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USMLE GI

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 most common esophageal cancer worldwide and in the US
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Worldwide - SC - US - adeno
AST >ALT - ration is usually 1.5

2. What kind of digestion is bile needed for
Femoral hernia
The entire
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
12 waves/min

3. What kind of salivary gland tumor is benign - heterotopic salivary gland tissue - trapped in lymph node and surrounded by lymphatic tissue

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4. What is a positive murphy's sign
ALT>AST
Esophageal varices
Backup of blood into the liver - RHF - budd chiari
Inspiratory arrest on deep palpation due to pain

5. When and why is stomach cancer termed linitis plastica
T cell lymphoma
When diffusely infiltrative - thickened rigid appearance like a leather bottle
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
ALT>AST

6. What are the main components of bile
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
EtOH
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Amylase

7. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
Ampulla of vater
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Skip lesions =crohns - colon = UC

8. What is the other name for GIP (gastric inhibitory peptide)
Glucose dependent insulinotropic peptide
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

9. Acute gastritis is caused By what process
Erosive - disruption of mucosal barrier leading to inflammation
Conj - inc - dec
Neutralizes oral bacertial acids and maintains dental health
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

10. Which kind of hemorrhoids are painful and why
Duodenal atresia - Downs
Terminal ileum and colon
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Tropical sprue

11. What are the complications of chronic pancreatitis
Angiodysplasia
Can lead to hematemesis - found in EtOHics and bulimics
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Alk pho

12. Why does volvulus occur more at cecum and sigmoid colon
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Elevated amylase - and lipase
Redundant mesentary
Crohns = maybe - UC= always

13. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Poor anastamoses
Closer to isotonic because of less time to reabsorb NaCl
Adhesion
Menetriers disease

14. What artery passes around the duodenum
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
ALT>AST
Diverticulitis in elderly - ectopic pregs use hCG to rule out
The gastroduodenal

15. What are the four Fs of gallstones
Female - fat - fertile - forty
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Older patients

16. What do tumors that arise in the head of the pancreas cause
Hemolytic anemia
Early childhood - neuro sx and malabsorption
Obstruction of the common bile duct
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders

17. What is the prognosis of adenocarcinoma
Hemolytic anemia
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
Averages 6 months - very aggressive - usually already metastasized at presentation
Amylase

18. What are the signs of peutz jehgers
No
Conj/unconj - inc - nl to dec
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Hyperpigmented mouth - lips - hands - genitalia

19. If the hemochromatosis is primary - What is the pattern of inheritance
Cirrhosis
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
The submucosal nerve plexus - meissner's
AR

20. What can hemochromatosis be secondary to...
Hirschsprungs
Phototherapy
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

21. What serum enzyme is elevated in acute pancreatitis and mumps
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Lubricate food (glycoprotiens)
Amylase
Crohns = noncaseating granulomas - UC = crypt abscesses

22. What findings are associated with reyes
Paraumbilical and superficial and inferior epigastric - umbilicus
Mitochondrial abnl - fatty liver - hypoglycemia - coma
L1
Cystic duct and common hepatic duct

23. What does bicab do in the mouth
Colonic polyps
Neutralizes oral bacertial acids and maintains dental health
Hydrocele
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

24. What is diverticulosis
Crigler - najjar type 1
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Diarrhea - steatorrhea - weight loss - weakness
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

25. People of what decent are associated with celiac sprue and what findings/antibodies are present
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Parietal cells in the stomach - B12 binding protein
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

26. This disease commonly presents as heartburn and regurg when lying down - What is another common presentation
The entire
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
GERD - may also present with nocturnal cough and dyspnea

27. What does TOASTED with alcoholic hepatitis stand for
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
ALT>AST
AST >ALT - ration is usually 1.5
Esophageal carcinoma

28. What are the barium swallow findings of achalasia
Downs
Via the superior pancreaticduodenal
Dilated esophagus with an area of distal stenosis - birds beak
Low pressure proximal to LES

29. What structures feed into the cystic duct
Zenkers - halitosis - dysphagia and obstruction
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Gallbladder
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

30. what percentage of colonic polyps are non - neoplastic
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
90%
Zenkers - halitosis - dysphagia and obstruction
Complications of UC

31. What kind of muscle is in the lower 1/3 of the esophagus
Smooth
Stimulate the H/K ATPase
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Acute pancreatitis

32. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Glucose dependent insulinotropic peptide
Portal HTN
L/R renal artery around L1

33. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Hemosiderosis - hemochromatosis
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

34. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Esophageal cancer
Poor anastamoses
Zollinger Ellison - phenylalanine and tryptophan
L/R renal artery around L1

35. What layer of fascia covers a direct inguinal hernia
Poor anastamoses
Lipase
External spermatic fascia only
Glucouronate - water soluble (direct)

36. What factors increase risk of malignancy of adenomatous polyps
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
AST
Falciform - ligamentum teres - fetal umbilical vein
Jewish and African American men

37. What is the HLA association and treatment for hemochromatosis
Repeated phlebotomy - deferoxamine - HLA- A3
The entire
Upregulated intracellular signal transduction
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

38. What does primary sclerosing cholangitis lead to...
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Lamina propria

39. If the abdominal aorta is blocked - How does blood get to the middle rectal artery
Crohns = maybe - UC= always
Decreased intercellular adhesion and increased proliferation
Superior rectal
Phenobarbital - inc liver enzyme synthesis

40. Gallstones that reach the common channel at ampulla can block which two ducts
Complications of UC
Pancreatic and bile
CEA - CA-19-9
Gut bacteria

41. Between what structures do strong anastamoses exist
Hyperpigmented mouth - lips - hands - genitalia
Left and right gastroepiploics - left and right gastrics
H2 receptor - inc cAMP
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

42. Why are most diverticula considered false
Omeprazole
US and cholecystectomy
AST >ALT - ration is usually 1.5
Lack or have an attenuated muscularis externa - often in the sigmoid colon

43. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Meconium ileus
3 waves/min
Below
Zollinger ellison - brunners glands

44. What does K- ras mutation cause
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Upregulated intracellular signal transduction
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Short gastrics - left greater and lesser

45. vasoactive intestinal polypeptide (VIP) - source - action - regulation
Inguninal ligament - sartorius muscle - adductor longus
Conj/unconj - inc - nl to dec
90%
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

46. What arteries exit just below the SMA
L/R renal artery around L1
L3
Paraumbilical and superficial and inferior epigastric - umbilicus
Ceruplasmin

47. malnutrition - toxic megacolon - colorectal carcinoma
Glucouronate - water soluble (direct)
Older patients
Complications of UC
Normal

48. Where is there sclerosis in alcoholic cirrohosis
Failure of the processus vagainlis to close
Cholesterol - 10-20% opaque due to calcifications
Around the central vein (zone III)
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

49. What is the characteristic histo finding in alcoholic hepatitis
Crigler - najjar type 1
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Mallory bodies

50. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
2ndary biliary cirrhosis
Above
The submucosal nerve plexus - meissner's
Femoral hernia - through femoral canal - lateral to pubic tubercle and women