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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 does autoimmune destruction of parietal cells lead to...
L1
Chronic gastritis and pernicious anemia
Neutralizes oral bacertial acids and maintains dental health
Colovesical leading to pneumaturia

2. Cholecytsokinin - source - action - regulation
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
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
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Via the middle colic

3. What are the hindgut structures and what supplies their blood and PANS innvervation
Cystic duct and common hepatic duct
Conj/unconj - inc - nl to dec
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

4. What structures feed into the common bile duct
Brunners
Gardner's syndrome
Pleomorphic adenoma
Cystic duct and common hepatic duct

5. What reaction does salivary amylase catalyze
Gastrohepatic ligament
Smooth
Lateral
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

6. What kind of anemia is in Wilsons
Above
Gardner's syndrome
Hemolytic anemia
Upregulated intracellular signal transduction

7. What enzyme is necessary to create conjugated bilirubin
Stimulate the H/K ATPase
Corticosteroids - infliximab
Uridine glucuronyl transferase
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

8. What artery passes around the duodenum
Primarly through ECL leading to histamine release
Dilated esophagus with an area of distal stenosis - birds beak
The gastroduodenal
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

9. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Crohns = maybe - UC= always
Crohns = noncaseating granulomas - UC = crypt abscesses

10. Malabsorption syndromes have what common clinical presentation
Diarrhea - steatorrhea - weight loss - weakness
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Via the superior pancreaticduodenal
Mucosa - submucosa - muscularis externa - serosa/adventitia

11. What do you use to diagnose meckels
Pertechnetate - study for uptake
Conj - inc - dec
Angiodysplasia
Begins starch digestion - inactivated by low pH upon reaching the stomach

12. What is the ddx associated with appendicitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Elevated amylase - and lipase
Uremia

13. How does gastrin increase acid secretion?
Inc conj bilirubin - inc cholesterol - inc alk phos
Cholesterol - 10-20% opaque due to calcifications
Primarly through ECL leading to histamine release
Pyoderma gangrenosum - primary sclerosing cholangitis

14. What kind of diarrhea is produced from a disaccharide def
Osmotic
H+
Serous on the sides parotids - mucinous in the middle sublingual
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

15. At what level of the spine does the IM exit the aorta
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
L3
Celiac sprue
No - chronic - can present with diarrhea or constipation or alternation - treat sx

16. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
H pylori (almost 100%)
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Muscularis mucosae
Colonic polyps

17. How many layers of spermatic fascia are covers an indirect inguinal hernia
Cholesterol
All 3
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Amylase

18. What is the other name for GIP (gastric inhibitory peptide)
Glucose dependent insulinotropic peptide
Paraumbilical and superficial and inferior epigastric - umbilicus
Erosive - disruption of mucosal barrier leading to inflammation
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

19. What kind of pathways do CCK act on to cause pancreatic secretion
Inferior rectal nerve
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Neural muscarinic pathways

20. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Hemosiderosis - hemochromatosis
Stercobilin
Crigler - najjar type 1
L2

21. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Pleomorphic adenoma
Averages 6 months - very aggressive - usually already metastasized at presentation
Celiac sprue

22. What are the two molecular pathways that lead to CRC
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Repeated phlebotomy - deferoxamine - HLA- A3
Downs
Cimetidine

23. Where is the pectinate line
Brunners
Celiac sprue
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Where hindgut meets ectoderm

24. Gq and inc cAMP both work to do what in parietal cells
Gut bacteria
Positive urease test
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Stimulate the H/K ATPase

25. What kind of muscle is in the middle 1/3 of esophagus
Barrett's esophagus
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Cystic dilation of the viteline duct
Striated and smooth

26. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Serous on the sides parotids - mucinous in the middle sublingual
Lateral
Corticosteroids - infliximab
Above

27. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
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
Terminal ileum and colon
Muscularis mucosae
Liver metabolizes 5HT

28. What does loss of p53 cause
Increase tumorigenesis
Below
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Brush border of intestine - produce monosaccharides from oligo and di

29. What receptor does histamine bind on the parietal cell and What does it activate
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
H2 receptor - inc cAMP
Gut bacteria
AST >ALT - ration is usually 1.5

30. in CF - meconium plug obstructs intestine - preventing stool passage at birth
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Meconium ileus
Phototherapy
External spermatic fascia only

31. What does extrahepatic biliary obstruction cause
Gilbert's
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Poor anastamoses
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

32. If the hemochromatosis is primary - What is the pattern of inheritance
Uremia
Angiodysplasia
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
AR

33. What is contained within the submucosa

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34. What does high flow rate mean
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Failure of the processus vagainlis to close
Closer to isotonic because of less time to reabsorb NaCl
Repeated phlebotomy - deferoxamine - HLA- A3

35. What intervention will intervention will relieve portal HTN
Failure of the processus vagainlis to close
Primary sclerosing cholangitis
GLUT 2
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

36. What are the complications of acute pancreatitis
Lateral to the inferior epigastric artery
Can lead to hematemesis - found in EtOHics and bulimics
Parietal cells in the stomach - B12 binding protein
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

37. What are the branches of the celiac trunk and What do they supply
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Common hepatic - splenic - left gastric - main blood supply for stomach
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Dissaccharidase def - most commonly lactase

38. How is bilirubin carried in the blood
FAP
With albumin
Ischemic colitis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

39. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

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40. What causes hirschsprungs
Superior rectal
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Failure of neural crest migration
Duodenal atresia - Downs

41. What does primary sclerosing cholangitis lead to...
Trypsin - chymotrypsin - elastase - carboxypeptidases
Mucosa - submucosa - muscularis externa - serosa/adventitia
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Smooth

42. At what spinal level does the is the bifurcation of aorta
Striated
Tropical sprue
Bleeding - intussusception - volvulus - obstruction near terminal ileum
L4

43. Where does type A chronic gastritis occur and What causes it
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
In the mucus that covers the gastric epithelium
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

44. What is the presenting course for appendicity

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45. What receptors does gastrin bind on the parietal cell and What does it activate
All 3
Stimulate the H/K ATPase
Common hepatic - splenic - left gastric - main blood supply for stomach
CCK8 receptor - Gq inc IP3/Ca

46. What pancreatic proteases are secreted as zymogens
Cirrhosis
Bleeding - penetration into pancreas - perforation - obstruction
Trypsin - chymotrypsin - elastase - carboxypeptidases
Femoral hernia

47. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Inguninal ligament - sartorius muscle - adductor longus
Bleeding - penetration into pancreas - perforation - obstruction
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

48. What separates the right greater and lesser sacs
Esophageal varices
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Gastrohepatic ligament
Alpha amylase

49. In what clinical scenarior do you see portosystemic anastomoses
Hemosiderosis - hemochromatosis
Mucoepidermoid carcinoma
Portal HTN
Crigler - najjar type 1

50. multiple juvenil polyps in GI tract - risk
CHF and inc risk of HCC
Ceruplasmin
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Enterokinase/enteropeptidase from the duodenal mucosa