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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 is the omphalomesenteric cyst
Glucouronate - water soluble (direct)
Cystic dilation of the viteline duct
Above
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

2. What pancreatic proteases are secreted as zymogens
Antrum - H.pylori - inc risk of MALT lymphoma
Trypsin - chymotrypsin - elastase - carboxypeptidases
ALT>AST
Chagas disease

3. 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
Warthins' tumor
Zenkers - halitosis - dysphagia and obstruction
Portal HTN

4. What structures feed into the common hepatic duct
Neural muscarinic pathways
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
NAV = nerve artery vein - venous near the penis (NAVEL)
Right and left hepatic duct

5. In viral hepatitis - which liver enzyme is higher
ALT>AST
Alpha1 antitrypsin def - codominant trait
L/R renal artery around L1
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

6. In alchoholic hepatitis which liver enzyme is higher
Femoral hernia
AST>ALT
L1
CCK8 receptor - Gq inc IP3/Ca

7. most common non - neoplastic polyp in colon
Hyperplastic
Inc smooth muscle relaxation - including lower esophageal sphincter
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

8. Which IBD is autoimmune and which may be a disordered response to bacteria
Alk pho
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Older patients
Striated

9. What does the splenorenal ligament connect - and What does it contain
Inc conj bilirubin - inc cholesterol - inc alk phos
Liver metabolizes 5HT
L/R renal artery around L1
Spleen to posterior abdominal wall - splenic artery and vein

10. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Alpha1 antitrypsin def - codominant trait
Bleeding - penetration into pancreas - perforation - obstruction
L/R renal artery around L1

11. What is the other name for GIP (gastric inhibitory peptide)
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Punched out - clean margins - carcinoma =raised irregular margins
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Glucose dependent insulinotropic peptide

12. Who gets Whipple disease and How do they present
Mucoepidermoid carcinoma
Old men - arthralgias - cardiac and neuro sx
Gut bacteria
Peptic ulcer disease

13. What makes a true diverticula
All 3 gut layers outpouch as in Meckels
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
EtOH
US and cholecystectomy

14. How is bilirubin carried in the blood
Terminal ileum and colon
With albumin
Paraumbilical and superficial and inferior epigastric - umbilicus
Dubin johnson

15. What structure is Not contained in the femoral sheath
The jejunum
Elevated amylase - and lipase
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

16. What is biliary colic
Decrease - weight gain
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Downs
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

17. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Warthins' tumor
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Mitochondrial abnl - fatty liver - hypoglycemia - coma

18. In an MI - which liver enzyme is elevated
CEA - CA-19-9
AST
The gastroduodenal
Failure of the processus vagainlis to close

19. What can fistula between the gallbladder and small intestine create and how can you tell
Alpha amylase
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Striated and smooth

20. Acute gastritis is caused By what process
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Lubricate food (glycoprotiens)
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
Erosive - disruption of mucosal barrier leading to inflammation

21. What is the most common cause of gallstones
The jejunum
US and cholecystectomy
8-9 waves/min
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

22. What are the treatmet options for crohns
Corticosteroids - infliximab
Inc - weight loss
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Brush border of intestine - produce monosaccharides from oligo and di

23. What is the mechanism for reyes syndrome
Parietal cells in the stomach - B12 binding protein
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Lipase
Unconjugated - water insoluble

24. What are the signs and symptoms of budd chiari
Elevated amylase - and lipase
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

25. Which patients have pigment stones
The proximal small bowel
Menetriers disease
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Meckels

26. somatostatin - source - action - regulation
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Inspiratory arrest on deep palpation due to pain
Diverticulum
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

27. At what level of the spine does the IM exit the aorta
True and most common congenital anomoly of GI tract
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Crigler - najjar type 1
L3

28. What structures feed into the common bile duct
Hyperpigmented mouth - lips - hands - genitalia
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Cystic duct and common hepatic duct
GLUT 2

29. conjugated hyperbilirubinemia due to defective liver excretion
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Dubin johnson
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

30. What serum markers increase in cholecystitis with bile duct involvement
Can lead to hematemesis - found in EtOHics and bulimics
Alk phos
Closer to isotonic because of less time to reabsorb NaCl
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

31. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Sphincter of oddi

32. B cells stimuated in the germinal centers of peyers patches differentiate into what?
IgA secreting plasma cells - ultimately reside in the lamina proporia
Krukenbergs tumor
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

33. Where is the deep inguinal ring relative to the inferior epigastric vessels
Ampulla of vater
Lateral
Glucouronate - water soluble (direct)
Femoral hernia

34. Where are tumors commonly in pancreatic adenocarcinoma
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
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Pancreatic head causing obstructive jaundice
Dilated esophagus with an area of distal stenosis - birds beak

35. How do you DX and TX gallstones
Parietal cells in the stomach - B12 binding protein
US and cholecystectomy
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
CHF and inc risk of HCC

36. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Zollinger ellison - brunners glands
Increase tumorigenesis
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Alcoholic cirrhosis

37. What is charcot triad of cholangitis
Right and left hepatic duct
Hemosiderosis - hemochromatosis
Jaundice - fever - RUQ
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

38. What are the extraintestinal manifestations of ulcerative colitis
Pyoderma gangrenosum - primary sclerosing cholangitis
HPNCC
Hepatic steatosis
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

39. What other condition can lead to acute gastritis - think renal
Uremia
Celiac sprue
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Liver metabolizes 5HT

40. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Nonkeritinized stratified sqamous epithelium
Inc smooth muscle relaxation - including lower esophageal sphincter
Above
Esophageal varices

41. What does autoimmune destruction of parietal cells lead to...
Begins starch digestion - inactivated by low pH upon reaching the stomach
Juvenille polyps - no risk if single
Chronic gastritis and pernicious anemia
Gastrohepatic ligament

42. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Alpha amylase
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Right and left hepatic duct
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

43. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Angiodysplasia
Duodenum - 2nd - 3rd and 4th parts
Increase tumorigenesis
Osmotic

44. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Inc - weight loss
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Carcinoid syndrome
Budd chiari syndrome

45. Who gets gastric ulcers
Neural muscarinic pathways
Diarrhea - steatorrhea - weight loss - weakness
HPNCC
Older patients

46. Diaphragmatic hernias occur in infants because of defective development of which membrane
Causes of gall stones
Cholesterol - 10-20% opaque due to calcifications
Pleuroperitoneal
Dysphagia (due to esophageal web) - glossitis - iron def anemia

47. What is diverticulosis
Right and left hepatic duct
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
IBS at least 2 with recurrent abdominal pain
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

48. Which serum enzyme increases with heavy EtOH consumption
Esophageal cancer
Repeated phlebotomy - deferoxamine - HLA- A3
Carcinoid syndrome
Gamma glutamyl transferase GGT

49. What is contained in the gastrosplenic and What areas does it separate
Warthins' tumor
Dermatitis herpetiformis
Alpha1 antitrypsin def - codominant trait
Short gastrics - left greater and lesser

50. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Zenkers - halitosis - dysphagia and obstruction
Falciform - ligamentum teres - fetal umbilical vein
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Redundant mesentary