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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 retroperitoneal structure flanks both sides of the pancreas on CT
Peptic ulcer disease
Dermatitis herpetiformis
Duodenum - 2nd - 3rd and 4th parts
Via the superior pancreaticduodenal

2. Dysphagia in achalasia results from
Juvenille polyps - no risk if single
Pleuroperitoneal
Cimetidine
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

3. Where is the arterial supply from above the pectinate line - and What is the venous drainage
HSV-1 - CMV - Candida
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
IgA secreting plasma cells - ultimately reside in the lamina proporia
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

4. milk intolerance
Hemolytic anemia
Dissaccharidase def - most commonly lactase
Punched out - clean margins - carcinoma =raised irregular margins
Older patients

5. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Alcoholic hepatitis
M3 - Gq - inc IP3/Ca
Esophageal cancer
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

6. What is the mechanism for reyes syndrome
Crigler - najjar type 1
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Hyperpigmented mouth - lips - hands - genitalia

7. What causes hirschsprungs
Volvulus
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Decreased intercellular adhesion and increased proliferation
Failure of neural crest migration

8. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
L1
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Colonic polyps

9. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Hepatic steatosis
Volvulus
True and most common congenital anomoly of GI tract

10. What is the presenting course for appendicity

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11. What kind of lesions are characteristic of duodenal PUD vs cancer
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
Punched out - clean margins - carcinoma =raised irregular margins
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Lipase

12. What is the TX of physiologic neonatal jaundice
GLUT 2
Phototherapy
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Alpha amylase

13. If the abdominal aorta is blocked - How does blood get to the left colic artery
Gamma glutamyl transferase GGT
Via the middle colic
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Decrease - weight gain

14. What are the treatmet options for crohns
Short gastrics - left greater and lesser
Corticosteroids - infliximab
Via the superior pancreaticduodenal
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

15. What is the classic triad of hemochromatosis

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16. What is the other name for GIP (gastric inhibitory peptide)
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Nonkeritinized stratified sqamous epithelium
Esophageal cancer
Glucose dependent insulinotropic peptide

17. What skin condition is associated with celiac sprue
Brunners
L3
Dermatitis herpetiformis
Causes of gall stones

18. What do tumors that arise in the head of the pancreas cause
Obstruction of the common bile duct
AR
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Esophageal varices

19. What type of insults result in micronodular cirrhosis
Black - rotors syndrome
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Gastrohepatic ligament
Gastric glands

20. somatostatin - source - action - regulation
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
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
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Via the middle colic

21. Which viral infxns/treatments are associated with reyes syndrome
All 3 gut layers outpouch as in Meckels
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
VZV and influenza B treated with salicylates

22. What is the action of NO as a GI hormone
Zenkers - halitosis - dysphagia and obstruction
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Inc smooth muscle relaxation - including lower esophageal sphincter
Unconj - absent (acholuria) - inc

23. signet ring cells - acanthosis nigracans - dz - character/association - spread
The proximal small bowel
Skip lesions =crohns - colon = UC
The submucosal nerve plexus - meissner's
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

24. How does abetalipoproteinemia lead to malabsorption
Gamma glutamyl transferase GGT
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Hepatic steatosis
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

25. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Unconj - absent (acholuria) - inc

26. What is the frequency of basal electric rhythm of the ilieum
Duodenal atresia - Downs
Striated and smooth
8-9 waves/min
Myenteric nerve plexus - aurbach

27. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Upregulated intracellular signal transduction
IBS at least 2 with recurrent abdominal pain
Positive urease test
External (superficial) ring only

28. Gastrin - source - action - regulation
Pertechnetate - study for uptake
Tropical sprue
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
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

29. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
NAV = nerve artery vein - venous near the penis (NAVEL)
Pleomorphic adenoma
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Diarrhea - steatorrhea - weight loss - weakness

30. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Hirschsprungs
Can lead to hematemesis - found in EtOHics and bulimics
Black - rotors syndrome
Ceruplasmin

31. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Small intestine
Meconium ileus
Omeprazole
Chronic gastritis and pernicious anemia

32. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
The jejunum
Superior rectal and middle and inferior rectal - rectum
Esophageal cancer
Alk pho

33. Who is at risk for pancreatic adenocarcinoma
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Gastric glands
Jewish and African American men
Lateral to the inferior epigastric artery

34. To what substance is bilirubin conjugated and why
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Muscularis mucosae
Where hindgut meets ectoderm
Glucouronate - water soluble (direct)

35. What pancreatic enzymes are responsible for fat digestion
Pancreatic head causing obstructive jaundice
Redness and tenderness on palpation of extremities
Lipase - phospholipase A - colipase
Lateral

36. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Crohns = maybe - UC= always
Unconjugated - water insoluble

37. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Juvenille polyps - no risk if single
Oral glucose
Failure of the processus vagainlis to close
IgA secreting plasma cells - ultimately reside in the lamina proporia

38. inflammatino of gallbadder
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Lateral
...

39. GIP - source - action regulation
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
The entire
Colovesical leading to pneumaturia
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

40. most common malignant salivary gland tumor
Warthins' tumor
Mucoepidermoid carcinoma
Gastric glands
Oral glucose

41. What findings are associated with reyes
Decreased intercellular adhesion and increased proliferation
H+
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Trypsin - chymotrypsin - elastase - carboxypeptidases

42. bilateral mets to ovaries with abundant mucus - signet ring cells
Crigler - najjar type 1
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
L1
Krukenbergs tumor

43. Where are tumors commonly in pancreatic adenocarcinoma
Pancreatic head causing obstructive jaundice
Diverticulum
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Neutralizes gastric acid allowing pancreatic enzymes to fxn

44. What pancreatic proteases are secreted as zymogens
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Trypsin - chymotrypsin - elastase - carboxypeptidases
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
Lye ingestion and acid reflux

45. What does GET SMASHED stand for in acute pancreatitis
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Esophageal cancer

46. What are the complications of chronic pancreatitis
Gastrohepatic ligament
CEA - CA-19-9
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Cimetidine

47. what kind of fistula is associated with diverticulitis
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Colovesical leading to pneumaturia
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

48. is meckels a true diverticulum and how common is it
Around the central vein (zone III)
True and most common congenital anomoly of GI tract
CEA - CA-19-9
Hypercoaguability - polycythemia vera - pregnancy - HCC

49. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Superior rectal and middle and inferior rectal - rectum
Decrease - weight gain
Failure of the processus vagainlis to close
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

50. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Old men - arthralgias - cardiac and neuro sx