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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 extraintestinal manifestations of crohns
Cholesterol
H pylori (almost 100%)
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Goes through deep inguinal ring - external inguinal ring and into the scrotum

2. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Centrilobular leading to congestive liver disease
NAV = nerve artery vein - venous near the penis (NAVEL)
Fasting and stress
Conj/unconj - inc - nl to dec

3. What does autoimmune destruction of parietal cells lead to...
Primary sclerosing cholangitis
Chronic gastritis and pernicious anemia
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

4. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
HSV-1 - CMV - Candida
Fe2+ in the duod
Gastric glands

5. What are the borders of Hesselbach's triangle
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Inspiratory arrest on deep palpation due to pain
GERD - may also present with nocturnal cough and dyspnea
Averages 6 months - very aggressive - usually already metastasized at presentation

6. What are the signs and symptoms of budd chiari
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Complications of UC
Neutralizes oral bacertial acids and maintains dental health
Glucose dependent insulinotropic peptide

7. What is the ddx associated with appendicitis
Left gastric vein and esophogeal vein - esophagus
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Diverticulitis in elderly - ectopic pregs use hCG to rule out

8. What transforms conjugated bilirubin to urobilinogen
Gut bacteria
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Appendicitis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

9. crigler - najjar type II responds to which therapy and How does it work
Phenobarbital - inc liver enzyme synthesis
Crigler - najjar type 1
Old men - arthralgias - cardiac and neuro sx
Lateral to the inferior epigastric artery

10. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis

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11. What test and result confirms H pylori infxn
Averages 6 months - very aggressive - usually already metastasized at presentation
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
EtOH
Positive urease test

12. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
M3 - Gq - inc IP3/Ca
Elevated amylase - and lipase

13. Where is B12 absorbed
In the ileum with bile acids - requires IF
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Hemolytic anemia
Hyperplastic

14. What structures feed into the common bile duct
Dense core bodies
H pylori (almost 100%)
L/R renal artery around L1
Cystic duct and common hepatic duct

15. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Below
Superior rectal and middle and inferior rectal - rectum
Hyperpigmented mouth - lips - hands - genitalia

16. If the hemochromatosis is primary - What is the pattern of inheritance
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
AR
Older patients
Necrotizing enterocolitis

17. why infxn is implicated in duodenal PUD
Angiodysplasia
H pylori (almost 100%)
Cigarettes and chronic pancreatitis - not EtOH
M3 - Gq - inc IP3/Ca

18. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Above
Cirrhosis
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Mitochondrial abnl - fatty liver - hypoglycemia - coma

19. What is indirect bilirubin
T cell lymphoma
Meckels
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Unconjugated - water insoluble

20. Where is there sclerosis in alcoholic cirrohosis
Hirschsprungs
Glucouronate - water soluble (direct)
Juvenille polyps - no risk if single
Around the central vein (zone III)

21. What are the four Fs of gallstones
Female - fat - fertile - forty
Early childhood - neuro sx and malabsorption
H+
3 waves/min

22. What is the leading cause of bowel incarceration
Femoral hernia
Begins starch digestion - inactivated by low pH upon reaching the stomach
Lateral
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

23. What is the most common cause of gallstones
Early childhood - neuro sx and malabsorption
Where hindgut meets ectoderm
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Lipase - phospholipase A - colipase

24. How are all 3 monosaccharides transported to the blood
GLUT 2
Superior rectal and middle and inferior rectal - rectum
Below
Complications of UC

25. Dysphagia in achalasia results from
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Lubricate food (glycoprotiens)
Muscularis mucosae
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

26. Where are peyers patches found
GERD - may also present with nocturnal cough and dyspnea
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
Lamina propora and submucosa
Copious diarrhea - non alpha - non beta cell pancreatic tumor

27. What do you use to diagnose meckels
Uridine glucuronyl transferase
Closer to isotonic because of less time to reabsorb NaCl
Hemolytic anemia
Pertechnetate - study for uptake

28. How do NSAIDs cause acute gastritis
Dec PGE2 leading to dec gastric mucosa protection
Peptic ulcer disease
Lateral to the inferior epigastric artery
Celiac sprue

29. What is the prognosis of adenocarcinoma
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Averages 6 months - very aggressive - usually already metastasized at presentation
Alcoholic hepatitis
Paraumbilical and superficial and inferior epigastric - umbilicus

30. What can hemochromatosis be secondary to...
Falciform - ligamentum teres - fetal umbilical vein
Redness and tenderness on palpation of extremities
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

31. Bile is critical for exrection of what substance
Cholesterol
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
CEA - CA-19-9
Elevated amylase - and lipase

32. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Averages 6 months - very aggressive - usually already metastasized at presentation
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Ischemic colitis
2ndary biliary cirrhosis

33. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Oligosaccharide digestion
Colovesical leading to pneumaturia
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Ceruplasmin

34. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Positive
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
HPNCC
Alfatoxin in peanuts

35. What is the cause of physiologic neonatal jaundice
Muscularis mucosae
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

36. What are the barium swallow findings of achalasia
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Dilated esophagus with an area of distal stenosis - birds beak
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Normal

37. What does bicab do in the mouth
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Lubricate food (glycoprotiens)
Neutralizes oral bacertial acids and maintains dental health
Positive

38. What conditions are associated with budd chiari
Averages 6 months - very aggressive - usually already metastasized at presentation
Hypercoaguability - polycythemia vera - pregnancy - HCC
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Urobilin

39. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Penicillinamine - AR inheritance

40. What is pancreatic adenocarcinoma associated with
Early childhood - neuro sx and malabsorption
Cigarettes and chronic pancreatitis - not EtOH
Nonkeritinized stratified sqamous epithelium
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

41. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Internal thoracic to superior epigastric to inferior epigastric
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Juvenile polyposis syndrome - inc risk of adenocarcinoma
US and cholecystectomy

42. What are the hindgut structures and what supplies their blood and PANS innvervation
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Menetriers disease
Dermatitis herpetiformis

43. What is the most common indication of emergent abdominal surgery in children
Increase tumorigenesis
L2
Appendicitis
Peyers patches

44. What are the treatment options for uclerative colitis
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Cigarettes and chronic pancreatitis - not EtOH
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

45. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Ampulla of vater
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Pancreatic and bile
Stimulate intestinal persistalsis

46. How is bilirubin carried in the blood
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
L/R renal artery around L1
With albumin
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

47. Where does copper accumulate in Wilsons and What are ABCD
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Pancreatic and bile
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Superior rectal and middle and inferior rectal - rectum

48. What does loss of p53 cause
L3
VZV and influenza B treated with salicylates
AR
Increase tumorigenesis

49. Esophagitis can result From which 3 infectious agents - or chemical ingestion
HSV-1 - CMV - Candida
Juvenille polyps - no risk if single
Common hepatic - splenic - left gastric - main blood supply for stomach
Erosive - disruption of mucosal barrier leading to inflammation

50. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Hyperpigmented mouth - lips - hands - genitalia
Falciform - ligamentum teres - fetal umbilical vein
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn