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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 kind of muscle is in the middle 1/3 of esophagus
Pleuroperitoneal
90%
Striated and smooth
Bleeding - intussusception - volvulus - obstruction near terminal ileum

2. What causes pancreatic insuff and What does it cause
H2 receptor - inc cAMP
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

3. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Crohns = maybe - UC= always
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Portal HTN

4. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
ALT>AST
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
CCK8 receptor - Gq inc IP3/Ca

5. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
Low pressure proximal to LES
Older patients
Inc smooth muscle relaxation - including lower esophageal sphincter

6. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Dermatitis herpetiformis
Cigarettes and chronic pancreatitis - not EtOH
Volvulus
Failure of the processus vagainlis to close

7. somatostatin - source - action - regulation
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
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
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

8. What enzyme is necessary to create conjugated bilirubin
Hemolytic anemia
Duodenal atresia - Downs
Complications of UC
Uridine glucuronyl transferase

9. What gives stool its characteristic color
AST>ALT
Lactase is located at the tips of intestinal villi
Lateral to the inferior epigastric artery
Stercobilin

10. What is the main symptom if a VIPoma
Dilated esophagus with an area of distal stenosis - birds beak
AST >ALT - ration is usually 1.5
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Poor anastamoses

11. What is the omphalomesenteric cyst
Stimulate the H/K ATPase
Cystic dilation of the viteline duct
Gallbladder
Portal HTN

12. What causes hirschsprungs
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Failure of neural crest migration
H pylori (almost 100%)
Acute pancreatitis

13. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Cholesterol - 10-20% opaque due to calcifications
Barrett's esophagus
Sphincter of oddi
Muscularis mucosae

14. How is salivary secretion stimulated
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

15. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Black - rotors syndrome
Esophageal cancer
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
L1

16. Failure of relaxation of lower esophageal sphincter - Name and etiology
Failure of the processus vagainlis to close
Achalasia due to loss of myenteric plexus (auberach)
Increase tumorigenesis
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

17. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Complications of crohns
T cell lymphoma
Erosive - disruption of mucosal barrier leading to inflammation
Striated and smooth

18. What histological findings are present in the stomach
Gastric glands
Stimulate the H/K ATPase
Inc smooth muscle relaxation - including lower esophageal sphincter
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

19. What are the tumor markers for pancreatic adenocarcinoma
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Achalasia due to loss of myenteric plexus (auberach)
Chronic calcifying pancreatitis - inc risk of panreatic cancer
CEA - CA-19-9

20. People of what decent are associated with celiac sprue and what findings/antibodies are present
Hypotonic because of more time to reabsorb NaCl
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Lubricate food (glycoprotiens)

21. What drug inhibits the H/K ATPase
Peyers patches
Omeprazole
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Volvulus

22. What are the structures of the femoral triangle and how are they organized
NAV = nerve artery vein - venous near the penis (NAVEL)
Alfatoxin in peanuts
Oligosaccharide digestion
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

23. What commonly leads to appendicity in kids vs adults
AST>ALT
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Diarrhea - steatorrhea - weight loss - weakness

24. Cholecytsokinin - source - action - regulation
AR
Dilated esophagus with an area of distal stenosis - birds beak
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
Elevated amylase - and lipase

25. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
AST >ALT - ration is usually 1.5
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Necrotizing enterocolitis
Centrilobular congestion and necrosis - cardiac cirrhosis

26. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Corticosteroids - infliximab
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

27. What is charcot triad of cholangitis
The jejunum
Corticosteroids - infliximab
Decreased intercellular adhesion and increased proliferation
Jaundice - fever - RUQ

28. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Colovesical leading to pneumaturia
Pertechnetate - study for uptake
Osmotic
Above

29. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Trypsin - chymotrypsin - elastase - carboxypeptidases
Juvenille polyps - no risk if single
EtOH
Virchow's node

30. concentric onion skin bile duct fibrosis
Centrilobular leading to congestive liver disease
Primary sclerosing cholangitis
L3
Myenteric nerve plexus - aurbach

31. What are the treatmet options for crohns
Corticosteroids - infliximab
AST >ALT - ration is usually 1.5
Above
Via the middle colic

32. At what spinal level does the is the bifurcation of aorta
Colovesical leading to pneumaturia
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
L4
Hydrocele

33. What are the effects of atropine on parietal cells and G cells
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Zollinger Ellison - phenylalanine and tryptophan

34. What happens to the short gastics if the splenic artery is blocked
Poor anastamoses
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
External (superficial) ring only
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

35. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
Hydrocele
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Dec PGE2 leading to dec gastric mucosa protection

36. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
All 3
Complications of UC
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Zenkers - halitosis - dysphagia and obstruction

37. What causes nutmeg liver
Early childhood - neuro sx and malabsorption
Backup of blood into the liver - RHF - budd chiari
Celiac sprue
MSI (15%) and APC/beta catenin chromosomal instability (85%)

38. Liver cell failure can lead to multisystem signs including
Menetriers disease
Lamina propria
Carcinoid syndrome
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

39. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Menetriers disease

40. What intervention will intervention will relieve portal HTN
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Parietal cells in the stomach - B12 binding protein

41. FAP + malignant CNS tumor
Virchow's node
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Turcot
Heme metabolism

42. What are the layers of the gut wall from inside out
Mucosa - submucosa - muscularis externa - serosa/adventitia
Gilbert's
Cirrhosis
VZV and influenza B treated with salicylates

43. How does loss of NO secretion affect the esophagus and what results
...
Gut bacteria
Inc lower esphogeal tone leading to achalasia
Gilbert's

44. What is the cause of Barrett's and the assocaited complications
Neutralizes oral bacertial acids and maintains dental health
Centrilobular congestion and necrosis - cardiac cirrhosis
Lack or have an attenuated muscularis externa - often in the sigmoid colon
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

45. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Failure of the processus vagainlis to close
Pleomorphic adenoma
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Zollinger ellison - brunners glands

46. milk intolerance
Dissaccharidase def - most commonly lactase
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
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
No

47. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Normal
Stercobilin
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

48. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Positive
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
The proximal small bowel

49. Transmural esophageal rupture due to violent retching

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50. What are the histological findings in the ileum

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