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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 contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Gastric glands
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Centrilobular congestion and necrosis - cardiac cirrhosis
2ndary biliary cirrhosis

2. List the clinical findings of HCC
Dubin johnson
Penicillinamine - AR inheritance
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

3. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
The submucosal nerve plexus - meissner's
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

4. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Superior rectal
Smooth
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Alcoholic hepatitis

5. Where is bicarb trapped
Female - fat - fertile - forty
Left gastric vein and esophogeal vein - esophagus
In the mucus that covers the gastric epithelium
Lipase

6. When do you see hypertrophy of brunners glands
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Stimulate the H/K ATPase
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Peptic ulcer disease

7. Where are carcinoid tumors most commonly malignant
Decreased intercellular adhesion and increased proliferation
Small intestine
Barrett's esophagus
PAS- positive globules in liver -

8. What is pancreatic adenocarcinoma associated with
Volvulus
Appendicitis
Cigarettes and chronic pancreatitis - not EtOH
Phototherapy

9. What causes nutmeg liver
US and cholecystectomy
T cell lymphoma
Backup of blood into the liver - RHF - budd chiari
Cholesterol - 10-20% opaque due to calcifications

10. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Mucosa - submucosa - muscularis externa - serosa/adventitia
No
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Striated

11. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Increase tumorigenesis
Duodenal atresia - Downs
2ndary biliary cirrhosis
Diarrhea - steatorrhea - weight loss - weakness

12. What is charcot triad of cholangitis
Budd chiari syndrome
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Boerhaave's Syndrome - Been heaving syndrome
Jaundice - fever - RUQ

13. What causes primary biliary cirrhosis
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Primarly through ECL leading to histamine release
Mallory bodies

14. What are the complications of Meckels
Can lead to hematemesis - found in EtOHics and bulimics
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
All 3
Bleeding - intussusception - volvulus - obstruction near terminal ileum

15. What does the splenorenal ligament connect - and What does it contain
Lubricate food (glycoprotiens)
Failure of the processus vagainlis to close
Alfatoxin in peanuts
Spleen to posterior abdominal wall - splenic artery and vein

16. With internal hemorrhoids Where is the anastomoses and Where is it
Superior rectal and middle and inferior rectal - rectum
Barrett's esophagus
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Intussusception

17. Where is the pectinate line
Turcot
Where hindgut meets ectoderm
Trypsin - chymotrypsin - elastase - carboxypeptidases
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

18. What test and result confirms H pylori infxn
Jewish and African American men
Left gastric vein and esophogeal vein - esophagus
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Positive urease test

19. absent UDPGT - presents early in life - early mortality
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Crigler - najjar type 1

20. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Turcot
Necrotizing enterocolitis
Esophageal varices
Menetriers disease

21. What serum enzyme is decreased in wilsons disease
Neutralizes oral bacertial acids and maintains dental health
Averages 6 months - very aggressive - usually already metastasized at presentation
Epigastric abdominal pain radiating to back - anorexia - nausea
Ceruplasmin

22. Which IBD is autoimmune and which may be a disordered response to bacteria
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Necrotizing enterocolitis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Lack or have an attenuated muscularis externa - often in the sigmoid colon

23. Where are peyers patches found
Lamina propora and submucosa
Celiac sprue
HSV-1 - CMV - Candida
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

24. Autoantibodies to gluten (gliadin) in wheat and other grains
Boerhaave's Syndrome - Been heaving syndrome
Left and right gastroepiploics - left and right gastrics
Celiac sprue
Neural muscarinic pathways

25. Acute gastritis is caused By what process
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
All 3 gut layers outpouch as in Meckels
Erosive - disruption of mucosal barrier leading to inflammation
Hemolytic anemia

26. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Glucose dependent insulinotropic peptide
Pyoderma gangrenosum - primary sclerosing cholangitis
Meconium ileus
Lye ingestion and acid reflux

27. What are the results of hemochromatosis
CHF and inc risk of HCC
HPNCC
Inc - weight loss
Source - I cells (duod - jej - action - inc pancreative secretion - inc gallbladder contraction - dec gastric emptying - sphincter of Oddi relaxation - regulation - inc by fatty acids and amino acids

28. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Hepatic steatosis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Bleeding - penetration into pancreas - perforation - obstruction
Left gastric vein and esophogeal vein - esophagus

29. What enzyme is necessary to create conjugated bilirubin
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Uridine glucuronyl transferase
Duodenal atresia - Downs
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

30. Where is folate absorbed
Backup of blood into the liver - RHF - budd chiari
12 waves/min
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
The jejunum

31. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Budd chiari syndrome
Positive
Decrease - weight gain
Complications of crohns

32. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Complications of crohns
Brunners
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Alpha amylase

33. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Skip lesions =crohns - colon = UC
Carcinoid syndrome
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Ischemic colitis

34. What are the longterm sequelae of nutmeg liver
Angiodysplasia
Alcoholic hepatitis
Centrilobular congestion and necrosis - cardiac cirrhosis
All 3 gut layers outpouch as in Meckels

35. What is contained within the muscularis externa
Lipase - phospholipase A - colipase
Cholesterol - 10-20% opaque due to calcifications
Upregulated intracellular signal transduction
Myenteric nerve plexus - aurbach

36. What are the complications of duodenal PUD
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Bleeding - penetration into pancreas - perforation - obstruction
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Inc - weight loss

37. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Juvenille polyps - no risk if single
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

38. What is contained within the submucosa

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39. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
The gastroduodenal
Crypts but not villi
Parietal cells in the stomach - B12 binding protein

40. What skin condition is associated with celiac sprue
Inc - weight loss
Dermatitis herpetiformis
NAV = nerve artery vein - venous near the penis (NAVEL)
MSI (15%) and APC/beta catenin chromosomal instability (85%)

41. What is the mechanism for reyes syndrome
Volvulus
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

42. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Neutralizes oral bacertial acids and maintains dental health
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

43. What serum markers increase in cholecystitis with bile duct involvement
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Hypotonic because of more time to reabsorb NaCl
Alk phos
Brunners

44. Gastrin - source - action - regulation
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
L1
Cigarettes and chronic pancreatitis - not EtOH
VZV and influenza B treated with salicylates

45. If the abdominal aorta is blocked - How does blood get to the left colic artery
Lateral
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Via the middle colic
Hirschsprungs

46. In what clinical scenarior do you see portosystemic anastomoses
Female - fat - fertile - forty
Peyers patches
External (superficial) ring only
Portal HTN

47. Are single polyps malignant in peutz jehgers
No
Parietal cells in the stomach - B12 binding protein
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

48. Through which aspect of the inguinal canal does a direct inguinal go
Ceruplasmin
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Colovesical leading to pneumaturia
External (superficial) ring only

49. What is the action of NO as a GI hormone
Hyperpigmented mouth - lips - hands - genitalia
L3
Inc smooth muscle relaxation - including lower esophageal sphincter
Complications of crohns

50. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Alpha1 antitrypsin def - codominant trait
Myenteric nerve plexus - aurbach
Elevated amylase - and lipase
Adhesion