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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 does K- ras mutation cause
Gardner's syndrome
Upregulated intracellular signal transduction
Alcoholic cirrhosis
Glucose dependent insulinotropic peptide

2. What is the most common indication of emergent abdominal surgery in children
Hirschsprungs
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Complications of UC
Appendicitis

3. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Portal HTN
Gilbert's
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

4. Who is at risk for pancreatic adenocarcinoma
Angiodysplasia
With albumin
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
Jewish and African American men

5. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Cholesterol - 10-20% opaque due to calcifications
Ischemic colitis
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

6. is meckels a true diverticulum and how common is it
ALT>AST
True and most common congenital anomoly of GI tract
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Lateral

7. How does loss of NO secretion affect the esophagus and what results
Inc lower esphogeal tone leading to achalasia
Stimulate intestinal persistalsis
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
L2

8. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

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9. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Dermatitis herpetiformis
Complications of crohns
Sister mary joseph nodule
Chronic calcifying pancreatitis - inc risk of panreatic cancer

10. What receptors does gastrin bind on the parietal cell and What does it activate
All 3
Internal thoracic to superior epigastric to inferior epigastric
Cholesterol - 10-20% opaque due to calcifications
CCK8 receptor - Gq inc IP3/Ca

11. What does a gastrinoma cause
Jaundice - fever - RUQ
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Superior rectal and middle and inferior rectal - rectum
Mucoepidermoid carcinoma

12. How does hirschsprung present and appear on imaging
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
GERD - may also present with nocturnal cough and dyspnea
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

13. What kind of pathways do CCK act on to cause pancreatic secretion
Penicillinamine - AR inheritance
Neural muscarinic pathways
Diverticulum
With albumin

14. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
L1
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

15. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Mucoepidermoid carcinoma
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Alfatoxin in peanuts

16. What is biliary colic
Pancreatic head causing obstructive jaundice
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Falciform - ligamentum teres - fetal umbilical vein

17. What are the complications of chronic pancreatitis
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
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Juvenille polyps - no risk if single
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

18. Where and How is iron absorbed
Fe2+ in the duod
Diarrhea - steatorrhea - weight loss - weakness
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Trypsin - chymotrypsin - elastase - carboxypeptidases

19. Where are oligosaccharide hydrolases and What do they do
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Brush border of intestine - produce monosaccharides from oligo and di
Lateral to the inferior epigastric artery
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

20. multiple juvenil polyps in GI tract - risk
The submucosal nerve plexus - meissner's
Juvenile polyposis syndrome - inc risk of adenocarcinoma
So hypertrophied they look like brain gyri
Budd chiari syndrome

21. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
The entire
The gastroduodenal
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Striated

22. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
US and cholecystectomy
Causes of gall stones
Upregulated intracellular signal transduction

23. What transforms conjugated bilirubin to urobilinogen
The gastroduodenal
Neutralizes oral bacertial acids and maintains dental health
HPNCC
Gut bacteria

24. What is a positive murphy's sign
HPNCC
The submucosal nerve plexus - meissner's
Inspiratory arrest on deep palpation due to pain
Peptic ulcer disease

25. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Jaundice - fever - RUQ
Via the superior pancreaticduodenal
Pancreatic head causing obstructive jaundice

26. Where is folate absorbed
Centrilobular leading to congestive liver disease
The jejunum
So hypertrophied they look like brain gyri
Alfatoxin in peanuts

27. What kind of cancer to celiac sprue put you as inc risk for
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
The proximal small bowel
T cell lymphoma
True and most common congenital anomoly of GI tract

28. If the hemochromatosis is primary - What is the pattern of inheritance
Angiodysplasia
AR
Hernia
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

29. What are the foregut structures and what supplies their blood and PANS innvervation
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Conj/unconj - inc - nl to dec
Complications of crohns

30. somatostatin - source - action - regulation
Lipase
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
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
Corticosteroids - infliximab

31. Dysphagia in achalasia results from
Tropical sprue
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Oral glucose
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

32. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Krukenbergs tumor
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

33. What kind of digestion is bile needed for
Esophageal varices
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
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Striated and smooth

34. What is the presenting course for appendicity

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35. bilateral mets to ovaries with abundant mucus - signet ring cells
AST
Erosive - disruption of mucosal barrier leading to inflammation
Hypercoaguability - polycythemia vera - pregnancy - HCC
Krukenbergs tumor

36. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Squamous - upper 1/3 - adeno - lower 1/3
Punched out - clean margins - carcinoma =raised irregular margins
Sister mary joseph nodule
Gardner's syndrome

37. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Peutz jeghers
8-9 waves/min
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
GLUT 2

38. Autoantibodies to gluten (gliadin) in wheat and other grains
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Celiac sprue
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Below

39. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Centrilobular leading to congestive liver disease
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
All 3 gut layers outpouch as in Meckels

40. What causes carcinoid syndrome amd What are the symptoms
Primarly through ECL leading to histamine release
Heme metabolism
Inc conj bilirubin - inc cholesterol - inc alk phos
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

41. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
In the mucus that covers the gastric epithelium
Hemolytic anemia
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

42. What are the extraintestinal manifestations of crohns
Duodenal atresia - Downs
Muscularis mucosae
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

43. What is the presentation of pancreatic adenocarcinoma
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Black - rotors syndrome
Alk phos

44. How is bilirubin carried in the blood
CEA - CA-19-9
With albumin
The gastroduodenal
Dilated esophagus with an area of distal stenosis - birds beak

45. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Inferior rectal nerve
Colonic polyps
Older patients
Uridine glucuronyl transferase

46. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Old men - arthralgias - cardiac and neuro sx
PAS- positive globules in liver -
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

47. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lateral
Gardner's syndrome
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
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

48. What drug inhibits the H/K ATPase
Omeprazole
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
H+
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

49. HCC is associated with what other conditions
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

50. People of what decent are associated with celiac sprue and what findings/antibodies are present
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Punched out - clean margins - carcinoma =raised irregular margins
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Liver metabolizes 5HT