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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 do you use to diagnose meckels
Pertechnetate - study for uptake
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Uremia
Muscularis mucosae

2. multiple juvenil polyps in GI tract - risk
Mucoepidermoid carcinoma
Trypsin - chymotrypsin - elastase - carboxypeptidases
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Phototherapy

3. Where are oligosaccharide hydrolases and What do they do
Liver metabolizes 5HT
Pancreatic head causing obstructive jaundice
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Brush border of intestine - produce monosaccharides from oligo and di

4. Autoantibodies to gluten (gliadin) in wheat and other grains
Colovesical leading to pneumaturia
Celiac sprue
Esophageal varices
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

5. Is there any structural abnl with IBS - What is the course of disease and presentation
Redundant mesentary
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
No - chronic - can present with diarrhea or constipation or alternation - treat sx

6. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

7. What are the main components of bile
Jaundice - fever - RUQ
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Small intestine
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

8. What is charcot triad of cholangitis
Falciform - ligamentum teres - fetal umbilical vein
Pyoderma gangrenosum - primary sclerosing cholangitis
Jaundice - fever - RUQ
H pylori (almost 100%)

9. conjugated hyperbilirubinemia due to defective liver excretion
Primary sclerosing cholangitis
Dubin johnson
Inguninal ligament - sartorius muscle - adductor longus
Hepatic steatosis

10. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
The submucosal nerve plexus - meissner's
Gardner's syndrome
Dense core bodies

11. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Pyoderma gangrenosum - primary sclerosing cholangitis
Acute pancreatitis

12. What are the borders of Hesselbach's triangle
Right and left hepatic duct
Around the central vein (zone III)
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Older patients

13. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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14. In alchoholic hepatitis which liver enzyme is higher
Unconj - absent (acholuria) - inc
H2 receptor - inc cAMP
AST>ALT
Adhesion

15. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Dermatitis herpetiformis
Skip lesions =crohns - colon = UC
Inc - weight loss
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

16. What retroperitoneal structure flanks both sides of the pancreas on CT
Duodenum - 2nd - 3rd and 4th parts
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Pyoderma gangrenosum - primary sclerosing cholangitis

17. Why does volvulus occur more at cecum and sigmoid colon
Enterokinase/enteropeptidase from the duodenal mucosa
Gut bacteria
Redundant mesentary
Zollinger Ellison - phenylalanine and tryptophan

18. Between what structures do strong anastamoses exist
Enterokinase/enteropeptidase from the duodenal mucosa
Left and right gastroepiploics - left and right gastrics
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

19. FAP + malignant CNS tumor
Repeated phlebotomy - deferoxamine - HLA- A3
Turcot
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
External (superficial) ring only

20. bilateral mets to ovaries with abundant mucus - signet ring cells
Splenic flexure
Source - S cells (duod) - action - inc pancreatic bicarb secretion - dec gastric acid secretin - inc bile secretion - regulation - inc by acid - fatty acids in lumen of duod
Dilated esophagus with an area of distal stenosis - birds beak
Krukenbergs tumor

21. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
Bleeding - penetration into pancreas - perforation - obstruction
Zollinger ellison - brunners glands
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

22. What drug blocks the H2R
Celiac sprue
Via the middle colic
2ndary biliary cirrhosis
Cimetidine

23. What is the most common indication of emergent abdominal surgery in children
Appendicitis
Chronic gastritis and pernicious anemia
Erosive - disruption of mucosal barrier leading to inflammation
Achalasia due to loss of myenteric plexus (auberach)

24. What nerve innervates the external hemorrhoids
All 3 gut layers outpouch as in Meckels
Sister mary joseph nodule
Gardner's syndrome
Inferior rectal nerve

25. Gallstones that reach the common channel at ampulla can block which two ducts
Pancreatic and bile
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
Turcot
Cholesterol

26. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Crohns = maybe - UC= always
Goes through deep inguinal ring - external inguinal ring and into the scrotum
H+

27. What are the treatmet options for crohns
Corticosteroids - infliximab
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Parietal cells in the stomach - B12 binding protein
Cigarettes and chronic pancreatitis - not EtOH

28. What serum enzyme is decreased in wilsons disease
Ceruplasmin
CCK8 receptor - Gq inc IP3/Ca
Brunners
Bleeding - intussusception - volvulus - obstruction near terminal ileum

29. What are the midgut structures and what supplies their blood and PANS innervation
Pancreatic and bile
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
H pylori (almost 100%)
Inc smooth muscle relaxation - including lower esophageal sphincter

30. What is the action of NO as a GI hormone
...
Crigler - najjar type 1
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Inc smooth muscle relaxation - including lower esophageal sphincter

31. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Positive
Uridine glucuronyl transferase
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Unconj - absent (acholuria) - inc

32. Who gets gastric ulcers
Older patients
Lamina propria
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Oligosaccharide digestion

33. What does high flow rate mean
Closer to isotonic because of less time to reabsorb NaCl
Parietal cells in the stomach - B12 binding protein
Oligosaccharide digestion
Boerhaave's Syndrome - Been heaving syndrome

34. If the abdominal aorta is blocked - How does blood get to the left colic artery
Barrett's esophagus
Via the middle colic
Jewish and African American men
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

35. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Lipase - phospholipase A - colipase
Cholesterol - 10-20% opaque due to calcifications
Heme metabolism
Hemolytic anemia

36. What artery passes around the duodenum
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Oligosaccharide digestion
The gastroduodenal
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

37. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Falciform - ligamentum teres - fetal umbilical vein
Female - fat - fertile - forty
L4

38. What serum markers increase in cholecystitis with bile duct involvement
Femoral hernia
Turcot
The gastroduodenal
Alk phos

39. What are esophageal strictures associated with
Lubricate food (glycoprotiens)
Peyers patches
M3 - Gq - inc IP3/Ca
Lye ingestion and acid reflux

40. What are the ABCDEF of esophageal cancer
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Paraumbilical and superficial and inferior epigastric - umbilicus
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

41. why infxn is implicated in duodenal PUD
NAV = nerve artery vein - venous near the penis (NAVEL)
Alpha1 antitrypsin def - codominant trait
Stimulate the H/K ATPase
H pylori (almost 100%)

42. What transforms conjugated bilirubin to urobilinogen
AST>ALT
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Gut bacteria

43. What is the presenting course for appendicity

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44. What factors increase risk of malignancy of adenomatous polyps
Dubin johnson
Normal
Early childhood - neuro sx and malabsorption
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

45. What receptors does ACH bind on the parietal cells and What does it activate
L1
Alcoholic hepatitis
Zollinger ellison - brunners glands
M3 - Gq - inc IP3/Ca

46. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
AST>ALT
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

47. Which is used more quickly - an oral glucose load - or that by IV
US and cholecystectomy
12 waves/min
Lipase - phospholipase A - colipase
Oral glucose

48. trypsinogen is converted to trypsin via what enzyme
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Enterokinase/enteropeptidase from the duodenal mucosa
Upregulated intracellular signal transduction
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

49. What layer in the mucosa is responsible for absorption
Gallbladder
Parietal cells in the stomach - B12 binding protein
Epithelium
Appendicitis

50. Which IBD is autoimmune and which may be a disordered response to bacteria
M3 - Gq - inc IP3/Ca
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides