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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 are the common causes of gastric ulcers - What causes gastric ulcer
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Pancreatic head causing obstructive jaundice
Female - fat - fertile - forty

2. What is the presenting course for appendicity

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3. What receptor does histamine bind on the parietal cell and What does it activate
Below
Hernia
H2 receptor - inc cAMP
Complications of crohns

4. What is charcot triad of cholangitis
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Jaundice - fever - RUQ
Osmotic
Ceruplasmin

5. What causes hirschsprungs
Parietal cells in the stomach - B12 binding protein
Failure of neural crest migration
Hypercoaguability - polycythemia vera - pregnancy - HCC
GERD - may also present with nocturnal cough and dyspnea

6. Bile is critical for exrection of what substance
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Cholesterol
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

7. Transmural esophageal rupture due to violent retching

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8. What are the complications of duodenal PUD
Cholesterol - 10-20% opaque due to calcifications
Lactase is located at the tips of intestinal villi
Oral glucose
Bleeding - penetration into pancreas - perforation - obstruction

9. What commonly leads to appendicity in kids vs adults
Adhesion
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
The jejunum
Inc smooth muscle relaxation - including lower esophageal sphincter

10. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
L2
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Internal thoracic to superior epigastric to inferior epigastric

11. What is the TX of physiologic neonatal jaundice
Phototherapy
Redundant mesentary
Bleeding - penetration into pancreas - perforation - obstruction
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

12. Why are most diverticula considered false
Tropical sprue
Lipase - phospholipase A - colipase
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

13. What is the mechanism for reyes syndrome
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Phototherapy
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

14. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Esophageal cancer
Gardner's syndrome
With albumin
So hypertrophied they look like brain gyri

15. With caput medusaw - between what vessels is the anastomoses and Where is it
Serous on the sides parotids - mucinous in the middle sublingual
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Worldwide - SC - US - adeno
Paraumbilical and superficial and inferior epigastric - umbilicus

16. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Alk pho
Unconj - absent (acholuria) - inc
Repeated phlebotomy - deferoxamine - HLA- A3

17. How does CRC present in the distal and proximal colon
Chagas disease
HPNCC
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Adhesion

18. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Primary sclerosing cholangitis
Meckels
Necrotizing enterocolitis
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

19. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Female - fat - fertile - forty
Crohns = maybe - UC= always
CHF and inc risk of HCC
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

20. What does bicab do in the mouth
Neutralizes oral bacertial acids and maintains dental health
Lactase is located at the tips of intestinal villi
Crigler - najjar type 1
Celiac sprue

21. What skin condition is associated with celiac sprue
Left and right gastroepiploics - left and right gastrics
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Cholesterol - 10-20% opaque due to calcifications
Dermatitis herpetiformis

22. What kind of pancreatitis is associated with EtOH and smoking
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Hernia
Colovesical leading to pneumaturia
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

23. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Hyperpigmented mouth - lips - hands - genitalia
Stimulate intestinal persistalsis
Enterokinase/enteropeptidase from the duodenal mucosa

24. What does GET SMASHED stand for in acute pancreatitis
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Hirschsprungs
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
3 waves/min

25. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Fasting and stress
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Bleeding - intussusception - volvulus - obstruction near terminal ileum

26. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
Amylase
L2
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

27. What causes carcinoid syndrome amd What are the symptoms
Alpha amylase
Small intestine
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

28. What reaction does salivary amylase catalyze
Inc conj bilirubin - inc cholesterol - inc alk phos
AST>ALT
Normal
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

29. A protrusion of peritoneum through an opening - usually a site of weakness
Femoral hernia
Hernia
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Gastrohepatic ligament

30. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Meconium ileus
Volvulus
Small intestine
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

31. Liver cell failure can lead to multisystem signs including
Unconjugated - water insoluble
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
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
Pertechnetate - study for uptake

32. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Cigarettes and chronic pancreatitis - not EtOH
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Liver metabolizes 5HT

33. What pancreatic enzymes are responsible for fat digestion
VZV and influenza B treated with salicylates
Lipase - phospholipase A - colipase
Fe2+ in the duod
Around the central vein (zone III)

34. What are the structures of the femoral triangle and how are they organized
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
NAV = nerve artery vein - venous near the penis (NAVEL)
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Duodenum - 2nd - 3rd and 4th parts

35. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Phenobarbital - inc liver enzyme synthesis
Centrilobular leading to congestive liver disease
Gallbladder
Crohns = noncaseating granulomas - UC = crypt abscesses

36. At what spinal level does the SMA exit
Antrum - H.pylori - inc risk of MALT lymphoma
No
Inc lower esphogeal tone leading to achalasia
L1

37. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Peyers patches
Falciform - ligamentum teres - fetal umbilical vein
ALT>AST
Punched out - clean margins - carcinoma =raised irregular margins

38. Where are tumors commonly in pancreatic adenocarcinoma
Carcinoid syndrome
Pancreatic head causing obstructive jaundice
Appendicitis
Omeprazole

39. Diaphragmatic hernias occur in infants because of defective development of which membrane
Left and right gastroepiploics - left and right gastrics
Pleuroperitoneal
The jejunum
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

40. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Lamina propora and submucosa
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Begins starch digestion - inactivated by low pH upon reaching the stomach

41. What does histo show for alpha1 antitrypsin def
EtOH
PAS- positive globules in liver -
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

42. 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
Internal thoracic to superior epigastric to inferior epigastric
Female - fat - fertile - forty
Copious diarrhea - non alpha - non beta cell pancreatic tumor

43. What type of insults result in micronodular cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Complications of UC
Dubin johnson

44. What does autoimmune destruction of parietal cells lead to...
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Chronic gastritis and pernicious anemia
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Unconj - absent (acholuria) - inc

45. Which viral infxns/treatments are associated with reyes syndrome
Barrett's esophagus
AR
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
VZV and influenza B treated with salicylates

46. in carcinoid tumors - What is seen on EM
Terminal ileum and colon
Gallbladder
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Dense core bodies

47. What drug blocks the H2R
Cimetidine
Tropical sprue
Stercobilin
Glucose dependent insulinotropic peptide

48. What drug inhibits the H/K ATPase
MSI (15%) and APC/beta catenin chromosomal instability (85%)
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Omeprazole
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

49. What structures feed into the common bile duct
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Cystic duct and common hepatic duct
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Dysphagia (due to esophageal web) - glossitis - iron def anemia

50. What factors increase risk of malignancy of adenomatous polyps
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Crigler - najjar type 1
Closer to isotonic because of less time to reabsorb NaCl
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC