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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. most common malignant salivary gland tumor
So hypertrophied they look like brain gyri
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Positive urease test
Mucoepidermoid carcinoma

2. What is biliary colic
Gut bacteria
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
No

3. 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
Terminal ileum and colon
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Crypts but not villi

4. What are esophageal strictures associated with
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Internal thoracic to superior epigastric to inferior epigastric
Lye ingestion and acid reflux

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

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6. What are the complications of chronic pancreatitis
Skip lesions =crohns - colon = UC
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Older patients
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

7. What percentage of gall stones are cholesterol stones and What are the associations
In the mucus that covers the gastric epithelium
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Closer to isotonic because of less time to reabsorb NaCl
Alcoholic hepatitis

8. secretin - source - action - regulation
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
In the ileum with bile acids - requires IF
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Source - S cells (duod) - action - inc pancreatic bicarb secretion - dec gastric acid secretin - inc bile secretion - regulation - inc by acid - fatty acids in lumen of duod

9. Who gets Whipple disease and How do they present
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Where hindgut meets ectoderm
Old men - arthralgias - cardiac and neuro sx
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

10. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Conj - inc - dec
Carcinoid syndrome
Striated and smooth
Spleen to posterior abdominal wall - splenic artery and vein

11. What is the action of NO as a GI hormone
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Mucosa - submucosa - muscularis externa - serosa/adventitia
Inc smooth muscle relaxation - including lower esophageal sphincter
Stercobilin

12. Where is B12 absorbed
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
In the ileum with bile acids - requires IF
Neutralizes oral bacertial acids and maintains dental health

13. Where is there sclerosis in alcoholic cirrohosis
Around the central vein (zone III)
Enterokinase/enteropeptidase from the duodenal mucosa
Splenic flexure
Gamma glutamyl transferase GGT

14. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Skip lesions =crohns - colon = UC
Squamous - upper 1/3 - adeno - lower 1/3

15. At what level of the spine does the IM exit the aorta
L3
Falciform - ligamentum teres - fetal umbilical vein
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
The gastroduodenal

16. What are causes of extrahepatic biliary obstruction
Trypsin - chymotrypsin - elastase - carboxypeptidases
Inguninal ligament - sartorius muscle - adductor longus
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Dysphagia (due to esophageal web) - glossitis - iron def anemia

17. Why are most diverticula considered false
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Inspiratory arrest on deep palpation due to pain
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Lack or have an attenuated muscularis externa - often in the sigmoid colon

18. What is the frequency of basal electric rhythm of the stomach
Downs
Repeated phlebotomy - deferoxamine - HLA- A3
Alcoholic hepatitis
3 waves/min

19. What are the labs in acute pancreatitis
Pyoderma gangrenosum - primary sclerosing cholangitis
Elevated amylase - and lipase
Inspiratory arrest on deep palpation due to pain
L1

20. What kind of muscle is in the lower 1/3 of the esophagus
Smooth
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Cystic duct and common hepatic duct
Primary sclerosing cholangitis

21. What intervention will intervention will relieve portal HTN
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Can lead to hematemesis - found in EtOHics and bulimics
Omeprazole
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

22. What is the most important mechanism in gastric acid secretion
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
Zollinger Ellison - phenylalanine and tryptophan
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Short gastrics - left greater and lesser

23. 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
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
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
Portal HTN

24. Are single polyps malignant in peutz jehgers
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
8-9 waves/min
No
Meconium ileus

25. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
90%
GERD - may also present with nocturnal cough and dyspnea
Colonic polyps

26. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Diverticulum
Zollinger ellison - brunners glands
Left and right gastroepiploics - left and right gastrics
ALT>AST

27. Which viral infxns/treatments are associated with reyes syndrome
Above
Complications of UC
Fasting and stress
VZV and influenza B treated with salicylates

28. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Hemosiderosis - hemochromatosis
Centrilobular congestion and necrosis - cardiac cirrhosis
Chagas disease
IBS at least 2 with recurrent abdominal pain

29. In PUD with a duodenal ulcer does pain inc or dec with meals
Inspiratory arrest on deep palpation due to pain
Meckels
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Decrease - weight gain

30. What is the clinical presentation of acute pancreatitis
Ceruplasmin
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
H pylori (almost 100%)
Epigastric abdominal pain radiating to back - anorexia - nausea

31. What gives urine its characteristic color
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Urobilin
Inc smooth muscle relaxation - including lower esophageal sphincter

32. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Uremia
Hydrocele
Positive
Zollinger Ellison - phenylalanine and tryptophan

33. How is salivary secretion stimulated
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Increase tumorigenesis
With albumin

34. What kind of anemia is in Wilsons
Corticosteroids - infliximab
The proximal small bowel
Hemolytic anemia
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

35. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Gastric glands
Cimetidine
Reye's syndrome
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

36. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Hyperplastic
Carcinoid syndrome
HSV-1 - CMV - Candida
Chagas disease

37. What are the histological findings of the colon
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
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Crypts but not villi
Turcot

38. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Gamma glutamyl transferase GGT
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Where hindgut meets ectoderm

39. What are the extraintestinal manifestations of crohns
Peptic ulcer disease
Fe2+ in the duod
IBS at least 2 with recurrent abdominal pain
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

40. In viral hepatitis - which liver enzyme is higher
H+
Parietal cells in the stomach - B12 binding protein
ALT>AST
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

41. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
Old men - arthralgias - cardiac and neuro sx
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

42. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Jewish and African American men
Meconium ileus
Causes of gall stones
Ampulla of vater

43. What are additional risk factors for CRC
External (superficial) ring only
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Sister mary joseph nodule
Inc lower esphogeal tone leading to achalasia

44. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
CEA - CA-19-9
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

45. With caput medusaw - between what vessels is the anastomoses and Where is it
Paraumbilical and superficial and inferior epigastric - umbilicus
Glucose dependent insulinotropic peptide
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Zollinger ellison - brunners glands

46. Where is IgA shuttled
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Phenobarbital - inc liver enzyme synthesis
CHF and inc risk of HCC

47. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Myenteric nerve plexus - aurbach
Alk pho
Turcot

48. What carcinogens are associated with HCC
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Inguninal ligament - sartorius muscle - adductor longus
Alfatoxin in peanuts

49. involvement of left supraclavicular node by mets from stomach

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50. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis

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