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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 do you use to diagnose meckels
Amylase
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Pertechnetate - study for uptake
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

2. What is the leading cause of bowel incarceration
HSV-1 - CMV - Candida
Chagas disease
Warthins' tumor
Femoral hernia

3. What is the path of an indirect inguinal hernia
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Ceruplasmin
Ischemic colitis
Goes through deep inguinal ring - external inguinal ring and into the scrotum

4. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Failure of neural crest migration
Brush border of intestine - produce monosaccharides from oligo and di
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Alcoholic hepatitis

5. What are the borders of the femoral triangle
Inguninal ligament - sartorius muscle - adductor longus
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Small intestine
Serous on the sides parotids - mucinous in the middle sublingual

6. What is the frequency of basal electric rhythm of the stomach
Hirschsprungs
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Repeated phlebotomy - deferoxamine - HLA- A3
3 waves/min

7. Achalasia increases the risk For what complication
Reye's syndrome
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Cystic duct and common hepatic duct
Esophageal carcinoma

8. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
Brush border of intestine - produce monosaccharides from oligo and di
Hemolytic anemia
2ndary biliary cirrhosis

9. What complication can arise from indirect inguinal hernias
Obstruction of the common bile duct
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Hydrocele
Penicillinamine - AR inheritance

10. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
GERD - may also present with nocturnal cough and dyspnea
Downs

11. What is the mechanism for reyes syndrome
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Common hepatic - splenic - left gastric - main blood supply for stomach
Crohns = noncaseating granulomas - UC = crypt abscesses

12. If the hemochromatosis is primary - What is the pattern of inheritance
Striated and smooth
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Paraumbilical and superficial and inferior epigastric - umbilicus
AR

13. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Alk pho
Pancreatic head causing obstructive jaundice
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

14. Why does volvulus occur more at cecum and sigmoid colon
Redundant mesentary
In the mucus that covers the gastric epithelium
Meconium ileus
Alpha amylase

15. What can hemochromatosis be secondary to...
Zenkers - halitosis - dysphagia and obstruction
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

16. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Splenic flexure
Adhesion
Short gastrics - left greater and lesser
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

17. What is the prognosis of adenocarcinoma
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Peyers patches
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Averages 6 months - very aggressive - usually already metastasized at presentation

18. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
With albumin
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
IgA secreting plasma cells - ultimately reside in the lamina proporia

19. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Reye's syndrome
Myenteric nerve plexus - aurbach
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

20. Where is IgA shuttled
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
T12
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

21. What is the frequency of basal electric rhythm of the ilieum
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Inc lower esphogeal tone leading to achalasia
8-9 waves/min

22. In what clinical scenarior do you see portosystemic anastomoses
External spermatic fascia only
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Hyperplastic
Portal HTN

23. likely infectious form of malabsorption - responds to antibiotics
Inspiratory arrest on deep palpation due to pain
Tropical sprue
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Unconjugated - water insoluble

24. When and why is stomach cancer termed linitis plastica
Lamina propria
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Elevated amylase - and lipase

25. What can fistula between the gallbladder and small intestine create and how can you tell
Dissaccharidase def - most commonly lactase
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Hypercoaguability - polycythemia vera - pregnancy - HCC
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

26. What gives stool its characteristic color
Gamma glutamyl transferase GGT
GERD - may also present with nocturnal cough and dyspnea
Where hindgut meets ectoderm
Stercobilin

27. With internal hemorrhoids Where is the anastomoses and Where is it
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Superior rectal and middle and inferior rectal - rectum
ALT>AST
Via the superior pancreaticduodenal

28. What intervention will intervention will relieve portal HTN
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Redundant mesentary
Alk phos
Tropical sprue

29. rare - often fatal childhood hepatoencephalopathy

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30. How does CRC present in the distal and proximal colon
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
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
Alpha1 antitrypsin def - codominant trait
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

31. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
With albumin
Terminal ileum and colon
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

32. Where are oligosaccharide hydrolases and What do they do
Angiodysplasia
Sphincter of oddi
Positive urease test
Brush border of intestine - produce monosaccharides from oligo and di

33. Diaphragmatic hernias occur in infants because of defective development of which membrane
Neural muscarinic pathways
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Stimulate intestinal persistalsis
Pleuroperitoneal

34. What structures feed into the common bile duct
Cystic duct and common hepatic duct
Epigastric abdominal pain radiating to back - anorexia - nausea
Left and right gastroepiploics - left and right gastrics
True and most common congenital anomoly of GI tract

35. With caput medusaw - between what vessels is the anastomoses and Where is it
Paraumbilical and superficial and inferior epigastric - umbilicus
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Left gastric vein and esophogeal vein - esophagus
Neutralizes oral bacertial acids and maintains dental health

36. most common non - neoplastic polyp in colon
T cell lymphoma
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Hyperplastic

37. What are the structures of the femoral triangle and how are they organized
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Complications of UC
NAV = nerve artery vein - venous near the penis (NAVEL)
Celiac sprue

38. What kind of muscle is in the lower 1/3 of the esophagus
Femoral hernia
Smooth
True and most common congenital anomoly of GI tract
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

39. What is the HLA association and treatment for hemochromatosis
L2
Repeated phlebotomy - deferoxamine - HLA- A3
Positive urease test
Barrett's esophagus

40. What are the branches of the celiac trunk and What do they supply
Gilbert's
Common hepatic - splenic - left gastric - main blood supply for stomach
Lipase - phospholipase A - colipase
Diverticulum

41. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Neutralizes oral bacertial acids and maintains dental health
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Squamous - upper 1/3 - adeno - lower 1/3
L2

42. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Alk pho
In the ileum with bile acids - requires IF

43. What drug blocks the H2R
Chagas disease
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Cimetidine

44. How does brain injury lead to acute gastritis and What is it called
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Conj/unconj - inc - nl to dec
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Mucoepidermoid carcinoma

45. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Hemolytic anemia
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
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
Gut bacteria

46. What are the complications of duodenal PUD
Bleeding - penetration into pancreas - perforation - obstruction
T12
Common hepatic - splenic - left gastric - main blood supply for stomach
VZV and influenza B treated with salicylates

47. What kind of anemia is in Wilsons
Ischemic colitis
Increase tumorigenesis
Hemolytic anemia
Epigastric abdominal pain radiating to back - anorexia - nausea

48. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Conj - inc - dec
Antrum - H.pylori - inc risk of MALT lymphoma
Complications of UC
Left gastric vein and esophogeal vein - esophagus

49. What kind of insults results in macronodular cirrhosis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Parietal cells in the stomach - B12 binding protein

50. What source of salivary secretion is the most serous and What is the most mucinous
AR
Striated and smooth
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Serous on the sides parotids - mucinous in the middle sublingual