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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. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lamina propora and submucosa
Zollinger Ellison - phenylalanine and tryptophan
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

2. What are the layers of the gut wall from inside out
Chronic gastritis and pernicious anemia
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Mucosa - submucosa - muscularis externa - serosa/adventitia
Spleen to posterior abdominal wall - splenic artery and vein

3. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Fasting and stress
Zollinger ellison - brunners glands
Via the superior pancreaticduodenal
Dilated esophagus with an area of distal stenosis - birds beak

4. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Internal thoracic to superior epigastric to inferior epigastric
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
No

5. What transforms conjugated bilirubin to urobilinogen
Gut bacteria
Diverticulum
All 3
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

6. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Uridine glucuronyl transferase
Uremia
Dissaccharidase def - most commonly lactase

7. Where is the pectinate line
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Where hindgut meets ectoderm
L1
Crohns = maybe - UC= always

8. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
IBS at least 2 with recurrent abdominal pain
Low pressure proximal to LES
External (superficial) ring only
Hypotonic because of more time to reabsorb NaCl

9. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Oligosaccharide digestion
Common hepatic - splenic - left gastric - main blood supply for stomach

10. GIP - source - action regulation
Primarly through ECL leading to histamine release
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Old men - arthralgias - cardiac and neuro sx

11. What layer of fascia covers a direct inguinal hernia
Glucouronate - water soluble (direct)
External spermatic fascia only
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Short gastrics - left greater and lesser

12. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Hepatic steatosis
Copious diarrhea - non alpha - non beta cell pancreatic tumor

13. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
Brunners
Positive urease test
Unconjugated - water insoluble

14. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Older patients
Meckels
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
HPNCC

15. What layer in the mucosa is responsible for absorption
Dilated esophagus with an area of distal stenosis - birds beak
H pylori (almost 100%)
Epithelium
Striated

16. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Crigler - najjar type 1
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Brunners
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

17. What are the tumor markers for pancreatic adenocarcinoma
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Lateral
Warthins' tumor
CEA - CA-19-9

18. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Esophageal carcinoma
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
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

19. What are the two molecular pathways that lead to CRC
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Chagas disease
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

20. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Inc conj bilirubin - inc cholesterol - inc alk phos
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
2ndary biliary cirrhosis

21. What do you treat Wilsons disease with and What is the inheritance
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Backup of blood into the liver - RHF - budd chiari
Penicillinamine - AR inheritance
Via the middle colic

22. Gq and inc cAMP both work to do what in parietal cells
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
2ndary biliary cirrhosis
8-9 waves/min
Stimulate the H/K ATPase

23. Why does indirect inguinal hernia happen in infacnts
Dissaccharidase def - most commonly lactase
Failure of the processus vagainlis to close
Oligosaccharide digestion
Lipase - phospholipase A - colipase

24. What kind of insults results in macronodular cirrhosis
Myenteric nerve plexus - aurbach
Fasting and stress
T12
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

25. How does brain injury lead to acute gastritis and What is it called
Positive
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
T cell lymphoma
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

26. What commonly leads to appendicity in kids vs adults
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
L2
AST>ALT

27. What are the signs of peutz jehgers
Begins starch digestion - inactivated by low pH upon reaching the stomach
Hyperpigmented mouth - lips - hands - genitalia
Old men - arthralgias - cardiac and neuro sx
Splenic flexure

28. multiple juvenil polyps in GI tract - risk
Diarrhea - steatorrhea - weight loss - weakness
Lateral
Paraumbilical and superficial and inferior epigastric - umbilicus
Juvenile polyposis syndrome - inc risk of adenocarcinoma

29. why infxn is implicated in duodenal PUD
8-9 waves/min
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
H pylori (almost 100%)
Alcoholic cirrhosis

30. How many layers of spermatic fascia are covers an indirect inguinal hernia
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
No
Phototherapy
All 3

31. Dysphagia in achalasia results from
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Via the middle colic
Fe2+ in the duod
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

32. crigler - najjar type II responds to which therapy and How does it work
Phenobarbital - inc liver enzyme synthesis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

33. What retroperitoneal structure flanks both sides of the pancreas on CT
The proximal small bowel
Hydrocele
Duodenum - 2nd - 3rd and 4th parts
Alcoholic hepatitis

34. What is the other name for GIP (gastric inhibitory peptide)
Gamma glutamyl transferase GGT
Glucose dependent insulinotropic peptide
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Alpha1 antitrypsin def - codominant trait

35. 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
Angiodysplasia
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Lipase

36. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
Diverticulum
Pyoderma gangrenosum - primary sclerosing cholangitis
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

37. Gallstones that reach the common channel at ampulla can block which two ducts
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
AR
Alcoholic hepatitis
Pancreatic and bile

38. What do tumors that arise in the head of the pancreas cause
Positive urease test
Heme metabolism
Obstruction of the common bile duct
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

39. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
No
Barrett's esophagus
T12
Alcoholic cirrhosis

40. What does TOASTED with alcoholic hepatitis stand for
AST >ALT - ration is usually 1.5
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Failure of the processus vagainlis to close
Zollinger ellison - brunners glands

41. What infection causes Whipple disease and What can you see on LM
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Pyoderma gangrenosum - primary sclerosing cholangitis
Colovesical leading to pneumaturia
Penicillinamine - AR inheritance

42. What kind of diarrhea is produced from a disaccharide def
Alcoholic cirrhosis
Osmotic
NAV = nerve artery vein - venous near the penis (NAVEL)
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

43. In alchoholic hepatitis which liver enzyme is higher
Superior rectal
Lateral to the inferior epigastric artery
AST>ALT
In the ileum with bile acids - requires IF

44. Bile is critical for exrection of what substance
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Cholesterol
Pancreatic and bile
Ischemic colitis

45. At what level of the spine does the IM exit the aorta
Reye's syndrome
L3
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Diverticulum

46. malnutrition - toxic megacolon - colorectal carcinoma
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Pancreatic head causing obstructive jaundice
Cigarettes and chronic pancreatitis - not EtOH
Complications of UC

47. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Fe2+ in the duod

48. How do NSAIDs cause acute gastritis
Increase tumorigenesis
Dermatitis herpetiformis
Neural muscarinic pathways
Dec PGE2 leading to dec gastric mucosa protection

49. With caput medusaw - between what vessels is the anastomoses and Where is it
Right and left hepatic duct
Paraumbilical and superficial and inferior epigastric - umbilicus
Small intestine
Oligosaccharide digestion

50. To what substance is bilirubin conjugated and why
NAV = nerve artery vein - venous near the penis (NAVEL)
Osmotic
Glucouronate - water soluble (direct)
Dysphagia (due to esophageal web) - glossitis - iron def anemia