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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. What factors increase risk of malignancy of adenomatous polyps
Conj/unconj - inc - nl to dec
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Paraumbilical and superficial and inferior epigastric - umbilicus
Lactase is located at the tips of intestinal villi

2. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Diverticulitis in elderly - ectopic pregs use hCG to rule out
HPNCC
Menetriers disease
ALT>AST

3. What portion of the bowel does sprue effect
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
The proximal small bowel
Stercobilin
Femoral hernia

4. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
2ndary biliary cirrhosis
Poor anastamoses
CEA - CA-19-9
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

5. What is diverticulosis
Amylase
Serous on the sides parotids - mucinous in the middle sublingual
GERD - may also present with nocturnal cough and dyspnea
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

6. What does the splenorenal ligament connect - and What does it contain
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Pleuroperitoneal
Spleen to posterior abdominal wall - splenic artery and vein
Colovesical leading to pneumaturia

7. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Zollinger Ellison - phenylalanine and tryptophan
GERD - may also present with nocturnal cough and dyspnea
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Elevated amylase - and lipase

8. What percentage of gall stones are cholesterol stones and What are the associations
Mucosa - submucosa - muscularis externa - serosa/adventitia
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Alpha1 antitrypsin def - codominant trait
Nonkeritinized stratified sqamous epithelium

9. When do you see hypertrophy of brunners glands
Jaundice - fever - RUQ
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Peptic ulcer disease
Alfatoxin in peanuts

10. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Lipase - phospholipase A - colipase
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Falciform - ligamentum teres - fetal umbilical vein
Left and right gastroepiploics - left and right gastrics

11. What is the cause of Barrett's and the assocaited complications
Lipase
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Lipase - phospholipase A - colipase

12. Who gets gastric ulcers
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Gastrohepatic ligament
Older patients
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

13. In what scenarios do pts with gilberts have inc bili
Fasting and stress
Inc lower esphogeal tone leading to achalasia
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
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

14. involvement of left supraclavicular node by mets from stomach

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15. What is Trousseau's sign
Peutz jeghers
Complications of UC
Redness and tenderness on palpation of extremities
Normal

16. Which patients have pigment stones
Epigastric abdominal pain radiating to back - anorexia - nausea
Hydrocele
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
H pylori (almost 100%)

17. What are the midgut structures and what supplies their blood and PANS innervation
T12
Crypts but not villi
Urobilin
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus

18. How do burns cause acute gastritis and What is it called

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19. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Lactase is located at the tips of intestinal villi
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Dubin johnson

20. How do villi appear in disaccharidease def
Normal
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Lipase - phospholipase A - colipase
Fasting and stress

21. Which viral infxns/treatments are associated with reyes syndrome
Chronic gastritis and pernicious anemia
VZV and influenza B treated with salicylates
Glucose dependent insulinotropic peptide
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

22. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Serous on the sides parotids - mucinous in the middle sublingual
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

23. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
2ndary biliary cirrhosis
Complications of UC
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

24. When and why is stomach cancer termed linitis plastica
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Elevated amylase - and lipase
Gardner's syndrome
Muscularis mucosae

25. somatostatin - source - action - regulation
Gut bacteria
Hernia
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
Falciform - ligamentum teres - fetal umbilical vein

26. What skin condition is associated with celiac sprue
Oral glucose
Zollinger ellison - brunners glands
Dermatitis herpetiformis
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

27. a false diverticulum - herniation of mucosal tissue at junction of pharynx and esophagus - How does this present
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Alcoholic hepatitis
Zenkers - halitosis - dysphagia and obstruction
Colovesical leading to pneumaturia

28. What are the complications of duodenal PUD
Tropical sprue
Bleeding - penetration into pancreas - perforation - obstruction
Peptic ulcer disease
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

29. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Myenteric nerve plexus - aurbach
With albumin
Esophageal cancer
90%

30. What is the frequency of basal electric rhythm of the ilieum
8-9 waves/min
Pancreatic head causing obstructive jaundice
Mucosa - submucosa - muscularis externa - serosa/adventitia
Redundant mesentary

31. in carcinoid tumors - What is seen on EM
Centrilobular leading to congestive liver disease
Ceruplasmin
Dense core bodies
Bleeding - penetration into pancreas - perforation - obstruction

32. What histological findings are present in the esophagus
Around the central vein (zone III)
Centrilobular congestion and necrosis - cardiac cirrhosis
Nonkeritinized stratified sqamous epithelium
Chagas disease

33. Where is the arterial supply from above the pectinate line - and What is the venous drainage
Bleeding - penetration into pancreas - perforation - obstruction
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

34. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
IgA secreting plasma cells - ultimately reside in the lamina proporia
Necrotizing enterocolitis
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
The gastroduodenal

35. What cells secrete bicarb - What does it do - and what regulates it
Early childhood - neuro sx and malabsorption
Esophageal varices
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

36. With caput medusaw - between what vessels is the anastomoses and Where is it
Positive urease test
Paraumbilical and superficial and inferior epigastric - umbilicus
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
HPNCC

37. What does K- ras mutation cause
Adhesion
Uridine glucuronyl transferase
Upregulated intracellular signal transduction
US and cholecystectomy

38. What is the most common cause of gallstones
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
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly

39. in budd chiari syndrome - Where is the congestion and necrosis
Centrilobular leading to congestive liver disease
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Elevated amylase - and lipase
Positive urease test

40. What intervention will intervention will relieve portal HTN
Budd chiari syndrome
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Ampulla of vater
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

41. What is the cause of physiologic neonatal jaundice
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

42. What are the four Fs of gallstones
Female - fat - fertile - forty
In the ileum with bile acids - requires IF
Lipase
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

43. What serum enzyme is elevated inacute pancreatitis
HSV-1 - CMV - Candida
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
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
Lipase

44. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
...
Brunners
Glucouronate - water soluble (direct)
Around the central vein (zone III)

45. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
All 3 gut layers outpouch as in Meckels
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Zollinger ellison - brunners glands

46. What is the frequency of basal electric rhythm in the duodenum
Pyoderma gangrenosum - primary sclerosing cholangitis
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
12 waves/min
Erosive - disruption of mucosal barrier leading to inflammation

47. Who gets Whipple disease and How do they present
Old men - arthralgias - cardiac and neuro sx
Causes of gall stones
Normal
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

48. What are the labs in acute pancreatitis
Sphincter of oddi
Around the central vein (zone III)
Elevated amylase - and lipase
90%

49. What causes hirschsprungs
Sister mary joseph nodule
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Failure of neural crest migration
Redness and tenderness on palpation of extremities

50. Where does an indirect inguinal hernia enter the deep inguinal ring
Diarrhea - steatorrhea - weight loss - weakness
Enterokinase/enteropeptidase from the duodenal mucosa
Oral glucose
Lateral to the inferior epigastric artery