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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. Why does carcinoid syndrome not occur if tumor is confined to GI system
Liver metabolizes 5HT
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Ischemic colitis

2. multiple juvenil polyps in GI tract - risk
Redundant mesentary
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Alpha amylase
Juvenile polyposis syndrome - inc risk of adenocarcinoma

3. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
IgA secreting plasma cells - ultimately reside in the lamina proporia
Parietal cells in the stomach - B12 binding protein
Heme metabolism

4. What are the layers of the gut wall from inside out
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
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Via the superior pancreaticduodenal
Mucosa - submucosa - muscularis externa - serosa/adventitia

5. Where is B12 absorbed
In the ileum with bile acids - requires IF
Neural muscarinic pathways
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

6. Gastrin - source - action - regulation
Smooth
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
Juvenille polyps - no risk if single
Via the superior pancreaticduodenal

7. What congenital birth defect is associated with Hirschsprung
Downs
Below
Carcinoid syndrome
Phenobarbital - inc liver enzyme synthesis

8. What does primary sclerosing cholangitis lead to...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Tropical sprue
Repeated phlebotomy - deferoxamine - HLA- A3
M3 - Gq - inc IP3/Ca

9. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
Common hepatic - splenic - left gastric - main blood supply for stomach
Oligosaccharide digestion
Dissaccharidase def - most commonly lactase

10. What are the borders of Hesselbach's triangle
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
12 waves/min
Glucouronate - water soluble (direct)
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

11. What factors increase risk of malignancy of adenomatous polyps
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Jewish and African American men
The gastroduodenal

12. What is the main symptom if a VIPoma
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Striated

13. What is the sphincter of the pancreatic duct
Uridine glucuronyl transferase
Terminal ileum and colon
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Sphincter of oddi

14. List the clinical findings of HCC
Angiodysplasia
Hirschsprungs
Gastrohepatic ligament
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

15. How does CRC present in the distal and proximal colon
No
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
When diffusely infiltrative - thickened rigid appearance like a leather bottle
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

16. What is the leading cause of bowel incarceration
Peptic ulcer disease
2ndary biliary cirrhosis
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Femoral hernia

17. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

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18. GIP - source - action regulation
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Striated and smooth
Reye's syndrome
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

19. Achalasia can be secondary to what infectious disease common in South America
Chagas disease
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Causes of gall stones
Cigarettes and chronic pancreatitis - not EtOH

20. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Alk phos
Decrease - weight gain

21. Which patients have pigment stones
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Barrett's esophagus
Peyers patches
External spermatic fascia only

22. Cholecytsokinin - source - action - regulation
12 waves/min
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
Mucoepidermoid carcinoma
Peyers patches

23. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Esophageal varices
Conj - inc - dec
Heme metabolism

24. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Crohns = maybe - UC= always
NAV = nerve artery vein - venous near the penis (NAVEL)
Above

25. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Low pressure proximal to LES
Nonkeritinized stratified sqamous epithelium
IBS at least 2 with recurrent abdominal pain
So hypertrophied they look like brain gyri

26. Bile is critical for exrection of what substance
Lubricate food (glycoprotiens)
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Cholesterol

27. What happens to the short gastics if the splenic artery is blocked
Poor anastamoses
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
Esophageal carcinoma
Alpha1 antitrypsin def - codominant trait

28. How does brain injury lead to acute gastritis and What is it called
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Chronic calcifying pancreatitis - inc risk of panreatic cancer
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Serous on the sides parotids - mucinous in the middle sublingual

29. What pancreatic enzymes are responsible for fat digestion
Reye's syndrome
Hernia
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Lipase - phospholipase A - colipase

30. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
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
Inc conj bilirubin - inc cholesterol - inc alk phos
CCK8 receptor - Gq inc IP3/Ca
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

31. What is diverticulosis
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Left and right gastroepiploics - left and right gastrics
Lipase
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

32. What does K- ras mutation cause
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Sphincter of oddi
Upregulated intracellular signal transduction
Splenic flexure

33. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Early childhood - neuro sx and malabsorption
Celiac sprue
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
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

34. malnutrition - toxic megacolon - colorectal carcinoma
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Erosive - disruption of mucosal barrier leading to inflammation
Complications of UC
Repeated phlebotomy - deferoxamine - HLA- A3

35. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
HSV-1 - CMV - Candida
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

36. What histological findings are present in the stomach
Conj - inc - dec
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Gastric glands
Penicillinamine - AR inheritance

37. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
3 waves/min
Inc smooth muscle relaxation - including lower esophageal sphincter
Zollinger Ellison - phenylalanine and tryptophan

38. bilateral mets to ovaries with abundant mucus - signet ring cells
Primarly through ECL leading to histamine release
Krukenbergs tumor
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

39. How does loss of NO secretion affect the esophagus and what results
Stimulate intestinal persistalsis
Inc lower esphogeal tone leading to achalasia
Smooth
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

40. What does extrahepatic biliary obstruction cause
Female - fat - fertile - forty
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Inc risk of CRC and other visceral malignancies
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

41. What is the other name for GIP (gastric inhibitory peptide)
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
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
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Glucose dependent insulinotropic peptide

42. What layer in the mucosa is responsible for support
Redness and tenderness on palpation of extremities
Serous on the sides parotids - mucinous in the middle sublingual
Lamina propria
All 3

43. motilin - source - action - regulation
Inc conj bilirubin - inc cholesterol - inc alk phos
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

44. How do villi appear in disaccharidease def
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Normal
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Cystic dilation of the viteline duct

45. What findings are associated with reyes
Duodenum - 2nd - 3rd and 4th parts
12 waves/min
Right and left hepatic duct
Mitochondrial abnl - fatty liver - hypoglycemia - coma

46. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Angiodysplasia

47. When do you see hypertrophy of brunners glands
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Parietal cells in the stomach - B12 binding protein
Upregulated intracellular signal transduction
Peptic ulcer disease

48. Where is there sclerosis in alcoholic cirrohosis
Around the central vein (zone III)
Conj - inc - dec
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Bleeding - intussusception - volvulus - obstruction near terminal ileum

49. What structures feed into the common bile duct
Uremia
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Cystic duct and common hepatic duct
Squamous - upper 1/3 - adeno - lower 1/3

50. Where does crohns usually affect the GI tract
Terminal ileum and colon
No
Osmotic
Cirrhosis