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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 is the prognosis of adenocarcinoma
All 3
3 waves/min
Averages 6 months - very aggressive - usually already metastasized at presentation
Failure of neural crest migration

2. What is the presenting course for appendicity

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3. What congenital birth defect is associated with Hirschsprung
Krukenbergs tumor
Dissaccharidase def - most commonly lactase
Cigarettes and chronic pancreatitis - not EtOH
Downs

4. likely infectious form of malabsorption - responds to antibiotics
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Tropical sprue
3 waves/min
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

5. What are the borders of the femoral triangle
Obstruction of the common bile duct
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
Inguninal ligament - sartorius muscle - adductor longus
Phenobarbital - inc liver enzyme synthesis

6. What are the longterm sequelae of nutmeg liver
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Centrilobular congestion and necrosis - cardiac cirrhosis
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Goes through deep inguinal ring - external inguinal ring and into the scrotum

7. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
Fasting and stress
Krukenbergs tumor
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
GERD - may also present with nocturnal cough and dyspnea

8. What causes hirschsprungs
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Parietal cells in the stomach - B12 binding protein
Failure of neural crest migration
GLUT 2

9. What does GET SMASHED stand for in acute pancreatitis
Around the central vein (zone III)
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Skip lesions =crohns - colon = UC
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

10. What does a low flow rate mean for saliva
Hypotonic because of more time to reabsorb NaCl
Early childhood - neuro sx and malabsorption
True and most common congenital anomoly of GI tract
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

11. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Mucosa - submucosa - muscularis externa - serosa/adventitia
External (superficial) ring only
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Via the superior pancreaticduodenal

12. congenital megacolon characterized by lack of ganglion/enteric nervous plexuses in segment on intestinal biopsy
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
Cholesterol - 10-20% opaque due to calcifications
Nonkeritinized stratified sqamous epithelium
Hirschsprungs

13. What causes primary biliary cirrhosis
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Where hindgut meets ectoderm
T12
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

14. With internal hemorrhoids Where is the anastomoses and Where is it
Superior rectal and middle and inferior rectal - rectum
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Lamina propria
When diffusely infiltrative - thickened rigid appearance like a leather bottle

15. Why does volvulus occur more at cecum and sigmoid colon
Antrum - H.pylori - inc risk of MALT lymphoma
Redundant mesentary
Gallbladder
Lubricate food (glycoprotiens)

16. Abuse of what substance leads to acute gastritis
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
EtOH
Reye's syndrome

17. HCC is associated with what other conditions
Alpha amylase
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
NAV = nerve artery vein - venous near the penis (NAVEL)
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

18. what kind of muscle is in the upper 1/3 of esophagus
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Striated
Krukenbergs tumor
Centrilobular congestion and necrosis - cardiac cirrhosis

19. Failure of relaxation of lower esophageal sphincter - Name and etiology
Centrilobular congestion and necrosis - cardiac cirrhosis
Achalasia due to loss of myenteric plexus (auberach)
In the mucus that covers the gastric epithelium
GERD - may also present with nocturnal cough and dyspnea

20. What histological findings are present in the stomach
Gastric glands
Inguninal ligament - sartorius muscle - adductor longus
Zollinger ellison - brunners glands
Around the central vein (zone III)

21. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
Unconj - absent (acholuria) - inc
Esophageal cancer
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

22. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Glucouronate - water soluble (direct)
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Alcoholic cirrhosis
Epithelium

23. vasoactive intestinal polypeptide (VIP) - source - action - regulation
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
Complications of crohns
AST>ALT
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

24. How do villi appear in disaccharidease def
Lamina propria
Boerhaave's Syndrome - Been heaving syndrome
Normal
True and most common congenital anomoly of GI tract

25. What kind of diarrhea is produced from a disaccharide def
Adhesion
Osmotic
Sphincter of oddi
Hyperpigmented mouth - lips - hands - genitalia

26. What is the cause of physiologic neonatal jaundice
The submucosal nerve plexus - meissner's
Centrilobular leading to congestive liver disease
2ndary biliary cirrhosis
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

