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USMLE GI

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Answer 50 questions in 15 minutes.
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1. multiple juvenil polyps in GI tract - risk
Menetriers disease
Stimulate the H/K ATPase
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Juvenile polyposis syndrome - inc risk of adenocarcinoma

2. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Duodenal atresia - Downs
Causes of gall stones
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Mucosa - submucosa - muscularis externa - serosa/adventitia

3. What kind of anemia is in Wilsons
Zollinger Ellison - phenylalanine and tryptophan
Hemolytic anemia
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

4. Who gets gastric ulcers
Alk phos
In the mucus that covers the gastric epithelium
Centrilobular leading to congestive liver disease
Older patients

5. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Cystic dilation of the viteline duct
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

6. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Crigler - najjar type 1
Repeated phlebotomy - deferoxamine - HLA- A3
Peutz jeghers
Zenkers - halitosis - dysphagia and obstruction

7. What layer in the mucosa is responsible for absorption
Epithelium
Jewish and African American men
Pleuroperitoneal
AR

8. What are the two molecular pathways that lead to CRC
Pyoderma gangrenosum - primary sclerosing cholangitis
Older patients
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Inc risk of CRC and other visceral malignancies

9. How is bilirubin carried in the blood
H+
Centrilobular leading to congestive liver disease
Poor anastamoses
With albumin

10. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Hernia
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
H+

11. What are the effects of atropine on parietal cells and G cells
US and cholecystectomy
H pylori (almost 100%)
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

12. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

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13. What receptors does gastrin bind on the parietal cell and What does it activate
Chronic gastritis and pernicious anemia
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
Pertechnetate - study for uptake
CCK8 receptor - Gq inc IP3/Ca

14. What are motilin receptor agonists used for clinically
Stimulate intestinal persistalsis
Dissaccharidase def - most commonly lactase
Crohns = maybe - UC= always
Zollinger ellison - brunners glands

15. What reaction does salivary amylase catalyze
US and cholecystectomy
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
True and most common congenital anomoly of GI tract
No - chronic - can present with diarrhea or constipation or alternation - treat sx

16. What histological findings are present in the esophagus
Worldwide - SC - US - adeno
Juvenille polyps - no risk if single
Gut bacteria
Nonkeritinized stratified sqamous epithelium

17. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Uridine glucuronyl transferase
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
Obstruction of the common bile duct
Crohns = maybe - UC= always

18. What is the most common indication of emergent abdominal surgery in children
Appendicitis
Mucoepidermoid carcinoma
Glucouronate - water soluble (direct)
VZV and influenza B treated with salicylates

19. What are the midgut structures and what supplies their blood and PANS innervation
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
AST
Serous on the sides parotids - mucinous in the middle sublingual

20. What are the ABCDEF of esophageal cancer
Nonkeritinized stratified sqamous epithelium
Punched out - clean margins - carcinoma =raised irregular margins
Celiac sprue
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

21. What is a positive murphy's sign
All 3 gut layers outpouch as in Meckels
Inspiratory arrest on deep palpation due to pain
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

22. At what spinal level does the SMA exit
L1
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
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

23. What are the signs of peutz jehgers
Brunners
L1
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Hyperpigmented mouth - lips - hands - genitalia

24. How do NSAIDs cause acute gastritis
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Dec PGE2 leading to dec gastric mucosa protection
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

25. What are the treatmet options for crohns
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Corticosteroids - infliximab
Femoral hernia
Smooth

26. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Portal HTN
In the ileum with bile acids - requires IF
Alpha amylase
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

27. What are the foregut structures and what supplies their blood and PANS innvervation
Menetriers disease
Heme metabolism
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Causes of gall stones

28. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
GERD - may also present with nocturnal cough and dyspnea
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
3 waves/min

29. Which viral infxns/treatments are associated with reyes syndrome
NAV = nerve artery vein - venous near the penis (NAVEL)
VZV and influenza B treated with salicylates
AST>ALT
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

30. What serum enzyme is decreased in wilsons disease
Pleuroperitoneal
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Ceruplasmin

31. What does a gastrinoma cause
Right and left hepatic duct
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Cystic dilation of the viteline duct
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

32. Why does carcinoid syndrome not occur if tumor is confined to GI system
Liver metabolizes 5HT
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
T12
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

33. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

34. subQ peribumbilical metastasis
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Dubin johnson
H pylori (almost 100%)
Sister mary joseph nodule

35. What is the frequency of basal electric rhythm of the ilieum
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
8-9 waves/min
Elevated amylase - and lipase
Reye's syndrome

36. What are the labs in acute pancreatitis
Elevated amylase - and lipase
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

37. When and why is stomach cancer termed linitis plastica
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
When diffusely infiltrative - thickened rigid appearance like a leather bottle
External spermatic fascia only
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

38. GIP - source - action regulation
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
The jejunum
Peptic ulcer disease
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

39. Achalasia increases the risk For what complication
Esophageal carcinoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

40. What does extrahepatic biliary obstruction cause
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Inguninal ligament - sartorius muscle - adductor longus

41. What is the ddx associated with appendicitis
Uremia
Cystic duct and common hepatic duct
In the ileum with bile acids - requires IF
Diverticulitis in elderly - ectopic pregs use hCG to rule out

42. what kind of fistula is associated with diverticulitis
True and most common congenital anomoly of GI tract
Lipase
Gastric glands
Colovesical leading to pneumaturia

43. What does bicab do in the mouth
Falciform - ligamentum teres - fetal umbilical vein
Neutralizes oral bacertial acids and maintains dental health
Crypts but not villi
Colovesical leading to pneumaturia

44. signet ring cells - acanthosis nigracans - dz - character/association - spread
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Portal HTN
Inc - weight loss

45. acute bowel obstruction - commonly from a recent surgery - can have well demarcated necrotic zones
Cigarettes and chronic pancreatitis - not EtOH
Pancreatic head causing obstructive jaundice
Adhesion
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

46. Where does type A chronic gastritis occur and What causes it
3 waves/min
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

47. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
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
H2 receptor - inc cAMP
When diffusely infiltrative - thickened rigid appearance like a leather bottle

48. What drug blocks the H2R
Complications of UC
T cell lymphoma
Colonic polyps
Cimetidine

49. What intervention will intervention will relieve portal HTN
Early childhood - neuro sx and malabsorption
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Low pressure proximal to LES

50. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Black - rotors syndrome
M3 - Gq - inc IP3/Ca
Averages 6 months - very aggressive - usually already metastasized at presentation

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USMLE GI

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