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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. Which serum enzyme increases with heavy EtOH consumption
Hernia
Osmotic
Dilated esophagus with an area of distal stenosis - birds beak
Gamma glutamyl transferase GGT

2. 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
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
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Juvenille polyps - no risk if single

3. secretin - source - action - regulation
Splenic flexure
Via the middle colic
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
Dense core bodies

4. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Carcinoid syndrome
GERD - may also present with nocturnal cough and dyspnea
Lack or have an attenuated muscularis externa - often in the sigmoid colon

5. What kind of cancer to celiac sprue put you as inc risk for
2ndary biliary cirrhosis
Squamous - upper 1/3 - adeno - lower 1/3
T cell lymphoma
Closer to isotonic because of less time to reabsorb NaCl

6. What serum enzyme is elevated in acute pancreatitis and mumps
Virchow's node
Amylase
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Menetriers disease

7. What factors increase risk of malignancy of adenomatous polyps
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
L3
Around the central vein (zone III)

8. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Nonkeritinized stratified sqamous epithelium
AR
8-9 waves/min

9. What is the rule of 2s for meckels
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
External (superficial) ring only
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

10. What drug inhibits the H/K ATPase
Terminal ileum and colon
Warthins' tumor
Hydrocele
Omeprazole

11. What are the labs in acute pancreatitis
Left gastric vein and esophogeal vein - esophagus
Krukenbergs tumor
Nonkeritinized stratified sqamous epithelium
Elevated amylase - and lipase

12. What does loss of p53 cause
Increase tumorigenesis
Crypts but not villi
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
H2 receptor - inc cAMP

13. If the abdominal aorta is blocked - How does blood get to the left colic artery
Crohns = maybe - UC= always
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Via the middle colic
Causes of gall stones

14. What are the midgut structures and what supplies their blood and PANS innervation
All 3 gut layers outpouch as in Meckels
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Lipase

15. Transmural esophageal rupture due to violent retching

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16. Where does type A chronic gastritis occur and What causes it
Brush border of intestine - produce monosaccharides from oligo and di
Cirrhosis
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Obstruction of the common bile duct

17. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
Decreased intercellular adhesion and increased proliferation
Short gastrics - left greater and lesser
Ceruplasmin

18. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
The submucosal nerve plexus - meissner's
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
Positive urease test
Heme metabolism

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

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20. Bilirubin is the product of what?
Femoral hernia
Heme metabolism
Peyers patches
90%

21. What carcinogens are associated with HCC
Downs
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Internal thoracic to superior epigastric to inferior epigastric
Alfatoxin in peanuts

22. What are the histological findings of the colon
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Crypts but not villi
AST>ALT
Neutralizes gastric acid allowing pancreatic enzymes to fxn

23. What kind of insults results in macronodular cirrhosis
Paraumbilical and superficial and inferior epigastric - umbilicus
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Penicillinamine - AR inheritance
L/R renal artery around L1

24. What are the histological findings in the duodenum

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25. How does loss of NO secretion affect the esophagus and what results
Dubin johnson
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
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
Inc lower esphogeal tone leading to achalasia

26. What is the cause of Barrett's and the assocaited complications
Positive urease test
HSV-1 - CMV - Candida
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

27. What is the presentation of pancreatic adenocarcinoma
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Muscularis mucosae
Pertechnetate - study for uptake
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

28. What intervention will intervention will relieve portal HTN
90%
...
Inc lower esphogeal tone leading to achalasia
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

29. What gives stool its characteristic color
GLUT 2
In the ileum with bile acids - requires IF
Stercobilin
Pancreatic and bile

30. What is the frequency of basal electric rhythm of the stomach
3 waves/min
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
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
CEA - CA-19-9

31. 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
Poor anastamoses
Skip lesions =crohns - colon = UC
Superior rectal
Averages 6 months - very aggressive - usually already metastasized at presentation

32. What artery passes around the duodenum
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Alcoholic cirrhosis
The gastroduodenal
Hepatic steatosis

33. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Meconium ileus
Via the superior pancreaticduodenal
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Zollinger Ellison - phenylalanine and tryptophan

34. What structures feed into the common hepatic duct
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Lamina propora and submucosa
US and cholecystectomy
Right and left hepatic duct

35. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Pleomorphic adenoma
Peyers patches
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

36. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

37. What type of insults result in micronodular cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Smooth
Low pressure proximal to LES
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

38. When do you see hypertrophy of brunners glands
Parietal cells in the stomach - B12 binding protein
Lateral
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Peptic ulcer disease

39. List the clinical findings of HCC
Failure of the processus vagainlis to close
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Dermatitis herpetiformis
T cell lymphoma

40. What are motilin receptor agonists used for clinically
Lipase
Inguninal ligament - sartorius muscle - adductor longus
Stimulate intestinal persistalsis
Acute pancreatitis

41. How does abetalipoproteinemia lead to malabsorption
CHF and inc risk of HCC
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
GLUT 2
Positive

42. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Can lead to hematemesis - found in EtOHics and bulimics
T12
Femoral hernia

43. malnutrition - toxic megacolon - colorectal carcinoma
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Lipase
Volvulus
Complications of UC

44. What are additional risk factors for CRC
Alpha amylase
Complications of UC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Esophageal varices

45. Scleroderma is associated with what kind of esophageal dysmotility
Around the central vein (zone III)
Low pressure proximal to LES
Inspiratory arrest on deep palpation due to pain
Gamma glutamyl transferase GGT

46. In what scenarios do pts with gilberts have inc bili
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Fasting and stress

47. What is the frequency of basal electric rhythm of the ilieum
The entire
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
8-9 waves/min
Esophageal varices

48. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
PAS- positive globules in liver -
Juvenille polyps - no risk if single
Causes of gall stones
Centrilobular leading to congestive liver disease

49. What are the foregut structures and what supplies their blood and PANS innvervation
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
H+
True and most common congenital anomoly of GI tract
GLUT 2

50. Who is at risk for pancreatic adenocarcinoma
Peyers patches
Boerhaave's Syndrome - Been heaving syndrome
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Jewish and African American men