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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 ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
True and most common congenital anomoly of GI tract
Via the superior pancreaticduodenal
L2
Falciform - ligamentum teres - fetal umbilical vein

2. What histological findings are present in the esophagus
Worldwide - SC - US - adeno
Nonkeritinized stratified sqamous epithelium
Failure of the processus vagainlis to close
Lipase - phospholipase A - colipase

3. What is charcot triad of cholangitis
Hyperpigmented mouth - lips - hands - genitalia
Jaundice - fever - RUQ
All 3
Oligosaccharide digestion

4. At what level do the testicular/ovarian arteries exit the aorta
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Diverticulum
Downs
L2

5. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Alk phos
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

6. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Hyperplastic
PAS- positive globules in liver -

7. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Unconjugated - water insoluble
Myenteric nerve plexus - aurbach
IgA secreting plasma cells - ultimately reside in the lamina proporia
Superior rectal

8. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Glucouronate - water soluble (direct)
Sphincter of oddi
Hirschsprungs
Gamma glutamyl transferase GGT

9. concentric onion skin bile duct fibrosis
Gallbladder
Primary sclerosing cholangitis
Crypts but not villi
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

10. Gallstones that reach the common channel at ampulla can block which two ducts
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Hydrocele
Pancreatic and bile
Hypotonic because of more time to reabsorb NaCl

11. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Bleeding - penetration into pancreas - perforation - obstruction
Alfatoxin in peanuts
Bleeding - intussusception - volvulus - obstruction near terminal ileum

12. What are the complications of duodenal PUD
Adhesion
L3
Bleeding - penetration into pancreas - perforation - obstruction
Dense core bodies

13. What are the tumor markers for pancreatic adenocarcinoma
Glucose dependent insulinotropic peptide
Dysphagia (due to esophageal web) - glossitis - iron def anemia
CEA - CA-19-9
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

14. What factors increase risk of malignancy of adenomatous polyps
ALT>AST
Virchow's node
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
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

15. Liver cell failure can lead to multisystem signs including
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Ceruplasmin
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

16. What is the TX of physiologic neonatal jaundice
Black - rotors syndrome
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Superior rectal
Phototherapy

17. What is pancreatic adenocarcinoma associated with
Cigarettes and chronic pancreatitis - not EtOH
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
L4
Zollinger Ellison - phenylalanine and tryptophan

18. When and How does Abetalipoproteinemia present
Celiac sprue
CCK8 receptor - Gq inc IP3/Ca
Early childhood - neuro sx and malabsorption
Meconium ileus

19. crigler - najjar type II responds to which therapy and How does it work
Pancreatic and bile
Phenobarbital - inc liver enzyme synthesis
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Around the central vein (zone III)

20. What is the most common indication of emergent abdominal surgery in children
Mucoepidermoid carcinoma
Inc smooth muscle relaxation - including lower esophageal sphincter
Appendicitis
Chronic calcifying pancreatitis - inc risk of panreatic cancer

21. What is the prognosis of adenocarcinoma
Skip lesions =crohns - colon = UC
H pylori (almost 100%)
Averages 6 months - very aggressive - usually already metastasized at presentation
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

22. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
Amylase
Chagas disease
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

23. How does abetalipoproteinemia lead to malabsorption
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
FAP
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

24. What are the signs and symptoms of budd chiari
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Zollinger Ellison - phenylalanine and tryptophan
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Osmotic

25. What is the path of an indirect inguinal hernia
Uridine glucuronyl transferase
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Complications of crohns

26. At what spinal level does the SMA exit
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
L1
Gamma glutamyl transferase GGT
Oral glucose

27. What are the histological findings of the colon
Causes of gall stones
Crypts but not villi
Zenkers - halitosis - dysphagia and obstruction
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

28. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Failure of the processus vagainlis to close
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Left gastric vein and esophogeal vein - esophagus

29. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
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
Zollinger ellison - brunners glands
Gallbladder

30. Autoantibodies to gluten (gliadin) in wheat and other grains
8-9 waves/min
Celiac sprue
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Inferior rectal nerve

31. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
No
Gallbladder
So hypertrophied they look like brain gyri

32. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
GERD - may also present with nocturnal cough and dyspnea
Short gastrics - left greater and lesser
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Female - fat - fertile - forty

33. What serum markers increase in cholecystitis with bile duct involvement
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Alk phos
Ampulla of vater
Begins starch digestion - inactivated by low pH upon reaching the stomach

34. GIP - source - action regulation
Terminal ileum and colon
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Corticosteroids - infliximab
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

35. What causes pancreatic insuff and What does it cause
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Complications of UC
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Penicillinamine - AR inheritance

36. What are the barium swallow findings of achalasia
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Dilated esophagus with an area of distal stenosis - birds beak
H2 receptor - inc cAMP
Cystic duct and common hepatic duct

37. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Paraumbilical and superficial and inferior epigastric - umbilicus
Squamous - upper 1/3 - adeno - lower 1/3
Primarly through ECL leading to histamine release
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

38. What enzyme is necessary to create conjugated bilirubin
Erosive - disruption of mucosal barrier leading to inflammation
External spermatic fascia only
Crypts but not villi
Uridine glucuronyl transferase

39. What is the most common esophageal cancer worldwide and in the US
12 waves/min
Crigler - najjar type 1
Inguninal ligament - sartorius muscle - adductor longus
Worldwide - SC - US - adeno

40. most common malignant salivary gland tumor
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Inc smooth muscle relaxation - including lower esophageal sphincter
Mucoepidermoid carcinoma
Dubin johnson

41. How do burns cause acute gastritis and What is it called

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42. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Alk phos
The gastroduodenal

43. What drug inhibits the H/K ATPase
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Omeprazole
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Nonkeritinized stratified sqamous epithelium

44. What does bicab do in the mouth
CCK8 receptor - Gq inc IP3/Ca
Neutralizes oral bacertial acids and maintains dental health
Nonkeritinized stratified sqamous epithelium
Centrilobular leading to congestive liver disease

45. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Internal thoracic to superior epigastric to inferior epigastric
Cholesterol - 10-20% opaque due to calcifications
Lamina propria

46. What portion of the bowel does sprue effect
Virchow's node
Brunners
Liver metabolizes 5HT
The proximal small bowel

47. Which area of the hindgut is a watershed area
Splenic flexure
Carcinoid syndrome
Bleeding - intussusception - volvulus - obstruction near terminal ileum
AR

48. What kind of lesions are characteristic of duodenal PUD vs cancer
Hyperplastic
Elevated amylase - and lipase
Phenobarbital - inc liver enzyme synthesis
Punched out - clean margins - carcinoma =raised irregular margins

49. What are the results of hemochromatosis
So hypertrophied they look like brain gyri
Femoral hernia
CHF and inc risk of HCC
AST

50. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Amylase
Colonic polyps
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria