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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. Where is B12 absorbed
L1
In the ileum with bile acids - requires IF
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Inferior rectal nerve

2. What structures feed into the common bile duct
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Appendicitis
Cystic duct and common hepatic duct
Chagas disease

3. milk intolerance
Crohns = maybe - UC= always
Dissaccharidase def - most commonly lactase
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
When diffusely infiltrative - thickened rigid appearance like a leather bottle

4. What are the main components of bile
Conj - inc - dec
Lateral
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Stimulate intestinal persistalsis

5. What layer of fascia covers a direct inguinal hernia
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
Increase tumorigenesis
External spermatic fascia only
Dubin johnson

6. How does abetalipoproteinemia lead to malabsorption
Dermatitis herpetiformis
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
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
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

7. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
The gastroduodenal
Meckels
Increase tumorigenesis
Alpha1 antitrypsin def - codominant trait

8. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Oligosaccharide digestion

9. What are the midgut structures and what supplies their blood and PANS innervation
GERD - may also present with nocturnal cough and dyspnea
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

10. What kind of insults results in macronodular cirrhosis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Primarly through ECL leading to histamine release
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

11. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Upregulated intracellular signal transduction
Squamous - upper 1/3 - adeno - lower 1/3
Mucoepidermoid carcinoma
90%

12. What does loss of p53 cause
Inc lower esphogeal tone leading to achalasia
Unconj - absent (acholuria) - inc
Achalasia due to loss of myenteric plexus (auberach)
Increase tumorigenesis

13. involvement of left supraclavicular node by mets from stomach

14. What is the most common cause of gallstones
Redness and tenderness on palpation of extremities
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
GERD - may also present with nocturnal cough and dyspnea
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

15. most common non - neoplastic polyp in colon
Peyers patches
Epigastric abdominal pain radiating to back - anorexia - nausea
Hyperplastic
Pancreatic and bile

16. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
The gastroduodenal
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Dissaccharidase def - most commonly lactase
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

17. In alchoholic hepatitis which liver enzyme is higher
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
HSV-1 - CMV - Candida
Dilated esophagus with an area of distal stenosis - birds beak
AST>ALT

18. What pancreatic proteases are secreted as zymogens
Peptic ulcer disease
Antrum - H.pylori - inc risk of MALT lymphoma
The jejunum
Trypsin - chymotrypsin - elastase - carboxypeptidases

19. What histological findings are present in the stomach
Gastric glands
Ischemic colitis
The jejunum
L3

20. Which viral infxns/treatments are associated with reyes syndrome
Erosive - disruption of mucosal barrier leading to inflammation
VZV and influenza B treated with salicylates
Cimetidine
Gallbladder

21. What is the classic triad of hemochromatosis

22. most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Poor anastamoses
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

23. malnutrition - toxic megacolon - colorectal carcinoma
Corticosteroids - infliximab
Complications of UC
In the ileum with bile acids - requires IF
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

24. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
90%
Urobilin
Unconj - absent (acholuria) - inc

25. Scleroderma is associated with what kind of esophageal dysmotility
Elevated amylase - and lipase
Duodenal atresia - Downs
Low pressure proximal to LES
Repeated phlebotomy - deferoxamine - HLA- A3

26. What layer in the mucosa is responsible for absorption
Epithelium
L/R renal artery around L1
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Normal

27. 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
Mucoepidermoid carcinoma
Skip lesions =crohns - colon = UC
Centrilobular leading to congestive liver disease
Lateral to the inferior epigastric artery

28. conjugated hyperbilirubinemia due to defective liver excretion
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Dubin johnson
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Warthins' tumor

29. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Pyoderma gangrenosum - primary sclerosing cholangitis
Crohns = noncaseating granulomas - UC = crypt abscesses
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Inferior rectal nerve

30. What structure is Not contained in the femoral sheath
CHF and inc risk of HCC
External spermatic fascia only
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
CEA - CA-19-9

31. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Achalasia due to loss of myenteric plexus (auberach)
FAP
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Pertechnetate - study for uptake

32. Where does copper accumulate in Wilsons and What are ABCD
US and cholecystectomy
Jewish and African American men
Complications of UC
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

33. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Inc - weight loss
Hydrocele
Goes through deep inguinal ring - external inguinal ring and into the scrotum

34. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Angiodysplasia
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

35. If the hemochromatosis is primary - What is the pattern of inheritance
Stimulate the H/K ATPase
AR
Poor anastamoses
Hernia

36. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Alk phos
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Necrotizing enterocolitis
Obstruction of the common bile duct

37. What parts of the small bowel can tropical sprue effect
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
The entire
Gamma glutamyl transferase GGT
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

38. Where is the deep inguinal ring relative to the inferior epigastric vessels
Alfatoxin in peanuts
Lateral
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
Lipase

39. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
True and most common congenital anomoly of GI tract
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Complications of crohns

40. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Crohns = noncaseating granulomas - UC = crypt abscesses
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

41. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
Hyperplastic
Cholesterol - 10-20% opaque due to calcifications
T12

42. What is the clinical presentation of acute pancreatitis
L4
Colonic polyps
Epigastric abdominal pain radiating to back - anorexia - nausea
Crypts but not villi

43. Gallstones that reach the common channel at ampulla can block which two ducts
Pancreatic and bile
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Alcoholic cirrhosis

44. motilin - source - action - regulation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Penicillinamine - AR inheritance
Virchow's node

45. What cells make pepsin - What does it do - and what regulates it
Cystic dilation of the viteline duct
Mucosa - submucosa - muscularis externa - serosa/adventitia
IgA secreting plasma cells - ultimately reside in the lamina proporia
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

46. How is the diagonsis of CRC made
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
Jewish and African American men
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Gallbladder

47. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Where hindgut meets ectoderm
Diarrhea - steatorrhea - weight loss - weakness
Inc risk of CRC and other visceral malignancies

48. How does gastrin increase acid secretion?
CEA - CA-19-9
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Primarly through ECL leading to histamine release
Causes of gall stones

49. How does loss of NO secretion affect the esophagus and what results
Old men - arthralgias - cardiac and neuro sx
Zenkers - halitosis - dysphagia and obstruction
Inc lower esphogeal tone leading to achalasia
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

50. How does CRC present in the distal and proximal colon
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
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
VZV and influenza B treated with salicylates