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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. At what spinal level does the celiac trunk exit
Downs
Sister mary joseph nodule
T12
Internal thoracic to superior epigastric to inferior epigastric

2. FAP + osseous and soft tissue tumors - retinal hyperplasia

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3. motilin - source - action - regulation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
External spermatic fascia only
Poor anastamoses

4. Where are carcinoid tumors most commonly malignant
Repeated phlebotomy - deferoxamine - HLA- A3
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Left gastric vein and esophogeal vein - esophagus
Small intestine

5. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Mucoepidermoid carcinoma
With albumin
Necrotizing enterocolitis

6. What is indirect bilirubin
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Heme metabolism
Unconjugated - water insoluble

7. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Sphincter of oddi
Meconium ileus
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
L4

8. What serum enzyme is elevated inacute pancreatitis
Fe2+ in the duod
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Lipase
Alfatoxin in peanuts

9. What is the risk with peutz jehgers
Inc risk of CRC and other visceral malignancies
Hyperpigmented mouth - lips - hands - genitalia
3 waves/min
Primary sclerosing cholangitis

10. signet ring cells - acanthosis nigracans - dz - character/association - spread
Gamma glutamyl transferase GGT
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Cystic dilation of the viteline duct
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

11. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
The entire
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Via the superior pancreaticduodenal

12. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Inc conj bilirubin - inc cholesterol - inc alk phos
Peyers patches
12 waves/min
Upregulated intracellular signal transduction

13. Bile is critical for exrection of what substance
Cholesterol
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
L/R renal artery around L1
Muscularis mucosae

14. What type of insults result in micronodular cirrhosis
Spleen to posterior abdominal wall - splenic artery and vein
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Acute pancreatitis

15. What structures feed into the cystic duct
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Gallbladder
Heme metabolism
External spermatic fascia only

16. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Common hepatic - splenic - left gastric - main blood supply for stomach
FAP

17. Dysphagia in achalasia results from
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Small intestine
Alfatoxin in peanuts
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

18. What is the main symptom if a VIPoma
Dissaccharidase def - most commonly lactase
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Gallbladder

19. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
All 3
Volvulus
Esophageal varices

20. Gastrin - source - action - regulation
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
Chronic gastritis and pernicious anemia
12 waves/min

21. What is the sphincter of the pancreatic duct
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Sphincter of oddi
Low pressure proximal to LES
Adhesion

22. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Hemolytic anemia
So hypertrophied they look like brain gyri
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
Dilated esophagus with an area of distal stenosis - birds beak

23. What test and result confirms H pylori infxn
Crypts but not villi
Positive urease test
Gardner's syndrome
Hernia

24. What are the borders of the femoral triangle
Mucoepidermoid carcinoma
Older patients
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Inguninal ligament - sartorius muscle - adductor longus

25. in carcinoid tumors - What is seen on EM
Dense core bodies
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Lipase

26. With internal hemorrhoids Where is the anastomoses and Where is it
M3 - Gq - inc IP3/Ca
Alcoholic cirrhosis
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Superior rectal and middle and inferior rectal - rectum

27. What carcinogens are associated with HCC
Mucoepidermoid carcinoma
Alk phos
Alfatoxin in peanuts
Dilated esophagus with an area of distal stenosis - birds beak

28. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
AST>ALT
Peptic ulcer disease
Can lead to hematemesis - found in EtOHics and bulimics
Normal

29. What is the most common cause of gallstones
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
L1
Left gastric vein and esophogeal vein - esophagus

30. If the abdominal aorta is blocked - How does blood get to the left colic artery
Tropical sprue
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Lateral to the inferior epigastric artery
Via the middle colic

31. What converts inactive pepsinogen to pepsin
Appendicitis
H+
Causes of gall stones
Hydrocele

32. What are the complications of chronic pancreatitis
Appendicitis
Striated
Dilated esophagus with an area of distal stenosis - birds beak
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

33. Achalasia increases the risk For what complication
IBS at least 2 with recurrent abdominal pain
Esophageal carcinoma
Hernia
Positive urease test

34. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Hernia
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Crohns = noncaseating granulomas - UC = crypt abscesses
Meckels

35. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
ALT>AST
All 3 gut layers outpouch as in Meckels
Jewish and African American men

36. What is the path of an indirect inguinal hernia
CHF and inc risk of HCC
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
L4
Goes through deep inguinal ring - external inguinal ring and into the scrotum

37. Gallstones that reach the common channel at ampulla can block which two ducts
Pancreatic and bile
Lipase - phospholipase A - colipase
Positive
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

38. What pancreatic enzymes are responsible for fat digestion
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Complications of crohns
Lipase - phospholipase A - colipase
Glucose dependent insulinotropic peptide

39. What kind of digestion is bile needed for
Juvenille polyps - no risk if single
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Virchow's node
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

40. If trypsin activates more trypsinogen - what kind of feedback loop is established
Positive
Left gastric vein and esophogeal vein - esophagus
Decrease - weight gain
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

41. What does a low flow rate mean for saliva
Gastric glands
L4
Hypotonic because of more time to reabsorb NaCl
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

42. Scleroderma is associated with what kind of esophageal dysmotility
Hyperpigmented mouth - lips - hands - genitalia
Low pressure proximal to LES
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

43. What separates the right greater and lesser sacs
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
GERD - may also present with nocturnal cough and dyspnea
Gastrohepatic ligament
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

44. What is the mechanism for reyes syndrome
The gastroduodenal
Common hepatic - splenic - left gastric - main blood supply for stomach
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Pleuroperitoneal

45. What reaction does salivary amylase catalyze
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
NAV = nerve artery vein - venous near the penis (NAVEL)
Punched out - clean margins - carcinoma =raised irregular margins
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

46. What are the ABCDEF of esophageal cancer
Crohns = noncaseating granulomas - UC = crypt abscesses
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Hyperplastic

47. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Menetriers disease
Gamma glutamyl transferase GGT
Pleuroperitoneal
FAP

48. How is the diagonsis of CRC made
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
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
CCK8 receptor - Gq inc IP3/Ca

49. What are the histological findings of the colon
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Lateral
Hypercoaguability - polycythemia vera - pregnancy - HCC
Crypts but not villi

50. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Early childhood - neuro sx and malabsorption
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Volvulus