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USMLE GI

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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. 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
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Copious diarrhea - non alpha - non beta cell pancreatic tumor

2. What is the other name for GIP (gastric inhibitory peptide)
Tropical sprue
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
All 3
Glucose dependent insulinotropic peptide

3. What other condition can lead to acute gastritis - think renal
Alpha1 antitrypsin def - codominant trait
Uremia
Early childhood - neuro sx and malabsorption
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

4. involvement of left supraclavicular node by mets from stomach

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5. What are the treatment options for uclerative colitis
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
12 waves/min
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Amylase

6. why infxn is implicated in duodenal PUD
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
H pylori (almost 100%)
So hypertrophied they look like brain gyri
Common hepatic - splenic - left gastric - main blood supply for stomach

7. What is the most common cause of gallstones
Paraumbilical and superficial and inferior epigastric - umbilicus
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Adhesion

8. In viral hepatitis - which liver enzyme is higher
Antrum - H.pylori - inc risk of MALT lymphoma
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Peptic ulcer disease
ALT>AST

9. What test and result confirms H pylori infxn
Positive urease test
Chagas disease
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

10. What intervention will intervention will relieve portal HTN
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Mallory bodies

11. What kind of lesions are characteristic of duodenal PUD vs cancer
Punched out - clean margins - carcinoma =raised irregular margins
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Phenobarbital - inc liver enzyme synthesis
Around the central vein (zone III)

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

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13. Where is B12 absorbed
In the ileum with bile acids - requires IF
T12
Backup of blood into the liver - RHF - budd chiari
Epithelium

14. What are the results of hemochromatosis
Inc conj bilirubin - inc cholesterol - inc alk phos
Lateral to the inferior epigastric artery
CHF and inc risk of HCC
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

15. What structures feed into the cystic duct
Pancreatic head causing obstructive jaundice
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Dissaccharidase def - most commonly lactase
Gallbladder

16. If the hemochromatosis is primary - What is the pattern of inheritance
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
AR
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Myenteric nerve plexus - aurbach

17. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Lamina propria
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Low pressure proximal to LES

18. If trypsin activates more trypsinogen - what kind of feedback loop is established
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Positive

19. At what level do the testicular/ovarian arteries exit the aorta
Centrilobular congestion and necrosis - cardiac cirrhosis
Around the central vein (zone III)
L2
Inspiratory arrest on deep palpation due to pain

20. What artery passes around the duodenum
Hypotonic because of more time to reabsorb NaCl
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Can lead to hematemesis - found in EtOHics and bulimics
The gastroduodenal

21. How is salivary secretion stimulated
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Peptic ulcer disease
Barrett's esophagus

22. conjugated hyperbilirubinemia due to defective liver excretion
Primarly through ECL leading to histamine release
In the mucus that covers the gastric epithelium
Dubin johnson
Lipase - phospholipase A - colipase

23. What findings are associated with reyes
Hirschsprungs
Inc smooth muscle relaxation - including lower esophageal sphincter
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Dec PGE2 leading to dec gastric mucosa protection

24. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
Skip lesions =crohns - colon = UC
Duodenal atresia - Downs
Erosive - disruption of mucosal barrier leading to inflammation

25. What can hemochromatosis be secondary to...
Around the central vein (zone III)
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
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
GLUT 2

26. Where and How is iron absorbed
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
8-9 waves/min
Fe2+ in the duod
The entire

27. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Inc - weight loss
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
Pertechnetate - study for uptake
Gardner's syndrome

28. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Alpha amylase
Begins starch digestion - inactivated by low pH upon reaching the stomach
Neural muscarinic pathways
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

29. What causes hirschsprungs
L2
Failure of neural crest migration
8-9 waves/min
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

30. What does extrahepatic biliary obstruction cause
Where hindgut meets ectoderm
Boerhaave's Syndrome - Been heaving syndrome
Obstruction of the common bile duct
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

31. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Crohns = maybe - UC= always
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
IBS at least 2 with recurrent abdominal pain
Omeprazole

32. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Volvulus
Pancreatic and bile
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

33. subQ peribumbilical metastasis
Lipase
Sister mary joseph nodule
Boerhaave's Syndrome - Been heaving syndrome
Urobilin

34. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Ischemic colitis
L/R renal artery around L1
Inspiratory arrest on deep palpation due to pain

35. Where are tumors commonly in pancreatic adenocarcinoma
Chagas disease
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Inc smooth muscle relaxation - including lower esophageal sphincter
Pancreatic head causing obstructive jaundice

36. What are the four Fs of gallstones
Appendicitis
Pancreatic head causing obstructive jaundice
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Female - fat - fertile - forty

37. What histological findings are present in the stomach
Oligosaccharide digestion
Gastric glands
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
Zollinger ellison - brunners glands

38. What is a positive murphy's sign
True and most common congenital anomoly of GI tract
Zollinger Ellison - phenylalanine and tryptophan
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Inspiratory arrest on deep palpation due to pain

39. What does K- ras mutation cause
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Pyoderma gangrenosum - primary sclerosing cholangitis
Upregulated intracellular signal transduction
Old men - arthralgias - cardiac and neuro sx

40. What pancreatic proteases are secreted as zymogens
Trypsin - chymotrypsin - elastase - carboxypeptidases
Budd chiari syndrome
Colovesical leading to pneumaturia
Hyperplastic

41. What are the effects of atropine on parietal cells and G cells
3 waves/min
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Esophageal varices

42. What are additional risk factors for CRC
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
GERD - may also present with nocturnal cough and dyspnea
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

43. Where are oligosaccharide hydrolases and What do they do
Brush border of intestine - produce monosaccharides from oligo and di
Lipase
Striated and smooth
GLUT 2

44. In PUD - with gastric ulcers - does pain inc or dec with meals?
EtOH
Oligosaccharide digestion
Carcinoid syndrome
Inc - weight loss

45. what percentage of colonic polyps are non - neoplastic
Oral glucose
Meckels
Myenteric nerve plexus - aurbach
90%

46. What are the ABCDEF of esophageal cancer
Worldwide - SC - US - adeno
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
8-9 waves/min
Gastric glands

47. What causes pancreatic insuff and What does it cause
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Hepatic steatosis
Redundant mesentary
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

48. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Decreased intercellular adhesion and increased proliferation
Worldwide - SC - US - adeno
Dermatitis herpetiformis
Cirrhosis

49. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Where hindgut meets ectoderm
Colonic polyps
Chronic gastritis and pernicious anemia
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

50. What structure is Not contained in the femoral sheath
Trypsin - chymotrypsin - elastase - carboxypeptidases
Alk phos
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Goes through deep inguinal ring - external inguinal ring and into the scrotum

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USMLE GI

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