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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 congenital birth defect is associated with Hirschsprung
Osmotic
Downs
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Unconjugated - water insoluble

2. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Intussusception
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

3. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Via the middle colic
Can lead to hematemesis - found in EtOHics and bulimics
H pylori (almost 100%)
Colonic polyps

4. What portion of the bowel does sprue effect
Centrilobular leading to congestive liver disease
Esophageal varices
Jaundice - fever - RUQ
The proximal small bowel

5. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Nonkeritinized stratified sqamous epithelium
Via the superior pancreaticduodenal
Causes of gall stones
Failure of neural crest migration

6. What does a gastrinoma cause
Esophageal varices
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Superior rectal and middle and inferior rectal - rectum

7. How many layers outpouch in a false diverticula and they occur At what point of weakness and what?
H pylori (almost 100%)
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Copious diarrhea - non alpha - non beta cell pancreatic tumor

8. What kind of diarrhea is produced from a disaccharide def
Osmotic
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Unconj - absent (acholuria) - inc
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

9. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Upregulated intracellular signal transduction
Increase tumorigenesis
Esophageal varices
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

10. What is the triad of Plummer - Vinson syndrome
Pancreatic head causing obstructive jaundice
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
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
Dysphagia (due to esophageal web) - glossitis - iron def anemia

11. What retroperitoneal structure flanks both sides of the pancreas on CT
Can lead to hematemesis - found in EtOHics and bulimics
NAV = nerve artery vein - venous near the penis (NAVEL)
Duodenum - 2nd - 3rd and 4th parts
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes

12. What is a positive murphy's sign
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Inspiratory arrest on deep palpation due to pain
Averages 6 months - very aggressive - usually already metastasized at presentation
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

13. In PUD with a duodenal ulcer does pain inc or dec with meals
Fasting and stress
Unconjugated - water insoluble
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Decrease - weight gain

14. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lactase is located at the tips of intestinal villi
Mucosa - submucosa - muscularis externa - serosa/adventitia
Repeated phlebotomy - deferoxamine - HLA- A3
Penicillinamine - AR inheritance

15. What is indirect bilirubin
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Zollinger ellison - brunners glands
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Unconjugated - water insoluble

16. What causes hirschsprungs
Uridine glucuronyl transferase
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Failure of neural crest migration
12 waves/min

17. rare - often fatal childhood hepatoencephalopathy

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18. What are the effects of atropine on parietal cells and G cells
Crypts but not villi
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Where hindgut meets ectoderm

19. What do you treat Wilsons disease with and What is the inheritance
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Penicillinamine - AR inheritance
Superior rectal
Lamina propora and submucosa

20. What do you use to diagnose meckels
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Gut bacteria
Pertechnetate - study for uptake
AST

21. What is the cause of Barrett's and the assocaited complications
Menetriers disease
Ampulla of vater
External spermatic fascia only
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

22. crigler - najjar type II responds to which therapy and How does it work
T cell lymphoma
Hemolytic anemia
Phenobarbital - inc liver enzyme synthesis
Mallory bodies

23. Who gets gastric ulcers
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Cigarettes and chronic pancreatitis - not EtOH
External spermatic fascia only
Older patients

24. Gastrin - source - action - regulation
L2
Hepatic steatosis
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
Common hepatic - splenic - left gastric - main blood supply for stomach

25. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Worldwide - SC - US - adeno
AR
Below
Alk phos

26. What does loss of p53 cause
Alk phos
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
Increase tumorigenesis
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

27. What are the signs and symptoms of budd chiari
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Alk phos
Fe2+ in the duod
Ischemic colitis

28. GIP - source - action regulation
Chronic calcifying pancreatitis - inc risk of panreatic cancer
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
Lateral to the inferior epigastric artery
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose

29. At what level of the spine does the IM exit the aorta
Conj/unconj - inc - nl to dec
Budd chiari syndrome
L3
Low pressure proximal to LES

30. What is the most important mechanism in gastric acid secretion
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Portal HTN
Neural muscarinic pathways
Myenteric nerve plexus - aurbach

31. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Left gastric vein and esophogeal vein - esophagus
Bleeding - penetration into pancreas - perforation - obstruction
Gut bacteria
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

32. is meckels a true diverticulum and how common is it
True and most common congenital anomoly of GI tract
Punched out - clean margins - carcinoma =raised irregular margins
Mucosa - submucosa - muscularis externa - serosa/adventitia
Alpha amylase

33. What is the frequency of basal electric rhythm of the stomach
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Inc - weight loss
Chronic gastritis and pernicious anemia
3 waves/min

34. Where does copper accumulate in Wilsons and What are ABCD
L2
Lye ingestion and acid reflux
HSV-1 - CMV - Candida
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

35. Why does indirect inguinal hernia happen in infacnts
Left gastric vein and esophogeal vein - esophagus
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Jaundice - fever - RUQ
Failure of the processus vagainlis to close

36. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

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37. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Zollinger Ellison - phenylalanine and tryptophan
Colovesical leading to pneumaturia

38. What is the sphincter of the pancreatic duct
Sphincter of oddi
Epithelium
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Positive urease test

39. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Acute pancreatitis
US and cholecystectomy
Colonic polyps
PAS- positive globules in liver -

40. What are esophageal strictures associated with
Lye ingestion and acid reflux
Epithelium
Menetriers disease
Turcot

41. Where does an indirect inguinal hernia enter the deep inguinal ring
Inspiratory arrest on deep palpation due to pain
Hirschsprungs
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Lateral to the inferior epigastric artery

42. How does abetalipoproteinemia lead to malabsorption
Dilated esophagus with an area of distal stenosis - birds beak
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Meconium ileus

43. Achalasia increases the risk For what complication
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
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Esophageal carcinoma

44. What nerve innervates the external hemorrhoids
Inferior rectal nerve
Inspiratory arrest on deep palpation due to pain
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

45. What are the histological findings in the ileum

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46. What kind of lesions are characteristic of duodenal PUD vs cancer
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Punched out - clean margins - carcinoma =raised irregular margins
L4

47. What are the longterm sequelae of nutmeg liver
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Centrilobular congestion and necrosis - cardiac cirrhosis
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes

48. Where are peyers patches found
Dec PGE2 leading to dec gastric mucosa protection
So hypertrophied they look like brain gyri
Lamina propora and submucosa
Bleeding - penetration into pancreas - perforation - obstruction

49. What are the common causes of gastric ulcers - What causes gastric ulcer
Cigarettes and chronic pancreatitis - not EtOH
CCK8 receptor - Gq inc IP3/Ca
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
MSI (15%) and APC/beta catenin chromosomal instability (85%)

50. What type of insults result in micronodular cirrhosis
Esophageal varices
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz