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USMLE GI

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What receptors does gastrin bind on the parietal cell and What does it activate
Low pressure proximal to LES
Lactase is located at the tips of intestinal villi
The submucosal nerve plexus - meissner's
CCK8 receptor - Gq inc IP3/Ca

2. When do you see hypertrophy of brunners glands
Stimulate the H/K ATPase
Below
Peptic ulcer disease
Intussusception

3. why infxn is implicated in duodenal PUD
HSV-1 - CMV - Candida
H pylori (almost 100%)
Brush border of intestine - produce monosaccharides from oligo and di
Menetriers disease

4. Gq and inc cAMP both work to do what in parietal cells
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Stimulate the H/K ATPase
90%

5. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Diverticulum
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
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
Cholesterol - 10-20% opaque due to calcifications

6. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Serous on the sides parotids - mucinous in the middle sublingual
Diverticulitis in elderly - ectopic pregs use hCG to rule out

7. What do you treat Wilsons disease with and What is the inheritance
Penicillinamine - AR inheritance
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Acute pancreatitis
Mitochondrial abnl - fatty liver - hypoglycemia - coma

8. motilin - source - action - regulation
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Black - rotors syndrome
Meckels
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

9. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Dec PGE2 leading to dec gastric mucosa protection
Lye ingestion and acid reflux
Lateral
Alk pho

10. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Parietal cells in the stomach - B12 binding protein
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
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

11. Transmural esophageal rupture due to violent retching

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12. What findings are associated with reyes
Centrilobular leading to congestive liver disease
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Redundant mesentary
Meckels

13. Where are oligosaccharide hydrolases and What do they do
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Complications of UC
Brush border of intestine - produce monosaccharides from oligo and di
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

14. What is the cause of physiologic neonatal jaundice
CEA - CA-19-9
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Normal

15. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Alpha1 antitrypsin def - codominant trait
Normal
No
Skip lesions =crohns - colon = UC

16. What is the frequency of basal electric rhythm in the duodenum
Stimulate the H/K ATPase
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
12 waves/min
The proximal small bowel

17. What does loss of APC cause
Fe2+ in the duod
T cell lymphoma
Decreased intercellular adhesion and increased proliferation
Striated and smooth

18. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
NAV = nerve artery vein - venous near the penis (NAVEL)
Acute pancreatitis
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Black - rotors syndrome

19. How is bilirubin carried in the blood
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Dense core bodies
With albumin
In the ileum with bile acids - requires IF

20. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Budd chiari syndrome
Decrease - weight gain
GLUT 2
Intussusception

21. What skin condition is associated with celiac sprue
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Warthins' tumor
Poor anastamoses
Dermatitis herpetiformis

22. What kind of pancreatitis is associated with EtOH and smoking
Skip lesions =crohns - colon = UC
Downs
Worldwide - SC - US - adeno
Chronic calcifying pancreatitis - inc risk of panreatic cancer

23. How many layers of spermatic fascia are covers an indirect inguinal hernia
Celiac sprue
Diverticulum
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
All 3

24. What is the arterial supply and venous drainage below pectinate line
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Conj - inc - dec

25. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Paraumbilical and superficial and inferior epigastric - umbilicus
Hydrocele
Lateral
Zenkers - halitosis - dysphagia and obstruction

26. What does extrahepatic biliary obstruction cause
Primary sclerosing cholangitis
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Backup of blood into the liver - RHF - budd chiari
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

27. How does abetalipoproteinemia lead to malabsorption
Pyoderma gangrenosum - primary sclerosing cholangitis
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Esophageal cancer

28. What are the treatment options for uclerative colitis
CCK8 receptor - Gq inc IP3/Ca
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

29. Where is the deep inguinal ring relative to the inferior epigastric vessels
HPNCC
Hypotonic because of more time to reabsorb NaCl
Lateral
Neutralizes oral bacertial acids and maintains dental health

30. What is the prognosis of adenocarcinoma
Parietal cells in the stomach - B12 binding protein
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Black - rotors syndrome
Averages 6 months - very aggressive - usually already metastasized at presentation

31. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
True and most common congenital anomoly of GI tract
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Adhesion
Bleeding - penetration into pancreas - perforation - obstruction

32. What does high flow rate mean
Closer to isotonic because of less time to reabsorb NaCl
Jewish and African American men
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

33. What is the sphincter of the pancreatic duct
Redness and tenderness on palpation of extremities
Increase tumorigenesis
Sphincter of oddi
Reye's syndrome

34. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Bleeding - intussusception - volvulus - obstruction near terminal ileum

35. What type of insults result in micronodular cirrhosis
Sister mary joseph nodule
Cystic duct and common hepatic duct
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Uridine glucuronyl transferase

36. What structures feed into the cystic duct
HSV-1 - CMV - Candida
Gallbladder
Redness and tenderness on palpation of extremities
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

37. What do you use to diagnose meckels
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
External (superficial) ring only
Pertechnetate - study for uptake
In the ileum with bile acids - requires IF

38. What is the mechanism for reyes syndrome
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Muscularis mucosae
Volvulus
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

39. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Inguninal ligament - sartorius muscle - adductor longus
Pancreatic head causing obstructive jaundice
Juvenille polyps - no risk if single
Zollinger ellison - brunners glands

40. What is the risk with peutz jehgers
Failure of the processus vagainlis to close
Inc risk of CRC and other visceral malignancies
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

41. What histological findings are present in the esophagus
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Nonkeritinized stratified sqamous epithelium
When diffusely infiltrative - thickened rigid appearance like a leather bottle

42. Where are peyers patches found
Dilated esophagus with an area of distal stenosis - birds beak
External spermatic fascia only
Lamina propora and submucosa
HSV-1 - CMV - Candida

43. What layer of fascia covers a direct inguinal hernia
Hernia
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
External spermatic fascia only

44. Why does volvulus occur more at cecum and sigmoid colon
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Can lead to hematemesis - found in EtOHics and bulimics
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Redundant mesentary

45. In alchoholic hepatitis which liver enzyme is higher
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
IgA secreting plasma cells - ultimately reside in the lamina proporia
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
AST>ALT

46. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Cystic dilation of the viteline duct
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
External (superficial) ring only
Can lead to hematemesis - found in EtOHics and bulimics

47. What is the rule of 2s for meckels
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
EtOH
Mallory bodies

48. What does GET SMASHED stand for in acute pancreatitis
Mucoepidermoid carcinoma
Tropical sprue
Short gastrics - left greater and lesser
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

49. What are the complications of duodenal PUD
Osmotic
Bleeding - penetration into pancreas - perforation - obstruction
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Adhesion

50. What nerve innervates the external hemorrhoids
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Inferior rectal nerve
Common hepatic - splenic - left gastric - main blood supply for stomach
Alcoholic cirrhosis

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USMLE GI

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