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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. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Brush border of intestine - produce monosaccharides from oligo and di
Erosive - disruption of mucosal barrier leading to inflammation
Volvulus

2. What does primary sclerosing cholangitis lead to...
Esophageal carcinoma
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Phenobarbital - inc liver enzyme synthesis
Liver metabolizes 5HT

3. Where is the pectinate line
Where hindgut meets ectoderm
Lateral to the inferior epigastric artery
Unconj - absent (acholuria) - inc
GERD - may also present with nocturnal cough and dyspnea

4. Is there any structural abnl with IBS - What is the course of disease and presentation
HSV-1 - CMV - Candida
Osmotic
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
No - chronic - can present with diarrhea or constipation or alternation - treat sx

5. How is salivary secretion stimulated
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Internal thoracic to superior epigastric to inferior epigastric
Alk pho

6. What are causes of extrahepatic biliary obstruction
Cholesterol - 10-20% opaque due to calcifications
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Virchow's node

7. occlusion of IVC or hepatic veins
Penicillinamine - AR inheritance
Budd chiari syndrome
Hyperplastic
Pancreatic head causing obstructive jaundice

8. Where are tumors commonly in pancreatic adenocarcinoma
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
Pancreatic head causing obstructive jaundice
Barrett's esophagus
FAP

9. What are the barium swallow findings of achalasia
Dilated esophagus with an area of distal stenosis - birds beak
NAV = nerve artery vein - venous near the penis (NAVEL)
Striated and smooth
AR

10. What is one potential precipitating factor for intussusception
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
AST>ALT
Diverticulum
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

11. What structures feed into the cystic duct
Pancreatic and bile
Uridine glucuronyl transferase
Chagas disease
Gallbladder

12. FAP + malignant CNS tumor
Turcot
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

13. Where does copper accumulate in Wilsons and What are ABCD
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
CHF and inc risk of HCC
Hemolytic anemia
Low pressure proximal to LES

14. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Zollinger Ellison - phenylalanine and tryptophan
Amylase

15. What drug blocks the H2R
Fe2+ in the duod
Cimetidine
Splenic flexure
Duodenum - 2nd - 3rd and 4th parts

16. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Via the superior pancreaticduodenal
Adhesion
Alcoholic cirrhosis
All 3 gut layers outpouch as in Meckels

17. What does bicarb do in the duodenum
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Stercobilin
Low pressure proximal to LES

18. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Parietal cells in the stomach - B12 binding protein
Hernia
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

19. What retroperitoneal structure flanks both sides of the pancreas on CT
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Crigler - najjar type 1
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Duodenum - 2nd - 3rd and 4th parts

20. What are the foregut structures and what supplies their blood and PANS innvervation
Diverticulum
Volvulus
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

21. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
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
VZV and influenza B treated with salicylates

22. What are motilin receptor agonists used for clinically
T12
Stimulate intestinal persistalsis
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

23. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

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24. In what clinical scenarior do you see portosystemic anastomoses
Esophageal varices
Portal HTN
Bleeding - intussusception - volvulus - obstruction near terminal ileum
All 3

25. What is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Appendicitis
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
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

26. What are the extraintestinal manifestations of crohns
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Common hepatic - splenic - left gastric - main blood supply for stomach
Closer to isotonic because of less time to reabsorb NaCl
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

27. What does the splenorenal ligament connect - and What does it contain
Esophageal cancer
Hypercoaguability - polycythemia vera - pregnancy - HCC
Paraumbilical and superficial and inferior epigastric - umbilicus
Spleen to posterior abdominal wall - splenic artery and vein

28. What does autoimmune destruction of parietal cells lead to...
Hyperplastic
Worldwide - SC - US - adeno
Chronic gastritis and pernicious anemia
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

29. bilateral mets to ovaries with abundant mucus - signet ring cells
VZV and influenza B treated with salicylates
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Unconjugated - water insoluble
Krukenbergs tumor

30. What does extrahepatic biliary obstruction cause
GERD - may also present with nocturnal cough and dyspnea
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

31. What layer in the mucosa is responsible for absorption
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Esophageal cancer
AR
Epithelium

32. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Causes of gall stones
External spermatic fascia only

33. What is the clinical presentation of acute pancreatitis
Fe2+ in the duod
Dermatitis herpetiformis
Hypercoaguability - polycythemia vera - pregnancy - HCC
Epigastric abdominal pain radiating to back - anorexia - nausea

34. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Hemolytic anemia

35. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Phototherapy
Fasting and stress
HSV-1 - CMV - Candida
CHF and inc risk of HCC

36. A protrusion of peritoneum through an opening - usually a site of weakness
Black - rotors syndrome
Hernia
Liver metabolizes 5HT
Muscularis mucosae

37. What arteries exit just below the SMA
Serous on the sides parotids - mucinous in the middle sublingual
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
L/R renal artery around L1
Via the middle colic

38. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Colonic polyps
Lactase is located at the tips of intestinal villi
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
With albumin

39. What is the risk with peutz jehgers
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Inc risk of CRC and other visceral malignancies
Falciform - ligamentum teres - fetal umbilical vein
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

40. If the abdominal aorta is blocked - How does blood get to the left colic artery
Phototherapy
Via the middle colic
AR
Old men - arthralgias - cardiac and neuro sx

41. in CF - meconium plug obstructs intestine - preventing stool passage at birth
The entire
Meconium ileus
2ndary biliary cirrhosis
Old men - arthralgias - cardiac and neuro sx

42. What is charcot triad of cholangitis
H pylori (almost 100%)
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Jaundice - fever - RUQ
Alfatoxin in peanuts

43. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Tropical sprue
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
No
Above

44. Dysphagia in achalasia results from
H2 receptor - inc cAMP
Crohns = noncaseating granulomas - UC = crypt abscesses
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Gastrohepatic ligament

45. Why does indirect inguinal hernia happen in infacnts
IgA secreting plasma cells - ultimately reside in the lamina proporia
Smooth
Dissaccharidase def - most commonly lactase
Failure of the processus vagainlis to close

46. At what level do the testicular/ovarian arteries exit the aorta
Increase tumorigenesis
L2
H+
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

47. What structures feed into the common hepatic duct
Pleuroperitoneal
Failure of neural crest migration
Right and left hepatic duct
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

48. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
The proximal small bowel
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Budd chiari syndrome
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

49. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
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
Older patients
Stimulate the H/K ATPase
Conj/unconj - inc - nl to dec

50. What is the most common indication of emergent abdominal surgery in children
L/R renal artery around L1
The entire
Appendicitis
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells