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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 factors increase risk of malignancy of adenomatous polyps
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Glucouronate - water soluble (direct)
Pleomorphic adenoma
Conj - inc - dec

2. What are the common causes of gastric ulcers - What causes gastric ulcer
AST>ALT
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

3. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Pleomorphic adenoma
Dec PGE2 leading to dec gastric mucosa protection
Gamma glutamyl transferase GGT

4. 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
Neural muscarinic pathways
Squamous - upper 1/3 - adeno - lower 1/3
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

5. What kind of insults results in macronodular cirrhosis
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
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
Meckels

6. What are the complications of duodenal PUD
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Bleeding - penetration into pancreas - perforation - obstruction
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Portal HTN

7. What are the structures of the femoral triangle and how are they organized
NAV = nerve artery vein - venous near the penis (NAVEL)
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
CEA - CA-19-9

8. What are additional risk factors for CRC
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Superior rectal and middle and inferior rectal - rectum
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Amylase

9. Who gets gastric ulcers
Older patients
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Turcot

10. somatostatin - source - action - regulation
Portal HTN
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Complications of crohns

11. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Adhesion
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
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
Sphincter of oddi

12. What receptor does histamine bind on the parietal cell and What does it activate
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
H2 receptor - inc cAMP
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Cystic duct and common hepatic duct

13. What are motilin receptor agonists used for clinically
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Stimulate intestinal persistalsis
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
T cell lymphoma

14. what kind of fistula is associated with diverticulitis
Pleuroperitoneal
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Colovesical leading to pneumaturia
CEA - CA-19-9

15. A protrusion of peritoneum through an opening - usually a site of weakness
Colovesical leading to pneumaturia
Poor anastamoses
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Hernia

16. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Meckels
Begins starch digestion - inactivated by low pH upon reaching the stomach
Left gastric vein and esophogeal vein - esophagus
Ischemic colitis

17. What is the most important mechanism in gastric acid secretion
Around the central vein (zone III)
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

18. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
AST>ALT
Hernia
Left gastric vein and esophogeal vein - esophagus
Ischemic colitis

19. Where is there sclerosis in alcoholic cirrohosis
Enterokinase/enteropeptidase from the duodenal mucosa
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
External spermatic fascia only
Around the central vein (zone III)

20. Which serum enzyme increases with heavy EtOH consumption
Hyperpigmented mouth - lips - hands - genitalia
Backup of blood into the liver - RHF - budd chiari
Gamma glutamyl transferase GGT
Virchow's node

21. What is the classic triad of hemochromatosis

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22. Acute gastritis is caused By what process
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Erosive - disruption of mucosal barrier leading to inflammation
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
L4

23. What are the histological findings in the jejunum
Juvenile polyposis syndrome - inc risk of adenocarcinoma
90%
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Hyperplastic

24. What is the most common cause of gallstones
Inc risk of CRC and other visceral malignancies
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Cystic duct and common hepatic duct

25. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Normal
Failure of the processus vagainlis to close
Crohns = noncaseating granulomas - UC = crypt abscesses
T12

26. What receptors does gastrin bind on the parietal cell and What does it activate
Decrease - weight gain
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
CCK8 receptor - Gq inc IP3/Ca
Virchow's node

27. At what spinal level does the celiac trunk exit
T12
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Amylase
Lack or have an attenuated muscularis externa - often in the sigmoid colon

28. Autoantibodies to gluten (gliadin) in wheat and other grains
Downs
Poor anastamoses
Liver metabolizes 5HT
Celiac sprue

29. What does high flow rate mean
PAS- positive globules in liver -
Inguninal ligament - sartorius muscle - adductor longus
Closer to isotonic because of less time to reabsorb NaCl
H+

30. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Peyers patches
8-9 waves/min
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

31. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Neutralizes oral bacertial acids and maintains dental health
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
AST
Esophageal varices

32. What commonly leads to appendicity in kids vs adults
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
H pylori (almost 100%)
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

33. What is the lumen of the pancreatic duct
Causes of gall stones
Appendicitis
External spermatic fascia only
Ampulla of vater

34. What structure is Not contained in the femoral sheath
Hemolytic anemia
Crypts but not villi
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
H pylori (almost 100%)

35. Where are tumors commonly in pancreatic adenocarcinoma
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Gilbert's
All 3
Pancreatic head causing obstructive jaundice

36. What is the TX of physiologic neonatal jaundice
Centrilobular congestion and necrosis - cardiac cirrhosis
Phototherapy
Lipase
Alpha amylase

37. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Fe2+ in the duod
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
AST
Esophageal cancer

38. Who gets Whipple disease and How do they present
Chagas disease
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
Gastric glands
Old men - arthralgias - cardiac and neuro sx

39. If the hemochromatosis is primary - What is the pattern of inheritance
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
T12
AR
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

40. What portion of the bowel does sprue effect
Centrilobular leading to congestive liver disease
Alfatoxin in peanuts
Zollinger Ellison - phenylalanine and tryptophan
The proximal small bowel

41. Liver cell failure can lead to multisystem signs including
Source - D cells (pancreatic islets - GI mucosa) - action - dec gastric acid and pepsinogen secretion - dec pancreatic and small intestine fluid secretion - dec gallbladder contraction - dec insulin and glucagon release
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

42. What are the main components of bile
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Centrilobular congestion and necrosis - cardiac cirrhosis
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

43. What serum enzyme is decreased in wilsons disease
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
Crigler - najjar type 1
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
Ceruplasmin

44. secretin - source - action - regulation
AST >ALT - ration is usually 1.5
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Epithelium
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

45. Which is used more quickly - an oral glucose load - or that by IV
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Oral glucose
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
CCK8 receptor - Gq inc IP3/Ca

46. What cells secrete bicarb - What does it do - and what regulates it
Epigastric abdominal pain radiating to back - anorexia - nausea
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Early childhood - neuro sx and malabsorption

47. What are the midgut structures and what supplies their blood and PANS innervation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Below
Hemolytic anemia
Erosive - disruption of mucosal barrier leading to inflammation

48. What are the branches of the celiac trunk and What do they supply
Common hepatic - splenic - left gastric - main blood supply for stomach
Boerhaave's Syndrome - Been heaving syndrome
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Conj - inc - dec

49. What separates the right greater and lesser sacs
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Hemosiderosis - hemochromatosis
Gastrohepatic ligament
ALT>AST

50. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Serous on the sides parotids - mucinous in the middle sublingual
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
12 waves/min