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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 contained in the gastrosplenic and What areas does it separate
Short gastrics - left greater and lesser
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
12 waves/min
Terminal ileum and colon

2. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Colonic polyps
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
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

3. At what level do the testicular/ovarian arteries exit the aorta
Hirschsprungs
Primarly through ECL leading to histamine release
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
L2

4. What is the path of an indirect inguinal hernia
Angiodysplasia
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Goes through deep inguinal ring - external inguinal ring and into the scrotum

5. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Black - rotors syndrome
Crohns = noncaseating granulomas - UC = crypt abscesses

6. What enzyme is necessary to create conjugated bilirubin
Stercobilin
Uridine glucuronyl transferase
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
IgA secreting plasma cells - ultimately reside in the lamina proporia

7. glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus

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8. What is the mechanism for reyes syndrome
Black - rotors syndrome
Redundant mesentary
Inferior rectal nerve
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN

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

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10. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Increase tumorigenesis
Cystic dilation of the viteline duct

11. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Lateral
Crohns = maybe - UC= always
Decreased intercellular adhesion and increased proliferation
Alk phos

12. What skin condition is associated with celiac sprue
Dermatitis herpetiformis
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
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

13. At what spinal level does the is the bifurcation of aorta
Hemolytic anemia
Left and right gastroepiploics - left and right gastrics
L4
...

14. What is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Hernia
Gastrohepatic ligament
Uridine glucuronyl transferase

15. What does histo show for alpha1 antitrypsin def
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
PAS- positive globules in liver -
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Elevated amylase - and lipase

16. What kind of cancer to celiac sprue put you as inc risk for
Crypts but not villi
Redness and tenderness on palpation of extremities
IBS at least 2 with recurrent abdominal pain
T cell lymphoma

17. What nerve innervates the external hemorrhoids
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
MSI (15%) and APC/beta catenin chromosomal instability (85%)
GLUT 2
Inferior rectal nerve

18. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
...
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Duodenal atresia - Downs

19. Gastrin - source - action - regulation
3 waves/min
Uremia
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
Brunners

20. Where are oligosaccharide hydrolases and What do they do
Gastrohepatic ligament
Brush border of intestine - produce monosaccharides from oligo and di
Hemolytic anemia
Striated

21. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
Hypotonic because of more time to reabsorb NaCl
Can lead to hematemesis - found in EtOHics and bulimics
Penicillinamine - AR inheritance
AST

22. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
In the mucus that covers the gastric epithelium
Ischemic colitis
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Conj/unconj - inc - nl to dec

23. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Necrotizing enterocolitis
Lactase is located at the tips of intestinal villi
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
2ndary biliary cirrhosis

24. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
When diffusely infiltrative - thickened rigid appearance like a leather bottle
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

25. How does CRC present in the distal and proximal colon
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

26. What can fistula between the gallbladder and small intestine create and how can you tell
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Dubin johnson
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
The proximal small bowel

27. A protrusion of peritoneum through an opening - usually a site of weakness
CHF and inc risk of HCC
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Hernia
Sister mary joseph nodule

28. What portion of the bowel does sprue effect
Osmotic
The proximal small bowel
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
...

29. Which IBD is autoimmune and which may be a disordered response to bacteria
Below
Pyoderma gangrenosum - primary sclerosing cholangitis
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

30. How does gastrin increase acid secretion?
Can lead to hematemesis - found in EtOHics and bulimics
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Unconj - absent (acholuria) - inc
Primarly through ECL leading to histamine release

31. What do mucins do?
Via the middle colic
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Lubricate food (glycoprotiens)

32. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
FAP
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
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
Adhesion

33. In PUD with a duodenal ulcer does pain inc or dec with meals
Jaundice - fever - RUQ
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
Decrease - weight gain
Heme metabolism

34. What are the labs in acute pancreatitis
Nonkeritinized stratified sqamous epithelium
Elevated amylase - and lipase
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
MSI (15%) and APC/beta catenin chromosomal instability (85%)

35. Achalasia increases the risk For what complication
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Dec PGE2 leading to dec gastric mucosa protection
Esophageal carcinoma
8-9 waves/min

36. What drug blocks the H2R
Duodenal atresia - Downs
Portal HTN
Inc lower esphogeal tone leading to achalasia
Cimetidine

37. What are the treatmet options for crohns
Redundant mesentary
Above
Hemosiderosis - hemochromatosis
Corticosteroids - infliximab

38. Where are carcinoid tumors most commonly malignant
Peyers patches
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Alcoholic cirrhosis
Small intestine

39. What layer in the mucosa is repsonsible for motility
Reye's syndrome
Alfatoxin in peanuts
Muscularis mucosae
Pyoderma gangrenosum - primary sclerosing cholangitis

40. trypsinogen is converted to trypsin via what enzyme
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
Tropical sprue
Enterokinase/enteropeptidase from the duodenal mucosa
Common hepatic - splenic - left gastric - main blood supply for stomach

41. What is the frequency of basal electric rhythm of the ilieum
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
8-9 waves/min
2ndary biliary cirrhosis
Myenteric nerve plexus - aurbach

42. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Cimetidine
Amylase

43. bilateral mets to ovaries with abundant mucus - signet ring cells
HSV-1 - CMV - Candida
Krukenbergs tumor
Terminal ileum and colon
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

44. How do villi appear in disaccharidease def
Angiodysplasia
2ndary biliary cirrhosis
Boerhaave's Syndrome - Been heaving syndrome
Normal

45. What artery passes around the duodenum
The gastroduodenal
Left gastric vein and esophogeal vein - esophagus
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

46. What are the results of hemochromatosis
AST>ALT
CHF and inc risk of HCC
Alpha amylase
CCK8 receptor - Gq inc IP3/Ca

47. What is the most common diaphragmatic hernia and What are the two types
Inspiratory arrest on deep palpation due to pain
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
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
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

48. Where are tumors commonly in pancreatic adenocarcinoma
Antrum - H.pylori - inc risk of MALT lymphoma
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Pancreatic head causing obstructive jaundice
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy

49. Autodigestion of pancreas by pancreatic enzymes
Lubricate food (glycoprotiens)
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Acute pancreatitis
Brush border of intestine - produce monosaccharides from oligo and di

50. In what clinical scenarior do you see portosystemic anastomoses
Portal HTN
Brush border of intestine - produce monosaccharides from oligo and di
Where hindgut meets ectoderm
Chagas disease