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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. Autoantibodies to gluten (gliadin) in wheat and other grains
Inc lower esphogeal tone leading to achalasia
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Celiac sprue

2. What are the borders of the femoral triangle
Crohns = maybe - UC= always
Striated
Inguninal ligament - sartorius muscle - adductor longus
External (superficial) ring only

3. Who gets Whipple disease and How do they present
No - chronic - can present with diarrhea or constipation or alternation - treat sx
12 waves/min
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Old men - arthralgias - cardiac and neuro sx

4. Who gets gastric ulcers
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Alfatoxin in peanuts
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Older patients

5. What are the ABCDEF of esophageal cancer
AST>ALT
Lactase is located at the tips of intestinal villi
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
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

6. What are causes of extrahepatic biliary obstruction
Sister mary joseph nodule
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Alcoholic cirrhosis
Virchow's node

7. Esophagitis can result From which 3 infectious agents - or chemical ingestion
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
8-9 waves/min
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
HSV-1 - CMV - Candida

8. What is the TX of physiologic neonatal jaundice
Duodenal atresia - Downs
Nonkeritinized stratified sqamous epithelium
Phototherapy
Complications of UC

9. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Punched out - clean margins - carcinoma =raised irregular margins
Gut bacteria
HPNCC
Glucouronate - water soluble (direct)

10. What is the path of an indirect inguinal hernia
Early childhood - neuro sx and malabsorption
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Complications of UC
Primary sclerosing cholangitis

11. What structures feed into the common bile duct
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
The entire
Cystic duct and common hepatic duct

12. motilin - source - action - regulation
AST>ALT
Zollinger Ellison - phenylalanine and tryptophan
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Antrum - H.pylori - inc risk of MALT lymphoma

13. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Lipase - phospholipase A - colipase
Causes of gall stones
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
Gardner's syndrome

14. What arteries exit just below the SMA
Fasting and stress
Alfatoxin in peanuts
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
L/R renal artery around L1

15. People of what decent are associated with celiac sprue and what findings/antibodies are present
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Corticosteroids - infliximab
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Lactase is located at the tips of intestinal villi

16. Scleroderma is associated with what kind of esophageal dysmotility
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
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
Low pressure proximal to LES
In the ileum with bile acids - requires IF

17. somatostatin - source - action - regulation
Volvulus
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
The submucosal nerve plexus - meissner's
Glucouronate - water soluble (direct)

18. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Inc conj bilirubin - inc cholesterol - inc alk phos
Esophageal carcinoma

19. At what spinal level does the is the bifurcation of aorta
Via the middle colic
Where hindgut meets ectoderm
Begins starch digestion - inactivated by low pH upon reaching the stomach
L4

20. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Internal thoracic to superior epigastric to inferior epigastric
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Gilbert's
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

21. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
US and cholecystectomy
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Alpha1 antitrypsin def - codominant trait
Uridine glucuronyl transferase

22. How do you DX and TX gallstones
US and cholecystectomy
So hypertrophied they look like brain gyri
Femoral hernia
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

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

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24. What is the classic triad of hemochromatosis

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25. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Short gastrics - left greater and lesser
Alcoholic hepatitis
AR

26. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Brunners
Oligosaccharide digestion
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
AST >ALT - ration is usually 1.5

27. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Smooth
Cirrhosis
Positive urease test
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels

28. What does primary sclerosing cholangitis lead to...
Below
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Heme metabolism
Gardner's syndrome

29. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Hyperplastic
Conj/unconj - inc - nl to dec
Dysphagia (due to esophageal web) - glossitis - iron def anemia

30. in budd chiari syndrome - Where is the congestion and necrosis
Downs
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Centrilobular leading to congestive liver disease
Muscularis mucosae

31. What are the layers of the gut wall from inside out
Diverticulum
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Mucosa - submucosa - muscularis externa - serosa/adventitia
Brush border of intestine - produce monosaccharides from oligo and di

32. If the hemochromatosis is primary - What is the pattern of inheritance
Pancreatic head causing obstructive jaundice
AR
Liver metabolizes 5HT
Pleuroperitoneal

33. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Below
All 3
90%

34. What does loss of p53 cause
Terminal ileum and colon
Virchow's node
Increase tumorigenesis
Where hindgut meets ectoderm

35. When and How does Abetalipoproteinemia present
Early childhood - neuro sx and malabsorption
Peutz jeghers
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Closer to isotonic because of less time to reabsorb NaCl

36. What is the sphincter of the pancreatic duct
Right and left hepatic duct
Via the middle colic
H pylori (almost 100%)
Sphincter of oddi

37. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Stercobilin
Alpha amylase
Failure of the processus vagainlis to close
Mucosa - submucosa - muscularis externa - serosa/adventitia

38. What receptors does ACH bind on the parietal cells and What does it activate
Terminal ileum and colon
T12
Black - rotors syndrome
M3 - Gq - inc IP3/Ca

39. What kind of muscle is in the middle 1/3 of esophagus
Primarly through ECL leading to histamine release
Positive urease test
Striated and smooth
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

40. How is salivary secretion stimulated
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Lactase is located at the tips of intestinal villi
AST

41. What is the most common diaphragmatic hernia and What are the two types
Terminal ileum and colon
Falciform - ligamentum teres - fetal umbilical vein
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

42. conjugated hyperbilirubinemia due to defective liver excretion
Menetriers disease
H2 receptor - inc cAMP
Dubin johnson
Primary sclerosing cholangitis

43. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
Alcoholic cirrhosis
Downs
VZV and influenza B treated with salicylates

44. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
90%
All 3 gut layers outpouch as in Meckels
Hirschsprungs
Inc lower esphogeal tone leading to achalasia

45. What percentage of gall stones are cholesterol stones and What are the associations
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Small intestine
Normal
Pyoderma gangrenosum - primary sclerosing cholangitis

46. What conditions are associated with budd chiari
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Hypercoaguability - polycythemia vera - pregnancy - HCC
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
All 3

47. What pancreatic enzymes are responsible for fat digestion
Lipase - phospholipase A - colipase
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
External (superficial) ring only

48. Malabsorption syndromes have what common clinical presentation
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Oligosaccharide digestion
Diarrhea - steatorrhea - weight loss - weakness
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

49. Where is folate absorbed
The jejunum
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Striated
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

50. What do the rugae of stomach look like in menetriers disease
So hypertrophied they look like brain gyri
GLUT 2
L/R renal artery around L1
Inguninal ligament - sartorius muscle - adductor longus