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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 are the signs of peutz jehgers
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Acute pancreatitis
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Hyperpigmented mouth - lips - hands - genitalia

2. How are all 3 monosaccharides transported to the blood
Mitochondrial abnl - fatty liver - hypoglycemia - coma
8-9 waves/min
Brush border of intestine - produce monosaccharides from oligo and di
GLUT 2

3. What are the tumor markers for pancreatic adenocarcinoma
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Primarly through ECL leading to histamine release
CEA - CA-19-9
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

4. How does abetalipoproteinemia lead to malabsorption
Phototherapy
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Lateral
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

5. What do the rugae of stomach look like in menetriers disease
Lamina propria
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
So hypertrophied they look like brain gyri
Celiac sprue

6. Who is at risk for pancreatic adenocarcinoma
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Jewish and African American men
Decreased intercellular adhesion and increased proliferation
Dermatitis herpetiformis

7. What cell produces IF and What does it do
Can lead to hematemesis - found in EtOHics and bulimics
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Parietal cells in the stomach - B12 binding protein
Cholesterol - 10-20% opaque due to calcifications

8. In alchoholic hepatitis which liver enzyme is higher
Peptic ulcer disease
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
AST>ALT
Gastrohepatic ligament

9. Where are tumors commonly in pancreatic adenocarcinoma
NAV = nerve artery vein - venous near the penis (NAVEL)
Lipase
Zollinger ellison - brunners glands
Pancreatic head causing obstructive jaundice

10. What are additional risk factors for CRC
Dysphagia (due to esophageal web) - glossitis - iron def anemia
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Stercobilin
Goes through deep inguinal ring - external inguinal ring and into the scrotum

11. At what level of the spine does the IM exit the aorta
L3
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
Stimulate the H/K ATPase
Black - rotors syndrome

12. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
FAP
Via the superior pancreaticduodenal
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

13. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Duodenum - 2nd - 3rd and 4th parts
Spleen to posterior abdominal wall - splenic artery and vein
Achalasia due to loss of myenteric plexus (auberach)

14. What is the prognosis of adenocarcinoma
Cystic duct and common hepatic duct
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Averages 6 months - very aggressive - usually already metastasized at presentation
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

15. Autodigestion of pancreas by pancreatic enzymes
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Via the superior pancreaticduodenal
Dissaccharidase def - most commonly lactase
Acute pancreatitis

16. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Inc risk of CRC and other visceral malignancies
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Hepatic steatosis
Esophageal varices

17. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Striated
Conj - inc - dec

18. What are the histological findings in the jejunum
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Crohns = maybe - UC= always
Dissaccharidase def - most commonly lactase
Phenobarbital - inc liver enzyme synthesis

19. Scleroderma is associated with what kind of esophageal dysmotility
Low pressure proximal to LES
Lipase
Stimulate intestinal persistalsis
Esophageal carcinoma

20. Which is used more quickly - an oral glucose load - or that by IV
Lactase is located at the tips of intestinal villi
Oral glucose
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Lamina propora and submucosa

21. Abuse of what substance leads to acute gastritis
NAV = nerve artery vein - venous near the penis (NAVEL)
EtOH
Menetriers disease
External (superficial) ring only

22. At what level do the testicular/ovarian arteries exit the aorta
Left and right gastroepiploics - left and right gastrics
Splenic flexure
L2
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

23. Malabsorption syndromes have what common clinical presentation
The submucosal nerve plexus - meissner's
Backup of blood into the liver - RHF - budd chiari
Diarrhea - steatorrhea - weight loss - weakness
Gastric glands

24. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Nonkeritinized stratified sqamous epithelium
FAP
Terminal ileum and colon
Krukenbergs tumor

25. Where does type A chronic gastritis occur and What causes it
Falciform - ligamentum teres - fetal umbilical vein
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Pancreatic head causing obstructive jaundice
Sphincter of oddi

26. What kind of muscle is in the middle 1/3 of esophagus
Volvulus
Centrilobular congestion and necrosis - cardiac cirrhosis
Worldwide - SC - US - adeno
Striated and smooth

27. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
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
Left and right gastroepiploics - left and right gastrics
Boerhaave's Syndrome - Been heaving syndrome

28. What arteries exit just below the SMA
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
L/R renal artery around L1
Complications of crohns
Obstruction of the common bile duct

29. FAP + osseous and soft tissue tumors - retinal hyperplasia

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30. What kind of cancer to celiac sprue put you as inc risk for
Dissaccharidase def - most commonly lactase
No - chronic - can present with diarrhea or constipation or alternation - treat sx
T cell lymphoma
Mallory bodies

31. What are the labs in acute pancreatitis
Zenkers - halitosis - dysphagia and obstruction
Elevated amylase - and lipase
Zollinger Ellison - phenylalanine and tryptophan
Neural muscarinic pathways

32. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Splenic flexure
Upregulated intracellular signal transduction
Alk pho

33. What separates the right greater and lesser sacs
Gastrohepatic ligament
Redundant mesentary
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Inc conj bilirubin - inc cholesterol - inc alk phos

34. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Gastric glands
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
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
Above

35. What are the histological findings in the ileum

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36. Who gets gastric ulcers
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Paraumbilical and superficial and inferior epigastric - umbilicus
Older patients
IgA secreting plasma cells - ultimately reside in the lamina proporia

37. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

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38. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Lateral
PAS- positive globules in liver -
Falciform - ligamentum teres - fetal umbilical vein
Via the superior pancreaticduodenal

39. At what spinal level does the SMA exit
L1
Conj - inc - dec
Alcoholic hepatitis
Peptic ulcer disease

40. What causes pancreatic insuff and What does it cause
Gastrohepatic ligament
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

41. What is the sphincter of the pancreatic duct
Lubricate food (glycoprotiens)
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Sphincter of oddi

42. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
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
H2 receptor - inc cAMP
The jejunum
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

43. somatostatin - source - action - regulation
IgA secreting plasma cells - ultimately reside in the lamina proporia
Erosive - disruption of mucosal barrier leading to inflammation
Nonkeritinized stratified sqamous epithelium
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

44. What are the four Fs of gallstones
Hyperpigmented mouth - lips - hands - genitalia
Female - fat - fertile - forty
T12
Esophageal carcinoma

45. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
AST
Krukenbergs tumor
Alcoholic cirrhosis

46. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
CHF and inc risk of HCC
Meconium ileus
Duodenal atresia - Downs
Pancreatic head causing obstructive jaundice

47. What is the path of an indirect inguinal hernia
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Decreased intercellular adhesion and increased proliferation

48. Acute gastritis is caused By what process
Female - fat - fertile - forty
Uridine glucuronyl transferase
Erosive - disruption of mucosal barrier leading to inflammation
Alpha1 antitrypsin def - codominant trait

49. what kind of muscle is in the upper 1/3 of esophagus
IBS at least 2 with recurrent abdominal pain
Striated
Repeated phlebotomy - deferoxamine - HLA- A3
Striated and smooth

50. Where are carcinoid tumors most commonly malignant
CHF and inc risk of HCC
Ampulla of vater
Small intestine
Crohns = noncaseating granulomas - UC = crypt abscesses