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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. In an MI - which liver enzyme is elevated
Mallory bodies
AST
Parietal cells in the stomach - B12 binding protein
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

2. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Esophageal cancer
Diverticulitis in elderly - ectopic pregs use hCG to rule out
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

3. why infxn is implicated in duodenal PUD
Lactase is located at the tips of intestinal villi
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
H pylori (almost 100%)
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

4. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Lamina propora and submucosa
NAV = nerve artery vein - venous near the penis (NAVEL)
Menetriers disease
Splenic flexure

5. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Internal thoracic to superior epigastric to inferior epigastric
Meconium ileus
AST>ALT

6. What is indirect bilirubin
Unconjugated - water insoluble
Bleeding - penetration into pancreas - perforation - obstruction
FAP
Cystic duct and common hepatic duct

7. Gallstones that reach the common channel at ampulla can block which two ducts
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
ALT>AST
Pancreatic and bile

8. Why does volvulus occur more at cecum and sigmoid colon
Centrilobular congestion and necrosis - cardiac cirrhosis
Redundant mesentary
Via the middle colic
Alcoholic hepatitis

9. What happens to the short gastics if the splenic artery is blocked
Lactase is located at the tips of intestinal villi
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Duodenum - 2nd - 3rd and 4th parts
Poor anastamoses

10. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Left and right gastroepiploics - left and right gastrics
Falciform - ligamentum teres - fetal umbilical vein
In the ileum with bile acids - requires IF
3 waves/min

11. What nerve innervates the external hemorrhoids
Superior rectal
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Conj/unconj - inc - nl to dec
Inferior rectal nerve

12. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Repeated phlebotomy - deferoxamine - HLA- A3

13. What are the layers of the gut wall from inside out
Mucosa - submucosa - muscularis externa - serosa/adventitia
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Pleomorphic adenoma
Brunners

14. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

15. What can hemochromatosis be secondary to...
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
FAP
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

16. secretin - source - action - regulation
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
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
Chronic gastritis and pernicious anemia
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

17. Where does copper accumulate in Wilsons and What are ABCD
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

18. most common malignant salivary gland tumor
Glucouronate - water soluble (direct)
Zenkers - halitosis - dysphagia and obstruction
Mucoepidermoid carcinoma
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

19. What are the foregut structures and what supplies their blood and PANS innvervation
Begins starch digestion - inactivated by low pH upon reaching the stomach
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Alk pho
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

20. How do burns cause acute gastritis and What is it called

21. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
External spermatic fascia only
Conj - inc - dec
Failure of neural crest migration

22. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Epigastric abdominal pain radiating to back - anorexia - nausea
Turcot
Diverticulum
Gastrohepatic ligament

23. Acute gastritis is caused By what process
Epigastric abdominal pain radiating to back - anorexia - nausea
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Erosive - disruption of mucosal barrier leading to inflammation
L1

24. Where does type A chronic gastritis occur and What causes it
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Acute pancreatitis
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

25. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Crohns = maybe - UC= always
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Pancreatic head causing obstructive jaundice
Boerhaave's Syndrome - Been heaving syndrome

26. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Failure of the processus vagainlis to close
Neutralizes oral bacertial acids and maintains dental health
Phototherapy

27. What is the omphalomesenteric cyst
Alk phos
Cystic dilation of the viteline duct
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
When diffusely infiltrative - thickened rigid appearance like a leather bottle

28. What structures feed into the common bile duct
Cystic duct and common hepatic duct
Adhesion
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

29. What is the cause of physiologic neonatal jaundice
Inspiratory arrest on deep palpation due to pain
Below
Pancreatic and bile
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

30. What does a gastrinoma cause
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Conj - inc - dec
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Hirschsprungs

31. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
HPNCC

32. What are the hindgut structures and what supplies their blood and PANS innvervation
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Worldwide - SC - US - adeno
Right and left hepatic duct
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

33. Between what structures do strong anastamoses exist
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Left and right gastroepiploics - left and right gastrics
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

34. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Chronic calcifying pancreatitis - inc risk of panreatic cancer

35. What separates the right greater and lesser sacs
Gastrohepatic ligament
Corticosteroids - infliximab
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

36. involvement of left supraclavicular node by mets from stomach

37. Liver cell failure can lead to multisystem signs including
Sphincter of oddi
Ceruplasmin
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Lamina propora and submucosa

38. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis

39. Bile is critical for exrection of what substance
Gilbert's
Cholesterol
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Lye ingestion and acid reflux

40. How does gastrin increase acid secretion?
Primarly through ECL leading to histamine release
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Downs
Lubricate food (glycoprotiens)

41. in budd chiari syndrome - Where is the congestion and necrosis
Common hepatic - splenic - left gastric - main blood supply for stomach
Conj - inc - dec
2ndary biliary cirrhosis
Centrilobular leading to congestive liver disease

42. What causes nutmeg liver
Causes of gall stones
CEA - CA-19-9
Terminal ileum and colon
Backup of blood into the liver - RHF - budd chiari

43. What does bicab do in the mouth
Neutralizes oral bacertial acids and maintains dental health
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

44. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Splenic flexure
Pancreatic and bile
Right and left hepatic duct
Colonic polyps

45. Achalasia increases the risk For what complication
Trypsin - chymotrypsin - elastase - carboxypeptidases
Failure of the processus vagainlis to close
Antrum - H.pylori - inc risk of MALT lymphoma
Esophageal carcinoma

46. At what level of the spine does the IM exit the aorta
VZV and influenza B treated with salicylates
Ampulla of vater
Inc smooth muscle relaxation - including lower esophageal sphincter
L3

47. What is one potential precipitating factor for intussusception
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
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
T cell lymphoma

48. What complication can arise from indirect inguinal hernias
VZV and influenza B treated with salicylates
Black - rotors syndrome
Peptic ulcer disease
Hydrocele

49. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Causes of gall stones
Below
Inc - weight loss
T cell lymphoma

50. What is the cause of Barrett's and the assocaited complications
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
H2 receptor - inc cAMP
Copious diarrhea - non alpha - non beta cell pancreatic tumor