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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. HCC is associated with what other conditions
Dilated esophagus with an area of distal stenosis - birds beak
Hyperpigmented mouth - lips - hands - genitalia
Esophageal cancer
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

2. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Early childhood - neuro sx and malabsorption
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
L3
Conj - inc - dec

3. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Acute pancreatitis
Myenteric nerve plexus - aurbach

4. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Reye's syndrome
Heme metabolism
Diverticulitis in elderly - ectopic pregs use hCG to rule out

5. In alchoholic hepatitis which liver enzyme is higher
Parietal cells in the stomach - B12 binding protein
Falciform - ligamentum teres - fetal umbilical vein
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
AST>ALT

6. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Alk phos
True and most common congenital anomoly of GI tract
Alpha1 antitrypsin def - codominant trait

7. What is the cause of physiologic neonatal jaundice
Ischemic colitis
Boerhaave's Syndrome - Been heaving syndrome
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Dissaccharidase def - most commonly lactase

8. What is the arterial supply and venous drainage below pectinate line
Dissaccharidase def - most commonly lactase
Smooth
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Crohns = maybe - UC= always

9. What is the most common diaphragmatic hernia and What are the two types
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Internal thoracic to superior epigastric to inferior epigastric
Hemosiderosis - hemochromatosis
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

10. 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
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Acute pancreatitis
Femoral hernia

11. What does autoimmune destruction of parietal cells lead to...
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Via the superior pancreaticduodenal
Chronic gastritis and pernicious anemia
Falciform - ligamentum teres - fetal umbilical vein

12. What skin condition is associated with celiac sprue
Cigarettes and chronic pancreatitis - not EtOH
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Dermatitis herpetiformis
Sister mary joseph nodule

13. inflammatino of gallbadder
All 3 gut layers outpouch as in Meckels
Squamous - upper 1/3 - adeno - lower 1/3
Gamma glutamyl transferase GGT
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

14. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Cholesterol - 10-20% opaque due to calcifications
Crohns = noncaseating granulomas - UC = crypt abscesses
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

15. Where does type A chronic gastritis occur and What causes it
Glucouronate - water soluble (direct)
Positive
PAS- positive globules in liver -
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

16. motilin - source - action - regulation
Crohns = noncaseating granulomas - UC = crypt abscesses
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

17. What commonly leads to appendicity in kids vs adults
Punched out - clean margins - carcinoma =raised irregular margins
Normal
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Old men - arthralgias - cardiac and neuro sx

18. Bile is critical for exrection of what substance
Cholesterol
Primarly through ECL leading to histamine release
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Gardner's syndrome

19. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
All 3
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Lipase - phospholipase A - colipase

20. Where are oligosaccharide hydrolases and What do they do
Normal
Pancreatic and bile
Duodenal atresia - Downs
Brush border of intestine - produce monosaccharides from oligo and di

21. What layer of fascia covers a direct inguinal hernia
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Carcinoid syndrome
External spermatic fascia only
Celiac sprue

22. Scleroderma is associated with what kind of esophageal dysmotility
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Alcoholic hepatitis
Low pressure proximal to LES
Zollinger ellison - brunners glands

23. In what scenarios do pts with gilberts have inc bili
Internal thoracic to superior epigastric to inferior epigastric
Increase tumorigenesis
Fasting and stress
Closer to isotonic because of less time to reabsorb NaCl

24. In an MI - which liver enzyme is elevated
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
AST
Lamina propora and submucosa
Short gastrics - left greater and lesser

25. What are the effects of atropine on parietal cells and G cells
Ischemic colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

26. Why does carcinoid syndrome not occur if tumor is confined to GI system
Repeated phlebotomy - deferoxamine - HLA- A3
Striated and smooth
Liver metabolizes 5HT
Right and left hepatic duct

27. What artery passes around the duodenum
The gastroduodenal
Jewish and African American men
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
Lateral to the inferior epigastric artery

28. Where does copper accumulate in Wilsons and What are ABCD
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Brush border of intestine - produce monosaccharides from oligo and di
Internal thoracic to superior epigastric to inferior epigastric
Cimetidine

29. To what substance is bilirubin conjugated and why
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Glucouronate - water soluble (direct)
Peptic ulcer disease
Lipase

30. What does a low flow rate mean for saliva
Left gastric vein and esophogeal vein - esophagus
Positive urease test
Hypotonic because of more time to reabsorb NaCl
CHF and inc risk of HCC

31. What makes a true diverticula
GERD - may also present with nocturnal cough and dyspnea
All 3 gut layers outpouch as in Meckels
PAS- positive globules in liver -
The jejunum

32. What are the results of hemochromatosis
Celiac sprue
CHF and inc risk of HCC
Crigler - najjar type 1
Zollinger ellison - brunners glands

33. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Crigler - najjar type 1
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

34. Dysphagia in achalasia results from
Liver metabolizes 5HT
Primary sclerosing cholangitis
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

35. What cells secrete bicarb - What does it do - and what regulates it
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Small intestine
Cystic dilation of the viteline duct

36. At what level of the spine does the IM exit the aorta
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Hydrocele
AST>ALT
L3

37. What enzyme is necessary to create conjugated bilirubin
Uridine glucuronyl transferase
Virchow's node
Pancreatic head causing obstructive jaundice
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

38. What is one potential precipitating factor for intussusception
Crigler - najjar type 1
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Obstruction of the common bile duct
Gamma glutamyl transferase GGT

39. What is the most common esophageal cancer worldwide and in the US
Unconjugated - water insoluble
Worldwide - SC - US - adeno
Stimulate intestinal persistalsis
ALT>AST

40. How does CRC present in the distal and proximal colon
Alcoholic cirrhosis
Meconium ileus
AR
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

41. signet ring cells - acanthosis nigracans - dz - character/association - spread
US and cholecystectomy
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

42. What do the rugae of stomach look like in menetriers disease
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Spleen to posterior abdominal wall - splenic artery and vein
Elevated amylase - and lipase
So hypertrophied they look like brain gyri

43. What is diverticulosis
Dilated esophagus with an area of distal stenosis - birds beak
Osmotic
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

44. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
Zollinger Ellison - phenylalanine and tryptophan
Right and left hepatic duct
Achalasia due to loss of myenteric plexus (auberach)

45. Where does type B chronic gastritis occur and What causes it
Antrum - H.pylori - inc risk of MALT lymphoma
H pylori (almost 100%)
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

46. What transforms conjugated bilirubin to urobilinogen
Boerhaave's Syndrome - Been heaving syndrome
With albumin
Below
Gut bacteria

47. Gallstones that reach the common channel at ampulla can block which two ducts
Unconjugated - water insoluble
Pancreatic and bile
Uremia
CHF and inc risk of HCC

48. What are the histological findings in the ileum

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49. FAP + osseous and soft tissue tumors - retinal hyperplasia

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50. What are the histological findings of the colon
Crypts but not villi
Hepatic steatosis
Closer to isotonic because of less time to reabsorb NaCl
Epigastric abdominal pain radiating to back - anorexia - nausea