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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 is pancreatic adenocarcinoma associated with
Positive urease test
AST>ALT
Cigarettes and chronic pancreatitis - not EtOH
Complications of UC

2. What is the cause of Barrett's and the assocaited complications
Averages 6 months - very aggressive - usually already metastasized at presentation
Corticosteroids - infliximab
Mitochondrial abnl - fatty liver - hypoglycemia - coma
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

3. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Lamina propora and submucosa
Pyoderma gangrenosum - primary sclerosing cholangitis
NAV = nerve artery vein - venous near the penis (NAVEL)

4. What is the arterial supply and venous drainage below pectinate line
Begins starch digestion - inactivated by low pH upon reaching the stomach
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Black - rotors syndrome
Esophageal cancer

5. In PUD - with gastric ulcers - does pain inc or dec with meals?
The submucosal nerve plexus - meissner's
Elevated amylase - and lipase
Pancreatic head causing obstructive jaundice
Inc - weight loss

6. concentric onion skin bile duct fibrosis
Hydrocele
Primary sclerosing cholangitis
Skip lesions =crohns - colon = UC
Zollinger ellison - brunners glands

7. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Gardner's syndrome
Dissaccharidase def - most commonly lactase
HSV-1 - CMV - Candida

8. What causes hirschsprungs
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
Failure of neural crest migration
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Gastric glands

9. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Pancreatic head causing obstructive jaundice
The jejunum
Brunners
L1

10. What does the splenorenal ligament connect - and What does it contain
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Spleen to posterior abdominal wall - splenic artery and vein
Boerhaave's Syndrome - Been heaving syndrome
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

11. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Ampulla of vater
Peutz jeghers

12. What structures feed into the common hepatic duct
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Short gastrics - left greater and lesser
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Right and left hepatic duct

13. What is the triad of Plummer - Vinson syndrome
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Failure of the processus vagainlis to close
Complications of UC

14. most common non - neoplastic polyp in colon
Hyperplastic
Serous on the sides parotids - mucinous in the middle sublingual
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
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

15. What can hemochromatosis be secondary to...
Terminal ileum and colon
AST >ALT - ration is usually 1.5
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Inc - weight loss

16. What are the midgut structures and what supplies their blood and PANS innervation
Serous on the sides parotids - mucinous in the middle sublingual
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Brush border of intestine - produce monosaccharides from oligo and di

17. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
AST
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
L2
Zollinger ellison - brunners glands

18. If the hemochromatosis is primary - What is the pattern of inheritance
Menetriers disease
Erosive - disruption of mucosal barrier leading to inflammation
AR
Hernia

19. What gives urine its characteristic color
Common hepatic - splenic - left gastric - main blood supply for stomach
Urobilin
Gilbert's
Stercobilin

20. What is the HLA association and treatment for hemochromatosis
Meconium ileus
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Warthins' tumor
Repeated phlebotomy - deferoxamine - HLA- A3

21. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Upregulated intracellular signal transduction
Dubin johnson
Chronic calcifying pancreatitis - inc risk of panreatic cancer

22. Where does an indirect inguinal hernia enter the deep inguinal ring
True and most common congenital anomoly of GI tract
So hypertrophied they look like brain gyri
Punched out - clean margins - carcinoma =raised irregular margins
Lateral to the inferior epigastric artery

23. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Above
Spleen to posterior abdominal wall - splenic artery and vein
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

24. What portion of the bowel does sprue effect
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
The proximal small bowel
Decrease - weight gain
True and most common congenital anomoly of GI tract

25. What is the action of NO as a GI hormone
Stimulate the H/K ATPase
Inferior rectal nerve
Mucoepidermoid carcinoma
Inc smooth muscle relaxation - including lower esophageal sphincter

26. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Nonkeritinized stratified sqamous epithelium
L/R renal artery around L1
CEA - CA-19-9

27. How many layers of spermatic fascia are covers an indirect inguinal hernia
All 3
Carcinoid syndrome
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Above

28. What is the characteristic histo finding in alcoholic hepatitis
AST >ALT - ration is usually 1.5
Smooth
Mallory bodies
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

29. What is charcot triad of cholangitis
2ndary biliary cirrhosis
When diffusely infiltrative - thickened rigid appearance like a leather bottle
FAP
Jaundice - fever - RUQ

30. What is the omphalomesenteric cyst
Esophageal cancer
Mallory bodies
Cystic dilation of the viteline duct
Inspiratory arrest on deep palpation due to pain

31. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Lipase - phospholipase A - colipase
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
IgA secreting plasma cells - ultimately reside in the lamina proporia

32. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lye ingestion and acid reflux
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Lactase is located at the tips of intestinal villi
Nonkeritinized stratified sqamous epithelium

33. What do you treat Wilsons disease with and What is the inheritance
Fasting and stress
Stimulate the H/K ATPase
Penicillinamine - AR inheritance
Inc smooth muscle relaxation - including lower esophageal sphincter

34. What pancreatic proteases are secreted as zymogens
Trypsin - chymotrypsin - elastase - carboxypeptidases
Alfatoxin in peanuts
Gilbert's
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

35. What source of salivary secretion is the most serous and What is the most mucinous
Serous on the sides parotids - mucinous in the middle sublingual
Alpha1 antitrypsin def - codominant trait
Can lead to hematemesis - found in EtOHics and bulimics
Liver metabolizes 5HT

36. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
US and cholecystectomy
Skip lesions =crohns - colon = UC
Cirrhosis

37. What is one potential precipitating factor for intussusception
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Duodenal atresia - Downs

38. Where are tumors commonly in pancreatic adenocarcinoma
Glucouronate - water soluble (direct)
Urobilin
With albumin
Pancreatic head causing obstructive jaundice

39. What receptors does gastrin bind on the parietal cell and What does it activate
L/R renal artery around L1
CCK8 receptor - Gq inc IP3/Ca
Pleomorphic adenoma
Penicillinamine - AR inheritance

40. In viral hepatitis - which liver enzyme is higher
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
ALT>AST
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Unconjugated - water insoluble

41. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Internal thoracic to superior epigastric to inferior epigastric
Stimulate intestinal persistalsis
Skip lesions =crohns - colon = UC

42. What kind of pathways do CCK act on to cause pancreatic secretion
Cimetidine
Crohns = noncaseating granulomas - UC = crypt abscesses
Dilated esophagus with an area of distal stenosis - birds beak
Neural muscarinic pathways

43. Liver cell failure can lead to multisystem signs including
Oligosaccharide digestion
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Increase tumorigenesis
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

44. How does hirschsprung present and appear on imaging
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
Hemolytic anemia
Stercobilin
Spleen to posterior abdominal wall - splenic artery and vein

45. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
The submucosal nerve plexus - meissner's
Backup of blood into the liver - RHF - budd chiari
Crohns = maybe - UC= always
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

46. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Urobilin
Gastric glands
AST>ALT

47. What structures feed into the cystic duct
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Gallbladder
Worldwide - SC - US - adeno
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

48. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Internal thoracic to superior epigastric to inferior epigastric
Dec PGE2 leading to dec gastric mucosa protection
So hypertrophied they look like brain gyri

49. What are the effects of atropine on parietal cells and G cells
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Duodenum - 2nd - 3rd and 4th parts
Normal
Increase tumorigenesis

50. What does loss of p53 cause
Neutralizes oral bacertial acids and maintains dental health
Epithelium
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Increase tumorigenesis