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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. 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
Amylase
Dilated esophagus with an area of distal stenosis - birds beak
L2

2. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
NAV = nerve artery vein - venous near the penis (NAVEL)
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

3. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Corticosteroids - infliximab
Black - rotors syndrome
Achalasia due to loss of myenteric plexus (auberach)

4. What are the ABCDEF of esophageal cancer
Splenic flexure
Liver metabolizes 5HT
Above
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

5. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Sphincter of oddi
Zollinger Ellison - phenylalanine and tryptophan
Pyoderma gangrenosum - primary sclerosing cholangitis
Alcoholic cirrhosis

6. What histological findings are present in the stomach
Gastric glands
Muscularis mucosae
Stercobilin
Esophageal carcinoma

7. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Black - rotors syndrome
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Menetriers disease

8. What can fistula between the gallbladder and small intestine create and how can you tell
Pancreatic head causing obstructive jaundice
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Unconjugated - water insoluble

9. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Failure of the processus vagainlis to close
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Peyers patches
Downs

10. Progressive dyshphage beginning with solids and moving to liquids and weight loss
L1
Striated and smooth
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Esophageal cancer

11. What are the labs in acute pancreatitis
Superior rectal and middle and inferior rectal - rectum
Mucoepidermoid carcinoma
Positive urease test
Elevated amylase - and lipase

12. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Corticosteroids - infliximab
Parietal cells in the stomach - B12 binding protein
Zenkers - halitosis - dysphagia and obstruction
Chronic calcifying pancreatitis - inc risk of panreatic cancer

13. How do villi appear in disaccharidease def
Inferior rectal nerve
Lipase - phospholipase A - colipase
Normal
The entire

14. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Adhesion
Colonic polyps
IgA secreting plasma cells - ultimately reside in the lamina proporia
GERD - may also present with nocturnal cough and dyspnea

15. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Spleen to posterior abdominal wall - splenic artery and vein
Dubin johnson

16. What is the frequency of basal electric rhythm in the duodenum
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
12 waves/min
M3 - Gq - inc IP3/Ca

17. What is the action of NO as a GI hormone
Inc smooth muscle relaxation - including lower esophageal sphincter
AST>ALT
HPNCC
Positive

18. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
Alpha1 antitrypsin def - codominant trait
Osmotic
Mucoepidermoid carcinoma

19. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Meconium ileus
Hyperplastic
T12
Zollinger ellison - brunners glands

20. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Neutralizes oral bacertial acids and maintains dental health
Adhesion
Diarrhea - steatorrhea - weight loss - weakness
Colonic polyps

21. What happens to the short gastics if the splenic artery is blocked
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Superior rectal and middle and inferior rectal - rectum
Poor anastamoses
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

22. What do tumors that arise in the head of the pancreas cause
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Sphincter of oddi
Cholesterol - 10-20% opaque due to calcifications
Obstruction of the common bile duct

23. What histological findings are present in the esophagus
Nonkeritinized stratified sqamous epithelium
Krukenbergs tumor
Budd chiari syndrome
US and cholecystectomy

24. What is the arterial supply and venous drainage below pectinate line
Where hindgut meets ectoderm
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Gastrohepatic ligament

25. Where are tumors commonly in pancreatic adenocarcinoma
Complications of crohns
Gilbert's
Pancreatic head causing obstructive jaundice
Hyperpigmented mouth - lips - hands - genitalia

26. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Falciform - ligamentum teres - fetal umbilical vein
All 3
Necrotizing enterocolitis
Where hindgut meets ectoderm

27. What does the splenorenal ligament connect - and What does it contain
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Skip lesions =crohns - colon = UC
Elevated amylase - and lipase
Spleen to posterior abdominal wall - splenic artery and vein

28. Why does carcinoid syndrome not occur if tumor is confined to GI system
Menetriers disease
Liver metabolizes 5HT
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Above

29. What do the rugae of stomach look like in menetriers disease
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Cimetidine
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
So hypertrophied they look like brain gyri

30. What is the prognosis of adenocarcinoma
All 3
Dermatitis herpetiformis
Peutz jeghers
Averages 6 months - very aggressive - usually already metastasized at presentation

31. Where is the pectinate line
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Where hindgut meets ectoderm
External spermatic fascia only

32. How is the diagonsis of CRC made
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
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
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

33. vasoactive intestinal polypeptide (VIP) - source - action - regulation
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
12 waves/min
Positive urease test
Dilated esophagus with an area of distal stenosis - birds beak

34. What skin condition is associated with celiac sprue
In the ileum with bile acids - requires IF
Diarrhea - steatorrhea - weight loss - weakness
The submucosal nerve plexus - meissner's
Dermatitis herpetiformis

35. What is Trousseau's sign
Cimetidine
Colonic polyps
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Redness and tenderness on palpation of extremities

36. What are the two molecular pathways that lead to CRC
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
8-9 waves/min
Centrilobular congestion and necrosis - cardiac cirrhosis
MSI (15%) and APC/beta catenin chromosomal instability (85%)

37. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Where hindgut meets ectoderm

38. What is a positive murphy's sign
Colonic polyps
HPNCC
Inspiratory arrest on deep palpation due to pain
Mallory bodies

39. What are the barium swallow findings of achalasia
Poor anastamoses
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Dilated esophagus with an area of distal stenosis - birds beak
Fasting and stress

40. What are the extraintestinal manifestations of crohns
Diarrhea - steatorrhea - weight loss - weakness
Virchow's node
Achalasia due to loss of myenteric plexus (auberach)
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

41. What arteries exit just below the SMA
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
L/R renal artery around L1
Cystic duct and common hepatic duct
Below

42. is meckels a true diverticulum and how common is it
Inferior rectal nerve
True and most common congenital anomoly of GI tract
Barrett's esophagus
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

43. Who is at risk for pancreatic adenocarcinoma
Warthins' tumor
Hemolytic anemia
Jewish and African American men
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

44. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
All 3
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Cirrhosis

45. What is the risk with peutz jehgers
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Inc risk of CRC and other visceral malignancies
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

46. absent UDPGT - presents early in life - early mortality
Increase tumorigenesis
Above
Crigler - najjar type 1
Epithelium

47. Where are carcinoid tumors most commonly malignant
Centrilobular leading to congestive liver disease
Small intestine
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

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

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49. Liver cell failure can lead to multisystem signs including
Left gastric vein and esophogeal vein - esophagus
H+
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
FAP

50. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Above
Where hindgut meets ectoderm
Complications of crohns
Cystic dilation of the viteline duct