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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 is the omphalomesenteric cyst
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
Cystic dilation of the viteline duct
Turcot

2. Tumor of neuroendocrine cells constituting 50% of small bowel tumors - most common sites are the appendix - ileum and rectum
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
US and cholecystectomy
L3
Carcinoid syndrome

3. What is the risk with peutz jehgers
Punched out - clean margins - carcinoma =raised irregular margins
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Inc risk of CRC and other visceral malignancies
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

4. What is indirect bilirubin
CCK8 receptor - Gq inc IP3/Ca
Gastrohepatic ligament
Alk pho
Unconjugated - water insoluble

5. What happens to the short gastics if the splenic artery is blocked
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Poor anastamoses

6. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
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
Downs
Terminal ileum and colon

7. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Gastric glands
Complications of crohns
IBS at least 2 with recurrent abdominal pain
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

8. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
Pancreatic and bile
Femoral hernia
Increase tumorigenesis

9. Which kind of hemorrhoids are painful and why
EtOH
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Hydrocele

10. Where does crohns usually affect the GI tract
Primary sclerosing cholangitis
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Terminal ileum and colon
90%

11. motilin - source - action - regulation
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Primary sclerosing cholangitis
AST >ALT - ration is usually 1.5

12. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Crohns = maybe - UC= always
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

13. Where and How is iron absorbed
Fe2+ in the duod
FAP
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
Dysphagia (due to esophageal web) - glossitis - iron def anemia

14. What is the clinical presentation of acute pancreatitis
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
T12
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Epigastric abdominal pain radiating to back - anorexia - nausea

15. What layer in the mucosa is repsonsible for motility
Normal
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Muscularis mucosae
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer

16. What layer in the mucosa is responsible for absorption
Zollinger ellison - brunners glands
External (superficial) ring only
Inc risk of CRC and other visceral malignancies
Epithelium

17. What is the action of NO as a GI hormone
Inc smooth muscle relaxation - including lower esophageal sphincter
Hypercoaguability - polycythemia vera - pregnancy - HCC
The proximal small bowel
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

18. What kind of digestion is bile needed for
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
H+

19. What are causes of extrahepatic biliary obstruction
Inc risk of CRC and other visceral malignancies
Older patients
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

20. What are the complications of Meckels
Alcoholic hepatitis
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

21. most common non - neoplastic polyp in colon
Meconium ileus
Appendicitis
Hyperplastic
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

22. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Hirschsprungs
Short gastrics - left greater and lesser
Esophageal varices

23. What does bicarb do in the duodenum
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Cystic dilation of the viteline duct
Heme metabolism

24. What carcinogens are associated with HCC
Primarly through ECL leading to histamine release
Alfatoxin in peanuts
Barrett's esophagus
Gut bacteria

25. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
The jejunum
Conj - inc - dec
Falciform - ligamentum teres - fetal umbilical vein
Corticosteroids - infliximab

26. vasoactive intestinal polypeptide (VIP) - source - action - regulation
True and most common congenital anomoly of GI tract
Esophageal varices
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
Via the middle colic

27. secretin - source - action - regulation
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
Complications of crohns
In the mucus that covers the gastric epithelium
AST

28. What enzyme is necessary to create conjugated bilirubin
Uridine glucuronyl transferase
Duodenum - 2nd - 3rd and 4th parts
Low pressure proximal to LES
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head

29. somatostatin - source - action - regulation
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
Where hindgut meets ectoderm
Omeprazole
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

30. is meckels a true diverticulum and how common is it
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
True and most common congenital anomoly of GI tract
Enterokinase/enteropeptidase from the duodenal mucosa
Old men - arthralgias - cardiac and neuro sx

31. What are the extraintestinal manifestations of crohns
Primarly through ECL leading to histamine release
Zenkers - halitosis - dysphagia and obstruction
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

32. What are the foregut structures and what supplies their blood and PANS innvervation
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
No
Gilbert's
Achalasia due to loss of myenteric plexus (auberach)

33. What does a low flow rate mean for saliva
Redness and tenderness on palpation of extremities
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Hypotonic because of more time to reabsorb NaCl
Pertechnetate - study for uptake

34. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Glucose dependent insulinotropic peptide
Pleomorphic adenoma
Lipase - phospholipase A - colipase

35. What cell produces IF and What does it do
Source - I cells (duod - jej - action - inc pancreative secretion - inc gallbladder contraction - dec gastric emptying - sphincter of Oddi relaxation - regulation - inc by fatty acids and amino acids
Parietal cells in the stomach - B12 binding protein
Alk phos
Falciform - ligamentum teres - fetal umbilical vein

36. With internal hemorrhoids Where is the anastomoses and Where is it
Ischemic colitis
Superior rectal and middle and inferior rectal - rectum
Adhesion
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

37. rare - often fatal childhood hepatoencephalopathy

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38. If the abdominal aorta is blocked - How does blood get to the left colic artery
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Via the middle colic
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

39. What histological findings are present in the stomach
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
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Falciform - ligamentum teres - fetal umbilical vein
Gastric glands

40. What is the most common diaphragmatic hernia and What are the two types
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Mucoepidermoid carcinoma

41. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis

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42. What kind of muscle is in the middle 1/3 of esophagus
Inc smooth muscle relaxation - including lower esophageal sphincter
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Meckels
Striated and smooth

43. If the hemochromatosis is primary - What is the pattern of inheritance
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
AR
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
3 waves/min

44. What are the complications of duodenal PUD
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Omeprazole
Bleeding - penetration into pancreas - perforation - obstruction

45. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Pleomorphic adenoma
Alk pho
Above
Autoimmune rxn leading to lymphcytic infiltrate + granulomas

46. At what level of the spine does the IM exit the aorta
L3
Positive urease test
Neural muscarinic pathways
Intussusception

47. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
...
Colovesical leading to pneumaturia
Pertechnetate - study for uptake

48. HCC is associated with what other conditions
Pertechnetate - study for uptake
Zollinger ellison - brunners glands
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Hyperplastic

49. What can hemochromatosis be secondary to...
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Virchow's node
Lipase - phospholipase A - colipase
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

50. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Small intestine
Punched out - clean margins - carcinoma =raised irregular margins