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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 color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
H+
Sister mary joseph nodule
Black - rotors syndrome
...

2. What kind of pathways do CCK act on to cause pancreatic secretion
Internal thoracic to superior epigastric to inferior epigastric
Ischemic colitis
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Neural muscarinic pathways

3. What is the frequency of basal electric rhythm of the ilieum
Epigastric abdominal pain radiating to back - anorexia - nausea
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
US and cholecystectomy
8-9 waves/min

4. bilateral mets to ovaries with abundant mucus - signet ring cells
Sphincter of oddi
Lactase is located at the tips of intestinal villi
Lipase - phospholipase A - colipase
Krukenbergs tumor

5. How does hirschsprung present and appear on imaging
Ampulla of vater
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Downs
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

6. What kind of lesions are characteristic of duodenal PUD vs cancer
The submucosal nerve plexus - meissner's
Cystic duct and common hepatic duct
Punched out - clean margins - carcinoma =raised irregular margins
3 waves/min

7. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Carcinoid syndrome
Jewish and African American men
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

8. What are the main components of bile
Pleuroperitoneal
VZV and influenza B treated with salicylates
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

9. How do NSAIDs cause acute gastritis
Dec PGE2 leading to dec gastric mucosa protection
Alcoholic hepatitis
Jaundice - fever - RUQ
Small intestine

10. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Dubin johnson
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
AST >ALT - ration is usually 1.5
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

11. What are the barium swallow findings of achalasia
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Dilated esophagus with an area of distal stenosis - birds beak
Chagas disease
Begins starch digestion - inactivated by low pH upon reaching the stomach

12. What is the risk with peutz jehgers
AST
Inc risk of CRC and other visceral malignancies
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
PAS- positive globules in liver -

13. What structures feed into the common bile duct
Zenkers - halitosis - dysphagia and obstruction
Cystic duct and common hepatic duct
Unconjugated - water insoluble
Spleen to posterior abdominal wall - splenic artery and vein

14. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
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
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Crohns = noncaseating granulomas - UC = crypt abscesses
Cirrhosis

15. With internal hemorrhoids Where is the anastomoses and Where is it
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Zollinger Ellison - phenylalanine and tryptophan
Superior rectal and middle and inferior rectal - rectum

16. What are the histological findings in the duodenum

17. What is the path of an indirect inguinal hernia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Epigastric abdominal pain radiating to back - anorexia - nausea
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Lateral to the inferior epigastric artery

18. What is the triad of Plummer - Vinson syndrome
90%
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Stercobilin
Lack or have an attenuated muscularis externa - often in the sigmoid colon

19. involvement of left supraclavicular node by mets from stomach

20. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Sphincter of oddi
Ischemic colitis
Duodenal atresia - Downs
IBS at least 2 with recurrent abdominal pain

21. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Carcinoid syndrome
Colonic polyps
Phenobarbital - inc liver enzyme synthesis

22. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Can lead to hematemesis - found in EtOHics and bulimics
Terminal ileum and colon
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

23. What are the hindgut structures and what supplies their blood and PANS innvervation
Obstruction of the common bile duct
Virchow's node
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Unconj - absent (acholuria) - inc

24. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Squamous - upper 1/3 - adeno - lower 1/3
Mallory bodies
Alcoholic cirrhosis
Left gastric vein and esophogeal vein - esophagus

25. What kind of diarrhea is produced from a disaccharide def
With albumin
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Osmotic

26. Where is there sclerosis in alcoholic cirrohosis
AST>ALT
Older patients
Around the central vein (zone III)
Superior rectal and middle and inferior rectal - rectum

27. What are the foregut structures and what supplies their blood and PANS innvervation
...
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Above
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

28. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Lye ingestion and acid reflux
Stercobilin
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

29. Where are tumors commonly in pancreatic adenocarcinoma
Zollinger Ellison - phenylalanine and tryptophan
Pancreatic head causing obstructive jaundice
The gastroduodenal
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

30. What does K- ras mutation cause
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Hyperpigmented mouth - lips - hands - genitalia
Upregulated intracellular signal transduction
Diverticulitis in elderly - ectopic pregs use hCG to rule out

31. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
No
Necrotizing enterocolitis

32. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
AST >ALT - ration is usually 1.5
Crohns = noncaseating granulomas - UC = crypt abscesses
Volvulus
Budd chiari syndrome

33. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
90%
Myenteric nerve plexus - aurbach
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

34. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Lack or have an attenuated muscularis externa - often in the sigmoid colon
CEA - CA-19-9
Conj - inc - dec
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

35. What commonly leads to appendicity in kids vs adults
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Pertechnetate - study for uptake
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

36. What are the complications of Meckels
Redness and tenderness on palpation of extremities
Dense core bodies
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Trypsin - chymotrypsin - elastase - carboxypeptidases

37. multiple juvenil polyps in GI tract - risk
Barrett's esophagus
Source - parasympathetic ganglion in sphincters - gallbladder - small intestine - action - inc intestinal water and electrolyte secretion - inc relaxation of intestinal smooth muscle and sphincters - regulation - inc by distention and vagal stimulati
Chagas disease
Juvenile polyposis syndrome - inc risk of adenocarcinoma

38. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Lubricate food (glycoprotiens)
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
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

39. What structures feed into the cystic duct
Gamma glutamyl transferase GGT
Gallbladder
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Gut bacteria

40. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Mallory bodies
Ischemic colitis
Cimetidine

41. When and How does Abetalipoproteinemia present
Dilated esophagus with an area of distal stenosis - birds beak
Early childhood - neuro sx and malabsorption
Female - fat - fertile - forty
Lye ingestion and acid reflux

42. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Diarrhea - steatorrhea - weight loss - weakness
Alpha amylase

43. What are the complications of chronic pancreatitis
Lactase is located at the tips of intestinal villi
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Diverticulum

44. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Normal
Duodenal atresia - Downs
Appendicitis
Positive

45. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Elevated amylase - and lipase
Nonkeritinized stratified sqamous epithelium
Hydrocele

46. What are motilin receptor agonists used for clinically
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
External spermatic fascia only
Stimulate intestinal persistalsis

47. When do you see hypertrophy of brunners glands
Lateral to the inferior epigastric artery
Turcot
Peptic ulcer disease
Pyoderma gangrenosum - primary sclerosing cholangitis

48. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Redness and tenderness on palpation of extremities
With albumin
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Volvulus

49. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Punched out - clean margins - carcinoma =raised irregular margins
Jewish and African American men

50. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Averages 6 months - very aggressive - usually already metastasized at presentation
Inc - weight loss
Diverticulum