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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 the risk with peutz jehgers
Cholesterol - 10-20% opaque due to calcifications
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Parietal cells in the stomach - B12 binding protein
Inc risk of CRC and other visceral malignancies

2. What layer of fascia covers a direct inguinal hernia
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Spleen to posterior abdominal wall - splenic artery and vein
External spermatic fascia only
Enterokinase/enteropeptidase from the duodenal mucosa

3. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Meckels
Via the middle colic

4. Bile is critical for exrection of what substance
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Cholesterol
Poor anastamoses
Neural muscarinic pathways

5. Through which aspect of the inguinal canal does a direct inguinal go
No
Oral glucose
Lubricate food (glycoprotiens)
External (superficial) ring only

6. What is the most common indication of emergent abdominal surgery in children
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
In the mucus that covers the gastric epithelium
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Appendicitis

7. What is the most important mechanism in gastric acid secretion
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Hernia
Via the superior pancreaticduodenal
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

8. What does loss of APC cause
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Gamma glutamyl transferase GGT
Decreased intercellular adhesion and increased proliferation
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

9. What are the effects of atropine on parietal cells and G cells
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Krukenbergs tumor
The entire
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

10. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Dissaccharidase def - most commonly lactase
Volvulus
Osmotic
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

11. rare - often fatal childhood hepatoencephalopathy

12. What is the ddx associated with appendicitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Krukenbergs tumor
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

13. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Epigastric abdominal pain radiating to back - anorexia - nausea
Inc lower esphogeal tone leading to achalasia
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
HSV-1 - CMV - Candida

14. What is biliary colic
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
AST

15. What is the most common cause of gallstones
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Achalasia due to loss of myenteric plexus (auberach)

16. What kind of digestion is bile needed for
Redundant mesentary
Virchow's node
AST>ALT
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

17. Which patients have pigment stones
Adhesion
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Ampulla of vater
Intussusception

18. Liver cell failure can lead to multisystem signs including
Uremia
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Mucoepidermoid carcinoma

19. Where are oligosaccharide hydrolases and What do they do
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Brush border of intestine - produce monosaccharides from oligo and di
T cell lymphoma
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

20. What is the presentation of pancreatic adenocarcinoma
Esophageal carcinoma
Older patients
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
3 waves/min

21. What kind of anemia is in Wilsons
Jaundice - fever - RUQ
Necrotizing enterocolitis
Hemolytic anemia
Zollinger Ellison - phenylalanine and tryptophan

22. Where and How is iron absorbed
Splenic flexure
Osmotic
Can lead to hematemesis - found in EtOHics and bulimics
Fe2+ in the duod

23. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Gastrohepatic ligament
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Diarrhea - steatorrhea - weight loss - weakness

24. What nerve innervates the external hemorrhoids
Duodenal atresia - Downs
Gut bacteria
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Inferior rectal nerve

25. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Hemosiderosis - hemochromatosis
Dense core bodies
Cystic duct and common hepatic duct

26. How does abetalipoproteinemia lead to malabsorption
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Fasting and stress
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

27. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Cystic duct and common hepatic duct
Krukenbergs tumor
Peutz jeghers
Stercobilin

28. What is the HLA association and treatment for hemochromatosis
Repeated phlebotomy - deferoxamine - HLA- A3
AST >ALT - ration is usually 1.5
Lye ingestion and acid reflux
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

29. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Pleomorphic adenoma
Small intestine
Hyperpigmented mouth - lips - hands - genitalia
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

30. What are the four Fs of gallstones
Falciform - ligamentum teres - fetal umbilical vein
Older patients
Female - fat - fertile - forty
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

31. What can fistula between the gallbladder and small intestine create and how can you tell
Causes of gall stones
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
The jejunum
Oligosaccharide digestion

32. What are the tumor markers for pancreatic adenocarcinoma
Begins starch digestion - inactivated by low pH upon reaching the stomach
Epithelium
CEA - CA-19-9
Lamina propria

33. why infxn is implicated in duodenal PUD
With albumin
Mallory bodies
H pylori (almost 100%)
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

34. Malabsorption syndromes have what common clinical presentation
L1
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
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Diarrhea - steatorrhea - weight loss - weakness

35. What are the branches of the celiac trunk and What do they supply
Averages 6 months - very aggressive - usually already metastasized at presentation
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Common hepatic - splenic - left gastric - main blood supply for stomach
Mallory bodies

36. What pancreatic enzymes are responsible for fat digestion
Crohns = noncaseating granulomas - UC = crypt abscesses
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
Lipase - phospholipase A - colipase
Gamma glutamyl transferase GGT

37. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Inc - weight loss
Acute pancreatitis
Female - fat - fertile - forty

38. in budd chiari syndrome - Where is the congestion and necrosis
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Centrilobular leading to congestive liver disease
Falciform - ligamentum teres - fetal umbilical vein
Meconium ileus

39. What causes nutmeg liver
Dubin johnson
Backup of blood into the liver - RHF - budd chiari
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Cigarettes and chronic pancreatitis - not EtOH

40. Abuse of what substance leads to acute gastritis
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Diarrhea - steatorrhea - weight loss - weakness
EtOH

41. motilin - source - action - regulation
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
H pylori (almost 100%)
Oligosaccharide digestion
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

42. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Antrum - H.pylori - inc risk of MALT lymphoma
Pertechnetate - study for uptake
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

43. How does brain injury lead to acute gastritis and What is it called
Backup of blood into the liver - RHF - budd chiari
NAV = nerve artery vein - venous near the penis (NAVEL)
Erosive - disruption of mucosal barrier leading to inflammation
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

44. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
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
Female - fat - fertile - forty
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

45. What gives urine its characteristic color
Via the superior pancreaticduodenal
Urobilin
Common hepatic - splenic - left gastric - main blood supply for stomach
Cystic dilation of the viteline duct

46. FAP + malignant CNS tumor
Left and right gastroepiploics - left and right gastrics
Turcot
CEA - CA-19-9
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

47. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Common hepatic - splenic - left gastric - main blood supply for stomach
2ndary biliary cirrhosis
Duodenal atresia - Downs
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

48. What skin condition is associated with celiac sprue
Zenkers - halitosis - dysphagia and obstruction
Dermatitis herpetiformis
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
MSI (15%) and APC/beta catenin chromosomal instability (85%)

49. How does gastrin increase acid secretion?
VZV and influenza B treated with salicylates
Primarly through ECL leading to histamine release
Portal HTN
Pleomorphic adenoma

50. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Zenkers - halitosis - dysphagia and obstruction
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
EtOH
H pylori (almost 100%)