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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 borders of Hesselbach's triangle
Female - fat - fertile - forty
Glucouronate - water soluble (direct)
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Oral glucose

2. What does autoimmune destruction of parietal cells lead to...
Chronic gastritis and pernicious anemia
Hyperplastic
Duodenal atresia - Downs
Via the superior pancreaticduodenal

3. What are the four Fs of gallstones
Omeprazole
Female - fat - fertile - forty
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

4. Where is there sclerosis in alcoholic cirrohosis
Around the central vein (zone III)
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
US and cholecystectomy
Lack or have an attenuated muscularis externa - often in the sigmoid colon

5. Malabsorption syndromes have what common clinical presentation
Gut bacteria
Diarrhea - steatorrhea - weight loss - weakness
Redness and tenderness on palpation of extremities
Achalasia due to loss of myenteric plexus (auberach)

6. What are the midgut structures and what supplies their blood and PANS innervation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Gardner's syndrome
Worldwide - SC - US - adeno
Reye's syndrome

7. What layer of fascia covers a direct inguinal hernia
Neural muscarinic pathways
Alfatoxin in peanuts
External spermatic fascia only
Alcoholic cirrhosis

8. At what level of the spine does the IM exit the aorta
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 cancer
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
L3

9. Liver cell failure can lead to multisystem signs including
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Erosive - disruption of mucosal barrier leading to inflammation
Antrum - H.pylori - inc risk of MALT lymphoma

10. What portion of the bowel does sprue effect
Fe2+ in the duod
External (superficial) ring only
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
The proximal small bowel

11. secretin - source - action - regulation
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
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
Hyperplastic
Mucoepidermoid carcinoma

12. What is the presenting course for appendicity

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13. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
L/R renal artery around L1
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Hydrocele

14. What are the main components of bile
Crohns = maybe - UC= always
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Bleeding - penetration into pancreas - perforation - obstruction
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

15. What test and result confirms H pylori infxn
Peptic ulcer disease
Colonic polyps
Positive urease test
Esophageal cancer

16. What complication can arise from indirect inguinal hernias
Spleen to posterior abdominal wall - splenic artery and vein
Can lead to hematemesis - found in EtOHics and bulimics
Hydrocele
Dilated esophagus with an area of distal stenosis - birds beak

17. What structures feed into the common bile duct
Cystic duct and common hepatic duct
Peutz jeghers
Inc - weight loss
The proximal small bowel

18. What causes nutmeg liver
Epithelium
Backup of blood into the liver - RHF - budd chiari
Increase tumorigenesis
Virchow's node

19. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Striated
Volvulus
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Alcoholic cirrhosis

20. most common malignant salivary gland tumor
Enterokinase/enteropeptidase from the duodenal mucosa
Redness and tenderness on palpation of extremities
L3
Mucoepidermoid carcinoma

21. What are the results of hemochromatosis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Urobilin
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
CHF and inc risk of HCC

22. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
EtOH
Uremia
Alcoholic hepatitis
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

23. What happens to the short gastics if the splenic artery is blocked
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Diarrhea - steatorrhea - weight loss - weakness
Alpha amylase
Poor anastamoses

24. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

25. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
So hypertrophied they look like brain gyri
Urobilin
Decreased intercellular adhesion and increased proliferation
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

26. Between what structures do strong anastamoses exist
Small intestine
Positive urease test
Boerhaave's Syndrome - Been heaving syndrome
Left and right gastroepiploics - left and right gastrics

27. multiple juvenil polyps in GI tract - risk
Alfatoxin in peanuts
Warthins' tumor
Hirschsprungs
Juvenile polyposis syndrome - inc risk of adenocarcinoma

28. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
Conj/unconj - inc - nl to dec
Centrilobular leading to congestive liver disease
Acute pancreatitis

29. What is the path of an indirect inguinal hernia
Parietal cells in the stomach - B12 binding protein
Hemosiderosis - hemochromatosis
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Hernia

30. Who gets Whipple disease and How do they present
Mallory bodies
Alcoholic hepatitis
Old men - arthralgias - cardiac and neuro sx
Inc conj bilirubin - inc cholesterol - inc alk phos

31. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Below
Meconium ileus
Gamma glutamyl transferase GGT
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

32. What nerve innervates the external hemorrhoids
Warthins' tumor
Inferior rectal nerve
Heme metabolism
Striated

33. What are the longterm sequelae of nutmeg liver
Nonkeritinized stratified sqamous epithelium
Failure of neural crest migration
Centrilobular congestion and necrosis - cardiac cirrhosis
Dysphagia (due to esophageal web) - glossitis - iron def anemia

34. What makes a true diverticula
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
All 3 gut layers outpouch as in Meckels

35. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Ischemic colitis
2ndary biliary cirrhosis
Left gastric vein and esophogeal vein - esophagus
PAS- positive globules in liver -

36. Why does indirect inguinal hernia happen in infacnts
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Virchow's node
Pertechnetate - study for uptake
Failure of the processus vagainlis to close

37. HCC is associated with what other conditions
Chagas disease
Glucose dependent insulinotropic peptide
L/R renal artery around L1
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

38. concentric onion skin bile duct fibrosis
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Normal
Falciform - ligamentum teres - fetal umbilical vein
Primary sclerosing cholangitis

39. rare - often fatal childhood hepatoencephalopathy

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40. At what spinal level does the SMA exit
So hypertrophied they look like brain gyri
Right and left hepatic duct
L1
External spermatic fascia only

41. What is the lumen of the pancreatic duct
Complications of UC
Ampulla of vater
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
Obstruction of the common bile duct

42. What is the characteristic histo finding in alcoholic hepatitis
Mallory bodies
Failure of neural crest migration
Positive
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

43. What do you use to diagnose meckels
Pertechnetate - study for uptake
PAS- positive globules in liver -
Redundant mesentary
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

44. What is the HLA association and treatment for hemochromatosis
Lye ingestion and acid reflux
Repeated phlebotomy - deferoxamine - HLA- A3
Zollinger ellison - brunners glands
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

45. What is the clinical presentation of acute pancreatitis
Epigastric abdominal pain radiating to back - anorexia - nausea
Achalasia due to loss of myenteric plexus (auberach)
Punched out - clean margins - carcinoma =raised irregular margins
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

46. What is the rule of 2s for meckels
Lubricate food (glycoprotiens)
Ceruplasmin
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

47. What is pancreatic adenocarcinoma associated with
The gastroduodenal
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Hyperplastic
Cigarettes and chronic pancreatitis - not EtOH

48. What are motilin receptor agonists used for clinically
Intussusception
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Stimulate intestinal persistalsis
Celiac sprue

49. What are the signs and symptoms of budd chiari
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Hirschsprungs
Inguninal ligament - sartorius muscle - adductor longus
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

50. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Crohns = transmural (cobblestone mucosa - creeping fat - string sign - linear ulcers fissures - fistulas) UC = mucosal and submucosal (friable mucosal pseudopolyps with freely hanging mesentary - loss of haustra - lead pipe appearance on imaging
L2
Cigarettes and chronic pancreatitis - not EtOH