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

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2. Are single polyps malignant in peutz jehgers
Virchow's node
Inc smooth muscle relaxation - including lower esophageal sphincter
Poor anastamoses
No

3. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
H pylori (almost 100%)
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
No

4. What is the path of an indirect inguinal hernia
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Chronic gastritis and pernicious anemia
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Crohns = noncaseating granulomas - UC = crypt abscesses

5. What cells secrete bicarb - What does it do - and what regulates it
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Stercobilin
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin

6. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Cholesterol - 10-20% opaque due to calcifications

7. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
AST >ALT - ration is usually 1.5
Above

8. What does GET SMASHED stand for in acute pancreatitis
Cholesterol - 10-20% opaque due to calcifications
Colovesical leading to pneumaturia
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
In the mucus that covers the gastric epithelium

9. How does brain injury lead to acute gastritis and What is it called
Cholesterol
Averages 6 months - very aggressive - usually already metastasized at presentation
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

10. Gq and inc cAMP both work to do what in parietal cells
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Lamina propria
Liver metabolizes 5HT
Stimulate the H/K ATPase

11. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Obstruction of the common bile duct
IgA secreting plasma cells - ultimately reside in the lamina proporia
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Failure of neural crest migration

12. What is Trousseau's sign
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Peptic ulcer disease
Redness and tenderness on palpation of extremities
Smooth

13. What is the most common cause of gallstones
Failure of the processus vagainlis to close
Myenteric nerve plexus - aurbach
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
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

14. Why does volvulus occur more at cecum and sigmoid colon
Dilated esophagus with an area of distal stenosis - birds beak
Redundant mesentary
Appendicitis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

15. motilin - source - action - regulation
90%
Virchow's node
Osmotic
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

16. Where is folate absorbed
Old men - arthralgias - cardiac and neuro sx
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
The jejunum
Copious diarrhea - non alpha - non beta cell pancreatic tumor

17. absent UDPGT - presents early in life - early mortality
Crigler - najjar type 1
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Hyperpigmented mouth - lips - hands - genitalia
Hydrocele

18. What layer in the mucosa is responsible for support
Celiac sprue
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Lamina propria
H2 receptor - inc cAMP

19. trypsinogen is converted to trypsin via what enzyme
Enterokinase/enteropeptidase from the duodenal mucosa
Ceruplasmin
Lactase is located at the tips of intestinal villi
Black - rotors syndrome

20. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Left and right gastroepiploics - left and right gastrics
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Dubin johnson
Pleomorphic adenoma

21. What does loss of APC cause
Normal
Bleeding - intussusception - volvulus - obstruction near terminal ileum
All 3 gut layers outpouch as in Meckels
Decreased intercellular adhesion and increased proliferation

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
Fasting and stress
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

23. What structures feed into the common bile duct
Femoral hernia
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Cystic duct and common hepatic duct
Neural muscarinic pathways

24. With caput medusaw - between what vessels is the anastomoses and Where is it
Zollinger ellison - brunners glands
Duodenal atresia - Downs
Paraumbilical and superficial and inferior epigastric - umbilicus
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

25. what kind of muscle is in the upper 1/3 of esophagus
Striated
Menetriers disease
H+
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

26. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
GERD - may also present with nocturnal cough and dyspnea
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Brush border of intestine - produce monosaccharides from oligo and di
Duodenal atresia - Downs

27. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Unconjugated - water insoluble
IgA secreting plasma cells - ultimately reside in the lamina proporia
EtOH

28. Which serum enzyme increases with heavy EtOH consumption
Gamma glutamyl transferase GGT
Sister mary joseph nodule
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

29. What is the clinical presentation of acute pancreatitis
Squamous - upper 1/3 - adeno - lower 1/3
Epigastric abdominal pain radiating to back - anorexia - nausea
CEA - CA-19-9
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

30. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Superior rectal

31. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Fasting and stress
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
8-9 waves/min
Hepatic steatosis

32. What can fistula between the gallbladder and small intestine create and how can you tell
L1
Antrum - H.pylori - inc risk of MALT lymphoma
Worldwide - SC - US - adeno
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

33. What are the tumor markers for pancreatic adenocarcinoma
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Amylase
Duodenum - 2nd - 3rd and 4th parts
CEA - CA-19-9

34. What does bicarb do in the duodenum
Inguninal ligament - sartorius muscle - adductor longus
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Black - rotors syndrome
Neutralizes gastric acid allowing pancreatic enzymes to fxn

35. What kind of pancreatitis is associated with EtOH and smoking
Left and right gastroepiploics - left and right gastrics
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Chronic calcifying pancreatitis - inc risk of panreatic cancer

36. subQ peribumbilical metastasis
Trypsin - chymotrypsin - elastase - carboxypeptidases
Sister mary joseph nodule
Right and left hepatic duct
L/R renal artery around L1

37. What retroperitoneal structure flanks both sides of the pancreas on CT
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Dilated esophagus with an area of distal stenosis - birds beak
Duodenum - 2nd - 3rd and 4th parts
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

38. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Epigastric abdominal pain radiating to back - anorexia - nausea
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Begins starch digestion - inactivated by low pH upon reaching the stomach

39. Is there any structural abnl with IBS - What is the course of disease and presentation
Lye ingestion and acid reflux
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Pancreatic and bile
Appendicitis

40. What is pancreatic adenocarcinoma associated with
Cigarettes and chronic pancreatitis - not EtOH
Striated
Meckels
Black - rotors syndrome

41. most common non - neoplastic polyp in colon
Unconjugated - water insoluble
Cystic duct and common hepatic duct
Hyperplastic
Via the middle colic

42. What are motilin receptor agonists used for clinically
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
Stimulate intestinal persistalsis
Inc conj bilirubin - inc cholesterol - inc alk phos
Brush border of intestine - produce monosaccharides from oligo and di

43. A protrusion of peritoneum through an opening - usually a site of weakness
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Hernia
Adhesion
Cimetidine

44. What kind of diarrhea is produced from a disaccharide def
Femoral hernia
Early childhood - neuro sx and malabsorption
Oral glucose
Osmotic

45. What are the histological findings in the jejunum
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Juvenille polyps - no risk if single
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

46. What commonly leads to appendicity in kids vs adults
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Short gastrics - left greater and lesser

47. What kind of insults results in macronodular cirrhosis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Epigastric abdominal pain radiating to back - anorexia - nausea
Esophageal carcinoma

48. Who is at risk for pancreatic adenocarcinoma
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Jewish and African American men
Backup of blood into the liver - RHF - budd chiari
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

49. occlusion of IVC or hepatic veins
Budd chiari syndrome
Hypercoaguability - polycythemia vera - pregnancy - HCC
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Black - rotors syndrome

50. Which IBD is autoimmune and which may be a disordered response to bacteria
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Nonkeritinized stratified sqamous epithelium
EtOH
Acute pancreatitis