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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 does bicab do in the mouth
Downs
Dec PGE2 leading to dec gastric mucosa protection
Neutralizes oral bacertial acids and maintains dental health
T12

2. What are additional risk factors for CRC
Esophageal carcinoma
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Squamous - upper 1/3 - adeno - lower 1/3
Hemosiderosis - hemochromatosis

3. Is there any structural abnl with IBS - What is the course of disease and presentation
Squamous - upper 1/3 - adeno - lower 1/3
Hypotonic because of more time to reabsorb NaCl
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

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

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5. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Trypsin - chymotrypsin - elastase - carboxypeptidases
Jaundice - fever - RUQ

6. What is diverticulosis
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
CHF and inc risk of HCC
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Neural muscarinic pathways

7. Mucosal lacerations at the gastroesophageal junction due to severe vomiting - presentation - and risk groups
EtOH
Can lead to hematemesis - found in EtOHics and bulimics
HPNCC
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -

8. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Gilbert's
Volvulus
Urobilin
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

9. What is Trousseau's sign
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Gamma glutamyl transferase GGT
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Redness and tenderness on palpation of extremities

10. What is the most common indication of emergent abdominal surgery in children
Reye's syndrome
Appendicitis
Inspiratory arrest on deep palpation due to pain
Intussusception

11. What is contained within the muscularis externa
Short gastrics - left greater and lesser
Achalasia due to loss of myenteric plexus (auberach)
Myenteric nerve plexus - aurbach
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

12. At what level of the spine does the IM exit the aorta
L3
Poor anastamoses
Causes of gall stones
Crohns = noncaseating granulomas - UC = crypt abscesses

13. what kind of muscle is in the upper 1/3 of esophagus
Gastric glands
Colonic polyps
Striated
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

14. mildly dec UDPGT or dec bilirubin uptake - asymptomatic - elevated uncong bili without over hemolysis

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15. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Pancreatic and bile
Hemosiderosis - hemochromatosis
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

16. What intervention will intervention will relieve portal HTN
H pylori (almost 100%)
Lye ingestion and acid reflux
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
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

17. What type of insults result in micronodular cirrhosis
Superior rectal and middle and inferior rectal - rectum
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Primary sclerosing cholangitis

18. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Failure of the processus vagainlis to close
Can lead to hematemesis - found in EtOHics and bulimics
Cigarettes and chronic pancreatitis - not EtOH
Ischemic colitis

19. What do mucins do?
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
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
Lubricate food (glycoprotiens)
Barrett's esophagus

20. What are the histological findings in the duodenum

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21. What enzyme is necessary to create conjugated bilirubin
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Uridine glucuronyl transferase
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
GLUT 2

22. Which area of the hindgut is a watershed area
Lateral to the inferior epigastric artery
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Splenic flexure
Dense core bodies

23. Which patients have pigment stones
Unconj - absent (acholuria) - inc
EtOH
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Uridine glucuronyl transferase

24. What is biliary colic
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Backup of blood into the liver - RHF - budd chiari
Many diverticula - associated with low fiber diets - caused by inc intraluminal pressure and focal weakness in colonic wall
Pain associated with cholecystitis and galls stones - diabetics may not present with pain

25. Where are tumors commonly in pancreatic adenocarcinoma
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Diverticulum
Pancreatic head causing obstructive jaundice
Centrilobular congestion and necrosis - cardiac cirrhosis

26. Why would a self - limited lactase def occur following an injury (viral diarrhea)
Downs
Lactase is located at the tips of intestinal villi
Colovesical leading to pneumaturia
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

27. What are the four Fs of gallstones
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Short gastrics - left greater and lesser
Female - fat - fertile - forty
Dense core bodies

28. How does CRC present in the distal and proximal colon
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Short gastrics - left greater and lesser
IBS at least 2 with recurrent abdominal pain

29. What kind of lesions are characteristic of duodenal PUD vs cancer
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Conj/unconj - inc - nl to dec
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin
Punched out - clean margins - carcinoma =raised irregular margins

30. Where is the pectinate line
Adhesion
Dermatitis herpetiformis
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Where hindgut meets ectoderm

31. When and How does Abetalipoproteinemia present
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Epithelium
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Early childhood - neuro sx and malabsorption

32. What serum enzyme is decreased in wilsons disease
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Ceruplasmin
The entire
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

33. What is the TX of physiologic neonatal jaundice
Epigastric abdominal pain radiating to back - anorexia - nausea
Phototherapy
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Cigarettes and chronic pancreatitis - not EtOH

34. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Obstruction of the common bile duct
AST>ALT
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
L/R renal artery around L1

35. What are the tumor markers for pancreatic adenocarcinoma
H2 receptor - inc cAMP
Goes through deep inguinal ring - external inguinal ring and into the scrotum
CEA - CA-19-9
ALT>AST

36. what kind of fistula is associated with diverticulitis
Ischemic colitis
Upregulated intracellular signal transduction
GERD - may also present with nocturnal cough and dyspnea
Colovesical leading to pneumaturia

37. What commonly leads to appendicity in kids vs adults
Unconjugated - water insoluble
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Tropical sprue
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

38. What are the borders of Hesselbach's triangle
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Primary sclerosing cholangitis
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons

39. What transforms conjugated bilirubin to urobilinogen
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Stercobilin
Gut bacteria
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder

40. What can hemochromatosis be secondary to...
Gallbladder
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Meconium ileus
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation

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

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42. What kind of muscle is in the middle 1/3 of esophagus
Striated and smooth
Failure of neural crest migration
Obstruction of the common bile duct
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

43. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Downs
Inc risk of CRC and other visceral malignancies

44. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Hypercoaguability - polycythemia vera - pregnancy - HCC
Necrotizing enterocolitis
L/R renal artery around L1

45. Why does carcinoid syndrome not occur if tumor is confined to GI system
Gardner's syndrome
Heme metabolism
Sister mary joseph nodule
Liver metabolizes 5HT

46. What artery passes around the duodenum
The gastroduodenal
Common hepatic - splenic - left gastric - main blood supply for stomach
Esophageal cancer
Crohns = maybe - UC= always

47. What is the most common diaphragmatic hernia and What are the two types
Low pressure proximal to LES
Alcoholic cirrhosis
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

48. What histological findings are present in the stomach
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
The gastroduodenal
Celiac sprue
Gastric glands

49. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
2ndary biliary cirrhosis
Turcot
H pylori (almost 100%)
IgA secreting plasma cells - ultimately reside in the lamina proporia

50. What kind of pathways do CCK act on to cause pancreatic secretion
Neural muscarinic pathways
Striated
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)