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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 the barium swallow findings of achalasia
HPNCC
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Colovesical leading to pneumaturia
Dilated esophagus with an area of distal stenosis - birds beak

2. inflammatino of gallbadder
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
HSV-1 - CMV - Candida
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

3. What is the clinical presentation of acute pancreatitis
Cholesterol
Crypts but not villi
Epigastric abdominal pain radiating to back - anorexia - nausea
Punched out - clean margins - carcinoma =raised irregular margins

4. How is bilirubin carried in the blood
Colovesical leading to pneumaturia
Fasting and stress
With albumin
L4

5. What is the rule of 2s for meckels
Alk phos
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Diarrhea - steatorrhea - weight loss - weakness
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

6. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
GERD - may also present with nocturnal cough and dyspnea
Older patients
Amylase
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

7. How do villi appear in disaccharidease def
Normal
Zollinger Ellison - phenylalanine and tryptophan
Crohns = maybe - UC= always
Epigastric abdominal pain radiating to back - anorexia - nausea

8. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Cirrhosis
Esophageal varices
Dubin johnson

9. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Lamina propria
Upregulated intracellular signal transduction
3 waves/min

10. What does bicarb do in the duodenum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Left gastric vein and esophogeal vein - esophagus
Hyperplastic
Diverticulitis in elderly - ectopic pregs use hCG to rule out

11. What are the two molecular pathways that lead to CRC
Unconjugated - water insoluble
Left and right gastroepiploics - left and right gastrics
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
MSI (15%) and APC/beta catenin chromosomal instability (85%)

12. What percentage of gall stones are cholesterol stones and What are the associations
Boerhaave's Syndrome - Been heaving syndrome
Acute pancreatitis
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

13. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Internal thoracic to superior epigastric to inferior epigastric
Redundant mesentary
Phenobarbital - inc liver enzyme synthesis
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

14. What artery passes around the duodenum
Turcot
Acute pancreatitis
Poor anastamoses
The gastroduodenal

15. Acute gastritis is caused By what process
Lipase
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Erosive - disruption of mucosal barrier leading to inflammation

16. What cells secrete bicarb - What does it do - and what regulates it
Lateral to the inferior epigastric artery
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

17. What is the lumen of the pancreatic duct
Ampulla of vater
Jaundice - fever - RUQ
Omeprazole
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

18. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Femoral hernia
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Crypts but not villi
Brunners

19. What is the characteristic histo finding in alcoholic hepatitis
Conj - inc - dec
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Mallory bodies
Lubricate food (glycoprotiens)

20. What are the histological findings in the jejunum
Gamma glutamyl transferase GGT
Hemolytic anemia
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Inc risk of CRC and other visceral malignancies

21. What skin condition is associated with celiac sprue
Paraumbilical and superficial and inferior epigastric - umbilicus
Can lead to hematemesis - found in EtOHics and bulimics
Crigler - najjar type 1
Dermatitis herpetiformis

22. How do you DX and TX gallstones
Gastric glands
US and cholecystectomy
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Older patients

23. secretin - source - action - regulation
Averages 6 months - very aggressive - usually already metastasized at presentation
Bleeding - penetration into pancreas - perforation - obstruction
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
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

24. What is the epi for CRC
Pleuroperitoneal
Complications of UC
Inferior rectal nerve
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

25. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
Neutralizes oral bacertial acids and maintains dental health
Intussusception
Superior rectal

26. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Cigarettes and chronic pancreatitis - not EtOH

27. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Phototherapy
Inc conj bilirubin - inc cholesterol - inc alk phos
Via the superior pancreaticduodenal
Urobilin

28. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Around the central vein (zone III)
Via the superior pancreaticduodenal
Poor anastamoses

29. What are the branches of the celiac trunk and What do they supply
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Common hepatic - splenic - left gastric - main blood supply for stomach
Pyoderma gangrenosum - primary sclerosing cholangitis
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

30. What does a low flow rate mean for saliva
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Hypotonic because of more time to reabsorb NaCl
Punched out - clean margins - carcinoma =raised irregular margins

31. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Lipase - phospholipase A - colipase
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
All 3 gut layers outpouch as in Meckels

32. What do you treat Wilsons disease with and What is the inheritance
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
HPNCC
External (superficial) ring only
Penicillinamine - AR inheritance

33. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Above
The entire
Stimulate the H/K ATPase
Muscularis mucosae

34. milk intolerance
Dissaccharidase def - most commonly lactase
Cimetidine
Oligosaccharide digestion
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

35. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Diverticulum
Angiodysplasia

36. In PUD with a duodenal ulcer does pain inc or dec with meals
Crigler - najjar type 1
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Decrease - weight gain
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

37. Where is the deep inguinal ring relative to the inferior epigastric vessels
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Lateral
ALT>AST
Intussusception

38. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
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
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Left gastric vein and esophogeal vein - esophagus
Pleomorphic adenoma

39. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Peptic ulcer disease
IgA secreting plasma cells - ultimately reside in the lamina proporia
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Peutz jeghers

40. What is the most common indication of emergent abdominal surgery in children
Hemosiderosis - hemochromatosis
Phenobarbital - inc liver enzyme synthesis
Appendicitis
Closer to isotonic because of less time to reabsorb NaCl

41. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
The gastroduodenal
Crypts but not villi
Virchow's node

42. What is one potential precipitating factor for intussusception
Unconj - absent (acholuria) - inc
HPNCC
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Glucouronate - water soluble (direct)

43. If the hemochromatosis is primary - What is the pattern of inheritance
AR
Reye's syndrome
Inc lower esphogeal tone leading to achalasia
Penicillinamine - AR inheritance

44. rare - often fatal childhood hepatoencephalopathy

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45. What are the complications of Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Black - rotors syndrome
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

46. In PUD - with gastric ulcers - does pain inc or dec with meals?
Decrease - weight gain
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Left gastric vein and esophogeal vein - esophagus
Inc - weight loss

47. What causes hirschsprungs
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Failure of neural crest migration
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

48. What receptors does gastrin bind on the parietal cell and What does it activate
CCK8 receptor - Gq inc IP3/Ca
Ceruplasmin
FAP
Spleen to posterior abdominal wall - splenic artery and vein

49. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Complications of crohns
Redness and tenderness on palpation of extremities
Dermatitis herpetiformis
Unconjugated - water insoluble

50. What portion of the bowel does sprue effect
M3 - Gq - inc IP3/Ca
Mitochondrial abnl - fatty liver - hypoglycemia - coma
The proximal small bowel
Cirrhosis