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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. A protrusion of peritoneum through an opening - usually a site of weakness
Hernia
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Left and right gastroepiploics - left and right gastrics
Dubin johnson

2. What is contained within the submucosa

3. What are the histological findings in the ileum

4. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Diverticulum
So hypertrophied they look like brain gyri
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

5. Where and How is iron absorbed
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Unconj - absent (acholuria) - inc
Brunners
Fe2+ in the duod

6. What are the structures of the femoral triangle and how are they organized
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Appendicitis
Cholesterol - 10-20% opaque due to calcifications
NAV = nerve artery vein - venous near the penis (NAVEL)

7. occlusion of IVC or hepatic veins
Inspiratory arrest on deep palpation due to pain
Below
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Budd chiari syndrome

8. What kind of insults results in macronodular cirrhosis
Nonkeritinized stratified sqamous epithelium
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
IgA secreting plasma cells - ultimately reside in the lamina proporia
Brush border of intestine - produce monosaccharides from oligo and di

9. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Primary sclerosing cholangitis
Crypts but not villi
Inc smooth muscle relaxation - including lower esophageal sphincter

10. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
The entire
In the ileum with bile acids - requires IF
Conj/unconj - inc - nl to dec
Dilated esophagus with an area of distal stenosis - birds beak

11. When and How does Abetalipoproteinemia present
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Early childhood - neuro sx and malabsorption
Dec PGE2 leading to dec gastric mucosa protection
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

12. conjugated hyperbilirubinemia due to defective liver excretion
Crohns = noncaseating granulomas - UC = crypt abscesses
Intussusception
Dubin johnson
Acute pancreatitis

13. What does extrahepatic biliary obstruction cause
Hirschsprungs
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Meconium ileus

14. What is the most common diaphragmatic hernia and What are the two types
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Upregulated intracellular signal transduction
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

15. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Left gastric vein and esophogeal vein - esophagus
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Positive
Cirrhosis

16. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
With albumin
Hypercoaguability - polycythemia vera - pregnancy - HCC
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Via the superior pancreaticduodenal

17. What is indirect bilirubin
Unconjugated - water insoluble
Dec PGE2 leading to dec gastric mucosa protection
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

18. Where is the arterial supply from above the pectinate line - and What is the venous drainage
3 waves/min
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Crypts but not villi
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

19. What are the longterm sequelae of nutmeg liver
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Crypts but not villi
Centrilobular congestion and necrosis - cardiac cirrhosis
Virchow's node

20. What are the tumor markers for pancreatic adenocarcinoma
CEA - CA-19-9
Gamma glutamyl transferase GGT
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

21. Are single polyps malignant in peutz jehgers
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Female - fat - fertile - forty
No
Diverticulum

22. trypsinogen is converted to trypsin via what enzyme
Necrotizing enterocolitis
Enterokinase/enteropeptidase from the duodenal mucosa
Can lead to hematemesis - found in EtOHics and bulimics
NAV = nerve artery vein - venous near the penis (NAVEL)

23. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Volvulus
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Meconium ileus

24. What are the effects of atropine on parietal cells and G cells
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Older patients

25. What is the mechanism for reyes syndrome
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
AST >ALT - ration is usually 1.5
Spleen to posterior abdominal wall - splenic artery and vein
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

26. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Right and left hepatic duct
IBS at least 2 with recurrent abdominal pain
Falciform - ligamentum teres - fetal umbilical vein
GLUT 2

27. What does TOASTED with alcoholic hepatitis stand for
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
External (superficial) ring only
AST >ALT - ration is usually 1.5
The proximal small bowel

28. Where are tumors commonly in pancreatic adenocarcinoma
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Phenobarbital - inc liver enzyme synthesis
Pancreatic head causing obstructive jaundice
Positive

29. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Cigarettes and chronic pancreatitis - not EtOH
Hirschsprungs
H+
...

30. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Necrotizing enterocolitis
Skip lesions =crohns - colon = UC
Poor anastamoses

31. What are the treatment options for uclerative colitis
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Carcinoid syndrome
Corticosteroids - infliximab
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

32. What serum enzyme is decreased in wilsons disease
...
Volvulus
Ceruplasmin
Celiac sprue

33. What is the classic triad of hemochromatosis

34. What other condition can lead to acute gastritis - think renal
Oligosaccharide digestion
H pylori (almost 100%)
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Uremia

35. What kind of lesions are characteristic of duodenal PUD vs cancer
Punched out - clean margins - carcinoma =raised irregular margins
Duodenum - 2nd - 3rd and 4th parts
Gamma glutamyl transferase GGT
VZV and influenza B treated with salicylates

36. vasoactive intestinal polypeptide (VIP) - source - action - regulation
ALT>AST
H+
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
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

37. What kind of digestion is bile needed for
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Failure of neural crest migration
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Achalasia due to loss of myenteric plexus (auberach)

38. What causes nutmeg liver
Backup of blood into the liver - RHF - budd chiari
CEA - CA-19-9
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Pancreatic head causing obstructive jaundice

39. FAP + osseous and soft tissue tumors - retinal hyperplasia

40. What is the ddx associated with appendicitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Lateral
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Phototherapy

41. How is the diagonsis of CRC made
US and cholecystectomy
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
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
GERD - may also present with nocturnal cough and dyspnea

42. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Complications of UC
HPNCC
Dec PGE2 leading to dec gastric mucosa protection

43. What are the labs in acute pancreatitis
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Elevated amylase - and lipase
Dysphagia (due to esophageal web) - glossitis - iron def anemia

44. What is biliary colic
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Phenobarbital - inc liver enzyme synthesis
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Right and left hepatic duct

45. 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
Angiodysplasia
No
Crohns = maybe - UC= always

46. What does GET SMASHED stand for in acute pancreatitis
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Dec PGE2 leading to dec gastric mucosa protection
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

47. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Tropical sprue
Bleeding - penetration into pancreas - perforation - obstruction
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

48. Is there any structural abnl with IBS - What is the course of disease and presentation
Inspiratory arrest on deep palpation due to pain
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Uremia
No - chronic - can present with diarrhea or constipation or alternation - treat sx

49. What kind of anemia is in Wilsons
Mucoepidermoid carcinoma
Volvulus
Hemolytic anemia
Closer to isotonic because of less time to reabsorb NaCl

50. Why does indirect inguinal hernia happen in infacnts
Failure of the processus vagainlis to close
Cystic duct and common hepatic duct
M3 - Gq - inc IP3/Ca
Hyperplastic