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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 complication can arise from indirect inguinal hernias
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Colovesical leading to pneumaturia
Hydrocele
Bleeding - intussusception - volvulus - obstruction near terminal ileum

2. What parts of the small bowel can tropical sprue effect
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
The entire
Repeated phlebotomy - deferoxamine - HLA- A3
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

3. At what spinal level does the celiac trunk exit
T12
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Lubricate food (glycoprotiens)
3 waves/min

4. What is charcot triad of cholangitis
Warthins' tumor
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
GERD - may also present with nocturnal cough and dyspnea
Jaundice - fever - RUQ

5. What are the extraintestinal manifestations of crohns
Small intestine
Internal thoracic to superior epigastric to inferior epigastric
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Bleeding - intussusception - volvulus - obstruction near terminal ileum

6. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Hemolytic anemia
VZV and influenza B treated with salicylates
Stimulate the H/K ATPase

7. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Angiodysplasia
Peutz jeghers
Older patients
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

8. What converts inactive pepsinogen to pepsin
H2 receptor - inc cAMP
Dense core bodies
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
H+

9. When and How does Abetalipoproteinemia present
Glucose dependent insulinotropic peptide
Mitochondrial abnl - fatty liver - hypoglycemia - coma
...
Early childhood - neuro sx and malabsorption

10. Which area of the hindgut is a watershed area
Decrease - weight gain
Obstruction of the common bile duct
Splenic flexure
Below

11. What type of insults result in micronodular cirrhosis
Phototherapy
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
8-9 waves/min
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

12. What makes a true diverticula
MSI (15%) and APC/beta catenin chromosomal instability (85%)
CCK8 receptor - Gq inc IP3/Ca
Nonkeritinized stratified sqamous epithelium
All 3 gut layers outpouch as in Meckels

13. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
2ndary biliary cirrhosis
Falciform - ligamentum teres - fetal umbilical vein
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Via the superior pancreaticduodenal

14. What artery passes around the duodenum
Hydrocele
The gastroduodenal
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Achalasia due to loss of myenteric plexus (auberach)

15. What does loss of APC cause
Krukenbergs tumor
All 3 gut layers outpouch as in Meckels
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Decreased intercellular adhesion and increased proliferation

16. What causes pancreatic insuff and What does it cause
Gardner's syndrome
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Internal thoracic to superior epigastric to inferior epigastric

17. What is the most important mechanism in gastric acid secretion
L/R renal artery around L1
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Left and right gastroepiploics - left and right gastrics
Early childhood - neuro sx and malabsorption

18. What are the midgut structures and what supplies their blood and PANS innervation
Cholesterol - 10-20% opaque due to calcifications
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Ischemic colitis
The proximal small bowel

19. What is the cause of Barrett's and the assocaited complications
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Uremia
Stercobilin

20. 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
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
AST >ALT - ration is usually 1.5
Lateral to the inferior epigastric artery

21. What is the rate limiting step of carbohydrate digestion
Pancreatic and bile
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
Oligosaccharide digestion
Obstruction of the common bile duct

22. How is bilirubin carried in the blood
Hepatic steatosis
Parietal cells in the stomach - B12 binding protein
Erosive - disruption of mucosal barrier leading to inflammation
With albumin

23. FAP + malignant CNS tumor
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Turcot
Lamina propria
Pertechnetate - study for uptake

24. signet ring cells - acanthosis nigracans - dz - character/association - spread
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
AST >ALT - ration is usually 1.5
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
L2

25. involvement of left supraclavicular node by mets from stomach

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26. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
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
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Hemosiderosis - hemochromatosis
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

27. Failure of relaxation of lower esophageal sphincter - Name and etiology
Omeprazole
Achalasia due to loss of myenteric plexus (auberach)
Positive
ALT>AST

28. What kind of muscle is in the middle 1/3 of esophagus
Decreased intercellular adhesion and increased proliferation
Crigler - najjar type 1
Striated and smooth
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

29. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Via the superior pancreaticduodenal

30. At what spinal level does the is the bifurcation of aorta
Unconj - absent (acholuria) - inc
Inc risk of CRC and other visceral malignancies
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
L4

31. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Downs
Glucose dependent insulinotropic peptide
Repeated phlebotomy - deferoxamine - HLA- A3

32. Abuse of what substance leads to acute gastritis
Lactase is located at the tips of intestinal villi
EtOH
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Heme metabolism

33. malnutrition - toxic megacolon - colorectal carcinoma
Neural muscarinic pathways
Lack or have an attenuated muscularis externa - often in the sigmoid colon
With albumin
Complications of UC

34. Where is IgA shuttled
Liver metabolizes 5HT
Hemosiderosis - hemochromatosis
Superior rectal
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

35. What portion of the bowel does sprue effect
Nonkeritinized stratified sqamous epithelium
Reye's syndrome
Gastrohepatic ligament
The proximal small bowel

36. why infxn is implicated in duodenal PUD
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
H pylori (almost 100%)
Centrilobular congestion and necrosis - cardiac cirrhosis
Downs

37. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Alcoholic hepatitis
Portal HTN
US and cholecystectomy

38. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
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
IBS at least 2 with recurrent abdominal pain
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
When diffusely infiltrative - thickened rigid appearance like a leather bottle

39. Diaphragmatic hernias occur in infants because of defective development of which membrane
Failure of the processus vagainlis to close
Acute pancreatitis
Low pressure proximal to LES
Pleuroperitoneal

40. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Jaundice - fever - RUQ
Conj/unconj - inc - nl to dec
US and cholecystectomy
Primarly through ECL leading to histamine release

41. People of what decent are associated with celiac sprue and what findings/antibodies are present
Epithelium
Stercobilin
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Alcoholic cirrhosis

42. What is the characteristic histo finding in alcoholic hepatitis
Cimetidine
Mallory bodies
Decrease - weight gain
External spermatic fascia only

43. What can hemochromatosis be secondary to...
Hydrocele
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Old men - arthralgias - cardiac and neuro sx
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

44. What is pancreatic adenocarcinoma associated with
Cigarettes and chronic pancreatitis - not EtOH
Phenobarbital - inc liver enzyme synthesis
Hernia
Jewish and African American men

45. What gives stool its characteristic color
Stercobilin
Inc conj bilirubin - inc cholesterol - inc alk phos
Crigler - najjar type 1
Spleen to posterior abdominal wall - splenic artery and vein

46. Between what structures do strong anastamoses exist
Serous on the sides parotids - mucinous in the middle sublingual
Splenic flexure
Left and right gastroepiploics - left and right gastrics
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

47. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Lactase is located at the tips of intestinal villi
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Budd chiari syndrome

48. What does loss of p53 cause
Hirschsprungs
Krukenbergs tumor
Increase tumorigenesis
Liver metabolizes 5HT

49. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Portal HTN
Alcoholic cirrhosis
L3
Zenkers - halitosis - dysphagia and obstruction

50. What are the extraintestinal manifestations of ulcerative colitis
Pyoderma gangrenosum - primary sclerosing cholangitis
...
Dubin johnson
Gastrohepatic ligament