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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 are the barium swallow findings of achalasia
Amylase
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Colonic polyps
Dilated esophagus with an area of distal stenosis - birds beak

2. In viral hepatitis - which liver enzyme is higher
Below
Serous on the sides parotids - mucinous in the middle sublingual
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
ALT>AST

3. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Gastrohepatic ligament
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Upregulated intracellular signal transduction
Adhesion

4. Bile is critical for exrection of what substance
Cholesterol
2ndary biliary cirrhosis
Poor anastamoses
Glucouronate - water soluble (direct)

5. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Brunners
Inc smooth muscle relaxation - including lower esophageal sphincter
Gamma glutamyl transferase GGT
Lack or have an attenuated muscularis externa - often in the sigmoid colon

6. What are the complications of chronic pancreatitis
Mucosa - submucosa - muscularis externa - serosa/adventitia
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
All 3
Peyers patches

7. Why does carcinoid syndrome not occur if tumor is confined to GI system
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
H+
Liver metabolizes 5HT
Appendicitis

8. What does a low flow rate mean for saliva
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Acute pancreatitis
Gut bacteria
Hypotonic because of more time to reabsorb NaCl

9. What are the complications of Meckels
Fasting and stress
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Femoral hernia

10. conjugated hyperbilirubinemia due to defective liver excretion
Striated and smooth
Inguninal ligament - sartorius muscle - adductor longus
90%
Dubin johnson

11. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Early childhood - neuro sx and malabsorption
Hirschsprungs
Dysphagia (due to esophageal web) - glossitis - iron def anemia

12. What are motilin receptor agonists used for clinically
Pertechnetate - study for uptake
Stimulate intestinal persistalsis
Duodenum - 2nd - 3rd and 4th parts
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

13. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Pyoderma gangrenosum - primary sclerosing cholangitis
Dense core bodies
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

14. what kind of muscle is in the upper 1/3 of esophagus
Female - fat - fertile - forty
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Striated
Lamina propora and submucosa

15. What structures feed into the common hepatic duct
Left and right gastroepiploics - left and right gastrics
Hypotonic because of more time to reabsorb NaCl
VZV and influenza B treated with salicylates
Right and left hepatic duct

16. What complication can arise from indirect inguinal hernias
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Diarrhea - steatorrhea - weight loss - weakness
Hydrocele
Via the middle colic

17. What serum markers increase in cholecystitis with bile duct involvement
AST >ALT - ration is usually 1.5
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Alk phos

18. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Necrotizing enterocolitis
Bleeding - penetration into pancreas - perforation - obstruction

19. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Below
Gut bacteria
Conj/unconj - inc - nl to dec

20. What is the epi for CRC
Phenobarbital - inc liver enzyme synthesis
Repeated phlebotomy - deferoxamine - HLA- A3
Inguninal ligament - sartorius muscle - adductor longus
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

21. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
L2
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
All 3

22. crigler - najjar type II responds to which therapy and How does it work
Meckels
Phenobarbital - inc liver enzyme synthesis
The jejunum
Complications of UC

23. What kind of pathways do CCK act on to cause pancreatic secretion
Neural muscarinic pathways
Achalasia due to loss of myenteric plexus (auberach)
Alpha amylase
Hypotonic because of more time to reabsorb NaCl

24. What are the borders of Hesselbach's triangle
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Neutralizes oral bacertial acids and maintains dental health
CHF and inc risk of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

25. What are the midgut structures and what supplies their blood and PANS innervation
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Reye's syndrome

26. What parts of the small bowel can tropical sprue effect
The entire
Upregulated intracellular signal transduction
Amylase
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

27. absent UDPGT - presents early in life - early mortality
Hyperplastic
Crigler - najjar type 1
Dissaccharidase def - most commonly lactase
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

28. What is the omphalomesenteric cyst
True and most common congenital anomoly of GI tract
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Cystic dilation of the viteline duct
Causes of gall stones

29. What is the arterial supply and venous drainage below pectinate line
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Gastrohepatic ligament
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

30. What are additional risk factors for CRC
Smooth
FAP
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

31. What does GET SMASHED stand for in acute pancreatitis
Alcoholic cirrhosis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Nonkeritinized stratified sqamous epithelium
Closer to isotonic because of less time to reabsorb NaCl

32. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Gallbladder
In the ileum with bile acids - requires IF
Pleuroperitoneal
Left gastric vein and esophogeal vein - esophagus

33. What are the histological findings of the colon
No
Turcot
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Crypts but not villi

34. signet ring cells - acanthosis nigracans - dz - character/association - spread
In the ileum with bile acids - requires IF
Antrum - H.pylori - inc risk of MALT lymphoma
Uridine glucuronyl transferase
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

35. What does autoimmune destruction of parietal cells lead to...
Turcot
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Chronic gastritis and pernicious anemia
Above

36. What is the most important mechanism in gastric acid secretion
Oligosaccharide digestion
Portal HTN
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

37. Transmural esophageal rupture due to violent retching

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38. Achalasia increases the risk For what complication
Esophageal carcinoma
Hepatic steatosis
Enterokinase/enteropeptidase from the duodenal mucosa
Left gastric vein and esophogeal vein - esophagus

39. What are the common causes of gastric ulcers - What causes gastric ulcer
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Cimetidine
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

40. In what scenarios do pts with gilberts have inc bili
Fasting and stress
L2
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
Female - fat - fertile - forty

41. Which area of the hindgut is a watershed area
Alk pho
Esophageal carcinoma
Necrotizing enterocolitis
Splenic flexure

42. What is the characteristic histo finding in alcoholic hepatitis
Lye ingestion and acid reflux
Mallory bodies
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
Superior rectal and middle and inferior rectal - rectum

43. Bilirubin is the product of what?
Cholesterol - 10-20% opaque due to calcifications
Duodenal atresia - Downs
Heme metabolism
Redness and tenderness on palpation of extremities

44. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Alpha1 antitrypsin def - codominant trait
Closer to isotonic because of less time to reabsorb NaCl
Internal thoracic to superior epigastric to inferior epigastric
Cholesterol

45. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Femoral hernia
Acute pancreatitis
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

46. What findings are associated with reyes
The entire
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Decrease - weight gain
Mitochondrial abnl - fatty liver - hypoglycemia - coma

47. What serum enzyme is decreased in wilsons disease
Alcoholic cirrhosis
Ceruplasmin
Conj - inc - dec
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

48. likely infectious form of malabsorption - responds to antibiotics
Corticosteroids - infliximab
Tropical sprue
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Inguninal ligament - sartorius muscle - adductor longus

49. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Alcoholic hepatitis
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
Lateral to the inferior epigastric artery

50. What structures feed into the cystic duct
Uremia
Gallbladder
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Dilated esophagus with an area of distal stenosis - birds beak