27. How does CRC present in the distal and proximal colon
Dec PGE2 leading to dec gastric mucosa protection
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Punched out - clean margins - carcinoma =raised irregular margins
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

28. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
FAP
ALT>AST
Appendicitis
Superior rectal

29. Where is the pectinate line
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Closer to isotonic because of less time to reabsorb NaCl
Pleomorphic adenoma
Where hindgut meets ectoderm

30. absent UDPGT - presents early in life - early mortality
Hernia
Centrilobular leading to congestive liver disease
90%
Crigler - najjar type 1

31. What causes carcinoid syndrome amd What are the symptoms
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Around the central vein (zone III)
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
12 waves/min

32. why infxn is implicated in duodenal PUD
H pylori (almost 100%)
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Iron def anemia in older pts - screening of pts >50 with stool occult blood test and colonscopy - apple core lesion on barium enema xray - CEA tumor marker
With albumin

33. What are the two molecular pathways that lead to CRC
ALT>AST
Unconjugated - water insoluble
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Lactase is located at the tips of intestinal villi

34. milk intolerance
The gastroduodenal
Dissaccharidase def - most commonly lactase
Hemosiderosis - hemochromatosis
Dilated esophagus with an area of distal stenosis - birds beak

35. What does bicarb do in the duodenum
The entire
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Hypercoaguability - polycythemia vera - pregnancy - HCC
Ceruplasmin

36. Where does type A chronic gastritis occur and What causes it
Gilbert's
All 3 gut layers outpouch as in Meckels
Pancreatic and bile
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

37. B cells stimuated in the germinal centers of peyers patches differentiate into what?
IgA secreting plasma cells - ultimately reside in the lamina proporia
Colovesical leading to pneumaturia
Budd chiari syndrome
Zollinger ellison - brunners glands

38. To what substance is bilirubin conjugated and why
AR
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Glucouronate - water soluble (direct)
Positive urease test

39. When and why is stomach cancer termed linitis plastica
Backup of blood into the liver - RHF - budd chiari
Carcinoid syndrome
Begins starch digestion - inactivated by low pH upon reaching the stomach
When diffusely infiltrative - thickened rigid appearance like a leather bottle

40. involvement of left supraclavicular node by mets from stomach

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41. Between what structures do strong anastamoses exist
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Superior rectal
Left and right gastroepiploics - left and right gastrics
Serous on the sides parotids - mucinous in the middle sublingual

42. What histological findings are present in the esophagus
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Warthins' tumor
Pertechnetate - study for uptake
Nonkeritinized stratified sqamous epithelium

43. What kind of lesions are characteristic of duodenal PUD vs cancer
Lactase is located at the tips of intestinal villi
Punched out - clean margins - carcinoma =raised irregular margins
Gallbladder
Elevated amylase - and lipase

44. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Alcoholic cirrhosis
Gastric glands
T cell lymphoma

45. What are the common causes of gastric ulcers - What causes gastric ulcer
The jejunum
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
VZV and influenza B treated with salicylates
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

46. What kind of muscle is in the lower 1/3 of the esophagus
Warthins' tumor
Smooth
Ampulla of vater
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

47. Where does an indirect inguinal hernia enter the deep inguinal ring
Worldwide - SC - US - adeno
Liver metabolizes 5HT
Lateral to the inferior epigastric artery
Internal thoracic to superior epigastric to inferior epigastric

48. what kind of fistula is associated with diverticulitis
Brunners
Dissaccharidase def - most commonly lactase
Inguninal ligament - sartorius muscle - adductor longus
Colovesical leading to pneumaturia

49. most common non - neoplastic polyp in colon
CHF and inc risk of HCC
Achalasia due to loss of myenteric plexus (auberach)
Hyperplastic
Elevated amylase - and lipase

50. What conditions are associated with budd chiari
Reye's syndrome
Hypercoaguability - polycythemia vera - pregnancy - HCC
Crypts but not villi
Backup of blood into the liver - RHF - budd chiari

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USMLE GI

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