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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 structures feed into the common hepatic duct
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Right and left hepatic duct
Alcoholic cirrhosis
Epithelium

2. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Can lead to hematemesis - found in EtOHics and bulimics
Achalasia due to loss of myenteric plexus (auberach)
Tropical sprue

3. What are the labs in acute pancreatitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Elevated amylase - and lipase

4. Achalasia increases the risk For what complication
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Left gastric vein and esophogeal vein - esophagus
Esophageal carcinoma

5. What drug blocks the H2R
Cimetidine
CCK8 receptor - Gq inc IP3/Ca
Inspiratory arrest on deep palpation due to pain
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

6. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
CEA - CA-19-9
Meckels
Complications of UC
Cirrhosis

7. What are the borders of the femoral triangle
Inguninal ligament - sartorius muscle - adductor longus
Dissaccharidase def - most commonly lactase
Carcinoid syndrome
Falciform - ligamentum teres - fetal umbilical vein

8. Through which aspect of the inguinal canal does a direct inguinal go
External (superficial) ring only
FAP
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Urobilin

9. What is the sphincter of the pancreatic duct
Sphincter of oddi
Glucose dependent insulinotropic peptide
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

10. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Decreased intercellular adhesion and increased proliferation
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

11. What layer in the mucosa is responsible for support
Lactase is located at the tips of intestinal villi
Lubricate food (glycoprotiens)
Lamina propria
Duodenum - 2nd - 3rd and 4th parts

12. What cells make pepsin - What does it do - and what regulates it
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
Inc - weight loss
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

13. subQ peribumbilical metastasis
Left gastric vein and esophogeal vein - esophagus
Omeprazole
Esophageal varices
Sister mary joseph nodule

14. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Adhesion
CEA - CA-19-9
Uridine glucuronyl transferase

15. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Lipase
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Inc conj bilirubin - inc cholesterol - inc alk phos
Cholesterol - 10-20% opaque due to calcifications

16. What is the risk with peutz jehgers
Celiac sprue
Inc risk of CRC and other visceral malignancies
Peyers patches
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

17. Where is the arterial supply from above the pectinate line - and What is the venous drainage
T cell lymphoma
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Causes of gall stones

18. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Neutralizes oral bacertial acids and maintains dental health
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
FAP
Lipase - phospholipase A - colipase

19. What is pancreatic adenocarcinoma associated with
GERD - may also present with nocturnal cough and dyspnea
Parietal cells in the stomach - B12 binding protein
Left and right gastroepiploics - left and right gastrics
Cigarettes and chronic pancreatitis - not EtOH

20. What structures feed into the common bile duct
Myenteric nerve plexus - aurbach
Penicillinamine - AR inheritance
Dissaccharidase def - most commonly lactase
Cystic duct and common hepatic duct

21. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Intussusception
Stimulate intestinal persistalsis
Phenobarbital - inc liver enzyme synthesis

22. At what level of the spine does the IM exit the aorta
Colovesical leading to pneumaturia
L3
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
So hypertrophied they look like brain gyri

23. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Hemosiderosis - hemochromatosis
Decrease - weight gain
Fe2+ in the duod
Primary sclerosing cholangitis

24. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Upregulated intracellular signal transduction
Superior rectal and middle and inferior rectal - rectum
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

25. secretin - source - action - regulation
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
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
Peyers patches
Below

26. What causes nutmeg liver
With albumin
Backup of blood into the liver - RHF - budd chiari
GLUT 2
Superior rectal and middle and inferior rectal - rectum

27. What is the cause of Barrett's and the assocaited complications
Decrease - weight gain
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Common hepatic - splenic - left gastric - main blood supply for stomach
Fasting and stress

28. What kind of anemia is in Wilsons
Striated and smooth
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Left and right gastroepiploics - left and right gastrics
Hemolytic anemia

29. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Glucose dependent insulinotropic peptide
AST>ALT

30. What portion of the bowel does sprue effect
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
NAV = nerve artery vein - venous near the penis (NAVEL)
Lateral to the inferior epigastric artery
The proximal small bowel

31. Where is folate absorbed
Necrotizing enterocolitis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
The jejunum
Paraumbilical and superficial and inferior epigastric - umbilicus

32. What is the presenting course for appendicity

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33. What kind of pancreatitis is associated with EtOH and smoking
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Common hepatic - splenic - left gastric - main blood supply for stomach
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Chronic calcifying pancreatitis - inc risk of panreatic cancer

34. What histological findings are present in the esophagus
External spermatic fascia only
Meckels
Muscularis mucosae
Nonkeritinized stratified sqamous epithelium

35. What histological findings are present in the stomach
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Decrease - weight gain
External spermatic fascia only
Gastric glands

36. To what substance is bilirubin conjugated and why
Lateral to the inferior epigastric artery
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Glucouronate - water soluble (direct)

37. What does loss of APC cause
Failure of the processus vagainlis to close
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
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Decreased intercellular adhesion and increased proliferation

38. In viral hepatitis - which liver enzyme is higher
Via the superior pancreaticduodenal
90%
ALT>AST
Spleen to posterior abdominal wall - splenic artery and vein

39. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Falciform - ligamentum teres - fetal umbilical vein
PAS- positive globules in liver -
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Internal thoracic to superior epigastric to inferior epigastric

40. What are the extraintestinal manifestations of crohns
Punched out - clean margins - carcinoma =raised irregular margins
Duodenal atresia - Downs
90%
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

41. Where is bicarb trapped
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
In the mucus that covers the gastric epithelium
Via the middle colic
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

42. What is the rule of 2s for meckels
Left and right gastroepiploics - left and right gastrics
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
The entire
GERD - may also present with nocturnal cough and dyspnea

43. What does high flow rate mean
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Gut bacteria
Corticosteroids - infliximab
Closer to isotonic because of less time to reabsorb NaCl

44. 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
Small intestine
Dilated esophagus with an area of distal stenosis - birds beak
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

45. What do you use to diagnose meckels
Pertechnetate - study for uptake
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Stimulate intestinal persistalsis

46. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
L4
Normal
Ischemic colitis
Mallory bodies

47. What does a low flow rate mean for saliva
Omeprazole
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Older patients
Hypotonic because of more time to reabsorb NaCl

48. Abuse of what substance leads to acute gastritis
NAV = nerve artery vein - venous near the penis (NAVEL)
Juvenile polyposis syndrome - inc risk of adenocarcinoma
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
EtOH

49. What pancreatic enzymes are responsible for fat digestion
Left and right gastroepiploics - left and right gastrics
Inc smooth muscle relaxation - including lower esophageal sphincter
Lipase - phospholipase A - colipase
Muscularis mucosae

50. What is one potential precipitating factor for intussusception
Inguninal ligament - sartorius muscle - adductor longus
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Peyers patches
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor