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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. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
IgA secreting plasma cells - ultimately reside in the lamina proporia
Adhesion
Femoral hernia
Cholesterol - 10-20% opaque due to calcifications

2. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Alcoholic hepatitis
Hyperpigmented mouth - lips - hands - genitalia
Bleeding - intussusception - volvulus - obstruction near terminal ileum

3. what kind of fistula is associated with diverticulitis
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Colovesical leading to pneumaturia
Jewish and African American men
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

4. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Unconj - absent (acholuria) - inc
Alfatoxin in peanuts
Repeated phlebotomy - deferoxamine - HLA- A3
Diverticulitis in elderly - ectopic pregs use hCG to rule out

5. Diaphragmatic hernias occur in infants because of defective development of which membrane
Above
Pleuroperitoneal
Dermatitis herpetiformis
Stimulate intestinal persistalsis

6. What receptors does gastrin bind on the parietal cell and What does it activate
Spleen to posterior abdominal wall - splenic artery and vein
So hypertrophied they look like brain gyri
Dec PGE2 leading to dec gastric mucosa protection
CCK8 receptor - Gq inc IP3/Ca

7. What can fistula between the gallbladder and small intestine create and how can you tell
Mucoepidermoid carcinoma
Inferior rectal nerve
Oral glucose
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

8. What intervention will intervention will relieve portal HTN
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Left gastric vein and esophogeal vein - esophagus
Angiodysplasia
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

9. 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
T cell lymphoma
Nonkeritinized stratified sqamous epithelium
AST >ALT - ration is usually 1.5

10. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Conj/unconj - inc - nl to dec
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Fasting and stress
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

11. What does loss of p53 cause
Zollinger Ellison - phenylalanine and tryptophan
Increase tumorigenesis
Stercobilin
Hernia

12. What is the clinical presentation of acute pancreatitis
Normal
Epigastric abdominal pain radiating to back - anorexia - nausea
Elevated amylase - and lipase
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

13. Why does indirect inguinal hernia happen in infacnts
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Failure of the processus vagainlis to close
12 waves/min
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

14. What layer of fascia covers a direct inguinal hernia
Centrilobular leading to congestive liver disease
External spermatic fascia only
Poor anastamoses
L1

15. In what scenarios do pts with gilberts have inc bili
Fasting and stress
Lamina propora and submucosa
Unconjugated - water insoluble
Celiac sprue

16. What parts of the small bowel can tropical sprue effect
The entire
H+
Mallory bodies
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

17. List the clinical findings of HCC
Mitochondrial abnl - fatty liver - hypoglycemia - coma
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Oligosaccharide digestion
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

18. What receptors does ACH bind on the parietal cells and What does it activate
Crigler - najjar type 1
M3 - Gq - inc IP3/Ca
Sphincter of oddi
H+

19. If the hemochromatosis is primary - What is the pattern of inheritance
Lamina propria
AR
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Neural muscarinic pathways

20. What are the complications of chronic pancreatitis
Lipase
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Increase tumorigenesis
AST >ALT - ration is usually 1.5

21. What does high flow rate mean
Carcinoid syndrome
Internal thoracic to superior epigastric to inferior epigastric
Closer to isotonic because of less time to reabsorb NaCl
Mucosa - submucosa - muscularis externa - serosa/adventitia

22. Where does copper accumulate in Wilsons and What are ABCD
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
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
Old men - arthralgias - cardiac and neuro sx
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

23. What skin condition is associated with celiac sprue
So hypertrophied they look like brain gyri
Falciform - ligamentum teres - fetal umbilical vein
Boerhaave's Syndrome - Been heaving syndrome
Dermatitis herpetiformis

24. What is the risk with peutz jehgers
Inc lower esphogeal tone leading to achalasia
Inc risk of CRC and other visceral malignancies
Cigarettes and chronic pancreatitis - not EtOH
2ndary biliary cirrhosis

25. somatostatin - source - action - regulation
Left gastric vein and esophogeal vein - esophagus
Gastrohepatic ligament
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
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

26. What is contained in the gastrosplenic and What areas does it separate
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
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
Dilated esophagus with an area of distal stenosis - birds beak

27. What is the rule of 2s for meckels
Sphincter of oddi
Bleeding - penetration into pancreas - perforation - obstruction
Inc risk of CRC and other visceral malignancies
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

28. subQ peribumbilical metastasis
Gastrohepatic ligament
Cirrhosis
Sister mary joseph nodule
Tropical sprue

29. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
The entire
Epithelium

30. What do tumors that arise in the head of the pancreas cause
Obstruction of the common bile duct
Adhesion
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Unconj - absent (acholuria) - inc

31. What cells secrete bicarb - What does it do - and what regulates it
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Splenic flexure
Inc risk of CRC and other visceral malignancies
L2

32. What causes primary biliary cirrhosis
Elevated amylase - and lipase
Cholesterol
Peyers patches
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

33. Which serum enzyme increases with heavy EtOH consumption
Alpha1 antitrypsin def - codominant trait
CEA - CA-19-9
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Gamma glutamyl transferase GGT

34. What is the prognosis of adenocarcinoma
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
CHF and inc risk of HCC
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Averages 6 months - very aggressive - usually already metastasized at presentation

35. What structures feed into the common bile duct
Krukenbergs tumor
3 waves/min
Cystic duct and common hepatic duct
Boerhaave's Syndrome - Been heaving syndrome

36. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Juvenille polyps - no risk if single
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
H pylori (almost 100%)
2ndary biliary cirrhosis

37. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Lateral to the inferior epigastric artery
Cystic duct and common hepatic duct
AST>ALT

38. What is the frequency of basal electric rhythm of the stomach
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Alcoholic hepatitis
Conj/unconj - inc - nl to dec
3 waves/min

39. what percentage of colonic polyps are non - neoplastic
90%
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Primary sclerosing cholangitis
Splenic flexure

40. What do you treat Wilsons disease with and What is the inheritance
Primary sclerosing cholangitis
Fasting and stress
Penicillinamine - AR inheritance
Terminal ileum and colon

41. In alchoholic hepatitis which liver enzyme is higher
AST>ALT
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Downs
All 3 gut layers outpouch as in Meckels

42. What complication can arise from indirect inguinal hernias
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Hydrocele
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
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

43. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Obstruction of the common bile duct
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Duodenal atresia - Downs
Redundant mesentary

44. What are the extraintestinal manifestations of crohns
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Decreased intercellular adhesion and increased proliferation
In the ileum with bile acids - requires IF
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

45. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Inguninal ligament - sartorius muscle - adductor longus
Angiodysplasia
Smooth
Jewish and African American men

46. What is the TX of physiologic neonatal jaundice
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Phototherapy
External spermatic fascia only

47. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Brunners
Hemolytic anemia
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
So hypertrophied they look like brain gyri

48. A protrusion of peritoneum through an opening - usually a site of weakness
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
AR
Hernia
Alfatoxin in peanuts

49. What drug inhibits the H/K ATPase
Carcinoid syndrome
Worldwide - SC - US - adeno
Omeprazole
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

50. Transmural esophageal rupture due to violent retching

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