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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. At what level do the testicular/ovarian arteries exit the aorta
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Dilated esophagus with an area of distal stenosis - birds beak
L2
Diverticulitis in elderly - ectopic pregs use hCG to rule out

2. What histological findings are present in the stomach
FAP
Gastric glands
Complications of UC
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

3. What are the common causes of gastric ulcers - What causes gastric ulcer
Diarrhea - steatorrhea - weight loss - weakness
Acute pancreatitis
No - chronic - can present with diarrhea or constipation or alternation - treat sx
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

4. What conditions are associated with budd chiari
Alpha1 antitrypsin def - codominant trait
Hypercoaguability - polycythemia vera - pregnancy - HCC
Normal
AST >ALT - ration is usually 1.5

5. motilin - source - action - regulation
Via the middle colic
Colovesical leading to pneumaturia
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

6. Acute gastritis is caused By what process
Brunners
Alfatoxin in peanuts
Erosive - disruption of mucosal barrier leading to inflammation
Hyperpigmented mouth - lips - hands - genitalia

7. In what scenarios do pts with gilberts have inc bili
Fasting and stress
Smooth
Jaundice - fever - RUQ
The jejunum

8. In PUD - with gastric ulcers - does pain inc or dec with meals?
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Via the superior pancreaticduodenal
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Inc - weight loss

9. What skin condition is associated with celiac sprue
Portal HTN
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Closer to isotonic because of less time to reabsorb NaCl
Dermatitis herpetiformis

10. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
Warthins' tumor
Celiac sprue
FAP

11. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Peptic ulcer disease
HSV-1 - CMV - Candida
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Hepatic steatosis

12. What kind of digestion is bile needed for
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
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Mucosa - submucosa - muscularis externa - serosa/adventitia
HSV-1 - CMV - Candida

13. What retroperitoneal structure flanks both sides of the pancreas on CT
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
AST >ALT - ration is usually 1.5
Duodenum - 2nd - 3rd and 4th parts

14. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
Hemosiderosis - hemochromatosis
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Right and left hepatic duct
Paraumbilical and superficial and inferior epigastric - umbilicus

15. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Black - rotors syndrome

16. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
The proximal small bowel
Unconjugated - water insoluble
Colonic polyps
Conj/unconj - inc - nl to dec

17. What happens to the short gastics if the splenic artery is blocked
Dense core bodies
Femoral hernia
Alcoholic cirrhosis
Poor anastamoses

18. bilateral mets to ovaries with abundant mucus - signet ring cells
Erosive - disruption of mucosal barrier leading to inflammation
Failure of the processus vagainlis to close
Krukenbergs tumor
Causes of gall stones

19. rare - often fatal childhood hepatoencephalopathy

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20. Which IBD is autoimmune and which may be a disordered response to bacteria
L/R renal artery around L1
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Via the middle colic

21. How many layers of spermatic fascia are covers an indirect inguinal hernia
Gardner's syndrome
All 3
Dubin johnson
Decreased intercellular adhesion and increased proliferation

22. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
8-9 waves/min
Spleen to posterior abdominal wall - splenic artery and vein

23. What are the four Fs of gallstones
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Pancreatic and bile
Pancreatic head causing obstructive jaundice
Female - fat - fertile - forty

24. What causes carcinoid syndrome amd What are the symptoms
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
T cell lymphoma
Mucoepidermoid carcinoma
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

25. If trypsin activates more trypsinogen - what kind of feedback loop is established
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Positive
Conj/unconj - inc - nl to dec
Neural muscarinic pathways

26. What does high flow rate mean
Increase tumorigenesis
Heme metabolism
Closer to isotonic because of less time to reabsorb NaCl
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

27. What is one potential precipitating factor for intussusception
Sister mary joseph nodule
Lye ingestion and acid reflux
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Juvenile polyposis syndrome - inc risk of adenocarcinoma

28. Where is there sclerosis in alcoholic cirrohosis
IgA secreting plasma cells - ultimately reside in the lamina proporia
Around the central vein (zone III)
8-9 waves/min
Cystic dilation of the viteline duct

29. multiple juvenil polyps in GI tract - risk
Above
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Left gastric vein and esophogeal vein - esophagus
3 waves/min

30. What separates the right greater and lesser sacs
Dissaccharidase def - most commonly lactase
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Gastrohepatic ligament
Hepatic steatosis

31. What are the signs and symptoms of budd chiari
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
8-9 waves/min
Stercobilin
Meckels

32. Unencapsulated lymphoid tissue found in lamina proporia and submucosa of small intestine containing specialized M cells that take up antigen
Inc risk of CRC and other visceral malignancies
Jaundice - fever - RUQ
Peyers patches
Positive

33. Where does an indirect inguinal hernia enter the deep inguinal ring
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Lateral to the inferior epigastric artery
Esophageal varices
No - chronic - can present with diarrhea or constipation or alternation - treat sx

34. What factors increase risk of malignancy of adenomatous polyps
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
VZV and influenza B treated with salicylates

35. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

36. What is the lumen of the pancreatic duct
Primary sclerosing cholangitis
Ampulla of vater
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Spleen to posterior abdominal wall - splenic artery and vein

37. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Conj - inc - dec
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Skip lesions =crohns - colon = UC

38. What kind of muscle is in the lower 1/3 of the esophagus
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Alpha amylase
Smooth

39. What are the treatment options for uclerative colitis
Stercobilin
Bleeding - intussusception - volvulus - obstruction near terminal ileum
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

40. What findings are associated with reyes
Virchow's node
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Boerhaave's Syndrome - Been heaving syndrome
AST

41. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
AST>ALT
Pancreatic and bile
Brunners
AR

42. What cells secrete bicarb - What does it do - and what regulates it
L3
Glucouronate - water soluble (direct)
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Inguninal ligament - sartorius muscle - adductor longus

43. conjugated hyperbilirubinemia due to defective liver excretion
Virchow's node
Lateral to the inferior epigastric artery
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Dubin johnson

44. With caput medusaw - between what vessels is the anastomoses and Where is it
IgA secreting plasma cells - ultimately reside in the lamina proporia
Dermatitis herpetiformis
Liver metabolizes 5HT
Paraumbilical and superficial and inferior epigastric - umbilicus

45. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

46. How is the diagonsis of CRC made
Jewish and African American men
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
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
Splenic flexure

47. How does CRC present in the distal and proximal colon
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
The entire
Virchow's node
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

48. Who gets Whipple disease and How do they present
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Primary sclerosing cholangitis
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Old men - arthralgias - cardiac and neuro sx

49. What is the main symptom if a VIPoma
Skip lesions =crohns - colon = UC
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Gut bacteria
Repeated phlebotomy - deferoxamine - HLA- A3

50. What nerve innervates the external hemorrhoids
Krukenbergs tumor
Inferior rectal nerve
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)