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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 serum enzyme is elevated in acute pancreatitis and mumps
Stimulate the H/K ATPase
Amylase
Female - fat - fertile - forty
Fe2+ in the duod

2. What retroperitoneal structure flanks both sides of the pancreas on CT
Primary sclerosing cholangitis
Duodenum - 2nd - 3rd and 4th parts
CCK8 receptor - Gq inc IP3/Ca
Copious diarrhea - non alpha - non beta cell pancreatic tumor

3. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
CHF and inc risk of HCC
Hemosiderosis - hemochromatosis
Necrotizing enterocolitis
Pancreatic head causing obstructive jaundice

4. When and why is stomach cancer termed linitis plastica
Parietal cells in the stomach - B12 binding protein
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Hypotonic because of more time to reabsorb NaCl
Necrotizing enterocolitis

5. In PUD with a duodenal ulcer does pain inc or dec with meals
Decrease - weight gain
Crohns = noncaseating granulomas - UC = crypt abscesses
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Inc conj bilirubin - inc cholesterol - inc alk phos

6. At what spinal level does the celiac trunk exit
Fasting and stress
Liver metabolizes 5HT
All 3 gut layers outpouch as in Meckels
T12

7. Why does volvulus occur more at cecum and sigmoid colon
Alk pho
Redundant mesentary
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Hyperpigmented mouth - lips - hands - genitalia

8. What transforms conjugated bilirubin to urobilinogen
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Striated and smooth
L3
Gut bacteria

9. What does GET SMASHED stand for in acute pancreatitis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
With albumin

10. What is the mechanism for reyes syndrome
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Source - S cells (duod) - action - inc pancreatic bicarb secretion - dec gastric acid secretin - inc bile secretion - regulation - inc by acid - fatty acids in lumen of duod
Common hepatic - splenic - left gastric - main blood supply for stomach

11. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Brunners
Mucoepidermoid carcinoma
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
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

12. What separates the right greater and lesser sacs
Gastrohepatic ligament
Inc smooth muscle relaxation - including lower esophageal sphincter
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Low pressure proximal to LES

13. What is the frequency of basal electric rhythm of the stomach
3 waves/min
Conj/unconj - inc - nl to dec
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
ALT>AST

14. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
90%
Crohns = noncaseating granulomas - UC = crypt abscesses
Crypts but not villi
Inc lower esphogeal tone leading to achalasia

15. Abuse of what substance leads to acute gastritis
EtOH
Lubricate food (glycoprotiens)
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

16. What is the risk with peutz jehgers
Pleomorphic adenoma
Cimetidine
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Inc risk of CRC and other visceral malignancies

17. How is the diagonsis of CRC made
Smooth
Common hepatic - splenic - left gastric - main blood supply for stomach
Jewish and African American men
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

18. What layer in the mucosa is repsonsible for motility
Necrotizing enterocolitis
Muscularis mucosae
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
In the mucus that covers the gastric epithelium

19. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
Old men - arthralgias - cardiac and neuro sx
All 3
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

20. What structures feed into the common bile duct
Muscularis mucosae
2ndary biliary cirrhosis
Cystic duct and common hepatic duct
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

21. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Achalasia due to loss of myenteric plexus (auberach)
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

22. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
3 waves/min
Via the superior pancreaticduodenal
Downs
Gallbladder

23. What is the triad of Plummer - Vinson syndrome
Volvulus
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Lactase is located at the tips of intestinal villi

24. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Inc smooth muscle relaxation - including lower esophageal sphincter
Volvulus
Brunners
Menetriers disease

25. What does primary sclerosing cholangitis lead to...
AST>ALT
IgA secreting plasma cells - ultimately reside in the lamina proporia
Inferior rectal nerve
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

26. What layer in the mucosa is responsible for absorption
Epithelium
GLUT 2
Low pressure proximal to LES
Superior rectal and middle and inferior rectal - rectum

27. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Internal thoracic to superior epigastric to inferior epigastric
Worldwide - SC - US - adeno
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
The jejunum

28. What are the foregut structures and what supplies their blood and PANS innvervation
L1
IgA secreting plasma cells - ultimately reside in the lamina proporia
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
HPNCC

29. What can fistula between the gallbladder and small intestine create and how can you tell
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Brunners

30. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Lateral
Fasting and stress
Liver metabolizes 5HT
Superior rectal

31. Where does type B chronic gastritis occur and What causes it
Mallory bodies
Antrum - H.pylori - inc risk of MALT lymphoma
Crypts but not villi
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

32. What histological findings are present in the stomach
Gastric glands
Complications of UC
Repeated phlebotomy - deferoxamine - HLA- A3
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

33. Where is bicarb trapped
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
L3
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
In the mucus that covers the gastric epithelium

34. Which area of the hindgut is a watershed area
Striated and smooth
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Splenic flexure
Cystic duct and common hepatic duct

35. How do NSAIDs cause acute gastritis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
AST >ALT - ration is usually 1.5
Osmotic
Dec PGE2 leading to dec gastric mucosa protection

36. What does extrahepatic biliary obstruction cause
Pyoderma gangrenosum - primary sclerosing cholangitis
IgA secreting plasma cells - ultimately reside in the lamina proporia
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Appendicitis

37. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Hepatic steatosis
Hyperplastic
Gastric glands
Lateral to the inferior epigastric artery

38. What is one potential precipitating factor for intussusception
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
External (superficial) ring only
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Penicillinamine - AR inheritance

39. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Lipase
Diarrhea - steatorrhea - weight loss - weakness

40. Diaphragmatic hernias occur in infants because of defective development of which membrane
Dec PGE2 leading to dec gastric mucosa protection
Older patients
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Pleuroperitoneal

41. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Conj/unconj - inc - nl to dec
Crohns = maybe - UC= always

42. How does hirschsprung present and appear on imaging
Superior rectal and middle and inferior rectal - rectum
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
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
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

43. What is the presentation of pancreatic adenocarcinoma
Inc lower esphogeal tone leading to achalasia
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Fasting and stress
With albumin

44. What is the frequency of basal electric rhythm in the duodenum
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
12 waves/min
Elevated amylase - and lipase
Complications of UC

45. What is the TX of physiologic neonatal jaundice
Phototherapy
Squamous - upper 1/3 - adeno - lower 1/3
Inferior rectal nerve
8-9 waves/min

46. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
The gastroduodenal
Hydrocele
Appendicitis
Alpha1 antitrypsin def - codominant trait

47. What artery passes around the duodenum
Alcoholic cirrhosis
Hernia
The gastroduodenal
Uremia

48. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
The jejunum
Centrilobular leading to congestive liver disease
Bleeding - penetration into pancreas - perforation - obstruction

49. Gastrin - source - action - regulation
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
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Jaundice - fever - RUQ
Skip lesions =crohns - colon = UC

50. At what spinal level does the is the bifurcation of aorta
L4
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Oral glucose