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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 kind of muscle is in the upper 1/3 of esophagus
Stimulate intestinal persistalsis
Striated
Hydrocele
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

2. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Esophageal carcinoma
Redness and tenderness on palpation of extremities
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Cholesterol - 10-20% opaque due to calcifications

3. Which area of the hindgut is a watershed area
Splenic flexure
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
2ndary biliary cirrhosis
Repeated phlebotomy - deferoxamine - HLA- A3

4. secretin - source - action - regulation
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
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

5. Where does type A chronic gastritis occur and What causes it
Meconium ileus
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
H+

6. What serum enzyme is elevated inacute pancreatitis
Volvulus
Lipase
Spleen to posterior abdominal wall - splenic artery and vein
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

7. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Lamina propora and submucosa
H2 receptor - inc cAMP
Gut bacteria
Juvenille polyps - no risk if single

8. What are the complications of Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Conj/unconj - inc - nl to dec
Boerhaave's Syndrome - Been heaving syndrome
Diverticulum

9. What kind of diarrhea is produced from a disaccharide def
Inc conj bilirubin - inc cholesterol - inc alk phos
L2
Normal
Osmotic

10. Where is IgA shuttled
Unconjugated - water insoluble
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Left gastric vein and esophogeal vein - esophagus

11. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Pertechnetate - study for uptake
Failure of neural crest migration
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

12. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
Cystic duct and common hepatic duct
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Goes through deep inguinal ring - external inguinal ring and into the scrotum

13. Which patients have pigment stones
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Can lead to hematemesis - found in EtOHics and bulimics
The proximal small bowel
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

14. in CF - meconium plug obstructs intestine - preventing stool passage at birth
Meconium ileus
Cimetidine
Pyoderma gangrenosum - primary sclerosing cholangitis
IgA secreting plasma cells - ultimately reside in the lamina proporia

15. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Hepatic steatosis
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

16. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Erosive - disruption of mucosal barrier leading to inflammation
HPNCC
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

17. FAP + malignant CNS tumor
Stimulate intestinal persistalsis
Turcot
Alk phos
Liver metabolizes 5HT

18. motilin - source - action - regulation
90%
Smooth
The gastroduodenal
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

19. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Alcoholic hepatitis
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

20. How many layers of spermatic fascia are covers an indirect inguinal hernia
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
HPNCC
Neutralizes oral bacertial acids and maintains dental health
All 3

21. HCC is associated with what other conditions
Sister mary joseph nodule
GLUT 2
Internal thoracic to superior epigastric to inferior epigastric
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

22. What does primary sclerosing cholangitis lead to...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Krukenbergs tumor
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Lateral to the inferior epigastric artery

23. If the hemochromatosis is primary - What is the pattern of inheritance
AR
...
Stimulate intestinal persistalsis
Dense core bodies

24. What does loss of p53 cause
Hernia
Old men - arthralgias - cardiac and neuro sx
Increase tumorigenesis
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

25. What do you use to diagnose meckels
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Pertechnetate - study for uptake
Celiac sprue
Complications of crohns

26. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Turcot
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Angiodysplasia

27. What is the mechanism for reyes syndrome
Angiodysplasia
Colovesical leading to pneumaturia
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

28. What cells secrete bicarb - What does it do - and what regulates it
Poor anastamoses
Hirschsprungs
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

29. What is the most common indication of emergent abdominal surgery in children
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Appendicitis
Terminal ileum and colon
Tropical sprue

30. People of what decent are associated with celiac sprue and what findings/antibodies are present
Complications of UC
Jaundice - fever - RUQ
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Phototherapy

31. What type of insults result in micronodular cirrhosis
Alpha amylase
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Hyperpigmented mouth - lips - hands - genitalia
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

32. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Hydrocele
H+
Achalasia due to loss of myenteric plexus (auberach)

33. Where is the deep inguinal ring relative to the inferior epigastric vessels
Zollinger Ellison - phenylalanine and tryptophan
Nonkeritinized stratified sqamous epithelium
Lateral
Antrum - H.pylori - inc risk of MALT lymphoma

34. What source of salivary secretion is the most serous and What is the most mucinous
Virchow's node
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Serous on the sides parotids - mucinous in the middle sublingual
Duodenum - 2nd - 3rd and 4th parts

35. What are the midgut structures and what supplies their blood and PANS innervation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Lateral
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
CCK8 receptor - Gq inc IP3/Ca

36. What are additional risk factors for CRC
Barrett's esophagus
Omeprazole
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Achalasia due to loss of myenteric plexus (auberach)

37. If trypsin activates more trypsinogen - what kind of feedback loop is established
Hypercoaguability - polycythemia vera - pregnancy - HCC
Stercobilin
Positive
Centrilobular congestion and necrosis - cardiac cirrhosis

38. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Adhesion
Peptic ulcer disease
Antrum - H.pylori - inc risk of MALT lymphoma
Skip lesions =crohns - colon = UC

39. in carcinoid tumors - What is seen on EM
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
NAV = nerve artery vein - venous near the penis (NAVEL)
H+
Dense core bodies

40. What does a low flow rate mean for saliva
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Hirschsprungs
Hypotonic because of more time to reabsorb NaCl
L3

41. What is the characteristic histo finding in alcoholic hepatitis
Mallory bodies
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Splenic flexure
Enterokinase/enteropeptidase from the duodenal mucosa

42. How does abetalipoproteinemia lead to malabsorption
Penicillinamine - AR inheritance
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

43. Where is folate absorbed
CHF and inc risk of HCC
Hyperplastic
The jejunum
Causes of gall stones

44. What separates the right greater and lesser sacs
Sphincter of oddi
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Gastrohepatic ligament
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

45. Gastrin - source - action - regulation
IgA secreting plasma cells - ultimately reside in the lamina proporia
Duodenum - 2nd - 3rd and 4th parts
Oligosaccharide digestion
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

46. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Redundant mesentary

47. How is salivary secretion stimulated
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Femoral hernia
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
H+

48. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Fasting and stress
Above
CHF and inc risk of HCC

49. What is the sphincter of the pancreatic duct
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Sphincter of oddi
CCK8 receptor - Gq inc IP3/Ca

50. What kind of muscle is in the lower 1/3 of the esophagus
Lipase
Smooth
L1
Tropical sprue