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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. What pancreatic proteases are secreted as zymogens
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Chronic gastritis and pernicious anemia
Trypsin - chymotrypsin - elastase - carboxypeptidases
Juvenile polyposis syndrome - inc risk of adenocarcinoma

2. What is the arterial supply and venous drainage below pectinate line
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Complications of UC
EtOH
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

3. What do the rugae of stomach look like in menetriers disease
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
So hypertrophied they look like brain gyri
Decrease - weight gain
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

4. What does high flow rate mean
Closer to isotonic because of less time to reabsorb NaCl
EtOH
Alcoholic hepatitis
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

5. Gq and inc cAMP both work to do what in parietal cells
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Stimulate the H/K ATPase
Causes of gall stones

6. What do mucins do?
External spermatic fascia only
Lubricate food (glycoprotiens)
Liver metabolizes 5HT
Alpha1 antitrypsin def - codominant trait

7. What causes primary biliary cirrhosis
Falciform - ligamentum teres - fetal umbilical vein
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Diarrhea - steatorrhea - weight loss - weakness
Superior rectal

8. What can hemochromatosis be secondary to...
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Peutz jeghers

9. What are the effects of atropine on parietal cells and G cells
Glucouronate - water soluble (direct)
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
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
Volvulus

10. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

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11. What are the signs of peutz jehgers
Hyperpigmented mouth - lips - hands - genitalia
Portal HTN
Complications of UC
CCK8 receptor - Gq inc IP3/Ca

12. What is the frequency of basal electric rhythm of the stomach
Alcoholic cirrhosis
3 waves/min
AR
Appendicitis

13. At what level do the testicular/ovarian arteries exit the aorta
Bleeding - penetration into pancreas - perforation - obstruction
Mitochondrial abnl - fatty liver - hypoglycemia - coma
L2
External spermatic fascia only

14. What findings are associated with reyes
Myenteric nerve plexus - aurbach
Duodenum - 2nd - 3rd and 4th parts
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Below

15. At what spinal level does the celiac trunk exit
Zollinger Ellison - phenylalanine and tryptophan
Dysphagia (due to esophageal web) - glossitis - iron def anemia
T12
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure

16. What is the presentation of pancreatic adenocarcinoma
Gut bacteria
HSV-1 - CMV - Candida
Zollinger ellison - brunners glands
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

17. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Redness and tenderness on palpation of extremities
Pancreatic head causing obstructive jaundice
Muscularis mucosae
Colonic polyps

18. What kind of diarrhea is produced from a disaccharide def
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
The gastroduodenal
Osmotic

19. multiple juvenil polyps in GI tract - risk
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Juvenile polyposis syndrome - inc risk of adenocarcinoma
CEA - CA-19-9
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

20. 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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21. What does a gastrinoma cause
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Primary sclerosing cholangitis
Intussusception

22. What kind of digestion is bile needed for
FAP
Lye ingestion and acid reflux
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Causes of gall stones

23. What is contained within the submucosa

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24. What is the most common indication of emergent abdominal surgery in children
Falciform - ligamentum teres - fetal umbilical vein
PAS- positive globules in liver -
Appendicitis
Epigastric abdominal pain radiating to back - anorexia - nausea

25. Where is there sclerosis in alcoholic cirrohosis
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Ischemic colitis
Around the central vein (zone III)
Epithelium

26. Bilirubin is the product of what?
Left gastric vein and esophogeal vein - esophagus
Centrilobular congestion and necrosis - cardiac cirrhosis
Lateral to the inferior epigastric artery
Heme metabolism

27. In what clinical scenarior do you see portosystemic anastomoses
Portal HTN
Ischemic colitis
Oral glucose
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

28. What kind of anemia is in Wilsons
Causes of gall stones
Repeated phlebotomy - deferoxamine - HLA- A3
...
Hemolytic anemia

29. Malabsorption syndromes have what common clinical presentation
In the ileum with bile acids - requires IF
Diarrhea - steatorrhea - weight loss - weakness
Erosive - disruption of mucosal barrier leading to inflammation
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

30. most common malignant salivary gland tumor
Diarrhea - steatorrhea - weight loss - weakness
Phototherapy
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Mucoepidermoid carcinoma

31. What is the triad of Plummer - Vinson syndrome
8-9 waves/min
Femoral hernia
Necrotizing enterocolitis
Dysphagia (due to esophageal web) - glossitis - iron def anemia

32. What is the HLA association and treatment for hemochromatosis
Alpha1 antitrypsin def - codominant trait
Repeated phlebotomy - deferoxamine - HLA- A3
Redundant mesentary
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

33. What are the complications of Meckels
Peutz jeghers
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Duodenal atresia - Downs
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

34. Autodigestion of pancreas by pancreatic enzymes
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
AR
Acute pancreatitis
Increase tumorigenesis

35. What are the results of hemochromatosis
Decrease - weight gain
Left gastric vein and esophogeal vein - esophagus
CHF and inc risk of HCC
Lye ingestion and acid reflux

36. What kind of muscle is in the lower 1/3 of the esophagus
Budd chiari syndrome
Smooth
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
L3

37. What does GET SMASHED stand for in acute pancreatitis
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Meckels
Closer to isotonic because of less time to reabsorb NaCl

38. What is the mechanism for reyes syndrome
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Hirschsprungs
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

39. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Epithelium
Complications of crohns
Paraumbilical and superficial and inferior epigastric - umbilicus
Chronic calcifying pancreatitis - inc risk of panreatic cancer

40. Which IBD is autoimmune and which may be a disordered response to bacteria
Necrotizing enterocolitis
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Crohns = noncaseating granulomas - UC = crypt abscesses
Hypercoaguability - polycythemia vera - pregnancy - HCC

41. Achalasia increases the risk For what complication
Primary sclerosing cholangitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn
Esophageal carcinoma

42. What does bicab do in the mouth
Neutralizes oral bacertial acids and maintains dental health
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Complications of UC
Pleuroperitoneal

43. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Superior rectal
Punched out - clean margins - carcinoma =raised irregular margins
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

44. Which kind of hemorrhoids are painful and why
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

45. What serum markers increase in cholecystitis with bile duct involvement
Alk phos
Splenic flexure
Primarly through ECL leading to histamine release
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

46. What causes nutmeg liver
Upregulated intracellular signal transduction
Black - rotors syndrome
Backup of blood into the liver - RHF - budd chiari
Diverticulitis in elderly - ectopic pregs use hCG to rule out

47. What are the barium swallow findings of achalasia
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
IgA secreting plasma cells - ultimately reside in the lamina proporia
US and cholecystectomy
Dilated esophagus with an area of distal stenosis - birds beak

48. internal hemorrhoids and adenocarcinoma occur above or below pectinate line?
Above
Smooth
Sphincter of oddi
Appendicitis

49. What is biliary colic
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Inc - weight loss
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

50. Where and How is iron absorbed
T12
GLUT 2
Fe2+ in the duod
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

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USMLE GI

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