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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. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Alcoholic cirrhosis
Can lead to hematemesis - found in EtOHics and bulimics
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Centrilobular leading to congestive liver disease

2. What is the triad of Plummer - Vinson syndrome
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Budd chiari syndrome
Dysphagia (due to esophageal web) - glossitis - iron def anemia

3. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Portal HTN
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Obstruction of the common bile duct
Esophageal varices

4. Dysphagia in achalasia results from
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Gallbladder
Alcoholic cirrhosis
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

5. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Falciform - ligamentum teres - fetal umbilical vein
Stimulate the H/K ATPase
8-9 waves/min
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

6. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
MSI (15%) and APC/beta catenin chromosomal instability (85%)
NAV = nerve artery vein - venous near the penis (NAVEL)
Zollinger ellison - brunners glands

7. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
So hypertrophied they look like brain gyri
Small intestine
Epithelium

8. What are the borders of the femoral triangle
Inguninal ligament - sartorius muscle - adductor longus
Via the middle colic
No
Intussusception

9. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Pyoderma gangrenosum - primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Dense core bodies

10. What intervention will intervention will relieve portal HTN
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Hernia
Inc risk of CRC and other visceral malignancies

11. in budd chiari syndrome - Where is the congestion and necrosis
Volvulus
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Lipase - phospholipase A - colipase
Centrilobular leading to congestive liver disease

12. Where are tumors commonly in pancreatic adenocarcinoma
Below
Hyperpigmented mouth - lips - hands - genitalia
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Pancreatic head causing obstructive jaundice

13. What cell produces IF and What does it do
Parietal cells in the stomach - B12 binding protein
GLUT 2
L4
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

14. What factors increase risk of malignancy of adenomatous polyps
Neural muscarinic pathways
Older patients
With albumin
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

15. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Spleen to posterior abdominal wall - splenic artery and vein
Unconj - absent (acholuria) - inc
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

16. Autodigestion of pancreas by pancreatic enzymes
Acute pancreatitis
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Begins starch digestion - inactivated by low pH upon reaching the stomach
Fasting and stress

17. At what level do the testicular/ovarian arteries exit the aorta
L2
Smooth
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Carcinoid syndrome

18. Which IBD is autoimmune and which may be a disordered response to bacteria
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Conj - inc - dec
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Corticosteroids - infliximab

19. What is the HLA association and treatment for hemochromatosis
Dubin johnson
Repeated phlebotomy - deferoxamine - HLA- A3
Ischemic colitis
Diarrhea - steatorrhea - weight loss - weakness

20. Where is there sclerosis in alcoholic cirrohosis
Around the central vein (zone III)
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Via the superior pancreaticduodenal
Pancreatic head causing obstructive jaundice

21. Achalasia increases the risk For what complication
Black - rotors syndrome
Alfatoxin in peanuts
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Esophageal carcinoma

22. multiple juvenil polyps in GI tract - risk
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Hemosiderosis - hemochromatosis
H2 receptor - inc cAMP
Complications of crohns

23. How do you DX and TX gallstones
Lipase
US and cholecystectomy
Peyers patches
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

24. Where is IgA shuttled
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Hemosiderosis - hemochromatosis
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
The entire

25. What portion of the bowel does sprue effect
The proximal small bowel
US and cholecystectomy
Dilated esophagus with an area of distal stenosis - birds beak
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

26. What does K- ras mutation cause
Upregulated intracellular signal transduction
The jejunum
Averages 6 months - very aggressive - usually already metastasized at presentation
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

27. What are the four Fs of gallstones
Black - rotors syndrome
Redundant mesentary
Female - fat - fertile - forty
H2 receptor - inc cAMP

28. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Obstruction of the common bile duct
Smooth
Alpha amylase
Diverticulum

29. What layer in the mucosa is responsible for support
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
Conj/unconj - inc - nl to dec
Phenobarbital - inc liver enzyme synthesis
Lamina propria

30. What does primary sclerosing cholangitis lead to...
M3 - Gq - inc IP3/Ca
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Low pressure proximal to LES
Myenteric nerve plexus - aurbach

31. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Gilbert's
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
So hypertrophied they look like brain gyri

32. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
AST
Peutz jeghers
Positive urease test
...

33. likely infectious form of malabsorption - responds to antibiotics
Around the central vein (zone III)
T cell lymphoma
Closer to isotonic because of less time to reabsorb NaCl
Tropical sprue

34. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Lye ingestion and acid reflux
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

35. What can fistula between the gallbladder and small intestine create and how can you tell
Zollinger ellison - brunners glands
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Where hindgut meets ectoderm
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

36. Why does indirect inguinal hernia happen in infacnts
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
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
Positive urease test
Failure of the processus vagainlis to close

37. What are the complications of Meckels
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Left and right gastroepiploics - left and right gastrics
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Unconjugated - water insoluble

38. What are the common causes of gastric ulcers - What causes gastric ulcer
Black - rotors syndrome
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

39. What is the frequency of basal electric rhythm in the duodenum
Peptic ulcer disease
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
12 waves/min
Squamous - upper 1/3 - adeno - lower 1/3

40. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
Jaundice - fever - RUQ
Closer to isotonic because of less time to reabsorb NaCl
Can lead to hematemesis - found in EtOHics and bulimics

41. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Inc smooth muscle relaxation - including lower esophageal sphincter
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Zenkers - halitosis - dysphagia and obstruction

42. is meckels a true diverticulum and how common is it
VZV and influenza B treated with salicylates
True and most common congenital anomoly of GI tract
Averages 6 months - very aggressive - usually already metastasized at presentation
Chagas disease

43. If trypsin activates more trypsinogen - what kind of feedback loop is established
Positive
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
Inc smooth muscle relaxation - including lower esophageal sphincter
Lactase is located at the tips of intestinal villi

44. What are the signs of peutz jehgers
Glucouronate - water soluble (direct)
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Menetriers disease
Hyperpigmented mouth - lips - hands - genitalia

45. What are the treatment options for uclerative colitis
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Downs
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

46. Where does type A chronic gastritis occur and What causes it
Jaundice - fever - RUQ
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Phototherapy
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

47. What are causes of extrahepatic biliary obstruction
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
With albumin
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

48. bilateral mets to ovaries with abundant mucus - signet ring cells
Alpha amylase
Krukenbergs tumor
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Cystic duct and common hepatic duct

49. What is biliary colic
Dissaccharidase def - most commonly lactase
Paraumbilical and superficial and inferior epigastric - umbilicus
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

50. In alchoholic hepatitis which liver enzyme is higher
AST>ALT
Alpha1 antitrypsin def - codominant trait
Urobilin
Turcot