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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 is the frequency of basal electric rhythm in the duodenum
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Downs
Chronic gastritis and pernicious anemia
12 waves/min

2. What are the hindgut structures and what supplies their blood and PANS innvervation
Colonic polyps
Spleen to posterior abdominal wall - splenic artery and vein
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Alcoholic hepatitis

3. What does extrahepatic biliary obstruction cause
Mallory bodies
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Cholesterol - 10-20% opaque due to calcifications
Corticosteroids - infliximab

4. What is the rate limiting step of carbohydrate digestion
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Oligosaccharide digestion
Appendicitis
Diarrhea - steatorrhea - weight loss - weakness

5. 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
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
Carcinoid syndrome
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

6. FAP + malignant CNS tumor
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Decreased intercellular adhesion and increased proliferation
Turcot
Terminal ileum and colon

7. What is contained in the gastrosplenic and What areas does it separate
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
The proximal small bowel
Short gastrics - left greater and lesser
Lye ingestion and acid reflux

8. What is the arterial supply and venous drainage below pectinate line
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Obstruction of the common bile duct
Lipase
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

9. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
Poor anastamoses
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
AST >ALT - ration is usually 1.5

10. milk intolerance
Dissaccharidase def - most commonly lactase
Redundant mesentary
Peptic ulcer disease
H2 receptor - inc cAMP

11. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
90%
Left gastric vein and esophogeal vein - esophagus
Carcinoid syndrome
Hydrocele

12. What serum enzyme is elevated inacute pancreatitis
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Intussusception
Colonic polyps
Lipase

13. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Inc smooth muscle relaxation - including lower esophageal sphincter
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Internal thoracic to superior epigastric to inferior epigastric
Lye ingestion and acid reflux

14. What is the most important mechanism in gastric acid secretion
L2
Dubin johnson
Zollinger ellison - brunners glands
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

15. Where does type B chronic gastritis occur and What causes it
Esophageal varices
Antrum - H.pylori - inc risk of MALT lymphoma
In the ileum with bile acids - requires IF
Zollinger ellison - brunners glands

16. When and How does Abetalipoproteinemia present
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Early childhood - neuro sx and malabsorption
IBS at least 2 with recurrent abdominal pain
Urobilin

17. What does the splenorenal ligament connect - and What does it contain
Small intestine
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Spleen to posterior abdominal wall - splenic artery and vein
Uridine glucuronyl transferase

18. If the hemochromatosis is primary - What is the pattern of inheritance
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
AR
Decrease - weight gain

19. In viral hepatitis - which liver enzyme is higher
ALT>AST
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Diarrhea - steatorrhea - weight loss - weakness
Glucose dependent insulinotropic peptide

20. What are the barium swallow findings of achalasia
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Hepatic steatosis
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Dilated esophagus with an area of distal stenosis - birds beak

21. Failure of relaxation of lower esophageal sphincter - Name and etiology
Normal
Crohns = noncaseating granulomas - UC = crypt abscesses
Achalasia due to loss of myenteric plexus (auberach)
Hypotonic because of more time to reabsorb NaCl

22. What does a gastrinoma cause
Conj/unconj - inc - nl to dec
Positive urease test
All 3
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

23. How is salivary secretion stimulated
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
The submucosal nerve plexus - meissner's
H+
Brunners

24. most common non - neoplastic polyp in colon
Hyperplastic
Inc smooth muscle relaxation - including lower esophageal sphincter
Crypts but not villi
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

25. Is there any structural abnl with IBS - What is the course of disease and presentation
US and cholecystectomy
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Esophageal carcinoma
FAP

26. What is the most common cause of gallstones
Meconium ileus
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
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Alk pho

27. What layer in the mucosa is responsible for support
Lamina propria
Duodenal atresia - Downs
Small intestine
Hepatic steatosis

28. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Turcot
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
Cimetidine
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

29. What gives stool its characteristic color
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Diverticulum
Lateral to the inferior epigastric artery
Stercobilin

30. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal atresia - Downs
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Pertechnetate - study for uptake
Dilated esophagus with an area of distal stenosis - birds beak

31. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
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
Phototherapy
EtOH
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

32. in carcinoid tumors - What is seen on EM
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
Unconj - absent (acholuria) - inc
Dense core bodies
Superior rectal and middle and inferior rectal - rectum

33. What are the common causes of gastric ulcers - What causes gastric ulcer
L/R renal artery around L1
Juvenille polyps - no risk if single
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
CHF and inc risk of HCC

34. What other condition can lead to acute gastritis - think renal
Mallory bodies
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Glucose dependent insulinotropic peptide
Uremia

35. What is the frequency of basal electric rhythm of the stomach
Uridine glucuronyl transferase
Oral glucose
3 waves/min
Mucosa - submucosa - muscularis externa - serosa/adventitia

36. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Angiodysplasia
L4
Cholesterol

37. Gallstones that reach the common channel at ampulla can block which two ducts
Hypotonic because of more time to reabsorb NaCl
Amylase
Gastrohepatic ligament
Pancreatic and bile

38. GIP - source - action regulation
Colonic polyps
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Spleen to posterior abdominal wall - splenic artery and vein

39. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
FAP
Lubricate food (glycoprotiens)
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

40. What is the path of an indirect inguinal hernia
AST >ALT - ration is usually 1.5
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Worldwide - SC - US - adeno
The submucosal nerve plexus - meissner's

41. Scleroderma is associated with what kind of esophageal dysmotility
Redness and tenderness on palpation of extremities
Primarly through ECL leading to histamine release
Low pressure proximal to LES
Complications of UC

42. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
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
MSI (15%) and APC/beta catenin chromosomal instability (85%)
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

43. When and why is stomach cancer termed linitis plastica
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
When diffusely infiltrative - thickened rigid appearance like a leather bottle

44. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
The gastroduodenal
Liver metabolizes 5HT
Alcoholic hepatitis

45. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
L3
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
L/R renal artery around L1

46. motilin - source - action - regulation
Cystic duct and common hepatic duct
Early childhood - neuro sx and malabsorption
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Jewish and African American men

47. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
L4
Lactase is located at the tips of intestinal villi

48. At what spinal level does the SMA exit
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
L1
EtOH

49. What drug inhibits the H/K ATPase
Omeprazole
HPNCC
ALT>AST
Repeated phlebotomy - deferoxamine - HLA- A3

50. What are the two molecular pathways that lead to CRC
External (superficial) ring only
Gilbert's
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Cholesterol - 10-20% opaque due to calcifications