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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 kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Reye's syndrome
Pleomorphic adenoma
Bleeding - intussusception - volvulus - obstruction near terminal ileum

2. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Necrotizing enterocolitis
Punched out - clean margins - carcinoma =raised irregular margins
Poor anastamoses

3. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
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
T cell lymphoma
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Causes of gall stones

4. What is the epi for CRC
Sister mary joseph nodule
Crigler - najjar type 1
Carcinoid syndrome
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

5. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lateral
Nonkeritinized stratified sqamous epithelium
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
The jejunum

6. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Jewish and African American men
Around the central vein (zone III)
Urobilin

7. most common non - neoplastic polyp in colon
Erosive - disruption of mucosal barrier leading to inflammation
Hyperplastic
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Duodenum - 2nd - 3rd and 4th parts

8. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Short gastrics - left greater and lesser
Juvenille polyps - no risk if single
Downs
In the ileum with bile acids - requires IF

9. What source of salivary secretion is the most serous and What is the most mucinous
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Internal thoracic to superior epigastric to inferior epigastric
Paraumbilical and superficial and inferior epigastric - umbilicus
Serous on the sides parotids - mucinous in the middle sublingual

10. What is one potential precipitating factor for intussusception
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Ischemic colitis
Cimetidine
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

11. What are the results of hemochromatosis
CHF and inc risk of HCC
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Failure of the processus vagainlis to close
Hemolytic anemia

12. What happens to the short gastics if the splenic artery is blocked
H+
Early childhood - neuro sx and malabsorption
Poor anastamoses
Menetriers disease

13. What is the rate limiting step of carbohydrate digestion
Oligosaccharide digestion
Cimetidine
AST >ALT - ration is usually 1.5
Stercobilin

14. What is the arterial supply and venous drainage below pectinate line
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Pleomorphic adenoma
Obstruction of the common bile duct
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

15. What are esophageal strictures associated with
Budd chiari syndrome
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
AST >ALT - ration is usually 1.5
Lye ingestion and acid reflux

16. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Intussusception
Black - rotors syndrome
The entire
Common hepatic - splenic - left gastric - main blood supply for stomach

17. multiple juvenil polyps in GI tract - risk
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Cigarettes and chronic pancreatitis - not EtOH
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

18. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Spleen to posterior abdominal wall - splenic artery and vein
Left gastric vein and esophogeal vein - esophagus
Inc - weight loss
Achalasia due to loss of myenteric plexus (auberach)

19. Bilirubin is the product of what?
Brush border of intestine - produce monosaccharides from oligo and di
Heme metabolism
In the mucus that covers the gastric epithelium
Neural muscarinic pathways

20. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Small intestine

21. Where are peyers patches found
AST>ALT
Pancreatic head causing obstructive jaundice
Lamina propora and submucosa
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

22. What serum enzyme is elevated in acute pancreatitis and mumps
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Zollinger ellison - brunners glands
Downs
Amylase

23. What layer of fascia covers a direct inguinal hernia
Inc - weight loss
Lamina propria
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
External spermatic fascia only

24. How does CRC present in the distal and proximal colon
Ampulla of vater
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
External spermatic fascia only
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

25. At what spinal level does the celiac trunk exit
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
T12
Duodenal atresia - Downs
Unconjugated - water insoluble

26. What kind of muscle is in the lower 1/3 of the esophagus
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Hypercoaguability - polycythemia vera - pregnancy - HCC
Where hindgut meets ectoderm
Smooth

27. What are the barium swallow findings of achalasia
In the ileum with bile acids - requires IF
Via the middle colic
Dilated esophagus with an area of distal stenosis - birds beak
Unconj - absent (acholuria) - inc

28. Acute gastritis is caused By what process
Older patients
Volvulus
Erosive - disruption of mucosal barrier leading to inflammation
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

29. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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30. What percentage of gall stones are cholesterol stones and What are the associations
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Brush border of intestine - produce monosaccharides from oligo and di
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

31. concentric onion skin bile duct fibrosis
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Primary sclerosing cholangitis
Terminal ileum and colon
All 3

32. what kind of fistula is associated with diverticulitis
Esophageal varices
AST
Serous on the sides parotids - mucinous in the middle sublingual
Colovesical leading to pneumaturia

33. What artery passes around the duodenum
The gastroduodenal
Gamma glutamyl transferase GGT
Krukenbergs tumor
Inc smooth muscle relaxation - including lower esophageal sphincter

34. Gallstones that reach the common channel at ampulla can block which two ducts
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Pancreatic and bile
2ndary biliary cirrhosis

35. What are motilin receptor agonists used for clinically
Dermatitis herpetiformis
Striated
Liver metabolizes 5HT
Stimulate intestinal persistalsis

36. What is contained in the gastrosplenic and What areas does it separate
Lubricate food (glycoprotiens)
Older patients
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Short gastrics - left greater and lesser

37. What causes hirschsprungs
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
Failure of neural crest migration
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Black - rotors syndrome

38. What do the rugae of stomach look like in menetriers disease
Peyers patches
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
Squamous - upper 1/3 - adeno - lower 1/3
So hypertrophied they look like brain gyri

39. What skin condition is associated with celiac sprue
Crigler - najjar type 1
Dermatitis herpetiformis
True and most common congenital anomoly of GI tract
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

40. What infection causes Whipple disease and What can you see on LM
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Hyperplastic
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

41. Abuse of what substance leads to acute gastritis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
T cell lymphoma
Nonkeritinized stratified sqamous epithelium
EtOH

42. How does gastrin increase acid secretion?
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Primarly through ECL leading to histamine release
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Striated

43. rare - often fatal childhood hepatoencephalopathy

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44. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Neutralizes oral bacertial acids and maintains dental health
Femoral hernia
Alpha amylase
Volvulus

45. In PUD with a duodenal ulcer does pain inc or dec with meals
Downs
VZV and influenza B treated with salicylates
Decrease - weight gain
Sister mary joseph nodule

46. What causes primary biliary cirrhosis
Gastric glands
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Diarrhea - steatorrhea - weight loss - weakness
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

47. What reaction does salivary amylase catalyze
Necrotizing enterocolitis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Chronic gastritis and pernicious anemia
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

48. At what spinal level does the SMA exit
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Inc - weight loss
L1
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

49. What makes a true diverticula
T cell lymphoma
Internal thoracic to superior epigastric to inferior epigastric
So hypertrophied they look like brain gyri
All 3 gut layers outpouch as in Meckels

50. What is the main symptom if a VIPoma
Adhesion
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Erosive - disruption of mucosal barrier leading to inflammation
Copious diarrhea - non alpha - non beta cell pancreatic tumor