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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 retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
Gastric glands
Small intestine
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

2. bilateral mets to ovaries with abundant mucus - signet ring cells
Muscularis mucosae
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Krukenbergs tumor
Phototherapy

3. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Nonkeritinized stratified sqamous epithelium
Tropical sprue
Inspiratory arrest on deep palpation due to pain

4. What are the tumor markers for pancreatic adenocarcinoma
Lipase
Barrett's esophagus
CEA - CA-19-9
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

5. malnutrition - toxic megacolon - colorectal carcinoma
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Complications of UC
Lateral to the inferior epigastric artery
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

6. What does alpha amylase do and what inactivates it
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Jaundice - fever - RUQ
Begins starch digestion - inactivated by low pH upon reaching the stomach

7. Transmural esophageal rupture due to violent retching

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8. What is the prognosis of adenocarcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Urobilin
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Zenkers - halitosis - dysphagia and obstruction

9. What does high flow rate mean
Closer to isotonic because of less time to reabsorb NaCl
Pleuroperitoneal
Dilated esophagus with an area of distal stenosis - birds beak
Goes through deep inguinal ring - external inguinal ring and into the scrotum

10. multiple juvenil polyps in GI tract - risk
90%
Pancreatic head causing obstructive jaundice
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Juvenile polyposis syndrome - inc risk of adenocarcinoma

11. What are the histological findings in the duodenum

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12. Is there any structural abnl with IBS - What is the course of disease and presentation
Begins starch digestion - inactivated by low pH upon reaching the stomach
Dubin johnson
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

13. What can hemochromatosis be secondary to...
Mallory bodies
Corticosteroids - infliximab
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

14. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Alk pho
Femoral hernia

15. What enzyme is necessary to create conjugated bilirubin
Redness and tenderness on palpation of extremities
Left and right gastroepiploics - left and right gastrics
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Uridine glucuronyl transferase

16. occlusion of IVC or hepatic veins
Ischemic colitis
AST>ALT
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Budd chiari syndrome

17. What does K- ras mutation cause
Glucouronate - water soluble (direct)
Cholesterol
Upregulated intracellular signal transduction
L4

18. somatostatin - source - action - regulation
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
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Warthins' tumor

19. What commonly leads to appendicity in kids vs adults
Redness and tenderness on palpation of extremities
Heme metabolism
M3 - Gq - inc IP3/Ca
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

20. What cell produces IF and What does it do
Penicillinamine - AR inheritance
Lipase - phospholipase A - colipase
Terminal ileum and colon
Parietal cells in the stomach - B12 binding protein

21. In PUD with a duodenal ulcer does pain inc or dec with meals
When diffusely infiltrative - thickened rigid appearance like a leather bottle
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
Decrease - weight gain
External spermatic fascia only

22. People of what decent are associated with celiac sprue and what findings/antibodies are present
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Small intestine
Decrease - weight gain

23. Abuse of what substance leads to acute gastritis
EtOH
Hirschsprungs
3 waves/min
Parietal cells in the stomach - B12 binding protein

24. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Cholesterol
Achalasia due to loss of myenteric plexus (auberach)
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Brunners

25. What causes carcinoid syndrome amd What are the symptoms
Appendicitis
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
8-9 waves/min
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

26. What are the complications of Meckels
Superior rectal
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Inc conj bilirubin - inc cholesterol - inc alk phos
The jejunum

27. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Duodenal atresia - Downs
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

28. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Meconium ileus
Skip lesions =crohns - colon = UC
Neural muscarinic pathways

29. What are the labs in acute pancreatitis
Elevated amylase - and lipase
Menetriers disease
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
GERD - may also present with nocturnal cough and dyspnea

30. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Cystic duct and common hepatic duct
Left gastric vein and esophogeal vein - esophagus
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Phototherapy

31. What do mucins do?
AST>ALT
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Lubricate food (glycoprotiens)
Hydrocele

32. What structures feed into the common bile duct
Meckels
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Inc risk of CRC and other visceral malignancies
Cystic duct and common hepatic duct

33. What are causes of extrahepatic biliary obstruction
Cigarettes and chronic pancreatitis - not EtOH
L4
Chagas disease
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

34. What kind of insults results in macronodular cirrhosis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Normal
The gastroduodenal
Fe2+ in the duod

35. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
All 3 gut layers outpouch as in Meckels
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Complications of UC

36. How does CRC present in the distal and proximal colon
Tropical sprue
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
FAP
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

37. Malabsorption syndromes have what common clinical presentation
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Left gastric vein and esophogeal vein - esophagus
Diarrhea - steatorrhea - weight loss - weakness

38. At what spinal level does the is the bifurcation of aorta
L4
In the ileum with bile acids - requires IF
Downs
Neutralizes gastric acid allowing pancreatic enzymes to fxn

39. How does hirschsprung present and appear on imaging
Hirschsprungs
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
Enterokinase/enteropeptidase from the duodenal mucosa
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

40. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Left gastric vein and esophogeal vein - esophagus
Volvulus

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

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42. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
In the ileum with bile acids - requires IF
Carcinoid syndrome
Below
Meckels

43. What is contained in the gastrosplenic and What areas does it separate
Dense core bodies
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Reye's syndrome
Short gastrics - left greater and lesser

44. Why does carcinoid syndrome not occur if tumor is confined to GI system
MSI (15%) and APC/beta catenin chromosomal instability (85%)
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
Muscularis mucosae
Liver metabolizes 5HT

45. rare - often fatal childhood hepatoencephalopathy

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46. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Duodenum - 2nd - 3rd and 4th parts
Positive
The jejunum
Black - rotors syndrome

47. What test and result confirms H pylori infxn
Can lead to hematemesis - found in EtOHics and bulimics
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Pleuroperitoneal
Positive urease test

48. What kind of pancreatitis is associated with EtOH and smoking
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Angiodysplasia
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Complications of UC

49. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Right and left hepatic duct
External (superficial) ring only
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
Neutralizes oral bacertial acids and maintains dental health

50. Dysphagia in achalasia results from
Centrilobular leading to congestive liver disease
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Repeated phlebotomy - deferoxamine - HLA- A3
IgA secreting plasma cells - ultimately reside in the lamina proporia