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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 main components of bile
Erosive - disruption of mucosal barrier leading to inflammation
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Striated and smooth
Increase tumorigenesis

2. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
2ndary biliary cirrhosis
Falciform - ligamentum teres - fetal umbilical vein
Meckels
Failure of the processus vagainlis to close

3. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Failure of neural crest migration
IBS at least 2 with recurrent abdominal pain
Achalasia due to loss of myenteric plexus (auberach)
Erosive - disruption of mucosal barrier leading to inflammation

4. What complication can arise from indirect inguinal hernias
Femoral hernia
Hydrocele
Pertechnetate - study for uptake
Glucose dependent insulinotropic peptide

5. How does loss of NO secretion affect the esophagus and what results
Inc lower esphogeal tone leading to achalasia
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Pleomorphic adenoma
Inferior rectal nerve

6. To what substance is bilirubin conjugated and why
Reye's syndrome
Glucouronate - water soluble (direct)
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

7. What is the sphincter of the pancreatic duct
Failure of neural crest migration
Sphincter of oddi
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
The jejunum

8. When and why is stomach cancer termed linitis plastica
Cirrhosis
Osmotic
When diffusely infiltrative - thickened rigid appearance like a leather bottle
AST >ALT - ration is usually 1.5

9. inflammatino of gallbadder
Gallbladder
Redundant mesentary
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
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

10. Where is folate absorbed
The jejunum
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Superior rectal

11. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Can lead to hematemesis - found in EtOHics and bulimics
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Causes of gall stones

12. What converts inactive pepsinogen to pepsin
Neural muscarinic pathways
Worldwide - SC - US - adeno
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
H+

13. multiple juvenil polyps in GI tract - risk
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Hemosiderosis - hemochromatosis
Gamma glutamyl transferase GGT

14. What is the epi for CRC
Upregulated intracellular signal transduction
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Squamous - upper 1/3 - adeno - lower 1/3
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

15. What does loss of APC cause
T12
Early childhood - neuro sx and malabsorption
Decreased intercellular adhesion and increased proliferation
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

16. What are the two molecular pathways that lead to CRC
Skip lesions =crohns - colon = UC
Poor anastamoses
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

17. What causes nutmeg liver
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Backup of blood into the liver - RHF - budd chiari
Epigastric abdominal pain radiating to back - anorexia - nausea

18. FAP + malignant CNS tumor
Turcot
L/R renal artery around L1
Hirschsprungs
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

19. What pancreatic proteases are secreted as zymogens
Stercobilin
Trypsin - chymotrypsin - elastase - carboxypeptidases
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
IBS at least 2 with recurrent abdominal pain

20. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Alk pho
ALT>AST
Ischemic colitis
Hypercoaguability - polycythemia vera - pregnancy - HCC

21. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Begins starch digestion - inactivated by low pH upon reaching the stomach
Budd chiari syndrome
Inc lower esphogeal tone leading to achalasia

22. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
Increase tumorigenesis
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
Cystic dilation of the viteline duct

23. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Internal thoracic to superior epigastric to inferior epigastric
Hirschsprungs
Uridine glucuronyl transferase
Krukenbergs tumor

24. What histological findings are present in the stomach
Gastric glands
External spermatic fascia only
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Fe2+ in the duod

25. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Portal HTN
Primarly through ECL leading to histamine release
Positive urease test
Peutz jeghers

26. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Tropical sprue
Angiodysplasia
Squamous - upper 1/3 - adeno - lower 1/3

27. What are the borders of Hesselbach's triangle
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Upregulated intracellular signal transduction
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Averages 6 months - very aggressive - usually already metastasized at presentation

28. Gq and inc cAMP both work to do what in parietal cells
Lipase - phospholipase A - colipase
...
Stimulate the H/K ATPase
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

29. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Glucouronate - water soluble (direct)
Lipase - phospholipase A - colipase
Enterokinase/enteropeptidase from the duodenal mucosa
Zenkers - halitosis - dysphagia and obstruction

30. What intervention will intervention will relieve portal HTN
Crohns = noncaseating granulomas - UC = crypt abscesses
Alk pho
Brush border of intestine - produce monosaccharides from oligo and di
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

31. What reaction does salivary amylase catalyze
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Neural muscarinic pathways

32. What are the results of hemochromatosis
CHF and inc risk of HCC
Gilbert's
Zenkers - halitosis - dysphagia and obstruction
T cell lymphoma

33. In what clinical scenarior do you see portosystemic anastomoses
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Portal HTN
Meckels

34. What is the prognosis of adenocarcinoma
Gallbladder
Phototherapy
Primarly through ECL leading to histamine release
Averages 6 months - very aggressive - usually already metastasized at presentation

35. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
ALT>AST
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Poor anastamoses

36. What structures feed into the common bile duct
Cystic duct and common hepatic duct
Brunners
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

37. Esophagitis can result From which 3 infectious agents - or chemical ingestion
HSV-1 - CMV - Candida
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Gut bacteria
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

38. What are the foregut structures and what supplies their blood and PANS innvervation
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Duodenum - 2nd - 3rd and 4th parts

39. What does the splenorenal ligament connect - and What does it contain
Failure of neural crest migration
Spleen to posterior abdominal wall - splenic artery and vein
In the ileum with bile acids - requires IF
Begins starch digestion - inactivated by low pH upon reaching the stomach

40. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Zollinger Ellison - phenylalanine and tryptophan
Terminal ileum and colon
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

41. Gallstones that reach the common channel at ampulla can block which two ducts
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Pancreatic and bile
12 waves/min
Causes of gall stones

42. What skin condition is associated with celiac sprue
Zollinger Ellison - phenylalanine and tryptophan
Failure of the processus vagainlis to close
Dermatitis herpetiformis
Lateral to the inferior epigastric artery

43. in carcinoid tumors - What is seen on EM
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Osmotic
Dense core bodies
Jewish and African American men

44. Which kind of hemorrhoids are painful and why
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Lye ingestion and acid reflux
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

45. What other condition can lead to acute gastritis - think renal
Appendicitis
Inc - weight loss
Uremia
The entire

46. What are the signs and symptoms of budd chiari
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Oligosaccharide digestion
Warthins' tumor

47. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Unconj - absent (acholuria) - inc
Stimulate intestinal persistalsis
Bleeding - penetration into pancreas - perforation - obstruction
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

48. What is the arterial supply and venous drainage below pectinate line
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

49. What arteries exit just below the SMA
No
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Inc - weight loss
L/R renal artery around L1

50. How does abetalipoproteinemia lead to malabsorption
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Esophageal cancer
T12