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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. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Striated
Can lead to hematemesis - found in EtOHics and bulimics
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Chronic gastritis and pernicious anemia

2. What are the ABCDEF of esophageal cancer
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Volvulus
Peyers patches
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

3. With internal hemorrhoids Where is the anastomoses and Where is it
Superior rectal and middle and inferior rectal - rectum
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Glucouronate - water soluble (direct)
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

4. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Hypotonic because of more time to reabsorb NaCl
Necrotizing enterocolitis
Around the central vein (zone III)
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

5. What are the signs of peutz jehgers
Zenkers - halitosis - dysphagia and obstruction
Normal
Hyperpigmented mouth - lips - hands - genitalia
Lipase - phospholipase A - colipase

6. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

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7. What enzyme is necessary to create conjugated bilirubin
Upregulated intracellular signal transduction
Uridine glucuronyl transferase
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

8. How are all 3 monosaccharides transported to the blood
In the mucus that covers the gastric epithelium
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
GLUT 2
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

9. What is the ddx associated with appendicitis
Complications of crohns
Diverticulitis in elderly - ectopic pregs use hCG to rule out
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Inc conj bilirubin - inc cholesterol - inc alk phos

10. What are the histological findings of the colon
Crypts but not villi
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

11. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Above
Primary sclerosing cholangitis
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

12. What does primary sclerosing cholangitis lead to...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Muscularis mucosae
Common hepatic - splenic - left gastric - main blood supply for stomach
Striated and smooth

13. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
Worldwide - SC - US - adeno
Gastric glands
Inc risk of CRC and other visceral malignancies

14. What is the most common diaphragmatic hernia and What are the two types
External spermatic fascia only
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Gastric glands
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

15. What are the structures of the femoral triangle and how are they organized
NAV = nerve artery vein - venous near the penis (NAVEL)
Epigastric abdominal pain radiating to back - anorexia - nausea
L1
Via the middle colic

16. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
Liver metabolizes 5HT
Peutz jeghers
AST

17. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Old men - arthralgias - cardiac and neuro sx
Left gastric vein and esophogeal vein - esophagus
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Colovesical leading to pneumaturia

18. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
In the ileum with bile acids - requires IF
Crohns = maybe - UC= always
Epigastric abdominal pain radiating to back - anorexia - nausea
12 waves/min

19. At what spinal level does the SMA exit
L1
Peptic ulcer disease
HPNCC
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

20. What cells make pepsin - What does it do - and what regulates it
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Mucosa - submucosa - muscularis externa - serosa/adventitia

21. What causes pancreatic insuff and What does it cause
Appendicitis
L4
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

22. Through which aspect of the inguinal canal does a direct inguinal go
Cystic dilation of the viteline duct
External (superficial) ring only
Heme metabolism
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

23. What does loss of APC cause
Enterokinase/enteropeptidase from the duodenal mucosa
Complications of crohns
Oligosaccharide digestion
Decreased intercellular adhesion and increased proliferation

24. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Colonic polyps
Fe2+ in the duod
Superior rectal and middle and inferior rectal - rectum
Copious diarrhea - non alpha - non beta cell pancreatic tumor

25. What kind of insults results in macronodular cirrhosis
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Upregulated intracellular signal transduction
Parietal cells in the stomach - B12 binding protein

26. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

27. What is a positive murphy's sign
All 3
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Inspiratory arrest on deep palpation due to pain
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

28. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Achalasia due to loss of myenteric plexus (auberach)
External (superficial) ring only

29. What is the main symptom if a VIPoma
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Acute pancreatitis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

30. What are the hindgut structures and what supplies their blood and PANS innvervation
Esophageal varices
Chronic gastritis and pernicious anemia
NAV = nerve artery vein - venous near the penis (NAVEL)
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

31. In PUD - with gastric ulcers - does pain inc or dec with meals?
Reye's syndrome
Inc - weight loss
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Normal

32. What does the splenorenal ligament connect - and What does it contain
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Striated and smooth
The entire
Spleen to posterior abdominal wall - splenic artery and vein

33. To what substance is bilirubin conjugated and why
Complications of UC
Redundant mesentary
Hepatic steatosis
Glucouronate - water soluble (direct)

34. What source of salivary secretion is the most serous and What is the most mucinous
AST>ALT
Alpha amylase
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Serous on the sides parotids - mucinous in the middle sublingual

35. What structures feed into the common bile duct
Older patients
Cystic duct and common hepatic duct
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Tropical sprue

36. What are the common causes of gastric ulcers - What causes gastric ulcer
Cystic dilation of the viteline duct
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

37. rare - often fatal childhood hepatoencephalopathy

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38. What is contained in the gastrosplenic and What areas does it separate
Splenic flexure
Primary sclerosing cholangitis
Brunners
Short gastrics - left greater and lesser

39. What is the triad of Plummer - Vinson syndrome
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Female - fat - fertile - forty
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Chronic calcifying pancreatitis - inc risk of panreatic cancer

40. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Meconium ileus
Zollinger Ellison - phenylalanine and tryptophan
Alcoholic cirrhosis
Fe2+ in the duod

41. Who is at risk for pancreatic adenocarcinoma
Juvenille polyps - no risk if single
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Redundant mesentary
Jewish and African American men

42. Esophagitis can result From which 3 infectious agents - or chemical ingestion
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Left gastric vein and esophogeal vein - esophagus
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
HSV-1 - CMV - Candida

43. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Alpha1 antitrypsin def - codominant trait
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Neutralizes oral bacertial acids and maintains dental health

44. What does GET SMASHED stand for in acute pancreatitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Duodenum - 2nd - 3rd and 4th parts
Ischemic colitis
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

45. What are the complications of duodenal PUD
AR
Skip lesions =crohns - colon = UC
Lubricate food (glycoprotiens)
Bleeding - penetration into pancreas - perforation - obstruction

46. What serum enzyme is elevated inacute pancreatitis
Lipase
T12
Inc risk of CRC and other visceral malignancies
Menetriers disease

47. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lactase is located at the tips of intestinal villi
Obstruction of the common bile duct
Lateral
CHF and inc risk of HCC

48. What are the two molecular pathways that lead to CRC
MSI (15%) and APC/beta catenin chromosomal instability (85%)
AST>ALT
Terminal ileum and colon
Femoral hernia

49. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Dilated esophagus with an area of distal stenosis - birds beak
Left and right gastroepiploics - left and right gastrics

50. What does a low flow rate mean for saliva
Failure of neural crest migration
Lamina propria
Hypotonic because of more time to reabsorb NaCl
Punched out - clean margins - carcinoma =raised irregular margins