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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. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Juvenille polyps - no risk if single
H2 receptor - inc cAMP
Superior rectal and middle and inferior rectal - rectum
Neutralizes oral bacertial acids and maintains dental health

2. What are the layers of the gut wall from inside out
Redness and tenderness on palpation of extremities
Mucosa - submucosa - muscularis externa - serosa/adventitia
Serous on the sides parotids - mucinous in the middle sublingual
AST >ALT - ration is usually 1.5

3. malnutrition - toxic megacolon - colorectal carcinoma
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Lateral to the inferior epigastric artery
Hirschsprungs
Complications of UC

4. What are the four Fs of gallstones
Internal thoracic to superior epigastric to inferior epigastric
IgA secreting plasma cells - ultimately reside in the lamina proporia
Female - fat - fertile - forty
Hypercoaguability - polycythemia vera - pregnancy - HCC

5. What are the barium swallow findings of achalasia
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Myenteric nerve plexus - aurbach
Dilated esophagus with an area of distal stenosis - birds beak
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

6. What kind of lesions are characteristic of duodenal PUD vs cancer
Around the central vein (zone III)
Normal
Zollinger ellison - brunners glands
Punched out - clean margins - carcinoma =raised irregular margins

7. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Crypts but not villi
Uremia
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Meckels

8. What is the frequency of basal electric rhythm of the ilieum
Smooth
FAP
Esophageal varices
8-9 waves/min

9. what kind of muscle is in the upper 1/3 of esophagus
Striated
Dubin johnson
Closer to isotonic because of less time to reabsorb NaCl
L/R renal artery around L1

10. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Punched out - clean margins - carcinoma =raised irregular margins
Gastrohepatic ligament
Heme metabolism

11. Which viral infxns/treatments are associated with reyes syndrome
Copious diarrhea - non alpha - non beta cell pancreatic tumor
AR
VZV and influenza B treated with salicylates
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

12. What are the tumor markers for pancreatic adenocarcinoma
IBS at least 2 with recurrent abdominal pain
CEA - CA-19-9
Striated and smooth
H+

13. Where and How is iron absorbed
Via the middle colic
Fe2+ in the duod
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Neural muscarinic pathways

14. Where does type B chronic gastritis occur and What causes it
H+
Antrum - H.pylori - inc risk of MALT lymphoma
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Intussusception

15. What is the clinical presentation of acute pancreatitis
Lamina propria
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Epigastric abdominal pain radiating to back - anorexia - nausea
Cystic duct and common hepatic duct

16. most common non - neoplastic polyp in colon
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Jaundice - fever - RUQ
Hyperplastic
Dilated esophagus with an area of distal stenosis - birds beak

17. What is the frequency of basal electric rhythm of the stomach
Lactase is located at the tips of intestinal villi
Glucouronate - water soluble (direct)
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
3 waves/min

18. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
Centrilobular congestion and necrosis - cardiac cirrhosis
Virchow's node
Common hepatic - splenic - left gastric - main blood supply for stomach

19. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Poor anastamoses
Esophageal cancer
L1
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

20. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
HSV-1 - CMV - Candida
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Inc lower esphogeal tone leading to achalasia
Corticosteroids - infliximab

21. What complication can arise from indirect inguinal hernias
Lamina propria
Hydrocele
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
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

22. What converts inactive pepsinogen to pepsin
Pancreatic head causing obstructive jaundice
Achalasia due to loss of myenteric plexus (auberach)
H+
Meconium ileus

23. What kind of pathways do CCK act on to cause pancreatic secretion
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Neural muscarinic pathways
Crohns = noncaseating granulomas - UC = crypt abscesses
Colonic polyps

24. When and How does Abetalipoproteinemia present
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Alpha amylase
Early childhood - neuro sx and malabsorption

25. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
Old men - arthralgias - cardiac and neuro sx
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Sister mary joseph nodule

26. secretin - source - action - regulation
L1
CEA - CA-19-9
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
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

27. What are the structures of the femoral triangle and how are they organized
NAV = nerve artery vein - venous near the penis (NAVEL)
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Penicillinamine - AR inheritance
Closer to isotonic because of less time to reabsorb NaCl

28. What does a low flow rate mean for saliva
Early childhood - neuro sx and malabsorption
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Hypotonic because of more time to reabsorb NaCl
Terminal ileum and colon

29. What is the triad of Plummer - Vinson syndrome
Pancreatic and bile
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

30. What is diverticulosis
Alcoholic hepatitis
Via the middle colic
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

31. When do you see hypertrophy of brunners glands
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Peptic ulcer disease
Unconj - absent (acholuria) - inc
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

32. What carcinogens are associated with HCC
Causes of gall stones
Alfatoxin in peanuts
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Goes through deep inguinal ring - external inguinal ring and into the scrotum

33. What does primary sclerosing cholangitis lead to...
When diffusely infiltrative - thickened rigid appearance like a leather bottle
...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

34. What are the branches of the celiac trunk and What do they supply
Centrilobular congestion and necrosis - cardiac cirrhosis
Dilated esophagus with an area of distal stenosis - birds beak
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Common hepatic - splenic - left gastric - main blood supply for stomach

35. What is the ddx associated with appendicitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Lateral to the inferior epigastric artery

36. What is one potential precipitating factor for intussusception
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Hepatic steatosis
8-9 waves/min

37. What does a gastrinoma cause
H pylori (almost 100%)
AR
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Hepatic steatosis

38. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Angiodysplasia
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Gardner's syndrome
Bleeding - intussusception - volvulus - obstruction near terminal ileum

39. What does high flow rate mean
So hypertrophied they look like brain gyri
Skip lesions =crohns - colon = UC
The jejunum
Closer to isotonic because of less time to reabsorb NaCl

40. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Older patients
Colonic polyps
Unconjugated - water insoluble
Hepatic steatosis

41. bilateral mets to ovaries with abundant mucus - signet ring cells
Duodenum - 2nd - 3rd and 4th parts
Portal HTN
Femoral hernia
Krukenbergs tumor

42. Where does an indirect inguinal hernia enter the deep inguinal ring
Lateral to the inferior epigastric artery
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Trypsin - chymotrypsin - elastase - carboxypeptidases
Primarly through ECL leading to histamine release

43. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
Around the central vein (zone III)
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Goes through deep inguinal ring - external inguinal ring and into the scrotum

44. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Falciform - ligamentum teres - fetal umbilical vein
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Cystic duct and common hepatic duct

45. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
Peyers patches
Hepatic steatosis
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

46. likely infectious form of malabsorption - responds to antibiotics
Portal HTN
Lamina propria
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Tropical sprue

47. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Below
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
Cimetidine
Necrotizing enterocolitis

48. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Conj - inc - dec
Alpha1 antitrypsin def - codominant trait
Internal thoracic to superior epigastric to inferior epigastric
T cell lymphoma

49. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Sister mary joseph nodule
L1
Below
Zenkers - halitosis - dysphagia and obstruction

50. 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
Centrilobular leading to congestive liver disease
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
CEA - CA-19-9