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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. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Inferior rectal nerve
Duodenal atresia - Downs
Inc risk of CRC and other visceral malignancies
Worldwide - SC - US - adeno

2. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Bleeding - intussusception - volvulus - obstruction near terminal ileum
GERD - may also present with nocturnal cough and dyspnea
Black - rotors syndrome
Hirschsprungs

3. Liver cell failure can lead to multisystem signs including
Krukenbergs tumor
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Alfatoxin in peanuts
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

4. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Muscularis mucosae
Neutralizes oral bacertial acids and maintains dental health
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

5. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

6. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
3 waves/min
Alpha amylase
PAS- positive globules in liver -
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

7. What are esophageal strictures associated with
Superior rectal
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Liver metabolizes 5HT
Lye ingestion and acid reflux

8. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Centrilobular leading to congestive liver disease
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Small intestine

9. What kind of muscle is in the lower 1/3 of the esophagus
Lipase
Smooth
Spleen to posterior abdominal wall - splenic artery and vein
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

10. Why would a self - limited lactase def occur following an injury (viral diarrhea)
All 3
Duodenum - 2nd - 3rd and 4th parts
Via the middle colic
Lactase is located at the tips of intestinal villi

11. What congenital birth defect is associated with Hirschsprung
Pancreatic head causing obstructive jaundice
Downs
EtOH
Gilbert's

12. Who gets gastric ulcers
Portal HTN
Cigarettes and chronic pancreatitis - not EtOH
Gut bacteria
Older patients

13. What does GET SMASHED stand for in acute pancreatitis
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
GLUT 2

14. What is pancreatic adenocarcinoma associated with
Upregulated intracellular signal transduction
Cigarettes and chronic pancreatitis - not EtOH
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

15. What is the characteristic histo finding in alcoholic hepatitis
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Mallory bodies

16. What are the effects of atropine on parietal cells and G cells
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Appendicitis
Below
Hepatic steatosis

17. What drug blocks the H2R
Cimetidine
Cirrhosis
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Menetriers disease

18. What is the rule of 2s for meckels
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Peyers patches
L4

19. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
8-9 waves/min
Above
Portal HTN
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

20. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Enterokinase/enteropeptidase from the duodenal mucosa
Epithelium
Peyers patches
Obstruction of the common bile duct

21. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Hirschsprungs
Dissaccharidase def - most commonly lactase
Peutz jeghers
Serous on the sides parotids - mucinous in the middle sublingual

22. Acute gastritis is caused By what process
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Tropical sprue
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Erosive - disruption of mucosal barrier leading to inflammation

23. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Pleuroperitoneal
Poor anastamoses
Can lead to hematemesis - found in EtOHics and bulimics

24. what kind of muscle is in the upper 1/3 of esophagus
Upregulated intracellular signal transduction
Striated
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
HSV-1 - CMV - Candida

25. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Inc risk of CRC and other visceral malignancies
Hemosiderosis - hemochromatosis
2ndary biliary cirrhosis
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

26. FAP + malignant CNS tumor
Urobilin
Striated
Turcot
Myenteric nerve plexus - aurbach

27. What does TOASTED with alcoholic hepatitis stand for
Hernia
The gastroduodenal
AST >ALT - ration is usually 1.5
Short gastrics - left greater and lesser

28. what percentage of colonic polyps are non - neoplastic
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Above
Goes through deep inguinal ring - external inguinal ring and into the scrotum
90%

29. What does a low flow rate mean for saliva
Hypotonic because of more time to reabsorb NaCl
Failure of the processus vagainlis to close
Black - rotors syndrome
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

30. What is the other name for GIP (gastric inhibitory peptide)
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Glucose dependent insulinotropic peptide
Pyoderma gangrenosum - primary sclerosing cholangitis
Urobilin

31. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Menetriers disease
...
Zenkers - halitosis - dysphagia and obstruction

32. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

33. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Left gastric vein and esophogeal vein - esophagus
VZV and influenza B treated with salicylates
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Angiodysplasia

34. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Antrum - H.pylori - inc risk of MALT lymphoma
Inspiratory arrest on deep palpation due to pain
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

35. What are the main components of bile
Failure of neural crest migration
AST>ALT
Backup of blood into the liver - RHF - budd chiari
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

36. What are the histological findings in the ileum

37. In PUD - with gastric ulcers - does pain inc or dec with meals?
Trypsin - chymotrypsin - elastase - carboxypeptidases
Corticosteroids - infliximab
Stimulate intestinal persistalsis
Inc - weight loss

38. What commonly leads to appendicity in kids vs adults
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Decrease - weight gain

39. How do NSAIDs cause acute gastritis
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Dec PGE2 leading to dec gastric mucosa protection
Where hindgut meets ectoderm
Mallory bodies

40. What serum enzyme is elevated in acute pancreatitis and mumps
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Amylase
Ischemic colitis

41. If trypsin activates more trypsinogen - what kind of feedback loop is established
Neural muscarinic pathways
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Centrilobular leading to congestive liver disease
Positive

42. What are the four Fs of gallstones
Antrum - H.pylori - inc risk of MALT lymphoma
Female - fat - fertile - forty
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

43. 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
Hydrocele
Hernia
Mitochondrial abnl - fatty liver - hypoglycemia - coma

44. What causes pancreatic insuff and What does it cause
Cholesterol - 10-20% opaque due to calcifications
Jewish and African American men
Enterokinase/enteropeptidase from the duodenal mucosa
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

45. motilin - source - action - regulation
8-9 waves/min
Inc smooth muscle relaxation - including lower esophageal sphincter
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
2ndary biliary cirrhosis

46. How do you DX and TX gallstones
Conj - inc - dec
Inc smooth muscle relaxation - including lower esophageal sphincter
US and cholecystectomy
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

47. How does brain injury lead to acute gastritis and What is it called
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
Alpha amylase
Begins starch digestion - inactivated by low pH upon reaching the stomach
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

48. What are the two molecular pathways that lead to CRC
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Elevated amylase - and lipase
Muscularis mucosae

49. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Left gastric vein and esophogeal vein - esophagus
Stercobilin

50. What is the epi for CRC
Esophageal cancer
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells