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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. in budd chiari syndrome - Where is the congestion and necrosis
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
Inguninal ligament - sartorius muscle - adductor longus
Centrilobular leading to congestive liver disease
Appendicitis

2. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Female - fat - fertile - forty

3. What does bicab do in the mouth
Complications of crohns
Mucosa - submucosa - muscularis externa - serosa/adventitia
Neutralizes oral bacertial acids and maintains dental health
Old men - arthralgias - cardiac and neuro sx

4. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Pleuroperitoneal
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Alcoholic cirrhosis

5. Through which aspect of the inguinal canal does a direct inguinal go
Upregulated intracellular signal transduction
Gilbert's
External (superficial) ring only
Stimulate intestinal persistalsis

6. What artery passes around the duodenum
The gastroduodenal
Lye ingestion and acid reflux
Below
Phenobarbital - inc liver enzyme synthesis

7. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Redundant mesentary
Closer to isotonic because of less time to reabsorb NaCl
Brunners
Carcinoid syndrome

8. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Intussusception
Esophageal cancer
So hypertrophied they look like brain gyri
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

9. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Lamina propora and submucosa
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Below

10. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Erosive - disruption of mucosal barrier leading to inflammation
HSV-1 - CMV - Candida
Lateral
The proximal small bowel

11. Where is the pectinate line
Where hindgut meets ectoderm
Lubricate food (glycoprotiens)
Worldwide - SC - US - adeno
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

12. What is the prognosis of adenocarcinoma
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Averages 6 months - very aggressive - usually already metastasized at presentation
Smooth
The proximal small bowel

13. What makes a true diverticula
Centrilobular congestion and necrosis - cardiac cirrhosis
All 3 gut layers outpouch as in Meckels
Nonkeritinized stratified sqamous epithelium
Trypsin - chymotrypsin - elastase - carboxypeptidases

14. What is the other name for GIP (gastric inhibitory peptide)
Glucose dependent insulinotropic peptide
Decrease - weight gain
Uremia
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

15. Gastrin - source - action - regulation
...
3 waves/min
12 waves/min
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

16. People of what decent are associated with celiac sprue and what findings/antibodies are present
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Hypercoaguability - polycythemia vera - pregnancy - HCC
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Turcot

17. Which area of the hindgut is a watershed area
Lye ingestion and acid reflux
Splenic flexure
Begins starch digestion - inactivated by low pH upon reaching the stomach
NAV = nerve artery vein - venous near the penis (NAVEL)

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

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19. What is the classic triad of hemochromatosis

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20. Dysphagia in achalasia results from
Primary sclerosing cholangitis
Dermatitis herpetiformis
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

21. With caput medusaw - between what vessels is the anastomoses and Where is it
Increase tumorigenesis
Brunners
Paraumbilical and superficial and inferior epigastric - umbilicus
L4

22. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
Inc lower esphogeal tone leading to achalasia
Black - rotors syndrome
Small intestine

23. What causes pancreatic insuff and What does it cause
Primary sclerosing cholangitis
PAS- positive globules in liver -
Lamina propora and submucosa
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

24. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
FAP
Superior rectal and middle and inferior rectal - rectum
Causes of gall stones
Intussusception

25. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Inc risk of CRC and other visceral malignancies
Dilated esophagus with an area of distal stenosis - birds beak
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Brush border of intestine - produce monosaccharides from oligo and di

26. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
L3
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

27. What kind of lesions are characteristic of duodenal PUD vs cancer
...
Gallbladder
Punched out - clean margins - carcinoma =raised irregular margins
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

28. How many layers of spermatic fascia are covers an indirect inguinal hernia
Skip lesions =crohns - colon = UC
All 3
Crohns = maybe - UC= always
Jewish and African American men

29. What gives stool its characteristic color
Spleen to posterior abdominal wall - splenic artery and vein
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Stercobilin
Omeprazole

30. What are the treatmet options for crohns
Striated
Meckels
Corticosteroids - infliximab
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

31. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Above
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Common hepatic - splenic - left gastric - main blood supply for stomach

32. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Squamous - upper 1/3 - adeno - lower 1/3
Conj - inc - dec
Appendicitis
Pleuroperitoneal

33. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
Sphincter of oddi
Where hindgut meets ectoderm
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

34. In what scenarios do pts with gilberts have inc bili
Crypts but not villi
Zenkers - halitosis - dysphagia and obstruction
Fasting and stress
Myenteric nerve plexus - aurbach

35. What kind of diarrhea is produced from a disaccharide def
IgA secreting plasma cells - ultimately reside in the lamina proporia
Skip lesions =crohns - colon = UC
Fe2+ in the duod
Osmotic

36. What kind of anemia is in Wilsons
Hemolytic anemia
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Crypts but not villi
Superior rectal

37. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Pleomorphic adenoma
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

38. What transforms conjugated bilirubin to urobilinogen
Gamma glutamyl transferase GGT
The gastroduodenal
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Gut bacteria

39. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Penicillinamine - AR inheritance
PAS- positive globules in liver -
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

40. What complication can arise from indirect inguinal hernias
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Budd chiari syndrome
Hydrocele
Centrilobular congestion and necrosis - cardiac cirrhosis

41. What is the most common indication of emergent abdominal surgery in children
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Appendicitis
Femoral hernia
Left and right gastroepiploics - left and right gastrics

42. concentric onion skin bile duct fibrosis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Budd chiari syndrome
Primary sclerosing cholangitis
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

43. in carcinoid tumors - What is seen on EM
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Cimetidine
Inc - weight loss
Dense core bodies

44. If the hemochromatosis is primary - What is the pattern of inheritance
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
AR
Bleeding - penetration into pancreas - perforation - obstruction
Chronic gastritis and pernicious anemia

45. Which IBD is autoimmune and which may be a disordered response to bacteria
Ampulla of vater
NAV = nerve artery vein - venous near the penis (NAVEL)
Splenic flexure
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

46. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
PAS- positive globules in liver -
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Inguninal ligament - sartorius muscle - adductor longus
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

47. Where is bicarb trapped
Alfatoxin in peanuts
In the mucus that covers the gastric epithelium
Upregulated intracellular signal transduction
True and most common congenital anomoly of GI tract

48. What are the foregut structures and what supplies their blood and PANS innvervation
Hepatic steatosis
Hypercoaguability - polycythemia vera - pregnancy - HCC
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Juvenile polyposis syndrome - inc risk of adenocarcinoma

49. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Alpha amylase
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Dense core bodies

50. What pancreatic proteases are secreted as zymogens
12 waves/min
Hydrocele
IgA secreting plasma cells - ultimately reside in the lamina proporia
Trypsin - chymotrypsin - elastase - carboxypeptidases