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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 transforms conjugated bilirubin to urobilinogen
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Gut bacteria
Alpha amylase
Pancreatic and bile

2. motilin - source - action - regulation
H pylori (almost 100%)
Elevated amylase - and lipase
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Cirrhosis

3. What are the borders of Hesselbach's triangle
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Inc risk of CRC and other visceral malignancies
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

4. What is indirect bilirubin
Stercobilin
Female - fat - fertile - forty
Causes of gall stones
Unconjugated - water insoluble

5. what percentage of colonic polyps are non - neoplastic
90%
GLUT 2
Intussusception
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

6. What does alpha amylase do and what inactivates it
Inc - weight loss
Terminal ileum and colon
Begins starch digestion - inactivated by low pH upon reaching the stomach
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

7. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Pleuroperitoneal
Striated and smooth
Zenkers - halitosis - dysphagia and obstruction
H pylori (almost 100%)

8. How do you DX and TX gallstones
Enterokinase/enteropeptidase from the duodenal mucosa
L4
US and cholecystectomy
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

9. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
Neutralizes gastric acid allowing pancreatic enzymes to fxn
GLUT 2
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

10. Where are tumors commonly in pancreatic adenocarcinoma
Lactase is located at the tips of intestinal villi
Below
Pancreatic head causing obstructive jaundice
Downs

11. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
All 3 gut layers outpouch as in Meckels
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Superior rectal
Hemosiderosis - hemochromatosis

12. What are causes of extrahepatic biliary obstruction
Paraumbilical and superficial and inferior epigastric - umbilicus
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

13. Where is B12 absorbed
In the ileum with bile acids - requires IF
Backup of blood into the liver - RHF - budd chiari
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Sister mary joseph nodule

14. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Peyers patches
GERD - may also present with nocturnal cough and dyspnea
Meckels
H+

15. What layer in the mucosa is responsible for support
Hypercoaguability - polycythemia vera - pregnancy - HCC
Lamina propria
Nonkeritinized stratified sqamous epithelium
The gastroduodenal

16. At what spinal level does the SMA exit
H+
Small intestine
Budd chiari syndrome
L1

17. How does loss of NO secretion affect the esophagus and what results
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Inc lower esphogeal tone leading to achalasia
The gastroduodenal
Juvenille polyps - no risk if single

18. What is the rate limiting step of carbohydrate digestion
US and cholecystectomy
Dec PGE2 leading to dec gastric mucosa protection
Neural muscarinic pathways
Oligosaccharide digestion

19. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Esophageal varices
Complications of UC
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

20. To what substance is bilirubin conjugated and why
Glucouronate - water soluble (direct)
Gardner's syndrome
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Peutz jeghers

21. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
All 3
Cholesterol - 10-20% opaque due to calcifications
Pertechnetate - study for uptake
Alpha amylase

22. What congenital birth defect is associated with Hirschsprung
Hemolytic anemia
Meconium ileus
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Downs

23. What is the presentation of pancreatic adenocarcinoma
Where hindgut meets ectoderm
Below
Stimulate the H/K ATPase
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

24. What factors increase risk of malignancy of adenomatous polyps
Redness and tenderness on palpation of extremities
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Lamina propria
AR

25. When and why is stomach cancer termed linitis plastica
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Sphincter of oddi

26. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Esophageal varices
Lamina propria
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

27. subQ peribumbilical metastasis
Sister mary joseph nodule
Zollinger ellison - brunners glands
Lateral
Complications of UC

28. What do tumors that arise in the head of the pancreas cause
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Peutz jeghers
Obstruction of the common bile duct
Lateral

29. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lateral
Gardner's syndrome
Serous on the sides parotids - mucinous in the middle sublingual
L/R renal artery around L1

30. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Skip lesions =crohns - colon = UC
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Gastric glands
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

31. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Adhesion
Brunners
The jejunum
H pylori (almost 100%)

32. At what level of the spine does the IM exit the aorta
Gilbert's
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Hypotonic because of more time to reabsorb NaCl
L3

33. What can fistula between the gallbladder and small intestine create and how can you tell
Stimulate the H/K ATPase
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Striated
Lye ingestion and acid reflux

34. Liver cell failure can lead to multisystem signs including
The entire
Ischemic colitis
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

35. What is the epi for CRC
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Mallory bodies

36. What is the path of an indirect inguinal hernia
Left and right gastroepiploics - left and right gastrics
IBS at least 2 with recurrent abdominal pain
Punched out - clean margins - carcinoma =raised irregular margins
Goes through deep inguinal ring - external inguinal ring and into the scrotum

37. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Meconium ileus
Dense core bodies
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

38. What do you treat Wilsons disease with and What is the inheritance
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Penicillinamine - AR inheritance
Elevated amylase - and lipase
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

39. What is the most common esophageal cancer worldwide and in the US
Liver metabolizes 5HT
Alk phos
Conj/unconj - inc - nl to dec
Worldwide - SC - US - adeno

40. Autoantibodies to gluten (gliadin) in wheat and other grains
IgA secreting plasma cells - ultimately reside in the lamina proporia
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Celiac sprue
Around the central vein (zone III)

41. What are the complications of acute pancreatitis
Neutralizes oral bacertial acids and maintains dental health
Nonkeritinized stratified sqamous epithelium
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

42. What causes carcinoid syndrome amd What are the symptoms
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

43. malnutrition - toxic megacolon - colorectal carcinoma
Crypts but not villi
Complications of UC
Cystic duct and common hepatic duct
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

44. What receptor does histamine bind on the parietal cell and What does it activate
Alfatoxin in peanuts
Crohns = maybe - UC= always
8-9 waves/min
H2 receptor - inc cAMP

45. What are esophageal strictures associated with
EtOH
Lye ingestion and acid reflux
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Cirrhosis

46. What drug inhibits the H/K ATPase
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Omeprazole
8-9 waves/min
Early childhood - neuro sx and malabsorption

47. What are the histological findings in the duodenum

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48. What serum enzyme is decreased in wilsons disease
Hypercoaguability - polycythemia vera - pregnancy - HCC
Ceruplasmin
Bleeding - penetration into pancreas - perforation - obstruction
Gut bacteria

49. What layer of fascia covers a direct inguinal hernia
All 3
External spermatic fascia only
Colovesical leading to pneumaturia
M3 - Gq - inc IP3/Ca

50. is meckels a true diverticulum and how common is it
Tropical sprue
Causes of gall stones
T cell lymphoma
True and most common congenital anomoly of GI tract