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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 pancreatic adenocarcinoma associated with
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Intussusception
Carcinoid syndrome
Cigarettes and chronic pancreatitis - not EtOH

2. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
HSV-1 - CMV - Candida
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
M3 - Gq - inc IP3/Ca
Inspiratory arrest on deep palpation due to pain

3. What is the arterial supply and venous drainage below pectinate line
Meckels
L2
VZV and influenza B treated with salicylates
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

4. People of what decent are associated with celiac sprue and what findings/antibodies are present
Necrotizing enterocolitis
Penicillinamine - AR inheritance
Hernia
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

5. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Dissaccharidase def - most commonly lactase
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Carcinoid syndrome

6. What is the risk with peutz jehgers
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Decreased intercellular adhesion and increased proliferation
Early childhood - neuro sx and malabsorption
Inc risk of CRC and other visceral malignancies

7. What infection causes Whipple disease and What can you see on LM
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Portal HTN
CHF and inc risk of HCC
Omeprazole

8. What reaction does salivary amylase catalyze
H2 receptor - inc cAMP
Punched out - clean margins - carcinoma =raised irregular margins
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

9. How does gastrin increase acid secretion?
Primarly through ECL leading to histamine release
Hernia
All 3
CCK8 receptor - Gq inc IP3/Ca

10. involvement of left supraclavicular node by mets from stomach

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11. What conditions are associated with budd chiari
Stimulate intestinal persistalsis
Hypercoaguability - polycythemia vera - pregnancy - HCC
Juvenille polyps - no risk if single
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

12. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
In the mucus that covers the gastric epithelium
Lipase
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

13. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Closer to isotonic because of less time to reabsorb NaCl

14. rare - often fatal childhood hepatoencephalopathy

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15. Where is folate absorbed
Gastrohepatic ligament
Osmotic
L2
The jejunum

16. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
In the ileum with bile acids - requires IF
2ndary biliary cirrhosis
Cirrhosis
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

17. malnutrition - toxic megacolon - colorectal carcinoma
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Averages 6 months - very aggressive - usually already metastasized at presentation
Complications of UC

18. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Zollinger Ellison - phenylalanine and tryptophan
Myenteric nerve plexus - aurbach

19. What are the borders of Hesselbach's triangle
Peptic ulcer disease
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
H pylori (almost 100%)
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

20. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Amylase
Common hepatic - splenic - left gastric - main blood supply for stomach
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Meckels

21. What gives stool its characteristic color
Stercobilin
Nonkeritinized stratified sqamous epithelium
Inc conj bilirubin - inc cholesterol - inc alk phos
Pleomorphic adenoma

22. What is the HLA association and treatment for hemochromatosis
Angiodysplasia
Hyperplastic
Repeated phlebotomy - deferoxamine - HLA- A3
Juvenille polyps - no risk if single

23. How do you DX and TX gallstones
12 waves/min
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
GERD - may also present with nocturnal cough and dyspnea
US and cholecystectomy

24. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Jewish and African American men
Fasting and stress
Cholesterol

25. What portion of the bowel does sprue effect
Chronic gastritis and pernicious anemia
Alpha amylase
The proximal small bowel
Lipase - phospholipase A - colipase

26. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Ischemic colitis
M3 - Gq - inc IP3/Ca
Parietal cells in the stomach - B12 binding protein

27. What kind of cancer to celiac sprue put you as inc risk for
AST
T cell lymphoma
Juvenille polyps - no risk if single
Common hepatic - splenic - left gastric - main blood supply for stomach

28. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Hydrocele
Alcoholic hepatitis
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

29. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
L/R renal artery around L1
NAV = nerve artery vein - venous near the penis (NAVEL)
Neural muscarinic pathways

30. What causes nutmeg liver
Cystic dilation of the viteline duct
Portal HTN
Backup of blood into the liver - RHF - budd chiari
Old men - arthralgias - cardiac and neuro sx

31. What are the complications of chronic pancreatitis
All 3 gut layers outpouch as in Meckels
Cigarettes and chronic pancreatitis - not EtOH
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
AST>ALT

32. What do tumors that arise in the head of the pancreas cause
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Obstruction of the common bile duct
Mitochondrial abnl - fatty liver - hypoglycemia - coma

33. How many layers of spermatic fascia are covers an indirect inguinal hernia
Lipase
All 3
Downs
Heme metabolism

34. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Esophageal cancer
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Menetriers disease
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

35. What causes hirschsprungs
12 waves/min
Striated
Failure of neural crest migration
Alpha1 antitrypsin def - codominant trait

36. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Crohns = maybe - UC= always
Parietal cells in the stomach - B12 binding protein
Superior rectal
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

37. What are the extraintestinal manifestations of ulcerative colitis
Pyoderma gangrenosum - primary sclerosing cholangitis
Splenic flexure
Superior rectal and middle and inferior rectal - rectum
Small intestine

38. What does a low flow rate mean for saliva
Unconjugated - water insoluble
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Hypotonic because of more time to reabsorb NaCl

39. What is the omphalomesenteric cyst
Crohns = noncaseating granulomas - UC = crypt abscesses
Uremia
Zollinger ellison - brunners glands
Cystic dilation of the viteline duct

40. What does autoimmune destruction of parietal cells lead to...
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Chronic gastritis and pernicious anemia
Zenkers - halitosis - dysphagia and obstruction

41. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
GERD - may also present with nocturnal cough and dyspnea
Closer to isotonic because of less time to reabsorb NaCl
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
Causes of gall stones

42. What is the frequency of basal electric rhythm of the ilieum
Centrilobular congestion and necrosis - cardiac cirrhosis
Brunners
8-9 waves/min
H+

43. Autodigestion of pancreas by pancreatic enzymes
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Acute pancreatitis
Closer to isotonic because of less time to reabsorb NaCl
Striated

44. Where are carcinoid tumors most commonly malignant
Diverticulum
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
M3 - Gq - inc IP3/Ca
Small intestine

45. What is the triad of Plummer - Vinson syndrome
Penicillinamine - AR inheritance
Cholesterol - 10-20% opaque due to calcifications
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Superior rectal and middle and inferior rectal - rectum

46. Bilirubin is the product of what?
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Heme metabolism
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Neutralizes gastric acid allowing pancreatic enzymes to fxn

47. What pancreatic proteases are secreted as zymogens
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
AST>ALT
Trypsin - chymotrypsin - elastase - carboxypeptidases
The entire

48. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Cholesterol - 10-20% opaque due to calcifications
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Erosive - disruption of mucosal barrier leading to inflammation

49. Is there any structural abnl with IBS - What is the course of disease and presentation
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
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
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

50. At what spinal level does the SMA exit
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
The jejunum
Cystic duct and common hepatic duct
L1