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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. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Gut bacteria
GLUT 2
Stimulate intestinal persistalsis
IBS at least 2 with recurrent abdominal pain

2. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Peyers patches
Cystic duct and common hepatic duct
Decreased intercellular adhesion and increased proliferation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

3. What are causes of extrahepatic biliary obstruction
Hemolytic anemia
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Cirrhosis

4. what kind of muscle is in the upper 1/3 of esophagus
Trypsin - chymotrypsin - elastase - carboxypeptidases
Striated
Ceruplasmin
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

5. What do you treat Wilsons disease with and What is the inheritance
Hemolytic anemia
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Crypts but not villi
Penicillinamine - AR inheritance

6. What is the omphalomesenteric cyst
Black - rotors syndrome
Cystic dilation of the viteline duct
Ceruplasmin
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

7. Abuse of what substance leads to acute gastritis
Hydrocele
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Gallbladder
EtOH

8. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
Positive urease test
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

9. What are the treatment options for uclerative colitis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Budd chiari syndrome
Around the central vein (zone III)

10. Where are tumors commonly in pancreatic adenocarcinoma
AST >ALT - ration is usually 1.5
Pancreatic head causing obstructive jaundice
Peyers patches
Mucosa - submucosa - muscularis externa - serosa/adventitia

11. What is the most common esophageal cancer worldwide and in the US
Pleomorphic adenoma
Worldwide - SC - US - adeno
Cigarettes and chronic pancreatitis - not EtOH
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

12. What is the presenting course for appendicity

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13. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lateral
Averages 6 months - very aggressive - usually already metastasized at presentation
Where hindgut meets ectoderm
Muscularis mucosae

14. How does gastrin increase acid secretion?
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
Primarly through ECL leading to histamine release
Dense core bodies
Bleeding - penetration into pancreas - perforation - obstruction

15. How does CRC present in the distal and proximal colon
Muscularis mucosae
Backup of blood into the liver - RHF - budd chiari
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

16. Why does volvulus occur more at cecum and sigmoid colon
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Redundant mesentary
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

17. What kind of muscle is in the middle 1/3 of esophagus
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
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
Striated and smooth
Alcoholic hepatitis

18. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Appendicitis
Crohns = noncaseating granulomas - UC = crypt abscesses
Common hepatic - splenic - left gastric - main blood supply for stomach
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

19. bilateral mets to ovaries with abundant mucus - signet ring cells
The proximal small bowel
Krukenbergs tumor
The gastroduodenal
CCK8 receptor - Gq inc IP3/Ca

20. What is the presentation of pancreatic adenocarcinoma
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
ALT>AST
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

21. What does bicarb do in the duodenum
Heme metabolism
Neutralizes gastric acid allowing pancreatic enzymes to fxn
...
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

22. What does loss of APC cause
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Femoral hernia
Decreased intercellular adhesion and increased proliferation
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

23. Autodigestion of pancreas by pancreatic enzymes
Acute pancreatitis
Lactase is located at the tips of intestinal villi
Gastrohepatic ligament
Muscularis mucosae

24. Malabsorption syndromes have what common clinical presentation
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Trypsin - chymotrypsin - elastase - carboxypeptidases
...
Diarrhea - steatorrhea - weight loss - weakness

25. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
L/R renal artery around L1
Cirrhosis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

26. In what clinical scenarior do you see portosystemic anastomoses
So hypertrophied they look like brain gyri
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Portal HTN
Alpha1 antitrypsin def - codominant trait

27. What gives stool its characteristic color
Stercobilin
T cell lymphoma
Common hepatic - splenic - left gastric - main blood supply for stomach
Diarrhea - steatorrhea - weight loss - weakness

28. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Primary sclerosing cholangitis
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
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

29. Where does copper accumulate in Wilsons and What are ABCD
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Complications of UC
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

30. What layer of fascia covers a direct inguinal hernia
Worldwide - SC - US - adeno
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Chronic calcifying pancreatitis - inc risk of panreatic cancer
External spermatic fascia only

31. in carcinoid tumors - What is seen on EM
AR
Dense core bodies
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Muscularis mucosae

32. What kind of pancreatitis is associated with EtOH and smoking
Alcoholic cirrhosis
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Oral glucose
Spleen to posterior abdominal wall - splenic artery and vein

33. What infection causes Whipple disease and What can you see on LM
Decrease - weight gain
Gut bacteria
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
12 waves/min

34. What test and result confirms H pylori infxn
Positive urease test
Superior rectal and middle and inferior rectal - rectum
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Femoral hernia

35. What is the action of NO as a GI hormone
Inc smooth muscle relaxation - including lower esophageal sphincter
Punched out - clean margins - carcinoma =raised irregular margins
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

36. What does extrahepatic biliary obstruction cause
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Hyperpigmented mouth - lips - hands - genitalia
Antrum - H.pylori - inc risk of MALT lymphoma

37. What does autoimmune destruction of parietal cells lead to...
Chronic gastritis and pernicious anemia
CEA - CA-19-9
No
H2 receptor - inc cAMP

38. How does abetalipoproteinemia lead to malabsorption
Via the middle colic
Gastric glands
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
H pylori (almost 100%)

39. What converts inactive pepsinogen to pepsin
3 waves/min
H+
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

40. What is the HLA association and treatment for hemochromatosis
Appendicitis
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Repeated phlebotomy - deferoxamine - HLA- A3
Alk phos

41. rare - often fatal childhood hepatoencephalopathy

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42. Where does type B chronic gastritis occur and What causes it
Bleeding - penetration into pancreas - perforation - obstruction
Ampulla of vater
Can lead to hematemesis - found in EtOHics and bulimics
Antrum - H.pylori - inc risk of MALT lymphoma

43. What nerve innervates the external hemorrhoids
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
PAS- positive globules in liver -
Inferior rectal nerve
Poor anastamoses

44. Where does crohns usually affect the GI tract
Gilbert's
Brunners
Terminal ileum and colon
Crohns = maybe - UC= always

45. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Brush border of intestine - produce monosaccharides from oligo and di
Zollinger ellison - brunners glands
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Jewish and African American men

46. Which is used more quickly - an oral glucose load - or that by IV
GLUT 2
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Alk phos
Oral glucose

47. How does loss of NO secretion affect the esophagus and what results
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
All 3 gut layers outpouch as in Meckels
AR
Inc lower esphogeal tone leading to achalasia

48. why infxn is implicated in duodenal PUD
L1
H pylori (almost 100%)
Lamina propora and submucosa
Alpha1 antitrypsin def - codominant trait

49. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Hirschsprungs
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Can lead to hematemesis - found in EtOHics and bulimics

50. What pancreatic proteases are secreted as zymogens
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
3 waves/min
Esophageal carcinoma
Trypsin - chymotrypsin - elastase - carboxypeptidases