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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 main components of bile
Pancreatic and bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Increase tumorigenesis
Female - fat - fertile - forty

2. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Can lead to hematemesis - found in EtOHics and bulimics
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Inguninal ligament - sartorius muscle - adductor longus
In the mucus that covers the gastric epithelium

3. What are the signs of peutz jehgers
Backup of blood into the liver - RHF - budd chiari
Lamina propora and submucosa
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Hyperpigmented mouth - lips - hands - genitalia

4. Where does copper accumulate in Wilsons and What are ABCD
IBS at least 2 with recurrent abdominal pain
Female - fat - fertile - forty
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

5. What are additional risk factors for CRC
Repeated phlebotomy - deferoxamine - HLA- A3
H2 receptor - inc cAMP
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

6. in CF - meconium plug obstructs intestine - preventing stool passage at birth
H pylori (almost 100%)
FAP
In the mucus that covers the gastric epithelium
Meconium ileus

7. is meckels a true diverticulum and how common is it
Peyers patches
Poor anastamoses
True and most common congenital anomoly of GI tract
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

8. How do you DX and TX gallstones
Obstruction of the common bile duct
US and cholecystectomy
Right and left hepatic duct
The gastroduodenal

9. inflammatino of gallbadder
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
AST
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Krukenbergs tumor

10. Gastrin - source - action - regulation
Normal
Hernia
Decrease - weight gain
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

11. What does a low flow rate mean for saliva
Cystic dilation of the viteline duct
Omeprazole
Hypotonic because of more time to reabsorb NaCl
Failure of neural crest migration

12. Between what structures do strong anastamoses exist
Alcoholic cirrhosis
Left and right gastroepiploics - left and right gastrics
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Meconium ileus

13. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Dilated esophagus with an area of distal stenosis - birds beak
FAP
Conj - inc - dec
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

14. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
IBS at least 2 with recurrent abdominal pain

15. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Alpha1 antitrypsin def - codominant trait
Cimetidine
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

16. subQ peribumbilical metastasis
Left and right gastroepiploics - left and right gastrics
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Sister mary joseph nodule

17. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Crypts but not villi
In the mucus that covers the gastric epithelium
Ampulla of vater

18. What do you treat Wilsons disease with and What is the inheritance
Epithelium
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Penicillinamine - AR inheritance

19. most common non - neoplastic polyp in colon
Spleen to posterior abdominal wall - splenic artery and vein
Hyperplastic
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Failure of the processus vagainlis to close

20. Who gets Whipple disease and How do they present
Old men - arthralgias - cardiac and neuro sx
Hirschsprungs
Barrett's esophagus
Heme metabolism

21. involvement of left supraclavicular node by mets from stomach

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22. Through which aspect of the inguinal canal does a direct inguinal go
Falciform - ligamentum teres - fetal umbilical vein
Antrum - H.pylori - inc risk of MALT lymphoma
Serous on the sides parotids - mucinous in the middle sublingual
External (superficial) ring only

23. likely infectious form of malabsorption - responds to antibiotics
Tropical sprue
The submucosal nerve plexus - meissner's
Neural muscarinic pathways
Inc risk of CRC and other visceral malignancies

24. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Upregulated intracellular signal transduction
Cystic duct and common hepatic duct
Failure of the processus vagainlis to close

25. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Adhesion
Esophageal cancer
Colovesical leading to pneumaturia
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

26. Cholecytsokinin - source - action - regulation
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Decrease - weight gain
Source - I cells (duod - jej - action - inc pancreative secretion - inc gallbladder contraction - dec gastric emptying - sphincter of Oddi relaxation - regulation - inc by fatty acids and amino acids
Peyers patches

27. What other condition can lead to acute gastritis - think renal
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Turcot
Uremia

28. What can hemochromatosis be secondary to...
Hyperplastic
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
H+
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

29. What are the signs and symptoms of budd chiari
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Lubricate food (glycoprotiens)
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

30. Which is used more quickly - an oral glucose load - or that by IV
Bleeding - penetration into pancreas - perforation - obstruction
Skip lesions =crohns - colon = UC
With albumin
Oral glucose

31. What are the histological findings in the ileum

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32. What is the frequency of basal electric rhythm of the stomach
Cystic duct and common hepatic duct
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
3 waves/min
Normal

33. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Peyers patches
FAP
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Pleomorphic adenoma

34. What does primary sclerosing cholangitis lead to...
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
M3 - Gq - inc IP3/Ca
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

35. In viral hepatitis - which liver enzyme is higher
Redness and tenderness on palpation of extremities
Osmotic
Decreased intercellular adhesion and increased proliferation
ALT>AST

36. In PUD with a duodenal ulcer does pain inc or dec with meals
Acute pancreatitis
Decrease - weight gain
In the ileum with bile acids - requires IF
Alk pho

37. What is the triad of Plummer - Vinson syndrome
Decreased intercellular adhesion and increased proliferation
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Unconj - absent (acholuria) - inc
Averages 6 months - very aggressive - usually already metastasized at presentation

38. Autodigestion of pancreas by pancreatic enzymes
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Inc smooth muscle relaxation - including lower esophageal sphincter
Acute pancreatitis
Cigarettes and chronic pancreatitis - not EtOH

39. Where is B12 absorbed
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Right and left hepatic duct
Short gastrics - left greater and lesser
In the ileum with bile acids - requires IF

40. Dysphagia in achalasia results from
Right and left hepatic duct
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
T12
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

41. signet ring cells - acanthosis nigracans - dz - character/association - spread
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Hypercoaguability - polycythemia vera - pregnancy - HCC
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

42. What happens to the short gastics if the splenic artery is blocked
In the mucus that covers the gastric epithelium
Poor anastamoses
External (superficial) ring only
Gut bacteria

43. What kind of diarrhea is produced from a disaccharide def
Colonic polyps
Osmotic
Alk pho
The submucosal nerve plexus - meissner's

44. People of what decent are associated with celiac sprue and what findings/antibodies are present
Zenkers - halitosis - dysphagia and obstruction
Alpha amylase
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
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

45. What pancreatic enzymes are responsible for fat digestion
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Superior rectal
Paraumbilical and superficial and inferior epigastric - umbilicus
Lipase - phospholipase A - colipase

46. What are the histological findings of the colon
PAS- positive globules in liver -
Jewish and African American men
Crypts but not villi
Diverticulitis in elderly - ectopic pregs use hCG to rule out

47. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Juvenille polyps - no risk if single
Alpha amylase
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Necrotizing enterocolitis

48. What is indirect bilirubin
Mucosa - submucosa - muscularis externa - serosa/adventitia
Unconjugated - water insoluble
Inc smooth muscle relaxation - including lower esophageal sphincter
Hepatic steatosis

49. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Pertechnetate - study for uptake
Falciform - ligamentum teres - fetal umbilical vein
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

50. What is the mechanism for reyes syndrome
AST >ALT - ration is usually 1.5
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Positive urease test
H+