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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. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
Penicillinamine - AR inheritance
Duodenum - 2nd - 3rd and 4th parts
Via the middle colic

2. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Cystic duct and common hepatic duct
Alpha1 antitrypsin def - codominant trait
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Epithelium

3. What is the main symptom if a VIPoma
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Zollinger ellison - brunners glands
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

4. occlusion of IVC or hepatic veins
Adhesion
Hemolytic anemia
Budd chiari syndrome
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

5. What is the frequency of basal electric rhythm of the ilieum
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
8-9 waves/min
So hypertrophied they look like brain gyri
Lubricate food (glycoprotiens)

6. Where are tumors commonly in pancreatic adenocarcinoma
Ceruplasmin
Terminal ileum and colon
Pancreatic head causing obstructive jaundice
Conj/unconj - inc - nl to dec

7. What is the prognosis of adenocarcinoma
Appendicitis
Averages 6 months - very aggressive - usually already metastasized at presentation
HPNCC
Turcot

8. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

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9. What is the triad of Plummer - Vinson syndrome
Inc - weight loss
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Peutz jeghers
Normal

10. Which IBD is autoimmune and which may be a disordered response to bacteria
Hirschsprungs
Downs
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Upregulated intracellular signal transduction

11. What kind of pancreatitis is associated with EtOH and smoking
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Elevated amylase - and lipase
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Averages 6 months - very aggressive - usually already metastasized at presentation

12. Acute gastritis is caused By what process
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Gardner's syndrome
Chronic gastritis and pernicious anemia
Erosive - disruption of mucosal barrier leading to inflammation

13. At what spinal level does the SMA exit
Pleuroperitoneal
L1
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Osmotic

14. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Adhesion
Esophageal cancer
Common hepatic - splenic - left gastric - main blood supply for stomach
Increase tumorigenesis

15. How do villi appear in disaccharidease def
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
...
Normal
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

16. Who is at risk for pancreatic adenocarcinoma
Obstruction of the common bile duct
So hypertrophied they look like brain gyri
The jejunum
Jewish and African American men

17. What converts inactive pepsinogen to pepsin
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
H+
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

18. When and How does Abetalipoproteinemia present
Chagas disease
Appendicitis
Gut bacteria
Early childhood - neuro sx and malabsorption

19. Scleroderma is associated with what kind of esophageal dysmotility
Increase tumorigenesis
Low pressure proximal to LES
NAV = nerve artery vein - venous near the penis (NAVEL)
Tropical sprue

20. HCC is associated with what other conditions
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Enterokinase/enteropeptidase from the duodenal mucosa
Failure of neural crest migration
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

21. What are the two molecular pathways that lead to CRC
Goes through deep inguinal ring - external inguinal ring and into the scrotum
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Pertechnetate - study for uptake
Closer to isotonic because of less time to reabsorb NaCl

22. What does GET SMASHED stand for in acute pancreatitis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Dissaccharidase def - most commonly lactase
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Inspiratory arrest on deep palpation due to pain

23. When and why is stomach cancer termed linitis plastica
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Oral glucose
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

24. What are the extraintestinal manifestations of crohns
EtOH
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
In the mucus that covers the gastric epithelium
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

25. what percentage of colonic polyps are non - neoplastic
90%
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Celiac sprue
Inspiratory arrest on deep palpation due to pain

26. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Acute pancreatitis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Obstruction of the common bile duct

27. Where does copper accumulate in Wilsons and What are ABCD
External (superficial) ring only
Budd chiari syndrome
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

28. What causes primary biliary cirrhosis
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Hemosiderosis - hemochromatosis

29. Where is the deep inguinal ring relative to the inferior epigastric vessels
Below
Lateral
Conj - inc - dec
Chagas disease

30. What are causes of extrahepatic biliary obstruction
Complications of crohns
Esophageal carcinoma
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Short gastrics - left greater and lesser

31. What does histo show for alpha1 antitrypsin def
PAS- positive globules in liver -
T12
Colovesical leading to pneumaturia
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

32. What does high flow rate mean
The submucosal nerve plexus - meissner's
Splenic flexure
Closer to isotonic because of less time to reabsorb NaCl
Jewish and African American men

33. What is the frequency of basal electric rhythm in the duodenum
Phototherapy
The submucosal nerve plexus - meissner's
12 waves/min
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

34. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Jewish and African American men
Brunners

35. What are the extraintestinal manifestations of ulcerative colitis
Pyoderma gangrenosum - primary sclerosing cholangitis
Hirschsprungs
Enterokinase/enteropeptidase from the duodenal mucosa
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

36. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Budd chiari syndrome
Inguninal ligament - sartorius muscle - adductor longus
GLUT 2
Necrotizing enterocolitis

37. What causes nutmeg liver
Backup of blood into the liver - RHF - budd chiari
Below
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Internal thoracic to superior epigastric to inferior epigastric

38. What can hemochromatosis be secondary to...
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Alpha amylase
Closer to isotonic because of less time to reabsorb NaCl
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

39. What separates the right greater and lesser sacs
Boerhaave's Syndrome - Been heaving syndrome
Gallbladder
Lye ingestion and acid reflux
Gastrohepatic ligament

40. What structures feed into the cystic duct
Glucouronate - water soluble (direct)
Ischemic colitis
Gallbladder
T cell lymphoma

41. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
Hirschsprungs
The submucosal nerve plexus - meissner's

42. What are the treatment options for uclerative colitis
Pancreatic and bile
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Short gastrics - left greater and lesser
T12

43. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
Appendicitis
Lamina propria
Diverticulum

44. In what scenarios do pts with gilberts have inc bili
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Fasting and stress
Esophageal carcinoma
VZV and influenza B treated with salicylates

45. Abuse of what substance leads to acute gastritis
Right and left hepatic duct
Black - rotors syndrome
12 waves/min
EtOH

46. Through which aspect of the inguinal canal does a direct inguinal go
Repeated phlebotomy - deferoxamine - HLA- A3
Hemolytic anemia
External (superficial) ring only
In the mucus that covers the gastric epithelium

47. What infection causes Whipple disease and What can you see on LM
Closer to isotonic because of less time to reabsorb NaCl
Below
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

48. If the abdominal aorta is blocked - How does blood get to the left colic artery
Via the middle colic
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Failure of neural crest migration
Crohns = maybe - UC= always

49. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
Older patients
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Zenkers - halitosis - dysphagia and obstruction

50. What are the tumor markers for pancreatic adenocarcinoma
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Downs
CEA - CA-19-9
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly