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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. trypsinogen is converted to trypsin via what enzyme
In the mucus that covers the gastric epithelium
Enterokinase/enteropeptidase from the duodenal mucosa
All 3
Skip lesions =crohns - colon = UC

2. At what level do the testicular/ovarian arteries exit the aorta
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
L2
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
L4

3. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Adhesion
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
GERD - may also present with nocturnal cough and dyspnea
Dec PGE2 leading to dec gastric mucosa protection

4. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Cholesterol
FAP
Inc smooth muscle relaxation - including lower esophageal sphincter
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

5. What can fistula between the gallbladder and small intestine create and how can you tell
External (superficial) ring only
Crohns = transmural (cobblestone mucosa - creeping fat - string sign - linear ulcers fissures - fistulas) UC = mucosal and submucosal (friable mucosal pseudopolyps with freely hanging mesentary - loss of haustra - lead pipe appearance on imaging
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Early childhood - neuro sx and malabsorption

6. Through which aspect of the inguinal canal does a direct inguinal go
Inguninal ligament - sartorius muscle - adductor longus
External (superficial) ring only
Enterokinase/enteropeptidase from the duodenal mucosa
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

7. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
In the mucus that covers the gastric epithelium
L3
Complications of crohns

8. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Neutralizes oral bacertial acids and maintains dental health
Hernia
Obstruction of the common bile duct
Superior rectal

9. blind pouch protruding from alimentary tract that communicates with lumen of the gut
L3
Diverticulum
Terminal ileum and colon
Common hepatic - splenic - left gastric - main blood supply for stomach

10. In alchoholic hepatitis which liver enzyme is higher
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
AST>ALT
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
Via the middle colic

11. What is the frequency of basal electric rhythm of the ilieum
Centrilobular congestion and necrosis - cardiac cirrhosis
Zenkers - halitosis - dysphagia and obstruction
8-9 waves/min
Epigastric abdominal pain radiating to back - anorexia - nausea

12. How is bilirubin carried in the blood
With albumin
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Jewish and African American men
AST>ALT

13. What is the prognosis of adenocarcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Crigler - najjar type 1
Ischemic colitis
Lipase

14. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Paraumbilical and superficial and inferior epigastric - umbilicus
In the ileum with bile acids - requires IF

15. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Unconj - absent (acholuria) - inc
Neural muscarinic pathways
Above

16. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Around the central vein (zone III)
Positive
Striated

17. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Gamma glutamyl transferase GGT

18. What is the arterial supply and venous drainage below pectinate line
Left and right gastroepiploics - left and right gastrics
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Stimulate intestinal persistalsis

19. When and why is stomach cancer termed linitis plastica
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Zollinger ellison - brunners glands
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Uridine glucuronyl transferase

20. Where is IgA shuttled
8-9 waves/min
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Dec PGE2 leading to dec gastric mucosa protection

21. What kind of diarrhea is produced from a disaccharide def
Tropical sprue
Phototherapy
Osmotic
Chronic constipation early in life with dilated portion of the colon proximal to the aganglionic segment resulting in a transition zone - involves rectum - usually a failure to pass meconium

22. What is the rule of 2s for meckels
Begins starch digestion - inactivated by low pH upon reaching the stomach
Mucosa - submucosa - muscularis externa - serosa/adventitia
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

23. How is the diagonsis of CRC made
Positive urease test
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
So hypertrophied they look like brain gyri
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

24. B cells stimuated in the germinal centers of peyers patches differentiate into what?
With albumin
IgA secreting plasma cells - ultimately reside in the lamina proporia
Primarly through ECL leading to histamine release
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

25. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Small intestine
Gamma glutamyl transferase GGT
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

26. What nerve innervates the external hemorrhoids
Inferior rectal nerve
No
With albumin
The entire

27. How many layers of spermatic fascia are covers an indirect inguinal hernia
Oligosaccharide digestion
All 3
Old men - arthralgias - cardiac and neuro sx
MSI (15%) and APC/beta catenin chromosomal instability (85%)

28. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Carcinoid syndrome
Alpha1 antitrypsin def - codominant trait

29. What test and result confirms H pylori infxn
Below
T12
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Positive urease test

30. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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31. Acute gastritis is caused By what process
Boerhaave's Syndrome - Been heaving syndrome
Erosive - disruption of mucosal barrier leading to inflammation
Elevated amylase - and lipase
Alpha amylase

32. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Boerhaave's Syndrome - Been heaving syndrome
Short gastrics - left greater and lesser
Volvulus
Peyers patches

33. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Via the superior pancreaticduodenal
Poor anastamoses
Dissaccharidase def - most commonly lactase
Complications of crohns

34. What is the presenting course for appendicity

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35. What serum enzyme is elevated inacute pancreatitis
Warthins' tumor
Lipase
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
So hypertrophied they look like brain gyri

36. What reaction does salivary amylase catalyze
Primary sclerosing cholangitis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Virchow's node
Normal

37. Who is at risk for pancreatic adenocarcinoma
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Centrilobular leading to congestive liver disease
8-9 waves/min
Jewish and African American men

38. Where is bicarb trapped
Crypts but not villi
In the mucus that covers the gastric epithelium
Redundant mesentary
Carcinoid syndrome

39. Bile is critical for exrection of what substance
Older patients
Crigler - najjar type 1
Zollinger ellison - brunners glands
Cholesterol

40. What is the most common esophageal cancer worldwide and in the US
Worldwide - SC - US - adeno
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Mucosa - submucosa - muscularis externa - serosa/adventitia
Lubricate food (glycoprotiens)

41. What are the histological findings of the colon
Alk phos
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Gut bacteria
Crypts but not villi

42. Diaphragmatic hernias occur in infants because of defective development of which membrane
Phenobarbital - inc liver enzyme synthesis
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Pleuroperitoneal

43. What kind of pancreatitis is associated with EtOH and smoking
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Right and left hepatic duct
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Chronic calcifying pancreatitis - inc risk of panreatic cancer

44. Where is B12 absorbed
EtOH
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Elevated amylase - and lipase
In the ileum with bile acids - requires IF

45. What are the extraintestinal manifestations of crohns
Ceruplasmin
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Brunners
Lateral

46. What layer in the mucosa is repsonsible for motility
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Decrease - weight gain
Muscularis mucosae
Decreased intercellular adhesion and increased proliferation

47. What is a positive murphy's sign
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
The submucosal nerve plexus - meissner's
Inspiratory arrest on deep palpation due to pain
Causes of gall stones

48. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Hypercoaguability - polycythemia vera - pregnancy - HCC
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

49. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Black - rotors syndrome
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Sister mary joseph nodule

50. What do mucins do?
Lubricate food (glycoprotiens)
VZV and influenza B treated with salicylates
Hemolytic anemia
Ampulla of vater