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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 are additional risk factors for CRC
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
L3
L1
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

2. What does high flow rate mean
Closer to isotonic because of less time to reabsorb NaCl
Redness and tenderness on palpation of extremities
L/R renal artery around L1
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

3. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Angiodysplasia
H pylori (almost 100%)
M3 - Gq - inc IP3/Ca
8-9 waves/min

4. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Diarrhea - steatorrhea - weight loss - weakness
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Trypsin - chymotrypsin - elastase - carboxypeptidases
Hypercoaguability - polycythemia vera - pregnancy - HCC

5. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Common hepatic - splenic - left gastric - main blood supply for stomach
Intussusception
Achalasia due to loss of myenteric plexus (auberach)
Angiodysplasia

6. At what level of the spine does the IM exit the aorta
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
L3
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Esophageal cancer

7. What intervention will intervention will relieve portal HTN
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
IgA secreting plasma cells - ultimately reside in the lamina proporia
Colonic polyps
Lamina propria

8. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
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
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Zollinger Ellison - phenylalanine and tryptophan

9. Bilirubin is the product of what?
Inc lower esphogeal tone leading to achalasia
Heme metabolism
Reye's syndrome
MSI (15%) and APC/beta catenin chromosomal instability (85%)

10. secretin - source - action - regulation
Averages 6 months - very aggressive - usually already metastasized at presentation
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
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

11. What kind of anemia is in Wilsons
Cirrhosis
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
The jejunum
Hemolytic anemia

12. Where is the deep inguinal ring relative to the inferior epigastric vessels
L4
CHF and inc risk of HCC
Lateral
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

13. What are the signs and symptoms of budd chiari
Paraumbilical and superficial and inferior epigastric - umbilicus
Juvenille polyps - no risk if single
M3 - Gq - inc IP3/Ca
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

14. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Neural muscarinic pathways

15. Is there any structural abnl with IBS - What is the course of disease and presentation
The jejunum
M3 - Gq - inc IP3/Ca
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Warthins' tumor

16. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
Crohns = noncaseating granulomas - UC = crypt abscesses
Reye's syndrome
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

17. What do mucins do?
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Lubricate food (glycoprotiens)
Centrilobular leading to congestive liver disease
Lamina propora and submucosa

18. What does primary sclerosing cholangitis lead to...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Peutz jeghers
Dissaccharidase def - most commonly lactase
Sister mary joseph nodule

19. In what scenarios do pts with gilberts have inc bili
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Trypsin - chymotrypsin - elastase - carboxypeptidases
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Fasting and stress

20. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis

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21. what kind of fistula is associated with diverticulitis
Alpha1 antitrypsin def - codominant trait
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
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Colovesical leading to pneumaturia

22. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
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
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Dubin johnson
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

23. In PUD - with gastric ulcers - does pain inc or dec with meals?
Ischemic colitis
Gilbert's
FAP
Inc - weight loss

24. Who gets gastric ulcers
Brunners
IgA secreting plasma cells - ultimately reside in the lamina proporia
Begins starch digestion - inactivated by low pH upon reaching the stomach
Older patients

25. What are the borders of the femoral triangle
AST
Penicillinamine - AR inheritance
Inguninal ligament - sartorius muscle - adductor longus
Decrease - weight gain

26. At what spinal level does the celiac trunk exit
AR
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
T12
Zollinger Ellison - phenylalanine and tryptophan

27. How is bilirubin carried in the blood
Glucouronate - water soluble (direct)
With albumin
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Stercobilin

28. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Primary sclerosing cholangitis
Complications of crohns

29. absent UDPGT - presents early in life - early mortality
Crigler - najjar type 1
Lactase is located at the tips of intestinal villi
Osmotic
Averages 6 months - very aggressive - usually already metastasized at presentation

30. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Enterokinase/enteropeptidase from the duodenal mucosa
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Boerhaave's Syndrome - Been heaving syndrome

31. Transmural esophageal rupture due to violent retching

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32. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
The gastroduodenal
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
IBS at least 2 with recurrent abdominal pain

33. What cells secrete bicarb - What does it do - and what regulates it
Small intestine
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Jaundice - fever - RUQ
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

34. How does hirschsprung present and appear on imaging
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
Repeated phlebotomy - deferoxamine - HLA- A3
Cholesterol - 10-20% opaque due to calcifications
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

35. What does TOASTED with alcoholic hepatitis stand for
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
AST >ALT - ration is usually 1.5
Chronic gastritis and pernicious anemia
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

36. Which is used more quickly - an oral glucose load - or that by IV
Oral glucose
Brush border of intestine - produce monosaccharides from oligo and di
Female - fat - fertile - forty
Osmotic

37. Where does type B chronic gastritis occur and What causes it
Esophageal varices
Lamina propria
Increase tumorigenesis
Antrum - H.pylori - inc risk of MALT lymphoma

38. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Femoral hernia
Hyperplastic
T cell lymphoma

39. What kind of pancreatitis is associated with EtOH and smoking
Chronic calcifying pancreatitis - inc risk of panreatic cancer
H2 receptor - inc cAMP
Failure of the processus vagainlis to close
Gallbladder

40. What are the histological findings in the jejunum
Erosive - disruption of mucosal barrier leading to inflammation
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Ceruplasmin
CCK8 receptor - Gq inc IP3/Ca

41. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
AST>ALT
Left gastric vein and esophogeal vein - esophagus
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

42. What enzyme is necessary to create conjugated bilirubin
Alfatoxin in peanuts
Uridine glucuronyl transferase
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

43. What are the common causes of gastric ulcers - What causes gastric ulcer
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Inferior rectal nerve
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

44. What pancreatic proteases are secreted as zymogens
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Conj - inc - dec
Trypsin - chymotrypsin - elastase - carboxypeptidases
Poor anastamoses

45. A protrusion of peritoneum through an opening - usually a site of weakness
Gilbert's
Hernia
Repeated phlebotomy - deferoxamine - HLA- A3
Omeprazole

46. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Old men - arthralgias - cardiac and neuro sx
Superior rectal
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Achalasia due to loss of myenteric plexus (auberach)

47. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
Crohns = noncaseating granulomas - UC = crypt abscesses
Oligosaccharide digestion
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

48. what kind of muscle is in the upper 1/3 of esophagus
Striated
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
Corticosteroids - infliximab
Esophageal cancer

49. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Worldwide - SC - US - adeno
No
Esophageal varices
Internal thoracic to superior epigastric to inferior epigastric

50. In viral hepatitis - which liver enzyme is higher
ALT>AST
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Brunners
Lack or have an attenuated muscularis externa - often in the sigmoid colon