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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. most common malignant salivary gland tumor
Diverticulum
Normal
Begins starch digestion - inactivated by low pH upon reaching the stomach
Mucoepidermoid carcinoma

2. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
Superior rectal and middle and inferior rectal - rectum
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
AST>ALT

3. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
GERD - may also present with nocturnal cough and dyspnea
Bleeding - intussusception - volvulus - obstruction near terminal ileum
AST>ALT

4. What is charcot triad of cholangitis
Virchow's node
Jaundice - fever - RUQ
H+
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

5. Why does carcinoid syndrome not occur if tumor is confined to GI system
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Liver metabolizes 5HT
Achalasia due to loss of myenteric plexus (auberach)
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

6. How do you DX and TX gallstones
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
US and cholecystectomy
Esophageal carcinoma
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

7. milk intolerance
Dissaccharidase def - most commonly lactase
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Lamina propria
Juvenile polyposis syndrome - inc risk of adenocarcinoma

8. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Peutz jeghers
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Cystic dilation of the viteline duct
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)

9. What does a gastrinoma cause
Female - fat - fertile - forty
Hemosiderosis - hemochromatosis
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Hernia

10. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
GLUT 2
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Inferior rectal nerve
2ndary biliary cirrhosis

11. Which patients have pigment stones
Inspiratory arrest on deep palpation due to pain
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
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
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

12. What layer in the mucosa is responsible for support
IgA secreting plasma cells - ultimately reside in the lamina proporia
Lamina propria
2ndary biliary cirrhosis
Nonkeritinized stratified sqamous epithelium

13. Is there any structural abnl with IBS - What is the course of disease and presentation
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Skip lesions =crohns - colon = UC

14. What are the branches of the celiac trunk and What do they supply
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Common hepatic - splenic - left gastric - main blood supply for stomach
Smooth

15. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Via the middle colic
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Skip lesions =crohns - colon = UC
Punched out - clean margins - carcinoma =raised irregular margins

16. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Acute pancreatitis
Black - rotors syndrome
3 waves/min

17. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
FAP
Paraumbilical and superficial and inferior epigastric - umbilicus
Acute pancreatitis

18. What are the histological findings of the colon
Crypts but not villi
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Glucouronate - water soluble (direct)
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

19. bilateral mets to ovaries with abundant mucus - signet ring cells
Krukenbergs tumor
Necrotizing enterocolitis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Sphincter of oddi

20. Bilirubin is the product of what?
Heme metabolism
Corticosteroids - infliximab
Diverticulum
Acute pancreatitis

21. What serum enzyme is elevated in acute pancreatitis and mumps
Hemolytic anemia
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Amylase
Jewish and African American men

22. What is the cause of physiologic neonatal jaundice
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Fasting and stress
Striated and smooth
Falciform - ligamentum teres - fetal umbilical vein

23. somatostatin - source - action - regulation
CCK8 receptor - Gq inc IP3/Ca
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Conj/unconj - inc - nl to dec
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

24. What is the clinical presentation of acute pancreatitis
Lateral
ALT>AST
AST >ALT - ration is usually 1.5
Epigastric abdominal pain radiating to back - anorexia - nausea

25. What makes a true diverticula
Hypercoaguability - polycythemia vera - pregnancy - HCC
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
Hyperpigmented mouth - lips - hands - genitalia
All 3 gut layers outpouch as in Meckels

26. What is the other name for GIP (gastric inhibitory peptide)
Glucose dependent insulinotropic peptide
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Squamous - upper 1/3 - adeno - lower 1/3
Inc - weight loss

27. Where are carcinoid tumors most commonly malignant
Cystic dilation of the viteline duct
H+
Small intestine
HSV-1 - CMV - Candida

28. inflammatino of gallbadder
Heme metabolism
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
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
Antrum - H.pylori - inc risk of MALT lymphoma

29. absent UDPGT - presents early in life - early mortality
Adhesion
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Crigler - najjar type 1
Above

30. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Decrease - weight gain
Ampulla of vater
Squamous - upper 1/3 - adeno - lower 1/3
Oligosaccharide digestion

31. What commonly leads to appendicity in kids vs adults
Averages 6 months - very aggressive - usually already metastasized at presentation
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Repeated phlebotomy - deferoxamine - HLA- A3

32. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
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
Esophageal varices

33. Where is IgA shuttled
Inc risk of CRC and other visceral malignancies
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
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Lipase

34. What serum enzyme is elevated inacute pancreatitis
Above
90%
Lipase
Neural muscarinic pathways

35. What artery passes around the duodenum
Mucosa - submucosa - muscularis externa - serosa/adventitia
Liver metabolizes 5HT
...
The gastroduodenal

36. What are the complications of chronic pancreatitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Menetriers disease
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Pancreatic and bile

37. What is the leading cause of bowel incarceration
Sphincter of oddi
Normal
Femoral hernia
Hypercoaguability - polycythemia vera - pregnancy - HCC

38. What other condition can lead to acute gastritis - think renal
Appendicitis
Uremia
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

39. What is the presenting course for appendicity

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40. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Cirrhosis
90%
Dec PGE2 leading to dec gastric mucosa protection

41. What is the rule of 2s for meckels
Brunners
L1
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

42. trypsinogen is converted to trypsin via what enzyme
Short gastrics - left greater and lesser
Common hepatic - splenic - left gastric - main blood supply for stomach
Parietal cells in the stomach - B12 binding protein
Enterokinase/enteropeptidase from the duodenal mucosa

43. What is the main symptom if a VIPoma
Oral glucose
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Causes of gall stones

44. To what substance is bilirubin conjugated and why
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Mucoepidermoid carcinoma
Glucouronate - water soluble (direct)
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

45. What are causes of extrahepatic biliary obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
ALT>AST
Mucosa - submucosa - muscularis externa - serosa/adventitia
Alpha1 antitrypsin def - codominant trait

46. What are the longterm sequelae of nutmeg liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
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
Cystic duct and common hepatic duct

47. What are the midgut structures and what supplies their blood and PANS innervation
Peutz jeghers
Female - fat - fertile - forty
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

48. What are the main components of bile
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Hepatic steatosis
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

49. What histological findings are present in the stomach
Gastric glands
Krukenbergs tumor
Parietal cells in the stomach - B12 binding protein
Colonic polyps

50. What layer in the mucosa is repsonsible for motility
Chronic gastritis and pernicious anemia
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Muscularis mucosae
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

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USMLE GI

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