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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 skin condition is associated with celiac sprue
Antrum - H.pylori - inc risk of MALT lymphoma
Dermatitis herpetiformis
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Unconjugated - water insoluble

2. inflammatino of gallbadder
Redness and tenderness on palpation of extremities
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Virchow's node

3. What kind of muscle is in the lower 1/3 of the esophagus
All 3
H2 receptor - inc cAMP
Smooth
Stimulate intestinal persistalsis

4. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
H pylori (almost 100%)
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
CCK8 receptor - Gq inc IP3/Ca

5. What are the midgut structures and what supplies their blood and PANS innervation
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Hirschsprungs

6. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Lipase
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
IBS at least 2 with recurrent abdominal pain
The gastroduodenal

7. What can hemochromatosis be secondary to...
Where hindgut meets ectoderm
Dermatitis herpetiformis
Squamous - upper 1/3 - adeno - lower 1/3
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

8. Why are most diverticula considered false
Ceruplasmin
External (superficial) ring only
Small intestine
Lack or have an attenuated muscularis externa - often in the sigmoid colon

9. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Erosive - disruption of mucosal barrier leading to inflammation
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 duodenum to proximal 2/3 of transverse colon - SMA - vagus

10. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Heme metabolism
Unconj - absent (acholuria) - inc
HPNCC

11. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
PAS- positive globules in liver -
Peyers patches
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Stercobilin

12. What is the risk with peutz jehgers
Inc risk of CRC and other visceral malignancies
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Lubricate food (glycoprotiens)

13. What is contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
Hemolytic anemia
L3
Spleen to posterior abdominal wall - splenic artery and vein

14. Where is folate absorbed
Phenobarbital - inc liver enzyme synthesis
Dermatitis herpetiformis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
The jejunum

15. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Elevated amylase - and lipase
Lubricate food (glycoprotiens)
Bleeding - intussusception - volvulus - obstruction near terminal ileum
FAP

16. Why does volvulus occur more at cecum and sigmoid colon
Poor anastamoses
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Redundant mesentary
Colovesical leading to pneumaturia

17. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Colonic polyps
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Reye's syndrome

18. involvement of left supraclavicular node by mets from stomach

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19. What drug blocks the H2R
Omeprazole
Cimetidine
Hepatic steatosis
With albumin

20. At what level do the testicular/ovarian arteries exit the aorta
GLUT 2
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
L2
Obstruction of the common bile duct

21. What can fistula between the gallbladder and small intestine create and how can you tell
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
So hypertrophied they look like brain gyri
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

22. persistence of viteline duct or yolk stalk possibly containing ectopic acid secreting gastric mucosa and/or pancreatic tissue
Meckels
Lipase - phospholipase A - colipase
T12
Angiodysplasia

23. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Closer to isotonic because of less time to reabsorb NaCl
...

24. Through which aspect of the inguinal canal does a direct inguinal go
External (superficial) ring only
Zenkers - halitosis - dysphagia and obstruction
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Boerhaave's Syndrome - Been heaving syndrome

25. most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Brush border of intestine - produce monosaccharides from oligo and di
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Reye's syndrome

26. What intervention will intervention will relieve portal HTN
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
AST
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
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

27. In PUD - with gastric ulcers - does pain inc or dec with meals?
Inc - weight loss
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
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
Lateral to the inferior epigastric artery

28. What infection causes Whipple disease and What can you see on LM
The jejunum
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Alcoholic hepatitis

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

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30. What does primary sclerosing cholangitis lead to...
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

31. How do villi appear in disaccharidease def
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Normal
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Hemolytic anemia

32. What is contained within the submucosa

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33. What are the treatment options for uclerative colitis
Lateral
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

34. What are the extraintestinal manifestations of ulcerative colitis
Pyoderma gangrenosum - primary sclerosing cholangitis
Gastrohepatic ligament
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Alk phos

35. What is the omphalomesenteric cyst
Cystic dilation of the viteline duct
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Dense core bodies

36. Abuse of what substance leads to acute gastritis
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
Mucosa - submucosa - muscularis externa - serosa/adventitia
EtOH
Corticosteroids - infliximab

37. How is salivary secretion stimulated
FAP
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Stercobilin
Colonic polyps

38. What kind of pathways do CCK act on to cause pancreatic secretion
Glucose dependent insulinotropic peptide
Neural muscarinic pathways
Meconium ileus
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

39. What is the frequency of basal electric rhythm in the duodenum
12 waves/min
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Brush border of intestine - produce monosaccharides from oligo and di

40. How does gastrin increase acid secretion?
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Gastrohepatic ligament
Primarly through ECL leading to histamine release

41. When do you see hypertrophy of brunners glands
L4
Inguninal ligament - sartorius muscle - adductor longus
Peptic ulcer disease
Uridine glucuronyl transferase

42. How does hirschsprung present and appear on imaging
Uridine glucuronyl transferase
Falciform - ligamentum teres - fetal umbilical vein
Antrum - H.pylori - inc risk of MALT lymphoma
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

43. Between what structures do strong anastamoses exist
Squamous - upper 1/3 - adeno - lower 1/3
Left and right gastroepiploics - left and right gastrics
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Meckels

44. What conditions are associated with budd chiari
Via the superior pancreaticduodenal
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Hypercoaguability - polycythemia vera - pregnancy - HCC
Gallbladder

45. What does autoimmune destruction of parietal cells lead to...
Chronic gastritis and pernicious anemia
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
Closer to isotonic because of less time to reabsorb NaCl
Pleuroperitoneal

46. What are the signs and symptoms of budd chiari
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Cigarettes and chronic pancreatitis - not EtOH
Worldwide - SC - US - adeno
IBS at least 2 with recurrent abdominal pain

47. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Complications of crohns
Peutz jeghers
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Hypotonic because of more time to reabsorb NaCl

48. What does alpha amylase do and what inactivates it
Mucosa - submucosa - muscularis externa - serosa/adventitia
H2 receptor - inc cAMP
Below
Begins starch digestion - inactivated by low pH upon reaching the stomach

49. What structure is Not contained in the femoral sheath
Centrilobular congestion and necrosis - cardiac cirrhosis
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Closer to isotonic because of less time to reabsorb NaCl
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

50. Diaphragmatic hernias occur in infants because of defective development of which membrane
The gastroduodenal
Mallory bodies
Pleuroperitoneal
GLUT 2