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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
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Unconj - absent (acholuria) - inc
Fasting and stress

2. most common non - neoplastic polyp in colon
8-9 waves/min
HSV-1 - CMV - Candida
Hyperplastic
Lubricate food (glycoprotiens)

3. Which serum enzyme increases with heavy EtOH consumption
Gamma glutamyl transferase GGT
Hyperplastic
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

4. What does bicarb do in the duodenum
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Portal HTN
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Alpha amylase

5. What are the layers of the gut wall from inside out
Left and right gastroepiploics - left and right gastrics
Mucosa - submucosa - muscularis externa - serosa/adventitia
Smooth
Downs

6. What is the arterial supply and venous drainage below pectinate line
Gastric glands
Worldwide - SC - US - adeno
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

7. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Smooth
Duodenum - 2nd - 3rd and 4th parts
AST
Juvenille polyps - no risk if single

8. What are the tumor markers for pancreatic adenocarcinoma
Dissaccharidase def - most commonly lactase
Zenkers - halitosis - dysphagia and obstruction
CEA - CA-19-9
Dermatitis herpetiformis

9. What kind of lesions are characteristic of duodenal PUD vs cancer
Punched out - clean margins - carcinoma =raised irregular margins
Dissaccharidase def - most commonly lactase
Zollinger ellison - brunners glands
Serous on the sides parotids - mucinous in the middle sublingual

10. Are single polyps malignant in peutz jehgers
L/R renal artery around L1
No
Neutralizes oral bacertial acids and maintains dental health
Trypsin - chymotrypsin - elastase - carboxypeptidases

11. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Heme metabolism
Colonic polyps
Averages 6 months - very aggressive - usually already metastasized at presentation

12. What is the path of an indirect inguinal hernia
Inc smooth muscle relaxation - including lower esophageal sphincter
Goes through deep inguinal ring - external inguinal ring and into the scrotum
8-9 waves/min
Inspiratory arrest on deep palpation due to pain

13. what kind of fistula is associated with diverticulitis
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
8-9 waves/min
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Colovesical leading to pneumaturia

14. In an MI - which liver enzyme is elevated
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Glucose dependent insulinotropic peptide
AST
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. What is the risk with peutz jehgers
Cholesterol - 10-20% opaque due to calcifications
Inc risk of CRC and other visceral malignancies
CEA - CA-19-9
Colonic polyps

16. What are the structures of the femoral triangle and how are they organized
NAV = nerve artery vein - venous near the penis (NAVEL)
AST >ALT - ration is usually 1.5
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Older patients

17. 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
Small intestine
Hirschsprungs
Dysphagia (due to esophageal web) - glossitis - iron def anemia

18. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Cholesterol
VZV and influenza B treated with salicylates
Peutz jeghers
Ischemic colitis

19. Gallstones that reach the common channel at ampulla can block which two ducts
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Pancreatic and bile
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Phototherapy

20. Liver cell failure can lead to multisystem signs including
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Antrum - H.pylori - inc risk of MALT lymphoma
L2

21. What histological findings are present in the esophagus
Right and left hepatic duct
Nonkeritinized stratified sqamous epithelium
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

22. multiple juvenil polyps in GI tract - risk
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Complications of UC
Carcinoid syndrome

23. What intervention will intervention will relieve portal HTN
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Inspiratory arrest on deep palpation due to pain
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

24. What is the lumen of the pancreatic duct
Normal
Ampulla of vater
Hernia
Unconj - absent (acholuria) - inc

25. bilateral mets to ovaries with abundant mucus - signet ring cells
Juvenille polyps - no risk if single
Krukenbergs tumor
Smooth
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

26. What does a gastrinoma cause
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Common hepatic - splenic - left gastric - main blood supply for stomach
Low pressure proximal to LES
Gastrohepatic ligament

27. likely infectious form of malabsorption - responds to antibiotics
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Tropical sprue
Peptic ulcer disease
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

28. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

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29. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
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
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Chronic calcifying pancreatitis - inc risk of panreatic cancer

30. What is the HLA association and treatment for hemochromatosis
Falciform - ligamentum teres - fetal umbilical vein
Repeated phlebotomy - deferoxamine - HLA- A3
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Above

31. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Alcoholic hepatitis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Zenkers - halitosis - dysphagia and obstruction

32. Bile is critical for exrection of what substance
Cholesterol
Dec PGE2 leading to dec gastric mucosa protection
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Meconium ileus

33. What kind of muscle is in the middle 1/3 of esophagus
Cholesterol - 10-20% opaque due to calcifications
IBS at least 2 with recurrent abdominal pain
Striated and smooth
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

34. What is the presenting course for appendicity

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35. What cells make pepsin - What does it do - and what regulates it
Complications of crohns
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Decrease - weight gain

36. What is the most common esophageal cancer worldwide and in the US
Worldwide - SC - US - adeno
Pancreatic and bile
Normal
Can lead to hematemesis - found in EtOHics and bulimics

37. rare - often fatal childhood hepatoencephalopathy

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38. what percentage of colonic polyps are non - neoplastic
Punched out - clean margins - carcinoma =raised irregular margins
Necrotizing enterocolitis
Gardner's syndrome
90%

39. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Diverticulum
Inferior rectal nerve
Cirrhosis
Enterokinase/enteropeptidase from the duodenal mucosa

40. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Alpha1 antitrypsin def - codominant trait
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

41. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Via the superior pancreaticduodenal
The proximal small bowel
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Falciform - ligamentum teres - fetal umbilical vein

42. What are the extraintestinal manifestations of crohns
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
PAS- positive globules in liver -
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Corticosteroids - infliximab

43. What do the rugae of stomach look like in menetriers disease
Alfatoxin in peanuts
Sphincter of oddi
So hypertrophied they look like brain gyri
Positive urease test

44. What layer in the mucosa is responsible for absorption
Epithelium
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Uridine glucuronyl transferase

45. A protrusion of peritoneum through an opening - usually a site of weakness
Pertechnetate - study for uptake
Mitochondrial abnl - fatty liver - hypoglycemia - coma
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Hernia

46. What is diverticulosis
Begins starch digestion - inactivated by low pH upon reaching the stomach
The proximal small bowel
Zollinger Ellison - phenylalanine and tryptophan
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

47. How are all 3 monosaccharides transported to the blood
Cholesterol
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
CHF and inc risk of HCC
GLUT 2

48. What is the TX of physiologic neonatal jaundice
Hydrocele
Hyperplastic
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Phototherapy

49. What serum markers increase in cholecystitis with bile duct involvement
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Alk phos

50. If the abdominal aorta is blocked - How does blood get to the left colic artery
Cigarettes and chronic pancreatitis - not EtOH
Phenobarbital - inc liver enzyme synthesis
AST
Via the middle colic