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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. multiple juvenil polyps in GI tract - risk
Failure of the processus vagainlis to close
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Sister mary joseph nodule
EtOH

2. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Short gastrics - left greater and lesser
Ceruplasmin
Menetriers disease
Pancreatic head causing obstructive jaundice

3. What pancreatic proteases are secreted as zymogens
Trypsin - chymotrypsin - elastase - carboxypeptidases
Lipase
Smooth
The jejunum

4. crigler - najjar type II responds to which therapy and How does it work
Gut bacteria
Paraumbilical and superficial and inferior epigastric - umbilicus
Phenobarbital - inc liver enzyme synthesis
L/R renal artery around L1

5. What nerve innervates the external hemorrhoids
Cirrhosis
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
L/R renal artery around L1
Inferior rectal nerve

6. What is the classic triad of hemochromatosis

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7. Why are most diverticula considered false
L/R renal artery around L1
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Phototherapy

8. What causes primary biliary cirrhosis
CEA - CA-19-9
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
L/R renal artery around L1
CCK8 receptor - Gq inc IP3/Ca

9. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Neural muscarinic pathways
Paraumbilical and superficial and inferior epigastric - umbilicus
Diverticulum
Internal thoracic to superior epigastric to inferior epigastric

10. What is the main symptom if a VIPoma
Diverticulum
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Normal

11. What gives urine its characteristic color
Urobilin
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Mallory bodies
Juvenille polyps - no risk if single

12. Esophagitis can result From which 3 infectious agents - or chemical ingestion
HSV-1 - CMV - Candida
Complications of crohns
Alcoholic hepatitis
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

13. A protrusion of peritoneum through an opening - usually a site of weakness
VZV and influenza B treated with salicylates
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Hernia
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

14. inflammatino of gallbadder
Cholesterol - 10-20% opaque due to calcifications
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Can lead to hematemesis - found in EtOHics and bulimics
Sphincter of oddi

15. What is the presenting course for appendicity

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16. In what scenarios do pts with gilberts have inc bili
Fasting and stress
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Penicillinamine - AR inheritance

17. What histological findings are present in the stomach
Gastric glands
Inc risk of CRC and other visceral malignancies
Urobilin
M3 - Gq - inc IP3/Ca

18. What receptors does ACH bind on the parietal cells and What does it activate
Short gastrics - left greater and lesser
Esophageal carcinoma
Esophageal varices
M3 - Gq - inc IP3/Ca

19. what kind of fistula is associated with diverticulitis
Appendicitis
VZV and influenza B treated with salicylates
Colovesical leading to pneumaturia
Conj/unconj - inc - nl to dec

20. What are the extraintestinal manifestations of crohns
Older patients
Decreased intercellular adhesion and increased proliferation
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
T cell lymphoma

21. What is contained within the submucosa

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22. How is bilirubin carried in the blood
L1
With albumin
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Superior rectal and middle and inferior rectal - rectum

23. Dysphagia in achalasia results from
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
CCK8 receptor - Gq inc IP3/Ca
H+

24. Where is IgA shuttled
Striated and smooth
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Cimetidine

25. What does GET SMASHED stand for in acute pancreatitis
Sister mary joseph nodule
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Corticosteroids - infliximab
Crohns = maybe - UC= always

26. If trypsin activates more trypsinogen - what kind of feedback loop is established
GERD - may also present with nocturnal cough and dyspnea
Positive
Diverticulitis in elderly - ectopic pregs use hCG to rule out
MSI (15%) and APC/beta catenin chromosomal instability (85%)

27. What are the treatmet options for crohns
Bleeding - penetration into pancreas - perforation - obstruction
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Cimetidine
Corticosteroids - infliximab

28. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Superior rectal
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
All 3

29. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Superior rectal and middle and inferior rectal - rectum
Epigastric abdominal pain radiating to back - anorexia - nausea

30. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Zollinger ellison - brunners glands
Lye ingestion and acid reflux

31. What drug inhibits the H/K ATPase
Penicillinamine - AR inheritance
Juvenille polyps - no risk if single
Omeprazole
Celiac sprue

32. subQ peribumbilical metastasis
Female - fat - fertile - forty
Tropical sprue
Sister mary joseph nodule
When diffusely infiltrative - thickened rigid appearance like a leather bottle

33. What layer in the mucosa is responsible for support
Necrotizing enterocolitis
AST
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Lamina propria

34. What findings are associated with reyes
Via the superior pancreaticduodenal
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

35. involvement of left supraclavicular node by mets from stomach

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36. At what level do the testicular/ovarian arteries exit the aorta
Fe2+ in the duod
L2
Cholesterol - 10-20% opaque due to calcifications
Dermatitis herpetiformis

37. What structure is Not contained in the femoral sheath
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Downs
Superior rectal

38. Which kind of hemorrhoids are painful and why
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Nonkeritinized stratified sqamous epithelium
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

39. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Left gastric vein and esophogeal vein - esophagus
...
Conj - inc - dec

40. What is contained in the gastrosplenic and What areas does it separate
Positive urease test
Smooth
Short gastrics - left greater and lesser
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

41. Where are peyers patches found
AST>ALT
Reye's syndrome
Above
Lamina propora and submucosa

42. What is the frequency of basal electric rhythm of the stomach
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Serous on the sides parotids - mucinous in the middle sublingual
3 waves/min
Barrett's esophagus

43. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Right and left hepatic duct
Gamma glutamyl transferase GGT
All 3
Duodenal atresia - Downs

44. What is the triad of Plummer - Vinson syndrome
Diverticulum
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Dysphagia (due to esophageal web) - glossitis - iron def anemia
L3

45. What do you use to diagnose meckels
External spermatic fascia only
Elevated amylase - and lipase
Pertechnetate - study for uptake
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

46. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
Gilbert's
FAP
Striated

47. What does primary sclerosing cholangitis lead to...
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
NAV = nerve artery vein - venous near the penis (NAVEL)
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
All 3

48. What percentage of gall stones are cholesterol stones and What are the associations
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Neutralizes oral bacertial acids and maintains dental health
Oligosaccharide digestion
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

49. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Crohns = noncaseating granulomas - UC = crypt abscesses
Alcoholic hepatitis
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

50. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Duodenal atresia - Downs
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
H+
Volvulus