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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 is the leading cause of bowel incarceration
Gastrohepatic ligament
Brush border of intestine - produce monosaccharides from oligo and di
Fasting and stress
Femoral hernia

2. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Penicillinamine - AR inheritance
Acute pancreatitis
Conj/unconj - inc - nl to dec

3. most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Right and left hepatic duct
The submucosal nerve plexus - meissner's
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

4. What are the barium swallow findings of achalasia
Bleeding - intussusception - volvulus - obstruction near terminal ileum
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Dilated esophagus with an area of distal stenosis - birds beak

5. Which viral infxns/treatments are associated with reyes syndrome
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Redness and tenderness on palpation of extremities
VZV and influenza B treated with salicylates
2ndary biliary cirrhosis

6. What histological findings are present in the esophagus
Striated
Virchow's node
Nonkeritinized stratified sqamous epithelium
Upregulated intracellular signal transduction

7. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
H2 receptor - inc cAMP
Hemosiderosis - hemochromatosis
Ampulla of vater
Gastric glands

8. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
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
Neural muscarinic pathways
Myenteric nerve plexus - aurbach

9. Which serum enzyme increases with heavy EtOH consumption
Krukenbergs tumor
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Inc lower esphogeal tone leading to achalasia
Gamma glutamyl transferase GGT

10. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
NAV = nerve artery vein - venous near the penis (NAVEL)
EtOH

11. What cell produces IF and What does it do
Falciform - ligamentum teres - fetal umbilical vein
Parietal cells in the stomach - B12 binding protein
Terminal ileum and colon
The entire

12. What causes nutmeg liver
Early childhood - neuro sx and malabsorption
Common hepatic - splenic - left gastric - main blood supply for stomach
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Backup of blood into the liver - RHF - budd chiari

13. Which patients have pigment stones
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Gut bacteria
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Alpha amylase

14. in carcinoid tumors - What is seen on EM
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Dense core bodies
Boerhaave's Syndrome - Been heaving syndrome
Bleeding - penetration into pancreas - perforation - obstruction

15. What kind of pathways do CCK act on to cause pancreatic secretion
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Neural muscarinic pathways
Internal thoracic to superior epigastric to inferior epigastric
Lateral to the inferior epigastric artery

16. What is the arterial supply and venous drainage below pectinate line
Peptic ulcer disease
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
8-9 waves/min
Cimetidine

17. What are the borders of Hesselbach's triangle
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Angiodysplasia
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Cystic duct and common hepatic duct

18. What are the ABCDEF of esophageal cancer
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Pancreatic head causing obstructive jaundice
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
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

19. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Turcot
Heme metabolism
Normal
Alcoholic hepatitis

20. What is the TX of physiologic neonatal jaundice
Phototherapy
The jejunum
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
True and most common congenital anomoly of GI tract

21. Where are oligosaccharide hydrolases and What do they do
Smooth
Brush border of intestine - produce monosaccharides from oligo and di
Colonic polyps
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

22. What kind of lesions are characteristic of duodenal PUD vs cancer
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Around the central vein (zone III)
Punched out - clean margins - carcinoma =raised irregular margins

23. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
Corticosteroids - infliximab
The gastroduodenal
Cystic dilation of the viteline duct

24. What are the treatmet options for crohns
AST
Alk phos
Hemosiderosis - hemochromatosis
Corticosteroids - infliximab

25. in budd chiari syndrome - Where is the congestion and necrosis
Gardner's syndrome
The jejunum
Centrilobular leading to congestive liver disease
Short gastrics - left greater and lesser

26. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Menetriers disease
HPNCC
Normal

27. What transforms conjugated bilirubin to urobilinogen
Averages 6 months - very aggressive - usually already metastasized at presentation
AST >ALT - ration is usually 1.5
Gut bacteria
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker

28. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Mucoepidermoid carcinoma
Antrum - H.pylori - inc risk of MALT lymphoma
Alpha amylase
Closer to isotonic because of less time to reabsorb NaCl

29. what kind of fistula is associated with diverticulitis
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Colovesical leading to pneumaturia
Necrotizing enterocolitis
Unconjugated - water insoluble

30. What is the ddx associated with appendicitis
Diarrhea - steatorrhea - weight loss - weakness
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Redundant mesentary

31. What are esophageal strictures associated with
Elevated amylase - and lipase
Lye ingestion and acid reflux
The jejunum
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

32. What are the midgut structures and what supplies their blood and PANS innervation
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Hyperplastic

33. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
2ndary biliary cirrhosis
Inc risk of CRC and other visceral malignancies
Unconj - absent (acholuria) - inc
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

34. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Internal thoracic to superior epigastric to inferior epigastric
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Intussusception
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

35. When and How does Abetalipoproteinemia present
Portal HTN
Lactase is located at the tips of intestinal villi
H pylori (almost 100%)
Early childhood - neuro sx and malabsorption

36. What portion of the bowel does sprue effect
Cystic dilation of the viteline duct
US and cholecystectomy
The entire
The proximal small bowel

37. What is charcot triad of cholangitis
Jaundice - fever - RUQ
Glucose dependent insulinotropic peptide
GERD - may also present with nocturnal cough and dyspnea
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

38. subQ peribumbilical metastasis
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Trypsin - chymotrypsin - elastase - carboxypeptidases
Sister mary joseph nodule
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

39. What is a positive murphy's sign
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Left gastric vein and esophogeal vein - esophagus
Inspiratory arrest on deep palpation due to pain
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

40. What test and result confirms H pylori infxn
Decreased intercellular adhesion and increased proliferation
Trypsin - chymotrypsin - elastase - carboxypeptidases
Positive urease test
Lubricate food (glycoprotiens)

41. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Positive urease test
Ischemic colitis
L/R renal artery around L1

42. What are the common causes of gastric ulcers - What causes gastric ulcer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Virchow's node
Smooth
Falciform - ligamentum teres - fetal umbilical vein

43. What are the longterm sequelae of nutmeg liver
Uremia
Centrilobular congestion and necrosis - cardiac cirrhosis
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Zollinger ellison - brunners glands

44. What is the HLA association and treatment for hemochromatosis
Repeated phlebotomy - deferoxamine - HLA- A3
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Uridine glucuronyl transferase
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

45. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
Crohns = noncaseating granulomas - UC = crypt abscesses
Epigastric abdominal pain radiating to back - anorexia - nausea
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

46. What separates the right greater and lesser sacs
Gastrohepatic ligament
Skip lesions =crohns - colon = UC
Stercobilin
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

47. What are the hindgut structures and what supplies their blood and PANS innvervation
Colonic polyps
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

48. concentric onion skin bile duct fibrosis
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Primary sclerosing cholangitis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Uridine glucuronyl transferase

49. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Gut bacteria
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
AST>ALT

50. How do NSAIDs cause acute gastritis
Dec PGE2 leading to dec gastric mucosa protection
All 3 gut layers outpouch as in Meckels
The entire
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation