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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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1. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Erosive - disruption of mucosal barrier leading to inflammation
Lamina propora and submucosa
Failure of neural crest migration

2. How is salivary secretion stimulated
Krukenbergs tumor
Around the central vein (zone III)
Striated
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

3. Which serum enzyme increases with heavy EtOH consumption
Diarrhea - steatorrhea - weight loss - weakness
Gamma glutamyl transferase GGT
Volvulus
Sister mary joseph nodule

4. is meckels a true diverticulum and how common is it
Splenic flexure
True and most common congenital anomoly of GI tract
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Backup of blood into the liver - RHF - budd chiari

5. How do NSAIDs cause acute gastritis
Dec PGE2 leading to dec gastric mucosa protection
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
L/R renal artery around L1
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

6. What kind of lesions are characteristic of duodenal PUD vs cancer
Punched out - clean margins - carcinoma =raised irregular margins
The jejunum
Liver metabolizes 5HT
Diarrhea - steatorrhea - weight loss - weakness

7. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Juvenille polyps - no risk if single
Causes of gall stones

8. Where is bicarb trapped
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
In the mucus that covers the gastric epithelium
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Alk phos

9. What drug blocks the H2R
Cimetidine
Ceruplasmin
Early childhood - neuro sx and malabsorption
Upregulated intracellular signal transduction

10. Which area of the hindgut is a watershed area
CCK8 receptor - Gq inc IP3/Ca
Pancreatic and bile
Splenic flexure
Lubricate food (glycoprotiens)

11. What reaction does salivary amylase catalyze
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Upregulated intracellular signal transduction
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

12. What commonly leads to appendicity in kids vs adults
Via the superior pancreaticduodenal
Glucose dependent insulinotropic peptide
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

13. What retroperitoneal structure flanks both sides of the pancreas on CT
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
True and most common congenital anomoly of GI tract
Duodenum - 2nd - 3rd and 4th parts

14. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Redundant mesentary
Small intestine
Conj/unconj - inc - nl to dec
Ceruplasmin

15. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
CHF and inc risk of HCC
Centrilobular congestion and necrosis - cardiac cirrhosis

16. What causes hirschsprungs
L1
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Failure of neural crest migration
Corticosteroids - infliximab

17. most common non - neoplastic polyp in colon
Hyperplastic
Striated and smooth
AST
Unconj - absent (acholuria) - inc

18. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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19. What structures feed into the common hepatic duct
So hypertrophied they look like brain gyri
Closer to isotonic because of less time to reabsorb NaCl
Inc conj bilirubin - inc cholesterol - inc alk phos
Right and left hepatic duct

20. Gastrin - source - action - regulation
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
Paraumbilical and superficial and inferior epigastric - umbilicus
Falciform - ligamentum teres - fetal umbilical vein
Inferior rectal nerve

21. involvement of left supraclavicular node by mets from stomach

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22. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Duodenal atresia - Downs
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

23. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
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
Squamous - upper 1/3 - adeno - lower 1/3
All 3
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

24. What is charcot triad of cholangitis
External spermatic fascia only
ALT>AST
Bleeding - penetration into pancreas - perforation - obstruction
Jaundice - fever - RUQ

25. Where does crohns usually affect the GI tract
Stimulate the H/K ATPase
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Terminal ileum and colon
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

26. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Can lead to hematemesis - found in EtOHics and bulimics
Lateral
Inc - weight loss
L4

27. Where and How is iron absorbed
T cell lymphoma
Upregulated intracellular signal transduction
Gallbladder
Fe2+ in the duod

28. malnutrition - toxic megacolon - colorectal carcinoma
Decrease - weight gain
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Complications of UC
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

29. List the clinical findings of HCC
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Complications of UC
Carcinoid syndrome
Ceruplasmin

30. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Inc risk of CRC and other visceral malignancies
Ischemic colitis
The proximal small bowel
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

31. Why does indirect inguinal hernia happen in infacnts
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Failure of the processus vagainlis to close

32. What is the action of NO as a GI hormone
Inc smooth muscle relaxation - including lower esophageal sphincter
Downs
Begins starch digestion - inactivated by low pH upon reaching the stomach
Positive

33. What is the path of an indirect inguinal hernia
Glucose dependent insulinotropic peptide
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Warthins' tumor
Goes through deep inguinal ring - external inguinal ring and into the scrotum

34. What is diverticulosis
Colovesical leading to pneumaturia
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Alpha1 antitrypsin def - codominant trait
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

35. What is the presenting course for appendicity

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36. inflammatino of gallbadder
Early childhood - neuro sx and malabsorption
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
True and most common congenital anomoly of GI tract
Carcinoid syndrome

37. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Trypsin - chymotrypsin - elastase - carboxypeptidases
Complications of crohns
Terminal ileum and colon

38. What histological findings are present in the stomach
AST >ALT - ration is usually 1.5
Copious diarrhea - non alpha - non beta cell pancreatic tumor
NAV = nerve artery vein - venous near the penis (NAVEL)
Gastric glands

39. If the abdominal aorta is blocked - How does blood get to the left colic artery
Via the middle colic
Downs
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Elevated amylase - and lipase

40. What is contained within the muscularis externa
ALT>AST
Redundant mesentary
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Myenteric nerve plexus - aurbach

41. Who gets gastric ulcers
Zollinger Ellison - phenylalanine and tryptophan
CHF and inc risk of HCC
Older patients
When diffusely infiltrative - thickened rigid appearance like a leather bottle

42. Where is B12 absorbed
Cirrhosis
Osmotic
In the ileum with bile acids - requires IF
All 3

43. What structures feed into the common bile duct
Bleeding - penetration into pancreas - perforation - obstruction
Cystic duct and common hepatic duct
Inc - weight loss
When diffusely infiltrative - thickened rigid appearance like a leather bottle

44. Liver cell failure can lead to multisystem signs including
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Phenobarbital - inc liver enzyme synthesis

45. What do mucins do?
Lubricate food (glycoprotiens)
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Pertechnetate - study for uptake
Myenteric nerve plexus - aurbach

46. What cell produces IF and What does it do
Uremia
Angiodysplasia
Short gastrics - left greater and lesser
Parietal cells in the stomach - B12 binding protein

47. In what scenarios do pts with gilberts have inc bili
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Lubricate food (glycoprotiens)
Fasting and stress
Epigastric abdominal pain radiating to back - anorexia - nausea

48. How does CRC present in the distal and proximal colon
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
12 waves/min
Inc lower esphogeal tone leading to achalasia
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

49. What causes carcinoid syndrome amd What are the symptoms
The gastroduodenal
Begins starch digestion - inactivated by low pH upon reaching the stomach
The submucosal nerve plexus - meissner's
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

50. When and How does Abetalipoproteinemia present
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Krukenbergs tumor
Early childhood - neuro sx and malabsorption
Spleen to posterior abdominal wall - splenic artery and vein