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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. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
The proximal small bowel
Menetriers disease
Left and right gastroepiploics - left and right gastrics
Low pressure proximal to LES

2. What cells secrete bicarb - What does it do - and what regulates it
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Diarrhea - steatorrhea - weight loss - weakness
H2 receptor - inc cAMP
Mucosa - submucosa - muscularis externa - serosa/adventitia

3. Who is at risk for pancreatic adenocarcinoma
Hypercoaguability - polycythemia vera - pregnancy - HCC
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Centrilobular congestion and necrosis - cardiac cirrhosis
Jewish and African American men

4. What is the most important mechanism in gastric acid secretion
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
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
Conj/unconj - inc - nl to dec

5. What are the hindgut structures and what supplies their blood and PANS innvervation
Above
Unconj - absent (acholuria) - inc
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Celiac sprue

6. How do villi appear in disaccharidease def
Barrett's esophagus
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Normal
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

7. Which serum enzyme increases with heavy EtOH consumption
Gamma glutamyl transferase GGT
M3 - Gq - inc IP3/Ca
Appendicitis
Pancreatic head causing obstructive jaundice

8. A protrusion of peritoneum through an opening - usually a site of weakness
Hernia
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
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Right and left hepatic duct

9. What intervention will intervention will relieve portal HTN
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Elevated amylase - and lipase
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

10. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Inc - weight loss
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
Dissaccharidase def - most commonly lactase
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

11. What are the tumor markers for pancreatic adenocarcinoma
CEA - CA-19-9
Colonic polyps
Diarrhea - steatorrhea - weight loss - weakness
Hemosiderosis - hemochromatosis

12. What does high flow rate mean
8-9 waves/min
Upregulated intracellular signal transduction
Closer to isotonic because of less time to reabsorb NaCl
Hernia

13. What is biliary colic
Oligosaccharide digestion
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Mucoepidermoid carcinoma
Brunners

14. What is the classic triad of hemochromatosis

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15. What commonly leads to appendicity in kids vs adults
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Crohns = noncaseating granulomas - UC = crypt abscesses
Esophageal carcinoma
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

16. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Increase tumorigenesis
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
CHF and inc risk of HCC
Lamina propora and submucosa

17. What is the path of an indirect inguinal hernia
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Crohns = noncaseating granulomas - UC = crypt abscesses
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

18. What are the complications of Meckels
Dense core bodies
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Turcot
Lye ingestion and acid reflux

19. What is the main symptom if a VIPoma
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
Crohns = noncaseating granulomas - UC = crypt abscesses
Copious diarrhea - non alpha - non beta cell pancreatic tumor
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

20. Gallstones that reach the common channel at ampulla can block which two ducts
Lactase is located at the tips of intestinal villi
Left and right gastroepiploics - left and right gastrics
Pancreatic and bile
Jaundice - fever - RUQ

21. Achalasia increases the risk For what complication
Esophageal carcinoma
Where hindgut meets ectoderm
Hyperpigmented mouth - lips - hands - genitalia
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

22. What layer in the mucosa is responsible for support
All 3 gut layers outpouch as in Meckels
Lamina propria
Turcot
Duodenal atresia - Downs

23. What findings are associated with reyes
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Chagas disease
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Mitochondrial abnl - fatty liver - hypoglycemia - coma

24. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Cystic duct and common hepatic duct
Duodenal atresia - Downs
Gardner's syndrome

25. What is a positive murphy's sign
Inspiratory arrest on deep palpation due to pain
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Female - fat - fertile - forty
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

26. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Cystic dilation of the viteline duct
Carcinoid syndrome

27. What reaction does salivary amylase catalyze
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Common hepatic - splenic - left gastric - main blood supply for stomach
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

28. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Volvulus
Alpha1 antitrypsin def - codominant trait
Femoral hernia
Phototherapy

29. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Complications of crohns
Menetriers disease
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Increase tumorigenesis

30. When and why is stomach cancer termed linitis plastica
Neural muscarinic pathways
Lamina propora and submucosa
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
When diffusely infiltrative - thickened rigid appearance like a leather bottle

31. Acute gastritis is caused By what process
Jaundice - fever - RUQ
Erosive - disruption of mucosal barrier leading to inflammation
Decreased intercellular adhesion and increased proliferation
CCK8 receptor - Gq inc IP3/Ca

32. What is one potential precipitating factor for intussusception
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Skip lesions =crohns - colon = UC
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Backup of blood into the liver - RHF - budd chiari

33. What arteries exit just below the SMA
So hypertrophied they look like brain gyri
L/R renal artery around L1
Fe2+ in the duod
HPNCC

34. What is contained in the gastrosplenic and What areas does it separate
Mucosa - submucosa - muscularis externa - serosa/adventitia
Ceruplasmin
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Short gastrics - left greater and lesser

35. What is indirect bilirubin
Unconjugated - water insoluble
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Small intestine
Dubin johnson

36. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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37. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Reye's syndrome
Below
Alcoholic cirrhosis

38. At what spinal level does the is the bifurcation of aorta
Zollinger Ellison - phenylalanine and tryptophan
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Terminal ileum and colon
L4

39. What causes primary biliary cirrhosis
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

40. What does histo show for alpha1 antitrypsin def
Smooth
Where hindgut meets ectoderm
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
PAS- positive globules in liver -

41. Where is the deep inguinal ring relative to the inferior epigastric vessels
So hypertrophied they look like brain gyri
Oral glucose
Lateral
Gardner's syndrome

42. What causes nutmeg liver
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Begins starch digestion - inactivated by low pH upon reaching the stomach
Hyperpigmented mouth - lips - hands - genitalia
Backup of blood into the liver - RHF - budd chiari

43. Why does volvulus occur more at cecum and sigmoid colon
Redundant mesentary
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
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
PAS- positive globules in liver -

44. How does hirschsprung present and appear on imaging
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Above
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
Failure of neural crest migration

45. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Peptic ulcer disease
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Intussusception
Osmotic

46. With internal hemorrhoids Where is the anastomoses and Where is it
Cystic duct and common hepatic duct
HPNCC
Below
Superior rectal and middle and inferior rectal - rectum

47. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Enterokinase/enteropeptidase from the duodenal mucosa
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Alcoholic cirrhosis

48. What is the most common diaphragmatic hernia and What are the two types
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Right and left hepatic duct
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

49. Why are most diverticula considered false
T12
Cystic duct and common hepatic duct
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Lipase

50. what percentage of colonic polyps are non - neoplastic
Lack or have an attenuated muscularis externa - often in the sigmoid colon
90%
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Menetriers disease