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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 is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Closer to isotonic because of less time to reabsorb NaCl
External spermatic fascia only
Cirrhosis

2. What artery passes around the duodenum
EtOH
FAP
Causes of gall stones
The gastroduodenal

3. What carcinogens are associated with HCC
Unconjugated - water insoluble
Alfatoxin in peanuts
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
Epigastric abdominal pain radiating to back - anorexia - nausea

4. What cell produces IF and What does it do
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Parietal cells in the stomach - B12 binding protein
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Backup of blood into the liver - RHF - budd chiari

5. What are the complications of chronic pancreatitis
Jaundice - fever - RUQ
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Erosive - disruption of mucosal barrier leading to inflammation

6. Scleroderma is associated with what kind of esophageal dysmotility
Mucosa - submucosa - muscularis externa - serosa/adventitia
Low pressure proximal to LES
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

7. Abuse of what substance leads to acute gastritis
EtOH
Celiac sprue
Muscularis mucosae
Nonkeritinized stratified sqamous epithelium

8. When and How does Abetalipoproteinemia present
Primary sclerosing cholangitis
Early childhood - neuro sx and malabsorption
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Striated

9. What are the tumor markers for pancreatic adenocarcinoma
CEA - CA-19-9
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Reye's syndrome
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

10. What kind of diarrhea is produced from a disaccharide def
Colovesical leading to pneumaturia
Osmotic
Intussusception
Colonic polyps

11. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Epigastric abdominal pain radiating to back - anorexia - nausea

12. What does autoimmune destruction of parietal cells lead to...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Pertechnetate - study for uptake
Chronic gastritis and pernicious anemia

13. what kind of muscle is in the upper 1/3 of esophagus
Striated
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Esophageal carcinoma

14. somatostatin - source - action - regulation
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Centrilobular leading to congestive liver disease
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

15. How does CRC present in the distal and proximal colon
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Black - rotors syndrome
GERD - may also present with nocturnal cough and dyspnea

16. What is the frequency of basal electric rhythm in the duodenum
Old men - arthralgias - cardiac and neuro sx
12 waves/min
Hypotonic because of more time to reabsorb NaCl
Glucose dependent insulinotropic peptide

17. What causes hirschsprungs
Failure of neural crest migration
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
90%

18. rare - often fatal childhood hepatoencephalopathy

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19. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Left gastric vein and esophogeal vein - esophagus
Hirschsprungs
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

20. At what spinal level does the is the bifurcation of aorta
AST>ALT
L4
Zollinger Ellison - phenylalanine and tryptophan
Terminal ileum and colon

21. What are the ABCDEF of esophageal cancer
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Brush border of intestine - produce monosaccharides from oligo and di
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Inferior rectal nerve

22. 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
Lateral
Lactase is located at the tips of intestinal villi
Gallbladder

23. What kind of muscle is in the lower 1/3 of the esophagus
Via the superior pancreaticduodenal
Erosive - disruption of mucosal barrier leading to inflammation
Smooth
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

24. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

25. In an MI - which liver enzyme is elevated
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
With albumin
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
AST

26. What is the ddx associated with appendicitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Appendicitis
Lamina propria
Primary sclerosing cholangitis

27. What is one potential precipitating factor for intussusception
Cholesterol
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Ampulla of vater
Chagas disease

28. secretin - source - action - regulation
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
Dysphagia (due to esophageal web) - glossitis - iron def anemia
M3 - Gq - inc IP3/Ca
L3

29. milk intolerance
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Can lead to hematemesis - found in EtOHics and bulimics
Dissaccharidase def - most commonly lactase
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

30. What are the common causes of gastric ulcers - What causes gastric ulcer
Alpha amylase
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Myenteric nerve plexus - aurbach
Colonic polyps

31. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Increase tumorigenesis
Internal thoracic to superior epigastric to inferior epigastric
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Repeated phlebotomy - deferoxamine - HLA- A3

32. What congenital birth defect is associated with Hirschsprung
HPNCC
H pylori (almost 100%)
Downs
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

33. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
T12
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Stercobilin

34. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
H pylori (almost 100%)
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
Superior rectal and middle and inferior rectal - rectum
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

35. GIP - source - action regulation
IgA secreting plasma cells - ultimately reside in the lamina proporia
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Myenteric nerve plexus - aurbach
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

36. What is the triad of Plummer - Vinson syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Hyperplastic
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Old men - arthralgias - cardiac and neuro sx

37. What does TOASTED with alcoholic hepatitis stand for
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Antrum - H.pylori - inc risk of MALT lymphoma
Alpha1 antitrypsin def - codominant trait
AST >ALT - ration is usually 1.5

38. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
12 waves/min
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

39. What are the foregut structures and what supplies their blood and PANS innvervation
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

40. Who gets gastric ulcers
Left and right gastroepiploics - left and right gastrics
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
Older patients
Spleen to posterior abdominal wall - splenic artery and vein

41. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Trypsin - chymotrypsin - elastase - carboxypeptidases
Falciform - ligamentum teres - fetal umbilical vein
Cholesterol - 10-20% opaque due to calcifications
Enterokinase/enteropeptidase from the duodenal mucosa

42. What are the signs of peutz jehgers
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
Hyperpigmented mouth - lips - hands - genitalia
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

43. Where is bicarb trapped
Necrotizing enterocolitis
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
In the mucus that covers the gastric epithelium
Dissaccharidase def - most commonly lactase

44. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Inspiratory arrest on deep palpation due to pain
Fasting and stress

45. What test and result confirms H pylori infxn
Oral glucose
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
All 3
Positive urease test

46. What does a low flow rate mean for saliva
Hypotonic because of more time to reabsorb NaCl
Hemolytic anemia
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
NAV = nerve artery vein - venous near the penis (NAVEL)

47. Where does type B chronic gastritis occur and What causes it
Antrum - H.pylori - inc risk of MALT lymphoma
Primary sclerosing cholangitis
Serous on the sides parotids - mucinous in the middle sublingual
Conj - inc - dec

48. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Conj/unconj - inc - nl to dec
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
8-9 waves/min

49. Where does type A chronic gastritis occur and What causes it
Inc lower esphogeal tone leading to achalasia
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
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Angiodysplasia

50. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
Dec PGE2 leading to dec gastric mucosa protection
...
Low pressure proximal to LES
Dermatitis herpetiformis