk if single
Jewish and African American men
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

26. What is diverticulosis
Peptic ulcer disease
Dense core bodies
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Primarly through ECL leading to histamine release

27. What structures feed into the common bile duct
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Cystic duct and common hepatic duct
Phenobarbital - inc liver enzyme synthesis
Unconjugated - water insoluble

28. What does TOASTED with alcoholic hepatitis stand for
Redness and tenderness on palpation of extremities
Closer to isotonic because of less time to reabsorb NaCl
AST >ALT - ration is usually 1.5
Enterokinase/enteropeptidase from the duodenal mucosa

29. Scleroderma is associated with what kind of esophageal dysmotility
2ndary biliary 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
Low pressure proximal to LES
Smooth

30. What is the lumen of the pancreatic duct
Enterokinase/enteropeptidase from the duodenal mucosa
Brunners
Ampulla of vater
CHF and inc risk of HCC

31. why infxn is implicated in duodenal PUD
Sister mary joseph nodule
With albumin
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
H pylori (almost 100%)

32. What layer in the mucosa is responsible for support
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Ampulla of vater
Lamina propria
Epithelium

33. What is the risk with peutz jehgers
Hepatic steatosis
Inc - weight loss
Inc risk of CRC and other visceral malignancies
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

34. Where are peyers patches found
Lamina propora and submucosa
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Dense core bodies
Inc smooth muscle relaxation - including lower esophageal sphincter

35. To what substance is bilirubin conjugated and why
Elevated amylase - and lipase
Glucouronate - water soluble (direct)
Striated and smooth
Where hindgut meets ectoderm

36. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Hemosiderosis - hemochromatosis
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Peutz jeghers
Trypsin - chymotrypsin - elastase - carboxypeptidases

37. What are the two molecular pathways that lead to CRC
Cystic duct and common hepatic duct
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
MSI (15%) and APC/beta catenin chromosomal instability (85%)
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

38. In PUD with a duodenal ulcer does pain inc or dec with meals
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Decrease - weight gain
Zenkers - halitosis - dysphagia and obstruction
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

39. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Pleuroperitoneal
2ndary biliary cirrhosis
Enterokinase/enteropeptidase from the duodenal mucosa
Zollinger ellison - brunners glands

40. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
3 waves/min
Intussusception
Dissaccharidase def - most commonly lactase
Cholesterol - 10-20% opaque due to calcifications

41. What is the rate limiting step of carbohydrate digestion
Reye's syndrome
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Oligosaccharide digestion

42. How is the diagonsis of CRC made
Meckels
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
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
Crohns = noncaseating granulomas - UC = crypt abscesses

43. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Hemosiderosis - hemochromatosis
The submucosal nerve plexus - meissner's
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Antrum - H.pylori - inc risk of MALT lymphoma

44. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Older patients
Krukenbergs tumor
HPNCC

45. What are the foregut structures and what supplies their blood and PANS innvervation
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Redundant mesentary
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

46. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Inc lower esphogeal tone leading to achalasia
Can lead to hematemesis - found in EtOHics and bulimics

47. What is the presentation of pancreatic adenocarcinoma
Phototherapy
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Acute pancreatitis
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

48. In an MI - which liver enzyme is elevated
GLUT 2
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
AST
Pleomorphic adenoma

49. What test and result confirms H pylori infxn
Peutz jeghers
Positive urease test
Left gastric vein and esophogeal vein - esophagus
Lactase is located at the tips of intestinal villi

50. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Terminal ileum and colon
Myenteric nerve plexus - aurbach
FAP
Common hepatic - splenic - left gastric - main blood supply for stomach