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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. At what spinal level does the SMA exit
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
L1
L2
Meconium ileus

2. Which kind of hemorrhoids are painful and why
AR
Zollinger ellison - brunners glands
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Necrotizing enterocolitis

3. Where is there sclerosis in alcoholic cirrohosis
Around the central vein (zone III)
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Peyers patches
Amylase

4. What gives urine its characteristic color
Urobilin
T12
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Normal

5. bilateral mets to ovaries with abundant mucus - signet ring cells
Lye ingestion and acid reflux
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Krukenbergs tumor
Splenic flexure

6. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Sphincter of oddi
Cholesterol - 10-20% opaque due to calcifications
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Hemosiderosis - hemochromatosis

7. How do burns cause acute gastritis and What is it called

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8. most common malignant salivary gland tumor
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
H2 receptor - inc cAMP
Mucoepidermoid carcinoma

9. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Amylase
Inc smooth muscle relaxation - including lower esophageal sphincter
Hernia

10. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Pleomorphic adenoma
Gilbert's
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

11. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
Inc risk of CRC and other visceral malignancies
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Complications of crohns

12. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Dubin johnson
Downs
FAP

13. What structures feed into the cystic duct
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Ampulla of vater
Gallbladder

14. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Squamous - upper 1/3 - adeno - lower 1/3
Internal thoracic to superior epigastric to inferior epigastric
Gallbladder
Increase tumorigenesis

15. How does CRC present in the distal and proximal colon
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Via the middle colic
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

16. What are the four Fs of gallstones
Muscularis mucosae
Female - fat - fertile - forty
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Bleeding - intussusception - volvulus - obstruction near terminal ileum

17. What are the extraintestinal manifestations of crohns
Gastric glands
Downs
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Trypsin - chymotrypsin - elastase - carboxypeptidases

18. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
External spermatic fascia only
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
The jejunum

19. milk intolerance
Dissaccharidase def - most commonly lactase
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Decrease - weight gain

20. What are the layers of the gut wall from inside out
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
The gastroduodenal
Mucosa - submucosa - muscularis externa - serosa/adventitia
Diverticulum

21. What enzyme is necessary to create conjugated bilirubin
Dissaccharidase def - most commonly lactase
IgA secreting plasma cells - ultimately reside in the lamina proporia
Uridine glucuronyl transferase
Gilbert's

22. In PUD - with gastric ulcers - does pain inc or dec with meals?
Primary sclerosing cholangitis
Nonkeritinized stratified sqamous epithelium
Cystic dilation of the viteline duct
Inc - weight loss

23. Where does type B chronic gastritis occur and What causes it
...
Antrum - H.pylori - inc risk of MALT lymphoma
Dubin johnson
Gastrohepatic ligament

24. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lactase is located at the tips of intestinal villi
3 waves/min
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Complications of UC

25. concentric onion skin bile duct fibrosis
Primary sclerosing cholangitis
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
...
Neutralizes oral bacertial acids and maintains dental health

26. GIP - source - action regulation
Striated
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
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
Fasting and stress

27. Gallstones that reach the common channel at ampulla can block which two ducts
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
...
Fe2+ in the duod
Pancreatic and bile

28. What kind of cancer to celiac sprue put you as inc risk for
Via the middle colic
Budd chiari syndrome
Dense core bodies
T cell lymphoma

29. What is the frequency of basal electric rhythm of the stomach
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Terminal ileum and colon
Smooth
3 waves/min

30. How does hirschsprung present and appear on imaging
The jejunum
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
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Mucosa - submucosa - muscularis externa - serosa/adventitia

31. What kind of pancreatitis is associated with EtOH and smoking
Cimetidine
Nonkeritinized stratified sqamous epithelium
Chronic calcifying pancreatitis - inc risk of panreatic cancer
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

32. What is the prognosis of adenocarcinoma
Gamma glutamyl transferase GGT
Complications of crohns
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Averages 6 months - very aggressive - usually already metastasized at presentation

33. What is the risk with peutz jehgers
Punched out - clean margins - carcinoma =raised irregular margins
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Inc risk of CRC and other visceral malignancies
Inferior rectal nerve

34. What complication can arise from indirect inguinal hernias
Hydrocele
Increase tumorigenesis
Cirrhosis
Boerhaave's Syndrome - Been heaving syndrome

35. What kind of digestion is bile needed for
Lactase is located at the tips of intestinal villi
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Conj/unconj - inc - nl to dec
Above

36. Where does copper accumulate in Wilsons and What are ABCD
Dense core bodies
AST
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Closer to isotonic because of less time to reabsorb NaCl

37. occlusion of IVC or hepatic veins
AST
Budd chiari syndrome
Dissaccharidase def - most commonly lactase
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

38. Why does carcinoid syndrome not occur if tumor is confined to GI system
Glucouronate - water soluble (direct)
Liver metabolizes 5HT
Low pressure proximal to LES
Upregulated intracellular signal transduction

39. What are the treatmet options for crohns
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Conj/unconj - inc - nl to dec
Corticosteroids - infliximab
Dilated esophagus with an area of distal stenosis - birds beak

40. What histological findings are present in the esophagus
Pyoderma gangrenosum - primary sclerosing cholangitis
Nonkeritinized stratified sqamous epithelium
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Angiodysplasia

41. If the hemochromatosis is primary - What is the pattern of inheritance
Lactase is located at the tips of intestinal villi
Gallbladder
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
AR

42. Is there any structural abnl with IBS - What is the course of disease and presentation
Alk pho
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Pyoderma gangrenosum - primary sclerosing cholangitis

43. What are the complications of Meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Crypts but not villi
H+

44. In alchoholic hepatitis which liver enzyme is higher
Ceruplasmin
AST>ALT
Inferior rectal nerve
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

45. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Early childhood - neuro sx and malabsorption
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Menetriers disease
Downs

46. At what spinal level does the celiac trunk exit
Repeated phlebotomy - deferoxamine - HLA- A3
Unconjugated - water insoluble
Boerhaave's Syndrome - Been heaving syndrome
T12

47. What parts of the small bowel can tropical sprue effect
Gut bacteria
3 waves/min
The entire
Stimulate intestinal persistalsis

48. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Downs
Superior rectal
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

49. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Brunners
Celiac sprue
Hepatic steatosis

50. what percentage of colonic polyps are non - neoplastic
Decrease - weight gain
Conj/unconj - inc - nl to dec
AR
90%