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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. somatostatin - source - action - regulation
Terminal ileum and colon
Colonic polyps
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
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

2. What transforms conjugated bilirubin to urobilinogen
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
CCK8 receptor - Gq inc IP3/Ca
Gut bacteria
H pylori (almost 100%)

3. What portion of the bowel does sprue effect
Gallbladder
The proximal small bowel
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Hernia

4. Where does copper accumulate in Wilsons and What are ABCD
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Stercobilin
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Inguninal ligament - sartorius muscle - adductor longus

5. List the clinical findings of HCC
Lactase is located at the tips of intestinal villi
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Left and right gastroepiploics - left and right gastrics
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

6. In PUD - with gastric ulcers - does pain inc or dec with meals?
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
GERD - may also present with nocturnal cough and dyspnea
Inc - weight loss
CCK8 receptor - Gq inc IP3/Ca

7. What is the sphincter of the pancreatic duct
Heme metabolism
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Sphincter of oddi
With albumin

8. How does abetalipoproteinemia lead to malabsorption
US and cholecystectomy
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Duodenum - 2nd - 3rd and 4th parts

9. 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
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Brush border of intestine - produce monosaccharides from oligo and di

10. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Internal thoracic to superior epigastric to inferior epigastric
ALT>AST
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
When diffusely infiltrative - thickened rigid appearance like a leather bottle

11. What converts inactive pepsinogen to pepsin
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Hepatic steatosis
H+

12. What enzyme is necessary to create conjugated bilirubin
Uridine glucuronyl transferase
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Nonkeritinized stratified sqamous epithelium

13. How does hirschsprung present and appear on imaging
Peyers patches
Striated and smooth
Inferior rectal nerve
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

14. In what scenarios do pts with gilberts have inc bili
Zenkers - halitosis - dysphagia and obstruction
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Fasting and stress
AST

15. What nerve innervates the external hemorrhoids
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Averages 6 months - very aggressive - usually already metastasized at presentation
AST
Inferior rectal nerve

16. What structure is Not contained in the femoral sheath
HPNCC
Where hindgut meets ectoderm
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Chagas disease

17. If trypsin activates more trypsinogen - what kind of feedback loop is established
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Lateral
Ampulla of vater
Positive

18. Cholecytsokinin - source - action - regulation
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Superior rectal
Myenteric nerve plexus - aurbach
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

19. What can fistula between the gallbladder and small intestine create and how can you tell
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
All 3
Downs

20. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
Chronic gastritis and pernicious anemia
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
CEA - CA-19-9

21. What is the mechanism for reyes syndrome
FAP
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Budd chiari syndrome
H pylori (almost 100%)

22. What layer in the mucosa is repsonsible for motility
Chagas disease
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Muscularis mucosae

23. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
The entire
Carcinoid syndrome
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Uremia

24. How is bilirubin carried in the blood
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
With albumin
Meconium ileus
Closer to isotonic because of less time to reabsorb NaCl

25. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
The jejunum
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Gardner's syndrome

26. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
Gut bacteria
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

27. What causes hirschsprungs
Failure of neural crest migration
H pylori (almost 100%)
Lateral to the inferior epigastric artery
Left and right gastroepiploics - left and right gastrics

28. What are the four Fs of gallstones
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Osmotic
Begins starch digestion - inactivated by low pH upon reaching the stomach
Female - fat - fertile - forty

29. What are the labs in acute pancreatitis
Failure of the processus vagainlis to close
Via the middle colic
Virchow's node
Elevated amylase - and lipase

30. Why does carcinoid syndrome not occur if tumor is confined to GI system
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Zollinger Ellison - phenylalanine and tryptophan
Liver metabolizes 5HT
Glucouronate - water soluble (direct)

31. why infxn is implicated in duodenal PUD
M3 - Gq - inc IP3/Ca
The entire
H pylori (almost 100%)
Zollinger ellison - brunners glands

32. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Lipase
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Inspiratory arrest on deep palpation due to pain

33. What is the cause of Barrett's and the assocaited complications
Achalasia due to loss of myenteric plexus (auberach)
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Conj - inc - dec
Peyers patches

34. What is the HLA association and treatment for hemochromatosis
Superior rectal
Repeated phlebotomy - deferoxamine - HLA- A3
90%
Failure of neural crest migration

35. What gives stool its characteristic color
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Stercobilin
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Gallbladder

36. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Alcoholic cirrhosis
Hypotonic because of more time to reabsorb NaCl
Esophageal carcinoma

37. Where is folate absorbed
Cigarettes and chronic pancreatitis - not EtOH
The jejunum
Left gastric vein and esophogeal vein - esophagus
Falciform - ligamentum teres - fetal umbilical vein

38. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Brush border of intestine - produce monosaccharides from oligo and di
Jaundice - fever - RUQ
Inc conj bilirubin - inc cholesterol - inc alk phos
HPNCC

39. What infection causes Whipple disease and What can you see on LM
External spermatic fascia only
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Diarrhea - steatorrhea - weight loss - weakness
Diverticulitis in elderly - ectopic pregs use hCG to rule out

40. Transmural esophageal rupture due to violent retching

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41. What are the treatment options for uclerative colitis
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Inferior rectal nerve
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Parietal cells in the stomach - B12 binding protein

42. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alk phos
VZV and influenza B treated with salicylates
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Alcoholic hepatitis

43. signet ring cells - acanthosis nigracans - dz - character/association - spread
VZV and influenza B treated with salicylates
Lye ingestion and acid reflux
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

44. Which area of the hindgut is a watershed area
Failure of the processus vagainlis to close
Splenic flexure
Esophageal carcinoma
Pancreatic and bile

45. How is salivary secretion stimulated
Acute pancreatitis
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Colonic polyps
Crohns = noncaseating granulomas - UC = crypt abscesses

46. What is the presentation of pancreatic adenocarcinoma
Via the superior pancreaticduodenal
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Zollinger ellison - brunners glands
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

47. People of what decent are associated with celiac sprue and what findings/antibodies are present
Backup of blood into the liver - RHF - budd chiari
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Stimulate the H/K ATPase

48. Acute gastritis is caused By what process
Acute pancreatitis
Erosive - disruption of mucosal barrier leading to inflammation
Cystic duct and common hepatic duct
Copious diarrhea - non alpha - non beta cell pancreatic tumor

49. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Ceruplasmin
Meconium ileus
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Alpha1 antitrypsin def - codominant trait

50. What pancreatic proteases are secreted as zymogens
Trypsin - chymotrypsin - elastase - carboxypeptidases
Esophageal varices
Dysphagia (due to esophageal web) - glossitis - iron def anemia
EtOH