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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 do you use to diagnose meckels
Hydrocele
Smooth
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Pertechnetate - study for uptake

2. What are the results of hemochromatosis
Pyoderma gangrenosum - primary sclerosing cholangitis
Decreased intercellular adhesion and increased proliferation
Warthins' tumor
CHF and inc risk of HCC

3. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Ischemic colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Oligosaccharide digestion

4. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Inspiratory arrest on deep palpation due to pain
Unconj - absent (acholuria) - inc
Internal thoracic to superior epigastric to inferior epigastric
Black - rotors syndrome

5. absent UDPGT - presents early in life - early mortality
Crigler - najjar type 1
Gastrohepatic ligament
Peptic ulcer disease
Dec PGE2 leading to dec gastric mucosa protection

6. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Epigastric abdominal pain radiating to back - anorexia - nausea
Phenobarbital - inc liver enzyme synthesis

7. How do burns cause acute gastritis and What is it called

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8. What are the signs of peutz jehgers
Cholesterol - 10-20% opaque due to calcifications
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Hyperpigmented mouth - lips - hands - genitalia
HPNCC

9. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Pleomorphic adenoma
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

10. What does TOASTED with alcoholic hepatitis stand for
AST >ALT - ration is usually 1.5
Complications of UC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

11. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
2ndary biliary cirrhosis
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Zollinger ellison - brunners glands

12. In what clinical scenarior do you see portosystemic anastomoses
Portal HTN
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
T12
ALT>AST

13. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Meconium ileus
Lamina propria
Mitochondrial abnl - fatty liver - hypoglycemia - coma

14. What is the most common cause of gallstones
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Inspiratory arrest on deep palpation due to pain
Internal thoracic to superior epigastric to inferior epigastric

15. Where are carcinoid tumors most commonly malignant
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Unconjugated - water insoluble
Small intestine
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

16. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Complications of crohns
Terminal ileum and colon
Juvenille polyps - no risk if single
Pancreatic head causing obstructive jaundice

17. What is indirect bilirubin
Unconjugated - water insoluble
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

18. People of what decent are associated with celiac sprue and what findings/antibodies are present
EtOH
Around the central vein (zone III)
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

19. What are the complications of Meckels
Striated and smooth
Alpha amylase
Peutz jeghers
Bleeding - intussusception - volvulus - obstruction near terminal ileum

20. conjugated hyperbilirubinemia due to defective liver excretion
Primary sclerosing cholangitis
Dubin johnson
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

21. What does histo show for alpha1 antitrypsin def
Nonkeritinized stratified sqamous epithelium
The gastroduodenal
PAS- positive globules in liver -
Bleeding - penetration into pancreas - perforation - obstruction

22. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Esophageal varices
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Sister mary joseph nodule
Peutz jeghers

23. What congenital birth defect is associated with Hirschsprung
Failure of neural crest migration
Epithelium
Downs
Hydrocele

24. What histological findings are present in the stomach
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Gastric glands
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

25. What percentage of gall stones are cholesterol stones and What are the associations
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Upregulated intracellular signal transduction
Via the middle colic
Early childhood - neuro sx and malabsorption

26. What intervention will intervention will relieve portal HTN
CEA - CA-19-9
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Achalasia due to loss of myenteric plexus (auberach)
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

27. What is contained in the gastrosplenic and What areas does it separate
Epithelium
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Short gastrics - left greater and lesser
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

28. What are esophageal strictures associated with
Lye ingestion and acid reflux
Black - rotors syndrome
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

29. What are the effects of atropine on parietal cells and G cells
90%
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Increase tumorigenesis
Dysphagia (due to esophageal web) - glossitis - iron def anemia

30. What retroperitoneal structure flanks both sides of the pancreas on CT
2ndary biliary cirrhosis
Cholesterol
Duodenum - 2nd - 3rd and 4th parts
Esophageal cancer

31. Failure of relaxation of lower esophageal sphincter - Name and etiology
Oligosaccharide digestion
T12
Achalasia due to loss of myenteric plexus (auberach)
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

32. motilin - source - action - regulation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
L/R renal artery around L1
Alcoholic hepatitis
Parietal cells in the stomach - B12 binding protein

33. Where is the deep inguinal ring relative to the inferior epigastric vessels
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Lateral
Right and left hepatic duct
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

34. B cells stimuated in the germinal centers of peyers patches differentiate into what?
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
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
IgA secreting plasma cells - ultimately reside in the lamina proporia
Sister mary joseph nodule

35. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Superior rectal
Dense core bodies
Inc - weight loss

36. What are motilin receptor agonists used for clinically
Peutz jeghers
Stimulate intestinal persistalsis
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

37. How does loss of NO secretion affect the esophagus and what results
Inc lower esphogeal tone leading to achalasia
Duodenum - 2nd - 3rd and 4th parts
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Inc smooth muscle relaxation - including lower esophageal sphincter

38. What is the prognosis of adenocarcinoma
Ampulla of vater
Averages 6 months - very aggressive - usually already metastasized at presentation
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

39. What commonly leads to appendicity in kids vs adults
Gut bacteria
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Erosive - disruption of mucosal barrier leading to inflammation
Lamina propora and submucosa

40. most common non - neoplastic polyp in colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Hyperplastic
L/R renal artery around L1
Duodenum - 2nd - 3rd and 4th parts

41. What causes hirschsprungs
IBS at least 2 with recurrent abdominal pain
Meckels
Failure of neural crest migration
Pleomorphic adenoma

42. Through which aspect of the inguinal canal does a direct inguinal go
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Epithelium
External (superficial) ring only
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

43. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Terminal ileum and colon
Left gastric vein and esophogeal vein - esophagus
M3 - Gq - inc IP3/Ca
Inguninal ligament - sartorius muscle - adductor longus

44. What complication can arise from indirect inguinal hernias
Hydrocele
Inc - weight loss
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Barrett's esophagus

45. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Dermatitis herpetiformis
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Meckels
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

46. Abuse of what substance leads to acute gastritis
Complications of UC
Jaundice - fever - RUQ
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
EtOH

47. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
Ceruplasmin
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Averages 6 months - very aggressive - usually already metastasized at presentation

48. What causes nutmeg liver
Obstruction of the common bile duct
GERD - may also present with nocturnal cough and dyspnea
Lateral
Backup of blood into the liver - RHF - budd chiari

49. What is the most common indication of emergent abdominal surgery in children
Meckels
Via the middle colic
Appendicitis
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

50. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Inspiratory arrest on deep palpation due to pain
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Hepatic steatosis
Volvulus