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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. In PUD with a duodenal ulcer does pain inc or dec with meals
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Positive urease test
Where hindgut meets ectoderm
Decrease - weight gain

2. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Jewish and African American men
The gastroduodenal
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

3. malnutrition - toxic megacolon - colorectal carcinoma
Trypsin - chymotrypsin - elastase - carboxypeptidases
Alfatoxin in peanuts
Complications of UC
Femoral hernia

4. What test and result confirms H pylori infxn
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
L3
Positive urease test
Corticosteroids - infliximab

5. What are the two molecular pathways that lead to CRC
Epithelium
AST
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Intussusception

6. What gives stool its characteristic color
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Stercobilin
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
HSV-1 - CMV - Candida

7. What are the histological findings of the colon
Obstruction of the common bile duct
Crypts but not villi
Lateral
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

8. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Alcoholic cirrhosis
Lipase
With albumin
Uremia

9. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Turcot
IBS at least 2 with recurrent abdominal pain

10. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Striated
Inc smooth muscle relaxation - including lower esophageal sphincter
Juvenille polyps - no risk if single

11. What does GET SMASHED stand for in acute pancreatitis
Splenic flexure
Internal thoracic to superior epigastric to inferior epigastric
Dermatitis herpetiformis
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

12. What complication can arise from indirect inguinal hernias
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Hydrocele
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

13. GIP - source - action regulation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
AST >ALT - ration is usually 1.5
Inc risk of CRC and other visceral malignancies
Failure of the processus vagainlis to close

14. What structures feed into the common hepatic duct
Right and left hepatic duct
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Diarrhea - steatorrhea - weight loss - weakness

15. Autoantibodies to gluten (gliadin) in wheat and other grains
L2
H+
Downs
Celiac sprue

16. What is the most common esophageal cancer worldwide and in the US
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Esophageal carcinoma
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Worldwide - SC - US - adeno

17. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Decreased intercellular adhesion and increased proliferation
Pleomorphic adenoma
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

18. In an MI - which liver enzyme is elevated
AST
T12
Conj - inc - dec
The proximal small bowel

19. What is the most common diaphragmatic hernia and What are the two types
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Neural muscarinic pathways
Phototherapy
Internal thoracic to superior epigastric to inferior epigastric

20. How do villi appear in disaccharidease def
Chronic calcifying pancreatitis - inc risk of panreatic cancer
The jejunum
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Normal

21. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
AST>ALT
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Decreased intercellular adhesion and increased proliferation

22. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Chronic gastritis and pernicious anemia
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Necrotizing enterocolitis
2ndary biliary cirrhosis

23. What pancreatic proteases are secreted as zymogens
Primary sclerosing cholangitis
Older patients
Meconium ileus
Trypsin - chymotrypsin - elastase - carboxypeptidases

24. What are the treatment options for uclerative colitis
Crohns = maybe - UC= always
Hepatic steatosis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

25. What layer of fascia covers a direct inguinal hernia
Dubin johnson
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
External spermatic fascia only
Alcoholic hepatitis

26. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Crohns = noncaseating granulomas - UC = crypt abscesses
Stercobilin
Lactase is located at the tips of intestinal villi
Neutralizes gastric acid allowing pancreatic enzymes to fxn

27. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Failure of the processus vagainlis to close
Alpha amylase
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
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

28. FAP + malignant CNS tumor
Liver metabolizes 5HT
Turcot
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Erosive - disruption of mucosal barrier leading to inflammation

29. What is the epi for CRC
Alfatoxin in peanuts
Cirrhosis
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

30. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Elevated amylase - and lipase
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Hirschsprungs
Penicillinamine - AR inheritance

31. What does loss of APC cause
Osmotic
Decreased intercellular adhesion and increased proliferation
Esophageal carcinoma
Conj - inc - dec

32. Bile is critical for exrection of what substance
Cholesterol
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Alpha amylase
Pertechnetate - study for uptake

33. Where is IgA shuttled
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Jewish and African American men
Penicillinamine - AR inheritance
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

34. Which patients have pigment stones
2ndary biliary cirrhosis
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Hemolytic anemia
Zollinger ellison - brunners glands

35. What is the other name for GIP (gastric inhibitory peptide)
Glucose dependent insulinotropic peptide
Femoral hernia
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Decreased intercellular adhesion and increased proliferation

36. HCC is associated with what other conditions
Trypsin - chymotrypsin - elastase - carboxypeptidases
Portal HTN
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
AR

37. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Erosive - disruption of mucosal barrier leading to inflammation
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Angiodysplasia
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

38. What gives urine its characteristic color
Uremia
Diverticulum
Urobilin
The entire

39. In PUD - with gastric ulcers - does pain inc or dec with meals?
Inc - weight loss
Dense core bodies
US and cholecystectomy
Complications of UC

40. List the clinical findings of HCC
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Peyers patches

41. What are the tumor markers for pancreatic adenocarcinoma
Zenkers - halitosis - dysphagia and obstruction
CEA - CA-19-9
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

42. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Duodenal atresia - Downs
Dermatitis herpetiformis
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

43. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Lack or have an attenuated muscularis externa - often in the sigmoid colon
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Pleomorphic adenoma
NAV = nerve artery vein - venous near the penis (NAVEL)

44. Scleroderma is associated with what kind of esophageal dysmotility
Positive
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Low pressure proximal to LES
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

45. most common malignant salivary gland tumor
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Mucoepidermoid carcinoma
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Epithelium

46. To what substance is bilirubin conjugated and why
Positive urease test
Hirschsprungs
Glucouronate - water soluble (direct)
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

47. What are the ABCDEF of esophageal cancer
Brush border of intestine - produce monosaccharides from oligo and di
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Muscularis mucosae
Smooth

48. What is the TX of physiologic neonatal jaundice
All 3 gut layers outpouch as in Meckels
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Phototherapy
Achalasia due to loss of myenteric plexus (auberach)

49. conjugated hyperbilirubinemia due to defective liver excretion
Goes through deep inguinal ring - external inguinal ring and into the scrotum
3 waves/min
Intussusception
Dubin johnson

50. multiple juvenil polyps in GI tract - risk
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
CHF and inc risk of HCC
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
Juvenile polyposis syndrome - inc risk of adenocarcinoma