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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. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Crohns = noncaseating granulomas - UC = crypt abscesses
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
FAP
Decrease - weight gain

2. What is the arterial supply and venous drainage below pectinate line
HPNCC
Epithelium
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

3. What does the gastrocolic ligament connect - What is contained - and what larger structure is it a part of...
Primarly through ECL leading to histamine release
The gastroduodenal
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Splenic flexure

4. secretin - source - action - regulation
Parietal cells in the stomach - B12 binding protein
Cigarettes and chronic pancreatitis - not EtOH
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
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

5. What is the most common cause of gallstones
Jaundice - fever - RUQ
Complications of crohns
Cirrhosis
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

6. What can hemochromatosis be secondary to...
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
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

7. What pancreatic proteases are secreted as zymogens
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
MSI (15%) and APC/beta catenin chromosomal instability (85%)
The submucosal nerve plexus - meissner's
Trypsin - chymotrypsin - elastase - carboxypeptidases

8. Where is the deep inguinal ring relative to the inferior epigastric vessels
External (superficial) ring only
Lateral
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Lipase

9. What kind of digestion is bile needed for
Lye ingestion and acid reflux
Acute pancreatitis
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

10. What is one potential precipitating factor for intussusception
Obstruction of the common bile duct
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
AST >ALT - ration is usually 1.5
Acute pancreatitis

11. How does abetalipoproteinemia lead to malabsorption
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Increase tumorigenesis

12. what kind of fistula is associated with diverticulitis
Colovesical leading to pneumaturia
Cholesterol
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Brush border of intestine - produce monosaccharides from oligo and di

13. What do you use to diagnose meckels
Pertechnetate - study for uptake
CCK8 receptor - Gq inc IP3/Ca
ALT>AST
IgA receives protective secretory component and is then transported across the epithelium to gut lumen

14. What carcinogens are associated with HCC
Alfatoxin in peanuts
Old men - arthralgias - cardiac and neuro sx
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Fe2+ in the duod

15. What does loss of p53 cause
Dermatitis herpetiformis
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Increase tumorigenesis
Unconjugated - water insoluble

16. What are esophageal strictures associated with
No
The submucosal nerve plexus - meissner's
Lye ingestion and acid reflux
Poor anastamoses

17. What are the four Fs of gallstones
IgA secreting plasma cells - ultimately reside in the lamina proporia
All 3
Female - fat - fertile - forty
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

18. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
L1
Left gastric vein and esophogeal vein - esophagus
Below
Pancreatic and bile

19. In viral hepatitis - which liver enzyme is higher
ALT>AST
L3
Phenobarbital - inc liver enzyme synthesis
Positive urease test

20. what kind of muscle is in the upper 1/3 of esophagus
Meckels
Striated
Myenteric nerve plexus - aurbach
Inc smooth muscle relaxation - including lower esophageal sphincter

21. alcoholic liver disease that requires sustained - long term consumption - with swollen and necrotic hepatocytes with neutrophilic infiltration
Adhesion
Alcoholic hepatitis
Juvenille polyps - no risk if single
Uremia

22. Bile is critical for exrection of what substance
Cholesterol
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
The entire
Unconj - absent (acholuria) - inc

23. Autoantibodies to gluten (gliadin) in wheat and other grains
Celiac sprue
H pylori (almost 100%)
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
Averages 6 months - very aggressive - usually already metastasized at presentation

24. How is the diagonsis of CRC made
Repeated phlebotomy - deferoxamine - HLA- A3
Acute pancreatitis
Dubin johnson
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

25. What serum enzyme is decreased in wilsons disease
Gut bacteria
Parietal cells in the stomach - B12 binding protein
Phenobarbital - inc liver enzyme synthesis
Ceruplasmin

26. What do the rugae of stomach look like in menetriers disease
Acute pancreatitis
Crigler - najjar type 1
So hypertrophied they look like brain gyri
With albumin

27. What is the omphalomesenteric cyst
Centrilobular leading to congestive liver disease
Hernia
Urobilin
Cystic dilation of the viteline duct

28. How do NSAIDs cause acute gastritis
Alcoholic cirrhosis
Old men - arthralgias - cardiac and neuro sx
Decrease - weight gain
Dec PGE2 leading to dec gastric mucosa protection

29. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Alk pho
Gastrohepatic ligament
Internal thoracic to superior epigastric to inferior epigastric
PAS- positive globules in liver -

30. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Causes of gall stones
Cholesterol
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

31. multiple juvenil polyps in GI tract - risk
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Volvulus
Elevated amylase - and lipase

32. What receptor does histamine bind on the parietal cell and What does it activate
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
H2 receptor - inc cAMP
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Older patients

33. What does autoimmune destruction of parietal cells lead to...
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Crigler - najjar type 1
Chronic gastritis and pernicious anemia
Gastric glands

34. Gallstones that reach the common channel at ampulla can block which two ducts
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Pancreatic and bile
Sister mary joseph nodule

35. Where does type B chronic gastritis occur and What causes it
Gilbert's
L1
Antrum - H.pylori - inc risk of MALT lymphoma
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

36. B cells stimuated in the germinal centers of peyers patches differentiate into what?
Lactase is located at the tips of intestinal villi
IgA secreting plasma cells - ultimately reside in the lamina proporia
90%
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall

37. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Cystic dilation of the viteline duct
IBS at least 2 with recurrent abdominal pain
Hepatic steatosis

38. Which is used more quickly - an oral glucose load - or that by IV
GLUT 2
Above
Oral glucose
Glucose dependent insulinotropic peptide

39. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Duodenal atresia - Downs
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Alk phos

40. What retroperitoneal structure flanks both sides of the pancreas on CT
Urobilin
Phototherapy
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Duodenum - 2nd - 3rd and 4th parts

41. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Ceruplasmin
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Crohns = noncaseating granulomas - UC = crypt abscesses

42. What are causes of extrahepatic biliary obstruction
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
CHF and inc risk of HCC
External spermatic fascia only
Positive urease test

43. What kind of diarrhea is produced from a disaccharide def
Intussusception
Osmotic
Pleuroperitoneal
Dubin johnson

44. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Hemosiderosis - hemochromatosis
Femoral hernia
With albumin
2ndary biliary cirrhosis

45. In an MI - which liver enzyme is elevated
Heme metabolism
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Pancreatic and bile
AST

46. What type of insults result in micronodular cirrhosis
Fe2+ in the duod
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria

47. How is bilirubin carried in the blood
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
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Peptic ulcer disease
With albumin

48. What kind of cancer to celiac sprue put you as inc risk for
T cell lymphoma
Krukenbergs tumor
Primary sclerosing cholangitis
Mallory bodies

49. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
The gastroduodenal
Cholesterol - 10-20% opaque due to calcifications
Older patients
Duodenum - 2nd - 3rd and 4th parts

50. Where does inflammation in diverticula likely cause pain - what other signs/symptoms are present and What are the complications
Fasting and stress
Appendicitis
Liver metabolizes 5HT
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics