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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. Why are most diverticula considered false
All 3 gut layers outpouch as in Meckels
Inguninal ligament - sartorius muscle - adductor longus
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Left gastric vein and esophogeal vein - esophagus

2. Autodigestion of pancreas by pancreatic enzymes
With albumin
Acute pancreatitis
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Sister mary joseph nodule

3. Which kind of hemorrhoids are painful and why
Female - fat - fertile - forty
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

4. What is the TX of physiologic neonatal jaundice
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Phototherapy
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Positive

5. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Dec PGE2 leading to dec gastric mucosa protection
Alpha1 antitrypsin def - codominant trait
NAV = nerve artery vein - venous near the penis (NAVEL)
Terminal ileum and colon

6. What factors increase risk of malignancy of adenomatous polyps
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Angiodysplasia
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

7. Which patients have pigment stones
GERD - may also present with nocturnal cough and dyspnea
Dilated esophagus with an area of distal stenosis - birds beak
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Oral glucose

8. What findings are associated with reyes
Low pressure proximal to LES
Cirrhosis
Brush border of intestine - produce monosaccharides from oligo and di
Mitochondrial abnl - fatty liver - hypoglycemia - coma

9. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
The submucosal nerve plexus - meissner's
Hepatic steatosis
Lamina propora and submucosa
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

10. What are the midgut structures and what supplies their blood and PANS innervation
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
HSV-1 - CMV - Candida
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
Diverticulum

11. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Carcinoid syndrome
Cirrhosis
Uremia

12. in CF - meconium plug obstructs intestine - preventing stool passage at birth
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
Portal HTN
Meconium ileus
L/R renal artery around L1

13. How does hirschsprung present and appear on imaging
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
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
In the mucus that covers the gastric epithelium
Inc smooth muscle relaxation - including lower esophageal sphincter

14. What serum enzyme is decreased in wilsons disease
Ceruplasmin
Hypercoaguability - polycythemia vera - pregnancy - HCC
Budd chiari syndrome
Small intestine

15. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
Gilbert's
Epithelium
Crypts but not villi

16. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
Alpha amylase
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Hirschsprungs
Peptic ulcer disease

17. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
H2 receptor - inc cAMP
Alcoholic cirrhosis
Dilated esophagus with an area of distal stenosis - birds beak
Conj - inc - dec

18. What are the layers of the gut wall from inside out
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Boerhaave's Syndrome - Been heaving syndrome
Mucosa - submucosa - muscularis externa - serosa/adventitia
Epigastric abdominal pain radiating to back - anorexia - nausea

19. What are the histological findings of the colon
Crypts but not villi
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Lamina propora and submucosa
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

20. What are the foregut structures and what supplies their blood and PANS innvervation
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Liver metabolizes 5HT
No - chronic - can present with diarrhea or constipation or alternation - treat sx

21. People of what decent are associated with celiac sprue and what findings/antibodies are present
Chronic gastritis and pernicious anemia
H2 receptor - inc cAMP
Lactase is located at the tips of intestinal villi
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

22. What happens to the short gastics if the splenic artery is blocked
Poor anastamoses
Cimetidine
Repeated phlebotomy - deferoxamine - HLA- A3
PAS- positive globules in liver -

23. What cells secrete bicarb - What does it do - and what regulates it
Lipase - phospholipase A - colipase
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
L3
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

24. 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
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Gallbladder
Copious diarrhea - non alpha - non beta cell pancreatic tumor

25. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
Positive
Primary sclerosing cholangitis
Acute pancreatitis

26. What pancreatic proteases are secreted as zymogens
Female - fat - fertile - forty
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Trypsin - chymotrypsin - elastase - carboxypeptidases
Primarly through ECL leading to histamine release

27. What are the results of hemochromatosis
Sister mary joseph nodule
CHF and inc risk of HCC
In the mucus that covers the gastric epithelium
Portal HTN

28. What do the rugae of stomach look like in menetriers disease
Cholesterol - 10-20% opaque due to calcifications
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
So hypertrophied they look like brain gyri
Chagas disease

29. What is the other name for GIP (gastric inhibitory peptide)
Brunners
Failure of the processus vagainlis to close
Glucose dependent insulinotropic peptide
Where hindgut meets ectoderm

30. What is the mechanism for reyes syndrome
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
L2
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

31. At what spinal level does the is the bifurcation of aorta
Phototherapy
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
L4
Oligosaccharide digestion

32. Liver cell failure can lead to multisystem signs including
Via the middle colic
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Esophageal carcinoma
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

33. involvement of left supraclavicular node by mets from stomach

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34. multiple juvenil polyps in GI tract - risk
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Failure of neural crest migration
Short gastrics - left greater and lesser
Corticosteroids - infliximab

35. What conditions are associated with budd chiari
Epigastric abdominal pain radiating to back - anorexia - nausea
Celiac sprue
Hypercoaguability - polycythemia vera - pregnancy - HCC
Juvenille polyps - no risk if single

36. To what substance is bilirubin conjugated and why
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Glucouronate - water soluble (direct)
Increase tumorigenesis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

37. What kind of muscle is in the lower 1/3 of the esophagus
Decreased intercellular adhesion and increased proliferation
Inspiratory arrest on deep palpation due to pain
All 3 gut layers outpouch as in Meckels
Smooth

38. What are esophageal strictures associated with
Turcot
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Lactase is located at the tips of intestinal villi
Lye ingestion and acid reflux

39. What enzyme is necessary to create conjugated bilirubin
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Uridine glucuronyl transferase
Krukenbergs tumor
Phenobarbital - inc liver enzyme synthesis

40. conjugated hyperbilirubinemia due to defective liver excretion
Redness and tenderness on palpation of extremities
Dubin johnson
Conj/unconj - inc - nl to dec
Oral glucose

41. Which serum enzyme increases with heavy EtOH consumption
Gamma glutamyl transferase GGT
Pleomorphic adenoma
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Cirrhosis

42. What do mucins do?
Lubricate food (glycoprotiens)
Gut bacteria
With albumin
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

43. What is the path of an indirect inguinal hernia
Phototherapy
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Goes through deep inguinal ring - external inguinal ring and into the scrotum
CCK8 receptor - Gq inc IP3/Ca

44. What is the cause of physiologic neonatal jaundice
Centrilobular congestion and necrosis - cardiac cirrhosis
Lamina propria
Striated and smooth
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

45. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Superior rectal
Black - rotors syndrome
AR
T12

46. Where are peyers patches found
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
Lamina propora and submucosa
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

47. What does the splenorenal ligament connect - and What does it contain
Crohns = maybe - UC= always
Spleen to posterior abdominal wall - splenic artery and vein
Positive urease test
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

48. How does CRC present in the distal and proximal colon
Ischemic colitis
Ampulla of vater
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Mitochondrial abnl - fatty liver - hypoglycemia - coma

49. What does a low flow rate mean for saliva
Hypotonic because of more time to reabsorb NaCl
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Lactase is located at the tips of intestinal villi
When diffusely infiltrative - thickened rigid appearance like a leather bottle

50. What is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Zollinger ellison - brunners glands
Bleeding - penetration into pancreas - perforation - obstruction
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue