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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 does volvulus occur more at cecum and sigmoid colon
Meckels
FAP
Parietal cells in the stomach - B12 binding protein
Redundant mesentary

2. 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
Turcot
Primary sclerosing cholangitis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)

3. What conditions are associated with budd chiari
Inc lower esphogeal tone leading to achalasia
Spleen to posterior abdominal wall - splenic artery and vein
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Hypercoaguability - polycythemia vera - pregnancy - HCC

4. What are the foregut structures and what supplies their blood and PANS innvervation
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Glucouronate - water soluble (direct)
Downs
Upregulated intracellular signal transduction

5. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Inc - weight loss
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Cystic dilation of the viteline duct
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

6. Tortuous dilation of vessels and bleeding - most often in cecum - terminal ileum and ascending colon - common in older patients - confirmed by angiography
L1
Cigarettes and chronic pancreatitis - not EtOH
Angiodysplasia
Juvenile polyposis syndrome - inc risk of adenocarcinoma

7. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Via the superior pancreaticduodenal
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Alpha amylase

8. Which serum enzyme increases with heavy EtOH consumption
Short gastrics - left greater and lesser
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Lactase is located at the tips of intestinal villi
Gamma glutamyl transferase GGT

9. What is the ddx associated with appendicitis
Crohns = maybe - UC= always
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Lipase - phospholipase A - colipase

10. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Smooth
US and cholecystectomy
Appendicitis

11. FAP + osseous and soft tissue tumors - retinal hyperplasia

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12. malnutrition - toxic megacolon - colorectal carcinoma
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Hepatic steatosis
Complications of UC
Erosive - disruption of mucosal barrier leading to inflammation

13. What is the sphincter of the pancreatic duct
Chronic gastritis and pernicious anemia
Upregulated intracellular signal transduction
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Sphincter of oddi

14. What is the cause of physiologic neonatal jaundice
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Common hepatic - splenic - left gastric - main blood supply for stomach
Skip lesions =crohns - colon = UC
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

15. what kind of muscle is in the upper 1/3 of esophagus
Striated
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Bleeding - penetration into pancreas - perforation - obstruction

16. most common non - neoplastic polyp in colon
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Hyperplastic
Penicillinamine - AR inheritance

17. Gallstones that reach the common channel at ampulla can block which two ducts
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Oral glucose
Pancreatic and bile
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

18. why infxn is implicated in duodenal PUD
Female - fat - fertile - forty
Paraumbilical and superficial and inferior epigastric - umbilicus
H pylori (almost 100%)
Ceruplasmin

19. Autodigestion of pancreas by pancreatic enzymes
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Small intestine
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Acute pancreatitis

20. What is the most common diaphragmatic hernia and What are the two types
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Gilbert's
Superior rectal

21. What is the cause of Barrett's and the assocaited complications
Worldwide - SC - US - adeno
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Angiodysplasia
Pancreatic head causing obstructive jaundice

22. 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
So hypertrophied they look like brain gyri
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Zollinger ellison - brunners glands

23. What is the most common cause of gallstones
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
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
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
HPNCC

24. What are the signs and symptoms of budd chiari
Lamina propria
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

25. FAP + malignant CNS tumor
Turcot
Skip lesions =crohns - colon = UC
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Old men - arthralgias - cardiac and neuro sx

26. What is Trousseau's sign
Averages 6 months - very aggressive - usually already metastasized at presentation
Redness and tenderness on palpation of extremities
Esophageal cancer
Epithelium

27. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Below
Unconj - absent (acholuria) - inc
Esophageal varices
Lamina propria

28. What do mucins do?
Lubricate food (glycoprotiens)
Diverticulum
Glucose dependent insulinotropic peptide
Old men - arthralgias - cardiac and neuro sx

29. What causes nutmeg liver
Enterokinase/enteropeptidase from the duodenal mucosa
Inc - weight loss
Backup of blood into the liver - RHF - budd chiari
Erosive - disruption of mucosal barrier leading to inflammation

30. crigler - najjar type II responds to which therapy and How does it work
Phenobarbital - inc liver enzyme synthesis
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Inguninal ligament - sartorius muscle - adductor longus
...

31. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Hirschsprungs
Causes of gall stones
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Complications of UC

32. Between what structures do strong anastamoses exist
Skip lesions =crohns - colon = UC
Amylase
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Left and right gastroepiploics - left and right gastrics

33. At what level of the spine does the IM exit the aorta
Backup of blood into the liver - RHF - budd chiari
L3
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Celiac sprue

34. Where is IgA shuttled
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
AR

35. What are the histological findings of the colon
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Lubricate food (glycoprotiens)
Paraumbilical and superficial and inferior epigastric - umbilicus
Crypts but not villi

36. What portion of the bowel does sprue effect
Turcot
No - chronic - can present with diarrhea or constipation or alternation - treat sx
The proximal small bowel
Necrotizing enterocolitis

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

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38. What do tumors that arise in the head of the pancreas cause
All 3
Common hepatic - splenic - left gastric - main blood supply for stomach
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Obstruction of the common bile duct

39. Achalasia increases the risk For what complication
Inc smooth muscle relaxation - including lower esophageal sphincter
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Esophageal carcinoma
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

40. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Inc conj bilirubin - inc cholesterol - inc alk phos
Colovesical leading to pneumaturia
AST
ALT>AST

41. What cells secrete bicarb - What does it do - and what regulates it
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Colovesical leading to pneumaturia
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

42. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Lateral
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
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
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

43. What does GET SMASHED stand for in acute pancreatitis
Left gastric vein and esophogeal vein - esophagus
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Epigastric abdominal pain radiating to back - anorexia - nausea
L4

44. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Peutz jeghers
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
90%
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

45. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Ischemic colitis
Stimulate intestinal persistalsis

46. What serum enzyme is elevated in acute pancreatitis and mumps
Inc lower esphogeal tone leading to achalasia
Amylase
NAV = nerve artery vein - venous near the penis (NAVEL)
Female - fat - fertile - forty

47. How is salivary secretion stimulated
Crigler - najjar type 1
Peutz jeghers
Gilbert's
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

48. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
AST>ALT
Via the middle colic
Backup of blood into the liver - RHF - budd chiari

49. What layer in the mucosa is repsonsible for motility
Muscularis mucosae
Right and left hepatic duct
Upregulated intracellular signal transduction
Neutralizes oral bacertial acids and maintains dental health

50. When and How does Abetalipoproteinemia present
All 3
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Early childhood - neuro sx and malabsorption
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid