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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. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis

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2. What is charcot triad of cholangitis
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Jaundice - fever - RUQ
Inc smooth muscle relaxation - including lower esophageal sphincter
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

3. What nerve innervates the external hemorrhoids
Lactase is located at the tips of intestinal villi
Gamma glutamyl transferase GGT
Inferior rectal nerve
ALT>AST

4. What are the layers of the gut wall from inside out
Mucosa - submucosa - muscularis externa - serosa/adventitia
Femoral hernia
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Hepatic steatosis

5. What do tumors that arise in the head of the pancreas cause
Striated
Obstruction of the common bile duct
HPNCC
All 3 gut layers outpouch as in Meckels

6. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Lactase is located at the tips of intestinal villi
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Boerhaave's Syndrome - Been heaving syndrome
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

7. In alchoholic hepatitis which liver enzyme is higher
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
AST>ALT
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
L4

8. What are the complications of acute pancreatitis
VZV and influenza B treated with salicylates
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Paraumbilical and superficial and inferior epigastric - umbilicus
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

9. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
T cell lymphoma
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Pertechnetate - study for uptake

10. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Redness and tenderness on palpation of extremities
L3
Peyers patches

11. What is a positive murphy's sign
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Inspiratory arrest on deep palpation due to pain
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Inc risk of CRC and other visceral malignancies

12. Through which aspect of the inguinal canal does a direct inguinal go
Left gastric vein and esophogeal vein - esophagus
With albumin
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
External (superficial) ring only

13. A protrusion of peritoneum through an opening - usually a site of weakness
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Intussusception
Around the central vein (zone III)
Hernia

14. What does the splenorenal ligament connect - and What does it contain
Juvenille polyps - no risk if single
Stimulate intestinal persistalsis
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Spleen to posterior abdominal wall - splenic artery and vein

15. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Volvulus
Epigastric abdominal pain radiating to back - anorexia - nausea
Alcoholic cirrhosis
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

16. What kind of lesions are characteristic of duodenal PUD vs cancer
Punched out - clean margins - carcinoma =raised irregular margins
Inferior rectal nerve
Upregulated intracellular signal transduction
Duodenum - 2nd - 3rd and 4th parts

17. What structures feed into the cystic duct
Can lead to hematemesis - found in EtOHics and bulimics
Crypts but not villi
Duodenal atresia - Downs
Gallbladder

18. What structure is Not contained in the femoral sheath
Cholesterol
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Begins starch digestion - inactivated by low pH upon reaching the stomach

19. What infection causes Whipple disease and What can you see on LM
Dilated esophagus with an area of distal stenosis - birds beak
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Bleeding - penetration into pancreas - perforation - obstruction

20. What does alpha amylase do and what inactivates it
Celiac sprue
Cystic dilation of the viteline duct
Begins starch digestion - inactivated by low pH upon reaching the stomach
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

21. How many layers of spermatic fascia are covers an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Common hepatic - splenic - left gastric - main blood supply for stomach
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
All 3

22. What serum enzyme is elevated inacute pancreatitis
Repeated phlebotomy - deferoxamine - HLA- A3
H+
Lipase
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

23. What are the signs of peutz jehgers
Hyperpigmented mouth - lips - hands - genitalia
AST
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

24. What kind of digestion is bile needed for
Splenic flexure
Chagas disease
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

25. Why does carcinoid syndrome not occur if tumor is confined to GI system
Liver metabolizes 5HT
Boerhaave's Syndrome - Been heaving syndrome
Redundant mesentary
Bleeding - penetration into pancreas - perforation - obstruction

26. Which patients have pigment stones
Meckels
Sister mary joseph nodule
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Serous on the sides parotids - mucinous in the middle sublingual

27. Cholecytsokinin - source - action - regulation
Colonic polyps
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
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

28. trypsinogen is converted to trypsin via what enzyme
Brunners
Causes of gall stones
Enterokinase/enteropeptidase from the duodenal mucosa
Unconj - absent (acholuria) - inc

29. What are the histological findings in the jejunum
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Angiodysplasia
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Internal thoracic to superior epigastric to inferior epigastric

30. What gives stool its characteristic color
Decrease - weight gain
Below
Stercobilin
Pleomorphic adenoma

31. Where is folate absorbed
Lack or have an attenuated muscularis externa - often in the sigmoid colon
The jejunum
Esophageal cancer
Can lead to hematemesis - found in EtOHics and bulimics

32. likely infectious form of malabsorption - responds to antibiotics
Centrilobular congestion and necrosis - cardiac cirrhosis
Crigler - najjar type 1
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Tropical sprue

33. What cells secrete bicarb - What does it do - and what regulates it
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Obstruction of the common bile duct
GERD - may also present with nocturnal cough and dyspnea
Stimulate intestinal persistalsis

34. What are motilin receptor agonists used for clinically
Uridine glucuronyl transferase
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Stimulate intestinal persistalsis
Gastric glands

35. involvement of left supraclavicular node by mets from stomach

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36. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Osmotic
Meckels
Nonkeritinized stratified sqamous epithelium
Splenic flexure

37. How does abetalipoproteinemia lead to malabsorption
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Skip lesions =crohns - colon = UC
Neural muscarinic pathways
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

38. What is pancreatic adenocarcinoma associated with
Inferior rectal nerve
Cigarettes and chronic pancreatitis - not EtOH
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Enterokinase/enteropeptidase from the duodenal mucosa

39. What factors increase risk of malignancy of adenomatous polyps
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Alk phos
Pancreatic and bile

40. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Crohns = transmural (cobblestone mucosa - creeping fat - string sign - linear ulcers fissures - fistulas) UC = mucosal and submucosal (friable mucosal pseudopolyps with freely hanging mesentary - loss of haustra - lead pipe appearance on imaging
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Duodenum - 2nd - 3rd and 4th parts
Redundant mesentary

41. How do villi appear in disaccharidease def
Below
Normal
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

42. What are the borders of the femoral triangle
Obstruction of the common bile duct
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Necrotizing enterocolitis
Inguninal ligament - sartorius muscle - adductor longus

43. What is the clinical presentation of acute pancreatitis
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Epigastric abdominal pain radiating to back - anorexia - nausea
Oligosaccharide digestion

44. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Pleomorphic adenoma
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Alcoholic cirrhosis

45. What are the extraintestinal manifestations of ulcerative colitis
Esophageal varices
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Mucosa - submucosa - muscularis externa - serosa/adventitia
Pyoderma gangrenosum - primary sclerosing cholangitis

46. What are the signs and symptoms of budd chiari
Erosive - disruption of mucosal barrier leading to inflammation
Lye ingestion and acid reflux
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

47. What is the frequency of basal electric rhythm of the stomach
3 waves/min
Mucosa - submucosa - muscularis externa - serosa/adventitia
Volvulus
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

48. Where does copper accumulate in Wilsons and What are ABCD
Bleeding - penetration into pancreas - perforation - obstruction
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
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

49. How does hirschsprung present and appear on imaging
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
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
...
Hernia

50. HCC is associated with what other conditions
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Via the middle colic
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Falciform - ligamentum teres - fetal umbilical vein