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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 is the lumen of the pancreatic duct
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Crigler - najjar type 1
Ampulla of vater

2. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Closer to isotonic because of less time to reabsorb NaCl
Below
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

3. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
All 3
Parietal cells in the stomach - B12 binding protein
Hepatic steatosis
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

4. What is the rate limiting step of carbohydrate digestion
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Oligosaccharide digestion
Oral glucose
8-9 waves/min

5. What receptors does gastrin bind on the parietal cell and What does it activate
Where hindgut meets ectoderm
CCK8 receptor - Gq inc IP3/Ca
Reye's syndrome
Omeprazole

6. What does bicab do in the mouth
Failure of neural crest migration
Duodenum - 2nd - 3rd and 4th parts
Neutralizes oral bacertial acids and maintains dental health
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

7. What parts of the small bowel can tropical sprue effect
Mallory bodies
The entire
Crohns = noncaseating granulomas - UC = crypt abscesses
Hyperplastic

8. Bilirubin is the product of what?
Barrett's esophagus
Heme metabolism
Gastrohepatic ligament
Older patients

9. What are the borders of the femoral triangle
Erosive - disruption of mucosal barrier leading to inflammation
AST >ALT - ration is usually 1.5
Inguninal ligament - sartorius muscle - adductor longus
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

10. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
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
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Jaundice - fever - RUQ

11. What serum enzyme is decreased in wilsons disease
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
H2 receptor - inc cAMP
Ceruplasmin

12. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Brunners
Juvenille polyps - no risk if single
Cholesterol
All 3 gut layers outpouch as in Meckels

13. What is contained within the submucosa

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14. what percentage of colonic polyps are non - neoplastic
Zollinger ellison - brunners glands
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
90%
Pancreatic and bile

15. Bile is critical for exrection of what substance
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
HSV-1 - CMV - Candida
Cholesterol
Corticosteroids - infliximab

16. What is the main symptom if a VIPoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Jaundice - fever - RUQ
Dissaccharidase def - most commonly lactase
PAS- positive globules in liver -

17. Acute gastritis is caused By what process
CHF and inc risk of HCC
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Penicillinamine - AR inheritance
Erosive - disruption of mucosal barrier leading to inflammation

18. How does gastrin increase acid secretion?
Heme metabolism
Primarly through ECL leading to histamine release
Smooth
Striated and smooth

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

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20. What layer in the mucosa is responsible for support
Meconium ileus
Internal thoracic to superior epigastric to inferior epigastric
Lamina propria
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

21. is meckels a true diverticulum and how common is it
Where hindgut meets ectoderm
In the mucus that covers the gastric epithelium
Alcoholic cirrhosis
True and most common congenital anomoly of GI tract

22. How many layers of spermatic fascia are covers an indirect inguinal hernia
All 3
Sister mary joseph nodule
Hemolytic anemia
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

23. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Chronic gastritis and pernicious anemia
Downs
Enterokinase/enteropeptidase from the duodenal mucosa

24. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
Pancreatic head causing obstructive jaundice
Terminal ileum and colon
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

25. What drug blocks the H2R
Cimetidine
L3
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
Inc risk of CRC and other visceral malignancies

26. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Skip lesions =crohns - colon = UC
Begins starch digestion - inactivated by low pH upon reaching the stomach
Cholesterol
Can lead to hematemesis - found in EtOHics and bulimics

27. What kind of insults results in macronodular cirrhosis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Conj/unconj - inc - nl to dec
Dense core bodies
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

28. What does histo show for alpha1 antitrypsin def
Alcoholic hepatitis
Neutralizes gastric acid allowing pancreatic enzymes to fxn
PAS- positive globules in liver -
2ndary biliary cirrhosis

29. What is the ddx associated with appendicitis
Stercobilin
Diverticulitis in elderly - ectopic pregs use hCG to rule out
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

30. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Crohns = maybe - UC= always
Alpha amylase
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
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

31. In alchoholic hepatitis which liver enzyme is higher
Omeprazole
Penicillinamine - AR inheritance
All 3 gut layers outpouch as in Meckels
AST>ALT

32. FAP + osseous and soft tissue tumors - retinal hyperplasia

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33. What pancreatic proteases are secreted as zymogens
FAP
AR
Trypsin - chymotrypsin - elastase - carboxypeptidases
Epithelium

34. Through which aspect of the inguinal canal does a direct inguinal go
Centrilobular congestion and necrosis - cardiac cirrhosis
Centrilobular leading to congestive liver disease
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
External (superficial) ring only

35. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Barrett's esophagus
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
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

36. In viral hepatitis - which liver enzyme is higher
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Sister mary joseph nodule
Erosive - disruption of mucosal barrier leading to inflammation
ALT>AST

37. What is the rule of 2s for meckels
Hydrocele
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Stercobilin
Around the central vein (zone III)

38. Where is the deep inguinal ring relative to the inferior epigastric vessels
CCK8 receptor - Gq inc IP3/Ca
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Lateral
CHF and inc risk of HCC

39. Where does type B chronic gastritis occur and What causes it
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Crohns = noncaseating granulomas - UC = crypt abscesses
Esophageal carcinoma
Antrum - H.pylori - inc risk of MALT lymphoma

40. What does GET SMASHED stand for in acute pancreatitis
Conj/unconj - inc - nl to dec
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Achalasia due to loss of myenteric plexus (auberach)
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

41. List the clinical findings of HCC
Hernia
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Cystic dilation of the viteline duct

42. Cholecytsokinin - source - action - regulation
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Black - rotors syndrome
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
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

43. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Alk phos
Low pressure proximal to LES
Alpha amylase
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

44. A protrusion of peritoneum through an opening - usually a site of weakness
No
So hypertrophied they look like brain gyri
Hernia
Backup of blood into the liver - RHF - budd chiari

45. How does hirschsprung present and appear on imaging
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
All 3
Decreased intercellular adhesion and increased proliferation
Primary sclerosing cholangitis

46. What are the two molecular pathways that lead to CRC
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Alpha1 antitrypsin def - codominant trait
Fe2+ in the duod
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

47. absent UDPGT - presents early in life - early mortality
Penicillinamine - AR inheritance
Crigler - najjar type 1
The jejunum
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

48. signet ring cells - acanthosis nigracans - dz - character/association - spread
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Poor anastamoses

49. What are the layers of the gut wall from inside out
Lye ingestion and acid reflux
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Mucosa - submucosa - muscularis externa - serosa/adventitia

50. What is the classic triad of hemochromatosis

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