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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 drug inhibits the H/K ATPase
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Unconj - absent (acholuria) - inc
Omeprazole
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

2. Where are tumors commonly in pancreatic adenocarcinoma
Below
Redness and tenderness on palpation of extremities
Pancreatic head causing obstructive jaundice
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

3. Where is there sclerosis in alcoholic cirrohosis
All 3 gut layers outpouch as in Meckels
Inspiratory arrest on deep palpation due to pain
Around the central vein (zone III)
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

4. What pancreatic enzymes are responsible for fat digestion
Paraumbilical and superficial and inferior epigastric - umbilicus
Lipase - phospholipase A - colipase
Gut bacteria
Failure of the processus vagainlis to close

5. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Hypotonic because of more time to reabsorb NaCl
Below
Mucosa - submucosa - muscularis externa - serosa/adventitia
Causes of gall stones

6. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Oral glucose
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Zollinger Ellison - phenylalanine and tryptophan
Jaundice - fever - RUQ

7. How are all 3 monosaccharides transported to the blood
All 3 gut layers outpouch as in Meckels
GLUT 2
Neutralizes oral bacertial acids and maintains dental health
Meconium ileus

8. What are the hindgut structures and what supplies their blood and PANS innvervation
Worldwide - SC - US - adeno
Via the superior pancreaticduodenal
Begins starch digestion - inactivated by low pH upon reaching the stomach
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

9. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Can lead to hematemesis - found in EtOHics and bulimics
Unconj - absent (acholuria) - inc
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

10. What gives urine its characteristic color
Nonkeritinized stratified sqamous epithelium
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Primarly through ECL leading to histamine release
Urobilin

11. In PUD - with gastric ulcers - does pain inc or dec with meals?
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Inc - weight loss
Complications of UC
Volvulus

12. If trypsin activates more trypsinogen - what kind of feedback loop is established
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Jewish and African American men
Positive

13. What is the ddx associated with appendicitis
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Common hepatic - splenic - left gastric - main blood supply for stomach
Uridine glucuronyl transferase
Diverticulitis in elderly - ectopic pregs use hCG to rule out

14. What is the frequency of basal electric rhythm of the ilieum
Inguninal ligament - sartorius muscle - adductor longus
8-9 waves/min
M3 - Gq - inc IP3/Ca
Early childhood - neuro sx and malabsorption

15. What is the omphalomesenteric cyst
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
The entire
GLUT 2
Cystic dilation of the viteline duct

16. What structure is Not contained in the femoral sheath
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Positive
Hyperpigmented mouth - lips - hands - genitalia
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

17. What does extrahepatic biliary obstruction cause
Small intestine
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

18. What are the layers of the gut wall from inside out
Gardner's syndrome
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
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Mucosa - submucosa - muscularis externa - serosa/adventitia

19. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
No
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

20. What is the arterial supply and venous drainage below pectinate line
Bleeding - intussusception - volvulus - obstruction near terminal ileum
The jejunum
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Paraumbilical and superficial and inferior epigastric - umbilicus

21. FAP + malignant CNS tumor
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
Left gastric vein and esophogeal vein - esophagus
Turcot
Hirschsprungs

22. A protrusion of peritoneum through an opening - usually a site of weakness
The entire
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Hernia
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

23. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Peyers patches
Phototherapy
Angiodysplasia

24. multiple juvenil polyps in GI tract - risk
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Tropical sprue

25. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Alpha amylase
Mallory bodies
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
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

26. What do tumors that arise in the head of the pancreas cause
Backup of blood into the liver - RHF - budd chiari
Internal thoracic to superior epigastric to inferior epigastric
Gardner's syndrome
Obstruction of the common bile duct

27. What is contained within the submucosa

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28. At what level do the testicular/ovarian arteries exit the aorta
L2
Enterokinase/enteropeptidase from the duodenal mucosa
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Nonkeritinized stratified sqamous epithelium

29. What layer of fascia covers a direct inguinal hernia
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
8-9 waves/min
External spermatic fascia only
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

30. Where does copper accumulate in Wilsons and What are ABCD
Jewish and African American men
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Alcoholic hepatitis
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

31. What are the signs and symptoms of budd chiari
Decrease - weight gain
Alpha1 antitrypsin def - codominant trait
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Ceruplasmin

32. What is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
Hypercoaguability - polycythemia vera - pregnancy - HCC
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Lamina propria

33. Why does volvulus occur more at cecum and sigmoid colon
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Striated
Lipase - phospholipase A - colipase
Redundant mesentary

34. likely infectious form of malabsorption - responds to antibiotics
Normal
Erosive - disruption of mucosal barrier leading to inflammation
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
Tropical sprue

35. What layer in the mucosa is responsible for absorption
Warthins' tumor
Epithelium
Liver metabolizes 5HT
Acute pancreatitis

36. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
...
FAP
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

37. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Ampulla of vater
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
With albumin

38. What are the main components of bile
Pancreatic head causing obstructive jaundice
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Superior rectal and middle and inferior rectal - rectum
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

39. What does bicab do in the mouth
Complications of crohns
Neutralizes oral bacertial acids and maintains dental health
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Dissaccharidase def - most commonly lactase

40. What is the leading cause of bowel incarceration
Jewish and African American men
90%
Alpha amylase
Femoral hernia

41. What is diverticulosis
Acute pancreatitis
Hemolytic anemia
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

42. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
Volvulus
Crypts but not villi
External (superficial) ring only

43. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
Source - S cells (duod) - action - inc pancreatic bicarb secretion - dec gastric acid secretin - inc bile secretion - regulation - inc by acid - fatty acids in lumen of duod
Hyperpigmented mouth - lips - hands - genitalia
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

44. Dysphagia in achalasia results from
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Enterokinase/enteropeptidase from the duodenal mucosa
Decrease - weight gain
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

45. What are the complications of acute pancreatitis
In the mucus that covers the gastric epithelium
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Gamma glutamyl transferase GGT
Hepatic steatosis

46. What does a low flow rate mean for saliva
Muscularis mucosae
Hypotonic because of more time to reabsorb NaCl
Inc risk of CRC and other visceral malignancies
Mucosa - submucosa - muscularis externa - serosa/adventitia

47. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Dec PGE2 leading to dec gastric mucosa protection
FAP
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

48. Who is at risk for pancreatic adenocarcinoma
HSV-1 - CMV - Candida
Budd chiari syndrome
Epigastric abdominal pain radiating to back - anorexia - nausea
Jewish and African American men

49. What is indirect bilirubin
Pancreatic and bile
Phenobarbital - inc liver enzyme synthesis
Liver metabolizes 5HT
Unconjugated - water insoluble

50. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
T cell lymphoma
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Older patients