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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 receptor does histamine bind on the parietal cell and What does it activate
Obstruction of the common bile duct
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Juvenile polyposis syndrome - inc risk of adenocarcinoma
H2 receptor - inc cAMP

2. Gallstones that reach the common channel at ampulla can block which two ducts
Around the central vein (zone III)
Lamina propora and submucosa
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Pancreatic and bile

3. What does TOASTED with alcoholic hepatitis stand for
AST >ALT - ration is usually 1.5
Neutralizes oral bacertial acids and maintains dental health
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Black - rotors syndrome

4. Where are oligosaccharide hydrolases and What do they do
Worldwide - SC - US - adeno
IgA secreting plasma cells - ultimately reside in the lamina proporia
Acute pancreatitis
Brush border of intestine - produce monosaccharides from oligo and di

5. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
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
CEA - CA-19-9
Falciform - ligamentum teres - fetal umbilical vein
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

6. Gastrin - source - action - regulation
H2 receptor - inc cAMP
Positive urease test
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
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

7. How does CRC present in the distal and proximal colon
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Ampulla of vater
Low pressure proximal to LES

8. How do burns cause acute gastritis and What is it called

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9. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
GERD - may also present with nocturnal cough and dyspnea
Inc lower esphogeal tone leading to achalasia
FAP
Hemosiderosis - hemochromatosis

10. What is the characteristic histo finding in alcoholic hepatitis
Zenkers - halitosis - dysphagia and obstruction
Colonic polyps
Mallory bodies
Via the superior pancreaticduodenal

11. What are the complications of Meckels
Inspiratory arrest on deep palpation due to pain
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Punched out - clean margins - carcinoma =raised irregular margins

12. What causes carcinoid syndrome amd What are the symptoms
Smooth
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Alpha amylase
Ischemic colitis

13. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
...
PAS- positive globules in liver -
Brunners
Meconium ileus

14. What complication can arise from indirect inguinal hernias
ALT>AST
Older patients
Repeated phlebotomy - deferoxamine - HLA- A3
Hydrocele

15. In what scenarios do pts with gilberts have inc bili
Centrilobular congestion and necrosis - cardiac cirrhosis
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Upregulated intracellular signal transduction
Fasting and stress

16. What are the extraintestinal manifestations of ulcerative colitis
Pyoderma gangrenosum - primary sclerosing cholangitis
Brunners
The entire
Gardner's syndrome

17. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Conj - inc - dec
Serous on the sides parotids - mucinous in the middle sublingual
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

18. Who gets gastric ulcers
Older patients
Above
Appendicitis
Hernia

19. Which is used more quickly - an oral glucose load - or that by IV
Penicillinamine - AR inheritance
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Oral glucose

20. What are the longterm sequelae of nutmeg liver
AST
Gilbert's
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Centrilobular congestion and necrosis - cardiac cirrhosis

21. What causes pancreatic insuff and What does it cause
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Can lead to hematemesis - found in EtOHics and bulimics
Lactase is located at the tips of intestinal villi
Brunners

22. At what spinal level does the celiac trunk exit
T12
Budd chiari syndrome
Esophageal cancer
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

23. What causes primary biliary cirrhosis
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Alfatoxin in peanuts
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Hernia

24. People of what decent are associated with celiac sprue and what findings/antibodies are present
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
EtOH
Superior rectal
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

25. Which IBD is autoimmune and which may be a disordered response to bacteria
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Hyperplastic
With albumin
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

26. Failure of relaxation of lower esophageal sphincter - Name and etiology
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Striated and smooth
Achalasia due to loss of myenteric plexus (auberach)
Copious diarrhea - non alpha - non beta cell pancreatic tumor

27. What are additional risk factors for CRC
Trypsin - chymotrypsin - elastase - carboxypeptidases
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Positive urease test

28. How many layers of spermatic fascia are covers an indirect inguinal hernia
Bleeding - intussusception - volvulus - obstruction near terminal ileum
All 3
Internal thoracic to superior epigastric to inferior epigastric
Chronic calcifying pancreatitis - inc risk of panreatic cancer

29. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Gamma glutamyl transferase GGT
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Superior rectal and middle and inferior rectal - rectum

30. What are causes of extrahepatic biliary obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Skip lesions =crohns - colon = UC
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
GLUT 2

31. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Left gastric vein and esophogeal vein - esophagus
GERD - may also present with nocturnal cough and dyspnea
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Crypts but not villi

32. What kind of pathways do CCK act on to cause pancreatic secretion
Neural muscarinic pathways
Dissaccharidase def - most commonly lactase
Lipase
Left gastric vein and esophogeal vein - esophagus

33. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Zollinger ellison - brunners glands
Adhesion
Inc - weight loss
Urobilin

34. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Via the middle colic
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Oligosaccharide digestion

35. What is the other name for GIP (gastric inhibitory peptide)
Meckels
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Glucose dependent insulinotropic peptide
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

36. In what clinical scenarior do you see portosystemic anastomoses
Portal HTN
Menetriers disease
Omeprazole
T cell lymphoma

37. What serum enzyme is elevated inacute pancreatitis
Crypts but not villi
Lipase
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

38. Bile is critical for exrection of what substance
Worldwide - SC - US - adeno
Esophageal cancer
Achalasia due to loss of myenteric plexus (auberach)
Cholesterol

39. Where is IgA shuttled
Appendicitis
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Hepatic steatosis

40. What is the presenting course for appendicity

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41. What kind of pancreatitis is associated with EtOH and smoking
Turcot
Fe2+ in the duod
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

42. What nerve innervates the external hemorrhoids
Cirrhosis
No
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Inferior rectal nerve

43. Where is B12 absorbed
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Stimulate the H/K ATPase
GLUT 2
In the ileum with bile acids - requires IF

44. 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
Epigastric abdominal pain radiating to back - anorexia - nausea
HPNCC
Can lead to hematemesis - found in EtOHics and bulimics

45. What commonly leads to appendicity in kids vs adults
Failure of the processus vagainlis to close
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Splenic flexure

46. What is the most common cause of gallstones
Redness and tenderness on palpation of extremities
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
FAP
CHF and inc risk of HCC

47. what percentage of colonic polyps are non - neoplastic
So hypertrophied they look like brain gyri
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
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
90%

48. Are single polyps malignant in peutz jehgers
No
Tropical sprue
Gut bacteria
Hernia

49. At what level of the spine does the IM exit the aorta
Myenteric nerve plexus - aurbach
Necrotizing enterocolitis
Brush border of intestine - produce monosaccharides from oligo and di
L3

50. What are the signs and symptoms of budd chiari
Gut bacteria
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Femoral hernia - through femoral canal - lateral to pubic tubercle and women