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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 high flow rate mean
Closer to isotonic because of less time to reabsorb NaCl
M3 - Gq - inc IP3/Ca
Inferior rectal nerve
Gastric glands

2. Where does crohns usually affect the GI tract
Falciform - ligamentum teres - fetal umbilical vein
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Lubricate food (glycoprotiens)
Terminal ileum and colon

3. With caput medusaw - between what vessels is the anastomoses and Where is it
Paraumbilical and superficial and inferior epigastric - umbilicus
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

4. What are the histological findings of the colon
Common hepatic - splenic - left gastric - main blood supply for stomach
Averages 6 months - very aggressive - usually already metastasized at presentation
Crypts but not villi
External spermatic fascia only

5. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
FAP
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Budd chiari syndrome
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

6. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Phenobarbital - inc liver enzyme synthesis
Esophageal cancer
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

7. What serum enzyme is elevated in acute pancreatitis and mumps
Conj/unconj - inc - nl to dec
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
IgA secreting plasma cells - ultimately reside in the lamina proporia
Amylase

8. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Striated and smooth
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
No

9. What do tumors that arise in the head of the pancreas cause
Obstruction of the common bile duct
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Gardner's syndrome
Superior rectal

10. multiple juvenil polyps in GI tract - risk
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Inspiratory arrest on deep palpation due to pain
Can lead to hematemesis - found in EtOHics and bulimics
External (superficial) ring only

11. What gives urine its characteristic color
Urobilin
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Dense core bodies
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker

12. What are causes of extrahepatic biliary obstruction
Femoral hernia
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Inc lower esphogeal tone leading to achalasia

13. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Hernia
IBS at least 2 with recurrent abdominal pain
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

14. Where is bicarb trapped
In the mucus that covers the gastric epithelium
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Primarly through ECL leading to histamine release

15. What are the histological findings in the duodenum

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16. How is the diagonsis of CRC made
PAS- positive globules in liver -
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
Lamina propora and submucosa
...

17. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Peutz jeghers
Femoral hernia
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Dubin johnson

18. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Lipase
Squamous - upper 1/3 - adeno - lower 1/3
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

19. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Above
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

20. What are the ABCDEF of esophageal cancer
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Crypts but not villi
Can lead to hematemesis - found in EtOHics and bulimics

21. What structures feed into the common bile duct
Penicillinamine - AR inheritance
Stimulate intestinal persistalsis
Cystic duct and common hepatic duct
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

22. What is the most common esophageal cancer worldwide and in the US
Worldwide - SC - US - adeno
Inc smooth muscle relaxation - including lower esophageal sphincter
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Neutralizes oral bacertial acids and maintains dental health

23. What is the frequency of basal electric rhythm of the ilieum
Hyperpigmented mouth - lips - hands - genitalia
Muscularis mucosae
8-9 waves/min
Carcinoid syndrome

24. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Chronic gastritis and pernicious anemia
Esophageal cancer
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
So hypertrophied they look like brain gyri

25. What is pancreatic adenocarcinoma associated with
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Cigarettes and chronic pancreatitis - not EtOH
So hypertrophied they look like brain gyri
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

26. What congenital birth defect is associated with Hirschsprung
Downs
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Pleuroperitoneal

27. Why does carcinoid syndrome not occur if tumor is confined to GI system
Liver metabolizes 5HT
Superior rectal and middle and inferior rectal - rectum
All 3
Gallbladder

28. What are the tumor markers for pancreatic adenocarcinoma
CEA - CA-19-9
So hypertrophied they look like brain gyri
Trypsin - chymotrypsin - elastase - carboxypeptidases
Dec PGE2 leading to dec gastric mucosa protection

29. What are the hindgut structures and what supplies their blood and PANS innvervation
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
AR
Carcinoid syndrome

30. In viral hepatitis - which liver enzyme is higher
ALT>AST
2ndary biliary cirrhosis
Via the middle colic
VZV and influenza B treated with salicylates

31. What is the presenting course for appendicity

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32. subQ peribumbilical metastasis
Sister mary joseph nodule
Lipase - phospholipase A - colipase
L3
Obstruction of the common bile duct

33. What are the main components of bile
Poor anastamoses
90%
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
When diffusely infiltrative - thickened rigid appearance like a leather bottle

34. What is the cause of Barrett's and the assocaited complications
Erosive - disruption of mucosal barrier leading to inflammation
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Gut bacteria
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

35. What is the prognosis of adenocarcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Spleen to posterior abdominal wall - splenic artery and vein
Falciform - ligamentum teres - fetal umbilical vein
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

36. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Redundant mesentary
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Peptic ulcer disease
Meckels

37. What is the presentation of pancreatic adenocarcinoma
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Boerhaave's Syndrome - Been heaving syndrome

38. What are the structures of the femoral triangle and how are they organized
Diverticulitis in elderly - ectopic pregs use hCG to rule out
NAV = nerve artery vein - venous near the penis (NAVEL)
Uridine glucuronyl transferase
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

39. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Gilbert's
Alk phos
Phototherapy

40. What are the treatmet options for crohns
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Corticosteroids - infliximab
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Neural muscarinic pathways

41. Who is at risk for pancreatic adenocarcinoma
Jewish and African American men
Portal HTN
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Bleeding - penetration into pancreas - perforation - obstruction

42. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Spleen to posterior abdominal wall - splenic artery and vein
Zollinger Ellison - phenylalanine and tryptophan
Bleeding - penetration into pancreas - perforation - obstruction
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

43. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
HPNCC
Colonic polyps

44. What are the complications of duodenal PUD
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
12 waves/min
Brush border of intestine - produce monosaccharides from oligo and di
Bleeding - penetration into pancreas - perforation - obstruction

45. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Dec PGE2 leading to dec gastric mucosa protection
2ndary biliary cirrhosis
Appendicitis

46. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Volvulus
Diarrhea - steatorrhea - weight loss - weakness
Centrilobular leading to congestive liver disease

47. How does hirschsprung present and appear on imaging
Stercobilin
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
Squamous - upper 1/3 - adeno - lower 1/3
HPNCC

48. How is bilirubin carried in the blood
With albumin
Smooth
Glucouronate - water soluble (direct)
Via the middle colic

49. what kind of fistula is associated with diverticulitis
Inc - weight loss
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Enterokinase/enteropeptidase from the duodenal mucosa
Colovesical leading to pneumaturia

50. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Meckels