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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 is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
GLUT 2
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
In the mucus that covers the gastric epithelium
Brunners

2. What kind of pathways do CCK act on to cause pancreatic secretion
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Neural muscarinic pathways
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
Inguninal ligament - sartorius muscle - adductor longus

3. How are all 3 monosaccharides transported to the blood
AR
GLUT 2
Reye's syndrome
Duodenum - 2nd - 3rd and 4th parts

4. What are esophageal strictures associated with
Lye ingestion and acid reflux
Older patients
Dec PGE2 leading to dec gastric mucosa protection
Colovesical leading to pneumaturia

5. What are the complications of acute pancreatitis
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

6. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Adhesion
Smooth
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

7. Bilirubin is the product of what?
Heme metabolism
Complications of UC
Gallbladder
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

8. What is the frequency of basal electric rhythm of the stomach
Hemolytic anemia
Osmotic
Inspiratory arrest on deep palpation due to pain
3 waves/min

9. What is charcot triad of cholangitis
Averages 6 months - very aggressive - usually already metastasized at presentation
Jaundice - fever - RUQ
Hemosiderosis - hemochromatosis
Dysphagia (due to esophageal web) - glossitis - iron def anemia

10. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Uremia
Paraumbilical and superficial and inferior epigastric - umbilicus
L1

11. What is the omphalomesenteric cyst
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Cystic dilation of the viteline duct
Dec PGE2 leading to dec gastric mucosa protection
PAS- positive globules in liver -

12. What is the most common diaphragmatic hernia and What are the two types
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

13. What are the structures of the femoral triangle and how are they organized
NAV = nerve artery vein - venous near the penis (NAVEL)
Celiac sprue
Epithelium
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

14. What does autoimmune destruction of parietal cells lead to...
External (superficial) ring only
Centrilobular congestion and necrosis - cardiac cirrhosis
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Chronic gastritis and pernicious anemia

15. How does gastrin increase acid secretion?
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Female - fat - fertile - forty
Primarly through ECL leading to histamine release
T cell lymphoma

16. What does high flow rate mean
Closer to isotonic because of less time to reabsorb NaCl
Necrotizing enterocolitis
Centrilobular congestion and necrosis - cardiac cirrhosis
Around the central vein (zone III)

17. what kind of muscle is in the upper 1/3 of esophagus
Colonic polyps
Phototherapy
Striated
Dissaccharidase def - most commonly lactase

18. What is the lumen of the pancreatic duct
Ampulla of vater
Repeated phlebotomy - deferoxamine - HLA- A3
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Complications of crohns

19. What are the effects of atropine on parietal cells and G cells
Old men - arthralgias - cardiac and neuro sx
Unconj - absent (acholuria) - inc
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

20. What separates the right greater and lesser sacs
Spleen to posterior abdominal wall - splenic artery and vein
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Gastrohepatic ligament
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

21. What kind of digestion is bile needed for
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Superior rectal and middle and inferior rectal - rectum
Alfatoxin in peanuts
Femoral hernia

22. What does a low flow rate mean for saliva
...
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Hypotonic because of more time to reabsorb NaCl
Redundant mesentary

23. What are causes of extrahepatic biliary obstruction
Alpha amylase
Lateral to the inferior epigastric artery
12 waves/min
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

24. What are the layers of the gut wall from inside out
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Mucosa - submucosa - muscularis externa - serosa/adventitia
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Appendicitis

25. in budd chiari syndrome - Where is the congestion and necrosis
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Gamma glutamyl transferase GGT
Inc lower esphogeal tone leading to achalasia
Centrilobular leading to congestive liver disease

26. What is the other name for GIP (gastric inhibitory peptide)
Acute pancreatitis
Dubin johnson
Intussusception
Glucose dependent insulinotropic peptide

27. How is salivary secretion stimulated
True and most common congenital anomoly of GI tract
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
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

28. What test and result confirms H pylori infxn
Positive urease test
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Colonic polyps
Menetriers disease

29. What is the frequency of basal electric rhythm in the duodenum
Fasting and stress
12 waves/min
M3 - Gq - inc IP3/Ca
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

30. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Achalasia due to loss of myenteric plexus (auberach)
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Alfatoxin in peanuts

31. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Neutralizes oral bacertial acids and maintains dental health
Peutz jeghers
Zollinger ellison - brunners glands
Inspiratory arrest on deep palpation due to pain

32. Why does volvulus occur more at cecum and sigmoid colon
Acute pancreatitis
Hyperplastic
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Redundant mesentary

33. What intervention will intervention will relieve portal HTN
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
No
Gastric glands
Diarrhea - steatorrhea - weight loss - weakness

34. What is the most common indication of emergent abdominal surgery in children
Appendicitis
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Pancreatic and bile
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

35. What infection causes Whipple disease and What can you see on LM
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Gamma glutamyl transferase GGT
Conj - inc - dec

36. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Repeated phlebotomy - deferoxamine - HLA- A3
Meconium ileus
Gastric glands
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

37. What are the midgut structures and what supplies their blood and PANS innervation
Stercobilin
Via the superior pancreaticduodenal
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Cigarettes and chronic pancreatitis - not EtOH

38. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
NAV = nerve artery vein - venous near the penis (NAVEL)
Causes of gall stones
Turcot
2ndary biliary cirrhosis

39. What do mucins do?
Colonic polyps
Lye ingestion and acid reflux
Lubricate food (glycoprotiens)
True and most common congenital anomoly of GI tract

40. Why does indirect inguinal hernia happen in infacnts
Tropical sprue
Failure of the processus vagainlis to close
Brunners
Lubricate food (glycoprotiens)

41. What is Trousseau's sign
Redness and tenderness on palpation of extremities
So hypertrophied they look like brain gyri
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Celiac sprue

42. What gives urine its characteristic color
Urobilin
Crypts but not villi
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
True and most common congenital anomoly of GI tract

43. What conditions are associated with budd chiari
Oligosaccharide digestion
Superior rectal and middle and inferior rectal - rectum
Low pressure proximal to LES
Hypercoaguability - polycythemia vera - pregnancy - HCC

44. Autoantibodies to gluten (gliadin) in wheat and other grains
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Celiac sprue
Hemosiderosis - hemochromatosis
Tropical sprue

45. What layer of fascia covers a direct inguinal hernia
AST
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
External spermatic fascia only
The jejunum

46. What skin condition is associated with celiac sprue
Dermatitis herpetiformis
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Amylase
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

47. What are the barium swallow findings of achalasia
Adhesion
Failure of the processus vagainlis to close
Dilated esophagus with an area of distal stenosis - birds beak
Budd chiari syndrome

48. What receptors does ACH bind on the parietal cells and What does it activate
Hypercoaguability - polycythemia vera - pregnancy - HCC
M3 - Gq - inc IP3/Ca
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Virchow's node

49. What causes hirschsprungs
Inferior rectal nerve
Esophageal carcinoma
Failure of neural crest migration
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

50. What is the most important mechanism in gastric acid secretion
Alk pho
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Tropical sprue
Redness and tenderness on palpation of extremities