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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 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
Backup of blood into the liver - RHF - budd chiari
Gastrohepatic ligament
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

2. 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
IgA secreting plasma cells - ultimately reside in the lamina proporia
Trypsin - chymotrypsin - elastase - carboxypeptidases
Unconj - absent (acholuria) - inc

3. Where is B12 absorbed
Antrum - H.pylori - inc risk of MALT lymphoma
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Mucoepidermoid carcinoma
In the ileum with bile acids - requires IF

4. What cell produces IF and What does it do
Lamina propora and submucosa
Parietal cells in the stomach - B12 binding protein
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Antrum - H.pylori - inc risk of MALT lymphoma

5. Who gets gastric ulcers
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Older patients
Above
Pleuroperitoneal

6. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Juvenille polyps - no risk if single
Fe2+ in the duod
Esophageal varices
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

7. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Hemosiderosis - hemochromatosis
Zollinger Ellison - phenylalanine and tryptophan
Meconium ileus

8. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Alcoholic hepatitis
Gastric glands
Femoral hernia
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

9. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Worldwide - SC - US - adeno
FAP
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Low pressure proximal to LES

10. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Inspiratory arrest on deep palpation due to pain
External (superficial) ring only

11. What kind of anemia is in Wilsons
Hemolytic anemia
Meckels
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

12. What are the signs of peutz jehgers
Necrotizing enterocolitis
Hyperpigmented mouth - lips - hands - genitalia
Crohns = maybe - UC= always
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

13. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Carcinoid syndrome
AR
PAS- positive globules in liver -
The jejunum

14. What source of salivary secretion is the most serous and What is the most mucinous
Serous on the sides parotids - mucinous in the middle sublingual
Neutralizes oral bacertial acids and maintains dental health
Unconj - absent (acholuria) - inc
Backup of blood into the liver - RHF - budd chiari

15. Which viral infxns/treatments are associated with reyes syndrome
Centrilobular leading to congestive liver disease
VZV and influenza B treated with salicylates
Decreased intercellular adhesion and increased proliferation
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

16. why infxn is implicated in duodenal PUD
Tropical sprue
Dilated esophagus with an area of distal stenosis - birds beak
H pylori (almost 100%)
90%

17. Where is folate absorbed
Fasting and stress
Positive urease test
The jejunum
Dec PGE2 leading to dec gastric mucosa protection

18. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Menetriers disease
Via the superior pancreaticduodenal
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
IgA secreting plasma cells - ultimately reside in the lamina proporia

19. What causes carcinoid syndrome amd What are the symptoms
90%
Meconium ileus
Bleeding - penetration into pancreas - perforation - obstruction
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

20. Abuse of what substance leads to acute gastritis
90%
EtOH
HPNCC
Brunners

21. How do burns cause acute gastritis and What is it called

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22. Why does carcinoid syndrome not occur if tumor is confined to GI system
Liver metabolizes 5HT
Sister mary joseph nodule
Pleomorphic adenoma
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

23. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
The submucosal nerve plexus - meissner's
Redness and tenderness on palpation of extremities
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Peutz jeghers

24. Dysphagia in achalasia results from
FAP
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Lipase
In the mucus that covers the gastric epithelium

25. What is the characteristic histo finding in alcoholic hepatitis
Hemolytic anemia
Normal
Mallory bodies
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

26. How is salivary secretion stimulated
MSI (15%) and APC/beta catenin chromosomal instability (85%)
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

27. in carcinoid tumors - What is seen on EM
Obstruction of the common bile duct
Dense core bodies
Via the middle colic
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

28. What is diverticulosis
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Esophageal carcinoma
Older patients
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

29. What does bicab do in the mouth
Via the middle colic
Neutralizes oral bacertial acids and maintains dental health
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

30. What structures feed into the common bile duct
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Hepatic steatosis
Gilbert's
Cystic duct and common hepatic duct

31. Where does an indirect inguinal hernia enter the deep inguinal ring
Squamous - upper 1/3 - adeno - lower 1/3
Lateral to the inferior epigastric artery
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Small intestine

32. What artery passes around the duodenum
Heme metabolism
The gastroduodenal
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

33. What are the histological findings of the colon
Gamma glutamyl transferase GGT
Pertechnetate - study for uptake
Gardner's syndrome
Crypts but not villi

34. What are the complications of Meckels
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
Enterokinase/enteropeptidase from the duodenal mucosa
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

35. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Centrilobular leading to congestive liver disease
Serous on the sides parotids - mucinous in the middle sublingual
Alk pho

36. What is the main symptom if a VIPoma
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Amylase
Carcinoid syndrome

37. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Inc conj bilirubin - inc cholesterol - inc alk phos
Lactase is located at the tips of intestinal villi
Lamina propria
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

38. What are the histological findings in the jejunum
Peutz jeghers
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
2ndary biliary cirrhosis
True and most common congenital anomoly of GI tract

39. Bile is critical for exrection of what substance
Cigarettes and chronic pancreatitis - not EtOH
Cholesterol
MSI (15%) and APC/beta catenin chromosomal instability (85%)
The gastroduodenal

40. milk intolerance
Dissaccharidase def - most commonly lactase
Budd chiari syndrome
AST >ALT - ration is usually 1.5
Acute pancreatitis

41. Where is the pectinate line
Poor anastamoses
Menetriers disease
Where hindgut meets ectoderm
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

42. What test and result confirms H pylori infxn
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Positive urease test
Ceruplasmin
Pancreatic head causing obstructive jaundice

43. Gallstones that reach the common channel at ampulla can block which two ducts
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Squamous - upper 1/3 - adeno - lower 1/3
Pancreatic and bile
Necrotizing enterocolitis

44. What structures feed into the common hepatic duct
Right and left hepatic duct
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Gastrohepatic ligament
Penicillinamine - AR inheritance

45. What is contained within the submucosa

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46. What pancreatic proteases are secreted as zymogens
Falciform - ligamentum teres - fetal umbilical vein
Trypsin - chymotrypsin - elastase - carboxypeptidases
Brunners
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

47. signet ring cells - acanthosis nigracans - dz - character/association - spread
Goes through deep inguinal ring - external inguinal ring and into the scrotum
3 waves/min
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Short gastrics - left greater and lesser

48. What receptors does ACH bind on the parietal cells and What does it activate
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Ischemic colitis
M3 - Gq - inc IP3/Ca
Alpha1 antitrypsin def - codominant trait

49. What are the tumor markers for pancreatic adenocarcinoma
Glucose dependent insulinotropic peptide
CEA - CA-19-9
Inc - weight loss
Cholesterol

50. At what level of the spine does the IM exit the aorta
L3
Alfatoxin in peanuts
Centrilobular leading to congestive liver disease
Cigarettes and chronic pancreatitis - not EtOH