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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. When do you see hypertrophy of brunners glands
Juvenille polyps - no risk if single
Squamous - upper 1/3 - adeno - lower 1/3
Peptic ulcer disease
Alpha1 antitrypsin def - codominant trait

2. Why does indirect inguinal hernia happen in infacnts
Failure of the processus vagainlis to close
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Causes of gall stones
Low pressure proximal to LES

3. How do NSAIDs cause acute gastritis
Chronic gastritis and pernicious anemia
Dec PGE2 leading to dec gastric mucosa protection
Lipase - phospholipase A - colipase
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

4. motilin - source - action - regulation
Black - rotors syndrome
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Virchow's node
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

5. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Ischemic colitis
Muscularis mucosae
Dissaccharidase def - most commonly lactase
M3 - Gq - inc IP3/Ca

6. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Alcoholic cirrhosis
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
Peptic ulcer disease
Internal thoracic to superior epigastric to inferior epigastric

7. Who gets Whipple disease and How do they present
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Portal HTN
Dubin johnson
Old men - arthralgias - cardiac and neuro sx

8. How does gastrin increase acid secretion?
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Myenteric nerve plexus - aurbach
Primarly through ECL leading to histamine release
Duodenal atresia - Downs

9. What are the complications of Meckels
Superior rectal
Phenobarbital - inc liver enzyme synthesis
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Complications of UC

10. In jaundice of hemolytic etiology - is the hyperbilirubinemia conj or unconj - what happens to urine bili - and urine urobilinogen
Angiodysplasia
CHF and inc risk of HCC
Unconj - absent (acholuria) - inc
MSI (15%) and APC/beta catenin chromosomal instability (85%)

11. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Hyperpigmented mouth - lips - hands - genitalia
Inferior rectal nerve
Begins starch digestion - inactivated by low pH upon reaching the stomach
Peutz jeghers

12. What is the path of an indirect inguinal hernia
Redundant mesentary
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Striated and smooth
Pyoderma gangrenosum - primary sclerosing cholangitis

13. What is the ddx associated with appendicitis
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Oral glucose
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

14. What is the HLA association and treatment for hemochromatosis
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Repeated phlebotomy - deferoxamine - HLA- A3
Alcoholic cirrhosis

15. What is the prognosis of adenocarcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Liver metabolizes 5HT
External (superficial) ring only
Pleomorphic adenoma

16. What structures feed into the common bile duct
90%
Cystic duct and common hepatic duct
Serous on the sides parotids - mucinous in the middle sublingual
Nonkeritinized stratified sqamous epithelium

17. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Lactase is located at the tips of intestinal villi
External spermatic fascia only

18. Which is used more quickly - an oral glucose load - or that by IV
M3 - Gq - inc IP3/Ca
Oral glucose
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
The entire

19. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Hypotonic because of more time to reabsorb NaCl
Lipase - phospholipase A - colipase
Lateral to the inferior epigastric artery
Carcinoid syndrome

20. How is the diagonsis of CRC made
Small intestine
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
Corticosteroids - infliximab
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

21. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Alk pho
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
US and cholecystectomy
Old men - arthralgias - cardiac and neuro sx

22. In PUD with a duodenal ulcer does pain inc or dec with meals
Angiodysplasia
Punched out - clean margins - carcinoma =raised irregular margins
Decrease - weight gain
Neutralizes oral bacertial acids and maintains dental health

23. What is contained within the submucosa

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24. What are the midgut structures and what supplies their blood and PANS innervation
Penicillinamine - AR inheritance
Virchow's node
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

25. What can fistula between the gallbladder and small intestine create and how can you tell
AR
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Punched out - clean margins - carcinoma =raised irregular margins

26. What other condition can lead to acute gastritis - think renal
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Colonic polyps
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Uremia

27. rare - often fatal childhood hepatoencephalopathy

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28. What causes primary biliary cirrhosis
Inferior rectal nerve
Punched out - clean margins - carcinoma =raised irregular margins
Lubricate food (glycoprotiens)
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

29. What are motilin receptor agonists used for clinically
VZV and influenza B treated with salicylates
Stimulate intestinal persistalsis
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Decreased intercellular adhesion and increased proliferation

30. What is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
Striated and smooth
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Female - fat - fertile - forty

31. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

32. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Right and left hepatic duct
Hyperpigmented mouth - lips - hands - genitalia
Alpha1 antitrypsin def - codominant trait
US and cholecystectomy

33. What is charcot triad of cholangitis
US and cholecystectomy
Jaundice - fever - RUQ
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Heme metabolism

34. What layer in the mucosa is responsible for absorption
Uremia
Dec PGE2 leading to dec gastric mucosa protection
Alpha amylase
Epithelium

35. What causes pancreatic insuff and What does it cause
Causes of gall stones
Corticosteroids - infliximab
Dec PGE2 leading to dec gastric mucosa protection
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

36. What kind of lesions are characteristic of duodenal PUD vs cancer
Punched out - clean margins - carcinoma =raised irregular margins
Gut bacteria
Sphincter of oddi
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

37. At what spinal level does the celiac trunk exit
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
T12
Gut bacteria
Smooth

38. concentric onion skin bile duct fibrosis
Stimulate intestinal persistalsis
Cholesterol
Primary sclerosing cholangitis
Positive urease test

39. Where does crohns usually affect the GI tract
Terminal ileum and colon
Neutralizes oral bacertial acids and maintains dental health
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Muscularis mucosae

40. If trypsin activates more trypsinogen - what kind of feedback loop is established
Glucouronate - water soluble (direct)
Positive
L4
Chronic calcifying pancreatitis - inc risk of panreatic cancer

41. Why would a self - limited lactase def occur following an injury (viral diarrhea)
NAV = nerve artery vein - venous near the penis (NAVEL)
Lactase is located at the tips of intestinal villi
Necrotizing enterocolitis
Decreased intercellular adhesion and increased proliferation

42. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Complications of crohns
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Stercobilin
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC

43. Where does type A chronic gastritis occur and What causes it
Obstruction of the common bile duct
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Fasting and stress
Normal

44. Gallstones that reach the common channel at ampulla can block which two ducts
Pancreatic and bile
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Duodenal atresia - Downs
The gastroduodenal

45. Are single polyps malignant in peutz jehgers
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Hemosiderosis - hemochromatosis
Lubricate food (glycoprotiens)
No

46. What source of salivary secretion is the most serous and What is the most mucinous
Krukenbergs tumor
Conj/unconj - inc - nl to dec
Tropical sprue
Serous on the sides parotids - mucinous in the middle sublingual

47. In what scenarios do pts with gilberts have inc bili
VZV and influenza B treated with salicylates
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Fasting and stress

48. What happens to the short gastics if the splenic artery is blocked
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Causes of gall stones
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Poor anastamoses

49. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Gardner's syndrome
Chronic gastritis and pernicious anemia
HPNCC
Osmotic

50. GIP - source - action regulation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Redundant mesentary
Left and right gastroepiploics - left and right gastrics
Lateral