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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 kind of cancer to celiac sprue put you as inc risk for
3 waves/min
Goes through deep inguinal ring - external inguinal ring and into the scrotum
T cell lymphoma
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

2. What separates the right greater and lesser sacs
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Gastrohepatic ligament
US and cholecystectomy
Decrease - weight gain

3. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Below
Lye ingestion and acid reflux
Conj - inc - dec
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

4. What test and result confirms H pylori infxn
Positive urease test
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Early childhood - neuro sx and malabsorption
Black - rotors syndrome

5. How does hirschsprung present and appear on imaging
Parietal cells in the stomach - B12 binding protein
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
L4
Epithelium

6. What is the TX of physiologic neonatal jaundice
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Femoral hernia
Paraumbilical and superficial and inferior epigastric - umbilicus
Phototherapy

7. If the hemochromatosis is primary - What is the pattern of inheritance
Centrilobular congestion and necrosis - cardiac cirrhosis
AST >ALT - ration is usually 1.5
CEA - CA-19-9
AR

8. With internal hemorrhoids Where is the anastomoses and Where is it
Superior rectal and middle and inferior rectal - rectum
Female - fat - fertile - forty
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Esophageal carcinoma

9. What carcinogens are associated with HCC
Normal
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Alfatoxin in peanuts
Chronic calcifying pancreatitis - inc risk of panreatic cancer

10. What are the signs of peutz jehgers
Hirschsprungs
Hyperpigmented mouth - lips - hands - genitalia
Gamma glutamyl transferase GGT
Old men - arthralgias - cardiac and neuro sx

11. What is the most important mechanism in gastric acid secretion
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
External (superficial) ring only
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

12. absent UDPGT - presents early in life - early mortality
Budd chiari syndrome
Crigler - najjar type 1
GERD - may also present with nocturnal cough and dyspnea
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

13. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Via the superior pancreaticduodenal
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Failure of the processus vagainlis to close

14. What are motilin receptor agonists used for clinically
Causes of gall stones
Falciform - ligamentum teres - fetal umbilical vein
Stimulate intestinal persistalsis
Hemolytic anemia

15. What is the most common cause of gallstones
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Heme metabolism
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

16. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Enterokinase/enteropeptidase from the duodenal mucosa
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Squamous - upper 1/3 - adeno - lower 1/3
Mucoepidermoid carcinoma

17. What are the longterm sequelae of nutmeg liver
Copious diarrhea - non alpha - non beta cell pancreatic tumor
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Oligosaccharide digestion
Centrilobular congestion and necrosis - cardiac cirrhosis

18. What does alpha amylase do and what inactivates it
Begins starch digestion - inactivated by low pH upon reaching the stomach
Enterokinase/enteropeptidase from the duodenal mucosa
Warthins' tumor
GLUT 2

19. What histological findings are present in the esophagus
Crohns = noncaseating granulomas - UC = crypt abscesses
Terminal ileum and colon
In the mucus that covers the gastric epithelium
Nonkeritinized stratified sqamous epithelium

20. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Internal thoracic to superior epigastric to inferior epigastric
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Begins starch digestion - inactivated by low pH upon reaching the stomach
Inc conj bilirubin - inc cholesterol - inc alk phos

21. Gastrin - source - action - regulation
Worldwide - SC - US - adeno
Serous on the sides parotids - mucinous in the middle sublingual
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
Juvenille polyps - no risk if single

22. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Intussusception
So hypertrophied they look like brain gyri
90%

23. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Erosive - disruption of mucosal barrier leading to inflammation
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Elevated amylase - and lipase
Enterokinase/enteropeptidase from the duodenal mucosa

24. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Black - rotors syndrome
Zollinger ellison - brunners glands
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Glucouronate - water soluble (direct)

25. Which glands secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach and are located in the duodenal submucosa
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Redness and tenderness on palpation of extremities
Brunners
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

26. How are all 3 monosaccharides transported to the blood
Enterokinase/enteropeptidase from the duodenal mucosa
Menetriers disease
GLUT 2
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

27. What is the cause of Barrett's and the assocaited complications
IgA secreting plasma cells - ultimately reside in the lamina proporia
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Begins starch digestion - inactivated by low pH upon reaching the stomach
Esophageal varices

28. signet ring cells - acanthosis nigracans - dz - character/association - spread
Lactase is located at the tips of intestinal villi
Inc lower esphogeal tone leading to achalasia
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood

29. What is the sphincter of the pancreatic duct
Sphincter of oddi
Reye's syndrome
Normal
CEA - CA-19-9

30. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Crypts but not villi
Hydrocele
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Spleen to posterior abdominal wall - splenic artery and vein

31. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Corticosteroids - infliximab
Poor anastamoses
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding

32. What causes pancreatic insuff and What does it cause
Brunners
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
GLUT 2
Antrum - H.pylori - inc risk of MALT lymphoma

33. 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
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia
Skip lesions =crohns - colon = UC
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Peyers patches

34. conjugated hyperbilirubinemia due to defective liver excretion
Dubin johnson
Via the middle colic
IBS at least 2 with recurrent abdominal pain
No - chronic - can present with diarrhea or constipation or alternation - treat sx

35. What does GET SMASHED stand for in acute pancreatitis
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Complications of UC
Phenobarbital - inc liver enzyme synthesis

36. What factors increase risk of malignancy of adenomatous polyps
Fasting and stress
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Turcot

37. How is the diagonsis of CRC made
All 3
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Nonkeritinized stratified sqamous epithelium
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

38. What serum enzyme is decreased in wilsons disease
Hyperplastic
Ceruplasmin
Striated
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

39. Abuse of what substance leads to acute gastritis
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
EtOH
90%
Chronic gastritis and pernicious anemia

40. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
The jejunum
H2 receptor - inc cAMP
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics

41. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Necrotizing enterocolitis
...
Right and left hepatic duct
Can lead to hematemesis - found in EtOHics and bulimics

42. How many layers of spermatic fascia are covers an indirect inguinal hernia
Crohns = maybe - UC= always
Closer to isotonic because of less time to reabsorb NaCl
All 3
12 waves/min

43. What are the histological findings of the colon
Virchow's node
CHF and inc risk of HCC
Internal thoracic to superior epigastric to inferior epigastric
Crypts but not villi

44. How is bilirubin carried in the blood
External (superficial) ring only
Duodenal atresia - Downs
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
With albumin

45. What does the splenorenal ligament connect - and What does it contain
Spleen to posterior abdominal wall - splenic artery and vein
Alpha amylase
Erosive - disruption of mucosal barrier leading to inflammation
CEA - CA-19-9

46. What kind of anemia is in Wilsons
Inspiratory arrest on deep palpation due to pain
Hemolytic anemia
Obstruction of the common bile duct
Mitochondrial abnl - fatty liver - hypoglycemia - coma

47. What makes a true diverticula
Pyoderma gangrenosum - primary sclerosing cholangitis
HSV-1 - CMV - Candida
All 3 gut layers outpouch as in Meckels
Inguninal ligament - sartorius muscle - adductor longus

48. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
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
Alpha amylase
Colonic polyps

49. With caput medusaw - between what vessels is the anastomoses and Where is it
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Sphincter of oddi
Worldwide - SC - US - adeno
Paraumbilical and superficial and inferior epigastric - umbilicus

50. What source of salivary secretion is the most serous and What is the most mucinous
Serous on the sides parotids - mucinous in the middle sublingual
Failure of neural crest migration
Striated and smooth
Hemosiderosis - hemochromatosis