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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. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Budd chiari syndrome

2. What are the borders of Hesselbach's triangle
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Menetriers disease

3. What separates the right greater and lesser sacs
Gastrohepatic ligament
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Mucoepidermoid carcinoma
Unconjugated - water insoluble

4. What is the cause of Barrett's and the assocaited complications
Mucosa - submucosa - muscularis externa - serosa/adventitia
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Glucouronate - water soluble (direct)
Black - rotors syndrome

5. What do tumors that arise in the head of the pancreas cause
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Esophageal cancer
Obstruction of the common bile duct
HSV-1 - CMV - Candida

6. What does high flow rate mean
Positive urease test
Inspiratory arrest on deep palpation due to pain
Closer to isotonic because of less time to reabsorb NaCl
Boerhaave's Syndrome - Been heaving syndrome

7. What commonly leads to appendicity in kids vs adults
Gamma glutamyl transferase GGT
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Positive

8. What are the treatment options for uclerative colitis
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Hypotonic because of more time to reabsorb NaCl
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

9. Progressive dyshphage beginning with solids and moving to liquids and weight loss
AST
Virchow's node
Esophageal cancer
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

10. What are the signs and symptoms of budd chiari
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Reye's syndrome
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

11. What cell produces IF and What does it do
Cimetidine
Parietal cells in the stomach - B12 binding protein
Hepatic steatosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

12. What are the two molecular pathways that lead to CRC
CEA - CA-19-9
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Dissaccharidase def - most commonly lactase

13. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Dilated esophagus with an area of distal stenosis - birds beak
Cirrhosis
Sister mary joseph nodule

14. Why are most diverticula considered false
Fasting and stress
Celiac sprue
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

15. somatostatin - source - action - regulation
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Peptic ulcer disease
AST
90%

16. What receptor does histamine bind on the parietal cell and What does it activate
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
T cell lymphoma
H2 receptor - inc cAMP
Centrilobular leading to congestive liver disease

17. What are the histological findings in the ileum

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18. What histological findings are present in the esophagus
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Nonkeritinized stratified sqamous epithelium
Hemosiderosis - hemochromatosis
Conj - inc - dec

19. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Volvulus
Appendicitis
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Juvenile polyposis syndrome - inc risk of adenocarcinoma

20. How do villi appear in disaccharidease def
Centrilobular congestion and necrosis - cardiac cirrhosis
Normal
The gastroduodenal
Cholesterol

21. rare - often fatal childhood hepatoencephalopathy

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22. bilateral mets to ovaries with abundant mucus - signet ring cells
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Dermatitis herpetiformis
Krukenbergs tumor
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

23. What is the omphalomesenteric cyst
Hernia
CHF and inc risk of HCC
Cystic dilation of the viteline duct
Around the central vein (zone III)

24. in budd chiari syndrome - Where is the congestion and necrosis
Uridine glucuronyl transferase
Skip lesions =crohns - colon = UC
Centrilobular leading to congestive liver disease
Neural muscarinic pathways

25. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
Below
Colonic polyps
L4

26. When and How does Abetalipoproteinemia present
Esophageal cancer
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Early childhood - neuro sx and malabsorption
T cell lymphoma

27. What are the borders of the femoral triangle
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Inguninal ligament - sartorius muscle - adductor longus
Intussusception

28. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Hirschsprungs
Causes of gall stones
Dec PGE2 leading to dec gastric mucosa protection

29. What is the presenting course for appendicity

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30. Where are carcinoid tumors most commonly malignant
Averages 6 months - very aggressive - usually already metastasized at presentation
Small intestine
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

31. When do you see hypertrophy of brunners glands
Peptic ulcer disease
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
Glucouronate - water soluble (direct)
Urobilin

32. Transmural esophageal rupture due to violent retching

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33. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Lateral to the inferior epigastric artery
Alk pho
Crohns = noncaseating granulomas - UC = crypt abscesses
Short gastrics - left greater and lesser

34. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
ALT>AST
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

35. What are the midgut structures and what supplies their blood and PANS innervation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Gastrohepatic ligament
Heme metabolism
Below

36. What is the action of NO as a GI hormone
Lateral
Antrum - H.pylori - inc risk of MALT lymphoma
Inc smooth muscle relaxation - including lower esophageal sphincter
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

37. What is the other name for GIP (gastric inhibitory peptide)
Krukenbergs tumor
T cell lymphoma
Gastrohepatic ligament
Glucose dependent insulinotropic peptide

38. What findings are associated with reyes
Failure of the processus vagainlis to close
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Jewish and African American men
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

39. People of what decent are associated with celiac sprue and what findings/antibodies are present
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
L2
Via the superior pancreaticduodenal
Diverticulum

40. What receptors does gastrin bind on the parietal cell and What does it activate
Primary sclerosing cholangitis
CCK8 receptor - Gq inc IP3/Ca
Lamina propora and submucosa
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

41. Dysphagia in achalasia results from
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Stimulate intestinal persistalsis
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

42. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Skip lesions =crohns - colon = UC
Urobilin
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

43. At what level do the testicular/ovarian arteries exit the aorta
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
AST>ALT
The entire
L2

44. occlusion of IVC or hepatic veins
12 waves/min
Meconium ileus
Budd chiari syndrome
8-9 waves/min

45. What does a gastrinoma cause
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
In the ileum with bile acids - requires IF
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

46. What drug blocks the H2R
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Lye ingestion and acid reflux
Cimetidine
Primary sclerosing cholangitis

47. How do you DX and TX gallstones
US and cholecystectomy
Menetriers disease
AST >ALT - ration is usually 1.5
Left and right gastroepiploics - left and right gastrics

48. What serum enzyme is elevated in acute pancreatitis and mumps
Alcoholic hepatitis
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Amylase
Redness and tenderness on palpation of extremities

49. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Esophageal varices
Ampulla of vater
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
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

50. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Inc risk of CRC and other visceral malignancies
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Gardner's syndrome