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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
Cystic dilation of the viteline duct
In the mucus that covers the gastric epithelium
Erosive - disruption of mucosal barrier leading to inflammation
Pyoderma gangrenosum - primary sclerosing cholangitis

2. What transforms conjugated bilirubin to urobilinogen
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Gut bacteria
AST >ALT - ration is usually 1.5
Liver metabolizes 5HT

3. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
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
Smooth
M3 - Gq - inc IP3/Ca

4. What are the hindgut structures and what supplies their blood and PANS innvervation
Chronic gastritis and pernicious anemia
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Jewish and African American men

5. Who is at risk for pancreatic adenocarcinoma
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Jewish and African American men

6. multiple juvenil polyps in GI tract - risk
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Antrum - H.pylori - inc risk of MALT lymphoma
Gastric glands
Glucouronate - water soluble (direct)

7. What is the cause of Barrett's and the assocaited complications
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Heme metabolism
Repeated phlebotomy - deferoxamine - HLA- A3
Pyoderma gangrenosum - primary sclerosing cholangitis

8. motilin - source - action - regulation
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Chronic calcifying pancreatitis - inc risk of panreatic cancer
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

9. What conditions are associated with budd chiari
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
Hypercoaguability - polycythemia vera - pregnancy - HCC
Unconjugated - water insoluble
Decreased intercellular adhesion and increased proliferation

10. What kind of pathways do CCK act on to cause pancreatic secretion
With albumin
Hypercoaguability - polycythemia vera - pregnancy - HCC
Neural muscarinic pathways
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

11. If trypsin activates more trypsinogen - what kind of feedback loop is established
Positive
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
Krukenbergs tumor
Left and right gastroepiploics - left and right gastrics

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

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13. What causes nutmeg liver
Colonic polyps
Below
Backup of blood into the liver - RHF - budd chiari
H pylori (almost 100%)

14. With internal hemorrhoids Where is the anastomoses and Where is it
Peyers patches
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Oligosaccharide digestion
Superior rectal and middle and inferior rectal - rectum

15. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
L1
Zollinger Ellison - phenylalanine and tryptophan
External spermatic fascia only

16. What receptor does histamine bind on the parietal cell and What does it activate
The gastroduodenal
H2 receptor - inc cAMP
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Primarly through ECL leading to histamine release

17. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Left and right gastroepiploics - left and right gastrics
Femoral hernia
Esophageal carcinoma
Falciform - ligamentum teres - fetal umbilical vein

18. In an MI - which liver enzyme is elevated
In the mucus that covers the gastric epithelium
AST
Peptic ulcer disease
Increase tumorigenesis

19. Achalasia increases the risk For what complication
Decreased intercellular adhesion and increased proliferation
Gilbert's
Esophageal carcinoma
Gallbladder

20. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Acute pancreatitis
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
...

21. What is the most common cause of gallstones
AST>ALT
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
GLUT 2
Primary sclerosing cholangitis

22. Where is the deep inguinal ring relative to the inferior epigastric vessels
Uridine glucuronyl transferase
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Lateral
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

23. Which IBD is autoimmune and which may be a disordered response to bacteria
Can lead to hematemesis - found in EtOHics and bulimics
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

24. FAP + malignant CNS tumor
Sphincter of oddi
Turcot
Averages 6 months - very aggressive - usually already metastasized at presentation
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

25. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Lye ingestion and acid reflux
Ampulla of vater
Uremia

26. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
US and cholecystectomy
Where hindgut meets ectoderm
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

27. What do you use to diagnose meckels
Goes through deep inguinal ring - external inguinal ring and into the scrotum
T12
Redness and tenderness on palpation of extremities
Pertechnetate - study for uptake

28. What are the midgut structures and what supplies their blood and PANS innervation
Jaundice - fever - RUQ
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Backup of blood into the liver - RHF - budd chiari

29. What is the TX of physiologic neonatal jaundice
Phototherapy
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Complications of crohns
The jejunum

30. What causes primary biliary cirrhosis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Barrett's esophagus
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Chronic calcifying pancreatitis - inc risk of panreatic cancer

31. What is the ddx associated with appendicitis
All 3
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Colonic polyps
Hypotonic because of more time to reabsorb NaCl

32. What is the frequency of basal electric rhythm in the duodenum
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
12 waves/min
Hernia
Below

33. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Unconjugated - water insoluble
Inc - weight loss
Intussusception
In the mucus that covers the gastric epithelium

34. In alchoholic hepatitis which liver enzyme is higher
Antrum - H.pylori - inc risk of MALT lymphoma
AST>ALT
Ischemic colitis
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

35. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
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
Zollinger Ellison - phenylalanine and tryptophan
Via the superior pancreaticduodenal
Inc - weight loss

36. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Urobilin
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

37. What is the other name for GIP (gastric inhibitory peptide)
The entire
Glucose dependent insulinotropic peptide
Dilated esophagus with an area of distal stenosis - birds beak
Enterokinase/enteropeptidase from the duodenal mucosa

38. What structures feed into the common hepatic duct
Worldwide - SC - US - adeno
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Right and left hepatic duct

39. What drug inhibits the H/K ATPase
L/R renal artery around L1
Dec PGE2 leading to dec gastric mucosa protection
Mucoepidermoid carcinoma
Omeprazole

40. Through which aspect of the inguinal canal does a direct inguinal go
External (superficial) ring only
Fasting and stress
Chronic gastritis and pernicious anemia
Repeated phlebotomy - deferoxamine - HLA- A3

41. When do you see hypertrophy of brunners glands
Peptic ulcer disease
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Punched out - clean margins - carcinoma =raised irregular margins
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

42. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Dec PGE2 leading to dec gastric mucosa protection
Low pressure proximal to LES
Begins starch digestion - inactivated by low pH upon reaching the stomach

43. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Conj/unconj - inc - nl to dec
Gut bacteria
Amylase
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

44. In viral hepatitis - which liver enzyme is higher
Low pressure proximal to LES
GERD - may also present with nocturnal cough and dyspnea
Downs
ALT>AST

45. Is there any structural abnl with IBS - What is the course of disease and presentation
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
No - chronic - can present with diarrhea or constipation or alternation - treat sx
FAP
Hemosiderosis - hemochromatosis

46. absent UDPGT - presents early in life - early mortality
VZV and influenza B treated with salicylates
Crigler - najjar type 1
Cigarettes and chronic pancreatitis - not EtOH
Inc risk of CRC and other visceral malignancies

47. What are the extraintestinal manifestations of crohns
Conj - inc - dec
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Common hepatic - splenic - left gastric - main blood supply for stomach
Juvenille polyps - no risk if single

48. How is salivary secretion stimulated
Meconium ileus
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
In the mucus that covers the gastric epithelium

49. Bilirubin is the product of what?
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Heme metabolism

50. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Colonic polyps
Phenobarbital - inc liver enzyme synthesis
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Below