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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. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
CHF and inc risk of HCC
Colonic polyps
GERD - may also present with nocturnal cough and dyspnea
Alpha amylase

2. What parts of the small bowel can tropical sprue effect
Low pressure proximal to LES
The entire
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Mitochondrial abnl - fatty liver - hypoglycemia - coma

3. What other condition can lead to acute gastritis - think renal
Turcot
Uremia
Inc smooth muscle relaxation - including lower esophageal sphincter
Peptic ulcer disease

4. What are the treatment options for uclerative colitis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Sphincter of oddi
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

5. What is the rate limiting step of carbohydrate digestion
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Oligosaccharide digestion
Pancreatic head causing obstructive jaundice
Peptic ulcer disease

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

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7. in carcinoid tumors - What is seen on EM
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Hepatic steatosis
Dense core bodies
EtOH

8. What are the hindgut structures and what supplies their blood and PANS innvervation
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Warthins' tumor
All 3 gut layers outpouch as in Meckels

9. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Lipase - phospholipase A - colipase
L4
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

10. What does high flow rate mean
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Closer to isotonic because of less time to reabsorb NaCl
Antrum - H.pylori - inc risk of MALT lymphoma
Celiac sprue

11. What is the risk with peutz jehgers
Inc risk of CRC and other visceral malignancies
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Dissaccharidase def - most commonly lactase
With albumin

12. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
CCK8 receptor - Gq inc IP3/Ca
Failure of neural crest migration
Squamous - upper 1/3 - adeno - lower 1/3
Striated and smooth

13. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Uremia
Causes of gall stones
Brunners
Cimetidine

14. What retroperitoneal structure flanks both sides of the pancreas on CT
Lateral to the inferior epigastric artery
Zollinger Ellison - phenylalanine and tryptophan
Duodenum - 2nd - 3rd and 4th parts
Muscularis mucosae

15. What is the most common indication of emergent abdominal surgery in children
Antrum - H.pylori - inc risk of MALT lymphoma
Appendicitis
Boerhaave's Syndrome - Been heaving syndrome
Striated and smooth

16. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Centrilobular leading to congestive liver disease
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Cholesterol - 10-20% opaque due to calcifications

17. GIP - source - action regulation
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Volvulus
Esophageal varices
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

18. What is the leading cause of bowel incarceration
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
T12
Cholesterol - 10-20% opaque due to calcifications
Femoral hernia

19. What kind of muscle is in the middle 1/3 of esophagus
Lamina propora and submucosa
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Striated and smooth

20. What test and result confirms H pylori infxn
Urobilin
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Positive urease test
Lipase - phospholipase A - colipase

21. What cell produces IF and What does it do
H pylori (almost 100%)
Juvenille polyps - no risk if single
Parietal cells in the stomach - B12 binding protein
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

22. What infection causes Whipple disease and What can you see on LM
Unconjugated - water insoluble
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Ischemic colitis

23. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Left gastric vein and esophogeal vein - esophagus
ALT>AST
Begins starch digestion - inactivated by low pH upon reaching the stomach

24. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Sphincter of oddi
Closer to isotonic because of less time to reabsorb NaCl
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
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

25. What is the prognosis of adenocarcinoma
Duodenum - 2nd - 3rd and 4th parts
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Averages 6 months - very aggressive - usually already metastasized at presentation

26. What complication can arise from indirect inguinal hernias
Hydrocele
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Dubin johnson
Virchow's node

27. Autodigestion of pancreas by pancreatic enzymes
Decreased intercellular adhesion and increased proliferation
Achalasia due to loss of myenteric plexus (auberach)
Acute pancreatitis
CHF and inc risk of HCC

28. Gastrin - source - action - regulation
Glucouronate - water soluble (direct)
Duodenum - 2nd - 3rd and 4th parts
GERD - may also present with nocturnal cough and dyspnea
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

29. At what level do the testicular/ovarian arteries exit the aorta
L2
Esophageal cancer
Conj - inc - dec
Fe2+ in the duod

30. FAP + malignant CNS tumor
Chagas disease
Centrilobular leading to congestive liver disease
IgA secreting plasma cells - ultimately reside in the lamina proporia
Turcot

31. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Brunners
In the ileum with bile acids - requires IF
Duodenal atresia - Downs
Adhesion

32. What causes carcinoid syndrome amd What are the symptoms
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
ALT>AST
Cimetidine
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

33. What pancreatic proteases are secreted as zymogens
Trypsin - chymotrypsin - elastase - carboxypeptidases
Menetriers disease
Osmotic
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

34. How does abetalipoproteinemia lead to malabsorption
Conj/unconj - inc - nl to dec
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Esophageal varices
Celiac sprue

35. What are the foregut structures and what supplies their blood and PANS innvervation
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
2ndary biliary cirrhosis
Tropical sprue
Lye ingestion and acid reflux

36. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Portal HTN
L1
Right and left hepatic duct

37. With caput medusaw - between what vessels is the anastomoses and Where is it
Cystic dilation of the viteline duct
Urobilin
Paraumbilical and superficial and inferior epigastric - umbilicus
PAS- positive globules in liver -

38. milk intolerance
Hydrocele
Peyers patches
Esophageal carcinoma
Dissaccharidase def - most commonly lactase

39. What are the labs in acute pancreatitis
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Adhesion
Elevated amylase - and lipase

40. Through which aspect of the inguinal canal does a direct inguinal go
External (superficial) ring only
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Brunners
Cholesterol - 10-20% opaque due to calcifications

41. What percentage of gall stones are cholesterol stones and What are the associations
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Gilbert's
Lactase is located at the tips of intestinal villi
Inc smooth muscle relaxation - including lower esophageal sphincter

42. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Inc smooth muscle relaxation - including lower esophageal sphincter
Meckels
Acute pancreatitis

43. What structure is Not contained in the femoral sheath
Neural muscarinic pathways
Dec PGE2 leading to dec gastric mucosa protection
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
The gastroduodenal

44. Gallstones that reach the common channel at ampulla can block which two ducts
GLUT 2
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Turcot
Pancreatic and bile

45. What histological findings are present in the stomach
Lubricate food (glycoprotiens)
Inc lower esphogeal tone leading to achalasia
Gastric glands
Cigarettes and chronic pancreatitis - not EtOH

46. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Diarrhea - steatorrhea - weight loss - weakness
Penicillinamine - AR inheritance
Hernia
Internal thoracic to superior epigastric to inferior epigastric

47. What does alpha amylase do and what inactivates it
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Pancreatic and bile
Begins starch digestion - inactivated by low pH upon reaching the stomach
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

48. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Internal thoracic to superior epigastric to inferior epigastric
Complications of crohns
Causes of gall stones
FAP

49. What does the splenorenal ligament connect - and What does it contain
Zollinger ellison - brunners glands
Hernia
Cigarettes and chronic pancreatitis - not EtOH
Spleen to posterior abdominal wall - splenic artery and vein

50. Cholecytsokinin - source - action - regulation
Averages 6 months - very aggressive - usually already metastasized at presentation
Source - I cells (duod - jej - action - inc pancreative secretion - inc gallbladder contraction - dec gastric emptying - sphincter of Oddi relaxation - regulation - inc by fatty acids and amino acids
Gut bacteria
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus