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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. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Hirschsprungs
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Conj/unconj - inc - nl to dec

2. What structures feed into the common bile duct
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Neural muscarinic pathways
Cystic duct and common hepatic duct
Stimulate the H/K ATPase

3. What are the histological findings in the ileum

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4. What are the extraintestinal manifestations of ulcerative colitis
Pyoderma gangrenosum - primary sclerosing cholangitis
Heme metabolism
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

5. What are the treatmet options for crohns
Corticosteroids - infliximab
Ceruplasmin
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

6. How is bilirubin carried in the blood
Erosive - disruption of mucosal barrier leading to inflammation
Phenobarbital - inc liver enzyme synthesis
With albumin
Can lead to hematemesis - found in EtOHics and bulimics

7. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Squamous - upper 1/3 - adeno - lower 1/3
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
Short gastrics - left greater and lesser
Erosive - disruption of mucosal barrier leading to inflammation

8. What is the leading cause of bowel incarceration
Femoral hernia
Mallory bodies
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
Erosive - disruption of mucosal barrier leading to inflammation

9. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Duodenum - 2nd - 3rd and 4th parts
Gilbert's
Neural muscarinic pathways

10. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Failure of the processus vagainlis to close
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Internal thoracic to superior epigastric to inferior epigastric

11. To what substance is bilirubin conjugated and why
Glucouronate - water soluble (direct)
Virchow's node
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Gamma glutamyl transferase GGT

12. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Boerhaave's Syndrome - Been heaving syndrome
VZV and influenza B treated with salicylates
Lipase - phospholipase A - colipase

13. What is contained in the gastrosplenic and What areas does it separate
Crigler - najjar type 1
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Meconium ileus
Short gastrics - left greater and lesser

14. in carcinoid tumors - What is seen on EM
Decrease - weight gain
Dense core bodies
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Hyperplastic

15. concentric onion skin bile duct fibrosis
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Primary sclerosing cholangitis
IgA secreting plasma cells - ultimately reside in the lamina proporia
Muscularis mucosae

16. If the hemochromatosis is primary - What is the pattern of inheritance
Closer to isotonic because of less time to reabsorb NaCl
Smooth
AR
Warthins' tumor

17. Which patients have pigment stones
Angiodysplasia
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Downs
Turcot

18. What separates the right greater and lesser sacs
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Lamina propria
Gastrohepatic ligament
Fe2+ in the duod

19. What is the prognosis of adenocarcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Angiodysplasia
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Black - rotors syndrome

20. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Decrease - weight gain
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Virchow's node

21. occlusion of IVC or hepatic veins
Inc lower esphogeal tone leading to achalasia
Budd chiari syndrome
Downs
Squamous - upper 1/3 - adeno - lower 1/3

22. What serum enzyme is elevated in acute pancreatitis and mumps
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Krukenbergs tumor
Amylase
Dubin johnson

23. What is the frequency of basal electric rhythm in the duodenum
Trypsin - chymotrypsin - elastase - carboxypeptidases
Portal HTN
Dec PGE2 leading to dec gastric mucosa protection
12 waves/min

24. FAP + malignant CNS tumor
Centrilobular congestion and necrosis - cardiac cirrhosis
Turcot
Gamma glutamyl transferase GGT
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

25. What congenital birth defect is associated with Hirschsprung
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Downs
Esophageal carcinoma
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

26. most common non - neoplastic polyp in colon
Hyperplastic
H pylori (almost 100%)
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Diverticulitis in elderly - ectopic pregs use hCG to rule out

27. What are the hindgut structures and what supplies their blood and PANS innvervation
Small intestine
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
H+

28. What is the most important mechanism in gastric acid secretion
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Cirrhosis
Bleeding - intussusception - volvulus - obstruction near terminal ileum
AST

29. What are the complications of acute pancreatitis
H pylori (almost 100%)
Causes of gall stones
Peptic ulcer disease
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

30. What carcinogens are associated with HCC
Peyers patches
Superior rectal
Alfatoxin in peanuts
Brush border of intestine - produce monosaccharides from oligo and di

31. What is the characteristic histo finding in alcoholic hepatitis
Trypsin - chymotrypsin - elastase - carboxypeptidases
Mallory bodies
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Peyers patches

32. When do you see hypertrophy of brunners glands
Cystic dilation of the viteline duct
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Peptic ulcer disease
Penicillinamine - AR inheritance

33. What kind of cancer to celiac sprue put you as inc risk for
Alcoholic cirrhosis
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
T cell lymphoma
External spermatic fascia only

34. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Punched out - clean margins - carcinoma =raised irregular margins
Diverticulum
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

35. What converts inactive pepsinogen to pepsin
Decreased intercellular adhesion and increased proliferation
H+
Primary sclerosing cholangitis
Necrotizing enterocolitis

36. What is charcot triad of cholangitis
Jaundice - fever - RUQ
The gastroduodenal
Decreased intercellular adhesion and increased proliferation
Paraumbilical and superficial and inferior epigastric - umbilicus

37. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
T cell lymphoma
IBS at least 2 with recurrent abdominal pain
NAV = nerve artery vein - venous near the penis (NAVEL)
Sister mary joseph nodule

38. Gastrin - source - action - regulation
All 3
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
US and cholecystectomy
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

39. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis

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40. What are the tumor markers for pancreatic adenocarcinoma
CEA - CA-19-9
Left and right gastroepiploics - left and right gastrics
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

41. What enzyme is necessary to create conjugated bilirubin
H+
Gamma glutamyl transferase GGT
Uridine glucuronyl transferase
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

42. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Peutz jeghers
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Complications of crohns
Glucouronate - water soluble (direct)

43. 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
Neural muscarinic pathways
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
NAV = nerve artery vein - venous near the penis (NAVEL)
Skip lesions =crohns - colon = UC

44. Scleroderma is associated with what kind of esophageal dysmotility
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
Low pressure proximal to LES
2ndary biliary cirrhosis
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

45. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Gastric glands

46. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Crohns = maybe - UC= always
L3
All 3
Peyers patches

47. Where is there sclerosis in alcoholic cirrohosis
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Esophageal carcinoma
Around the central vein (zone III)
AST >ALT - ration is usually 1.5

48. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Peyers patches
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
2ndary biliary cirrhosis
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

49. How do villi appear in disaccharidease def
Normal
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Alpha1 antitrypsin def - codominant trait

50. What structure is Not contained in the femoral sheath
Amylase
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Dec PGE2 leading to dec gastric mucosa protection
Acute pancreatitis