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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 serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Spleen to posterior abdominal wall - splenic artery and vein
Alk pho
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Redundant mesentary

2. What portion of the bowel does sprue effect
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
IBS at least 2 with recurrent abdominal pain
IgA secreting plasma cells - ultimately reside in the lamina proporia
The proximal small bowel

3. What is the main symptom if a VIPoma
Backup of blood into the liver - RHF - budd chiari
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Peptic ulcer disease
Lamina propora and submucosa

4. How many layers of spermatic fascia are covers an indirect inguinal hernia
AST>ALT
Antrum - H.pylori - inc risk of MALT lymphoma
All 3
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

5. What do you use to diagnose meckels
Pleomorphic adenoma
Pertechnetate - study for uptake
Hypercoaguability - polycythemia vera - pregnancy - HCC
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

6. What are the main components of bile
Normal
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
AR
Hemosiderosis - hemochromatosis

7. At what spinal level does the SMA exit
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
L1
Primary sclerosing cholangitis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

8. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Internal thoracic to superior epigastric to inferior epigastric
Gastric glands
All 3 gut layers outpouch as in Meckels
T12

9. What are causes of extrahepatic biliary obstruction
PAS- positive globules in liver -
Centrilobular leading to congestive liver disease
L3
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

10. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Hepatic steatosis
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Pleuroperitoneal

11. Which area of the hindgut is a watershed area
Redness and tenderness on palpation of extremities
Splenic flexure
Old men - arthralgias - cardiac and neuro sx
IBS at least 2 with recurrent abdominal pain

12. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Colonic polyps
External (superficial) ring only
L2

13. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Peyers patches
Peutz jeghers
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

14. In alchoholic hepatitis which liver enzyme is higher
Achalasia due to loss of myenteric plexus (auberach)
The submucosal nerve plexus - meissner's
AST>ALT
Jewish and African American men

15. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
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
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Begins starch digestion - inactivated by low pH upon reaching the stomach
Necrotizing enterocolitis

16. What are the results of hemochromatosis
Centrilobular leading to congestive liver disease
90%
Myenteric nerve plexus - aurbach
CHF and inc risk of HCC

17. Which IBD is autoimmune and which may be a disordered response to bacteria
CCK8 receptor - Gq inc IP3/Ca
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Positive
Warthins' tumor

18. What cells secrete bicarb - What does it do - and what regulates it
Osmotic
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Stimulate intestinal persistalsis
Virchow's node

19. Where is folate absorbed
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
The jejunum
Zollinger Ellison - phenylalanine and tryptophan
Neutralizes gastric acid allowing pancreatic enzymes to fxn

20. Diaphragmatic hernias occur in infants because of defective development of which membrane
The submucosal nerve plexus - meissner's
Common hepatic - splenic - left gastric - main blood supply for stomach
Phenobarbital - inc liver enzyme synthesis
Pleuroperitoneal

21. What are the layers of the gut wall from inside out
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
Myenteric nerve plexus - aurbach
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Mucosa - submucosa - muscularis externa - serosa/adventitia

22. What are the four Fs of gallstones
Female - fat - fertile - forty
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Small intestine

23. At what level of the spine does the IM exit the aorta
Colovesical leading to pneumaturia
L3
Alpha1 antitrypsin def - codominant trait
Penicillinamine - AR inheritance

24. Where is IgA shuttled
HPNCC
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
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

25. Where are carcinoid tumors most commonly malignant
Small intestine
Warthins' tumor
Antrum - H.pylori - inc risk of MALT lymphoma
Nonkeritinized stratified sqamous epithelium

26. multiple juvenil polyps in GI tract - risk
Glucouronate - water soluble (direct)
Juvenile polyposis syndrome - inc risk of adenocarcinoma
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
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

27. involvement of left supraclavicular node by mets from stomach

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28. What are the two molecular pathways that lead to CRC
Obstruction of the common bile duct
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Achalasia due to loss of myenteric plexus (auberach)
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

29. conjugated hyperbilirubinemia due to defective liver excretion
GLUT 2
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Esophageal carcinoma
Dubin johnson

30. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Ischemic colitis
Uridine glucuronyl transferase
All 3 gut layers outpouch as in Meckels

31. How do NSAIDs cause acute gastritis
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Dec PGE2 leading to dec gastric mucosa protection
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

32. What source of salivary secretion is the most serous and What is the most mucinous
Serous on the sides parotids - mucinous in the middle sublingual
Corticosteroids - infliximab
Complications of UC
Glucose dependent insulinotropic peptide

33. Is there any structural abnl with IBS - What is the course of disease and presentation
Alk phos
Gastrohepatic ligament
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Parietal cells in the stomach - B12 binding protein

34. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Failure of neural crest migration
L4
MSI (15%) and APC/beta catenin chromosomal instability (85%)

35. What pancreatic proteases are secreted as zymogens
Cystic dilation of the viteline duct
Trypsin - chymotrypsin - elastase - carboxypeptidases
Lubricate food (glycoprotiens)
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

36. What do mucins do?
Esophageal carcinoma
Lubricate food (glycoprotiens)
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Hydrocele

37. absent UDPGT - presents early in life - early mortality
Corticosteroids - infliximab
Meconium ileus
Bleeding - penetration into pancreas - perforation - obstruction
Crigler - najjar type 1

38. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Crohns = noncaseating granulomas - UC = crypt abscesses
Zenkers - halitosis - dysphagia and obstruction
Common hepatic - splenic - left gastric - main blood supply for stomach
Elevated amylase - and lipase

39. What does a gastrinoma cause
Amylase
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
All 3 gut layers outpouch as in Meckels
Bleeding - penetration into pancreas - perforation - obstruction

40. is meckels a true diverticulum and how common is it
Elevated amylase - and lipase
AR
Normal
True and most common congenital anomoly of GI tract

41. What do tumors that arise in the head of the pancreas cause
Acute pancreatitis
In the ileum with bile acids - requires IF
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Obstruction of the common bile duct

42. most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Spleen to posterior abdominal wall - splenic artery and vein
No - chronic - can present with diarrhea or constipation or alternation - treat sx
HSV-1 - CMV - Candida

43. What serum markers increase in cholecystitis with bile duct involvement
3 waves/min
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Alk phos
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

44. bilateral mets to ovaries with abundant mucus - signet ring cells
Zollinger Ellison - phenylalanine and tryptophan
Krukenbergs tumor
True and most common congenital anomoly of GI tract
Hyperpigmented mouth - lips - hands - genitalia

45. What is the ddx associated with appendicitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
So hypertrophied they look like brain gyri
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
MSI (15%) and APC/beta catenin chromosomal instability (85%)

46. Where and How is iron absorbed
Internal thoracic to superior epigastric to inferior epigastric
Mallory bodies
Black - rotors syndrome
Fe2+ in the duod

47. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Dec PGE2 leading to dec gastric mucosa protection
Intussusception
Colovesical leading to pneumaturia
Hemolytic anemia

48. What are the treatment options for uclerative colitis
Gallbladder
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Hyperpigmented mouth - lips - hands - genitalia

49. Liver cell failure can lead to multisystem signs including
Closer to isotonic because of less time to reabsorb NaCl
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
AST
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

50. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Cholesterol - 10-20% opaque due to calcifications
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
In the mucus that covers the gastric epithelium
Fasting and stress