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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. motilin - source - action - regulation
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Duodenum - 2nd - 3rd and 4th parts
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

2. Transmural esophageal rupture due to violent retching

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3. What serum enzyme is elevated inacute pancreatitis
Chronic gastritis and pernicious anemia
Lipase
Terminal ileum and colon
Urobilin

4. What is the sphincter of the pancreatic duct
Virchow's node
Stercobilin
Sphincter of oddi
Elevated amylase - and lipase

5. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Colonic polyps
Urobilin

6. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Crohns = maybe - UC= always
Ischemic colitis
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

7. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
IgA secreting plasma cells - ultimately reside in the lamina proporia

8. Where are peyers patches found
Lamina propora and submucosa
Decrease - weight gain
The entire
Corticosteroids - infliximab

9. What is the path of an indirect inguinal hernia
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Decreased intercellular adhesion and increased proliferation
The jejunum
Goes through deep inguinal ring - external inguinal ring and into the scrotum

10. Why does carcinoid syndrome not occur if tumor is confined to GI system
Mitochondrial abnl - fatty liver - hypoglycemia - coma
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Parietal cells in the stomach - B12 binding protein
Liver metabolizes 5HT

11. How does abetalipoproteinemia lead to malabsorption
Tropical sprue
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Meckels

12. Where does type A chronic gastritis occur and What causes it
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Esophageal cancer
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

13. What does bicab do in the mouth
Pyoderma gangrenosum - primary sclerosing cholangitis
Lubricate food (glycoprotiens)
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
Neutralizes oral bacertial acids and maintains dental health

14. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Neutralizes oral bacertial acids and maintains dental health
Left and right gastroepiploics - left and right gastrics
Superior rectal

15. What is the other name for GIP (gastric inhibitory peptide)
Glucose dependent insulinotropic peptide
Tropical sprue
All 3
Hernia

16. What pancreatic enzymes are responsible for fat digestion
Cystic duct and common hepatic duct
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Lipase - phospholipase A - colipase

17. What congenital birth defect is associated with Hirschsprung
Alpha amylase
Diarrhea - steatorrhea - weight loss - weakness
Downs
Crohns = maybe - UC= always

18. Where does type B chronic gastritis occur and What causes it
Antrum - H.pylori - inc risk of MALT lymphoma
Hirschsprungs
Cimetidine
IgA secreting plasma cells - ultimately reside in the lamina proporia

19. What are the longterm sequelae of nutmeg liver
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Centrilobular congestion and necrosis - cardiac cirrhosis

20. What is the lumen of the pancreatic duct
3 waves/min
Begins starch digestion - inactivated by low pH upon reaching the stomach
Ampulla of vater
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging

21. How do villi appear in disaccharidease def
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
Normal
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Diverticulum

22. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Jewish and African American men

23. Bile is critical for exrection of what substance
Alcoholic hepatitis
Cholesterol
Lactase is located at the tips of intestinal villi
HSV-1 - CMV - Candida

24. What is the ddx associated with appendicitis
Small intestine
Zollinger ellison - brunners glands
Lamina propria
Diverticulitis in elderly - ectopic pregs use hCG to rule out

25. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Crohns = noncaseating granulomas - UC = crypt abscesses
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Worldwide - SC - US - adeno

26. In what clinical scenarior do you see portosystemic anastomoses
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Mallory bodies
Portal HTN
All 3

27. Gastrin - source - action - regulation
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
Alk pho
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
3 waves/min

28. What are the treatment options for uclerative colitis
Left gastric vein and esophogeal vein - esophagus
ASA preparations (sulfasalazine) 6- mercaptopurine - infliximab - colectomy
Inc lower esphogeal tone leading to achalasia
Decrease - weight gain

29. What separates the right greater and lesser sacs
Carcinoid syndrome
Gastrohepatic ligament
Small intestine
Inc - weight loss

30. Which kind of hemorrhoids are painful and why
GLUT 2
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Pleuroperitoneal

31. What are esophageal strictures associated with
Lye ingestion and acid reflux
Hypercoaguability - polycythemia vera - pregnancy - HCC
Lactase is located at the tips of intestinal villi
Superior rectal

32. What serum enzyme is decreased in wilsons disease
Omeprazole
Crohns = maybe - UC= always
Ceruplasmin
NAV = nerve artery vein - venous near the penis (NAVEL)

33. signet ring cells - acanthosis nigracans - dz - character/association - spread
Brunners
Splenic flexure
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Jaundice - fever - RUQ

34. What cell produces IF and What does it do
Mucoepidermoid carcinoma
Parietal cells in the stomach - B12 binding protein
Punched out - clean margins - carcinoma =raised irregular margins
Normal

35. What is the HLA association and treatment for hemochromatosis
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
AST >ALT - ration is usually 1.5
Repeated phlebotomy - deferoxamine - HLA- A3
Juvenille polyps - no risk if single

36. In what scenarios do pts with gilberts have inc bili
Gallbladder
Hemolytic anemia
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Fasting and stress

37. A protrusion of peritoneum through an opening - usually a site of weakness
Hernia
So hypertrophied they look like brain gyri
L4
Jaundice - fever - RUQ

38. With caput medusaw - between what vessels is the anastomoses and Where is it
Peutz jeghers
Paraumbilical and superficial and inferior epigastric - umbilicus
Inc lower esphogeal tone leading to achalasia
Common hepatic - splenic - left gastric - main blood supply for stomach

39. What layer of fascia covers a direct inguinal hernia
Gut bacteria
Cholesterol - 10-20% opaque due to calcifications
Crypts but not villi
External spermatic fascia only

40. What kind of diarrhea is produced from a disaccharide def
Osmotic
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
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
Internal thoracic to superior epigastric to inferior epigastric

41. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
GLUT 2
Where hindgut meets ectoderm
Striated

42. What are additional risk factors for CRC
Diarrhea - steatorrhea - weight loss - weakness
Neutralizes gastric acid allowing pancreatic enzymes to fxn
NAV = nerve artery vein - venous near the penis (NAVEL)
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

43. Achalasia increases the risk For what complication
Esophageal carcinoma
Juvenille polyps - no risk if single
Chagas disease
Lateral

44. Bilirubin is the product of what?
Heme metabolism
Boerhaave's Syndrome - Been heaving syndrome
Mucosa - submucosa - muscularis externa - serosa/adventitia
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers

45. What kind of salivary gland tumor is painless - moveable mass - bening with high rate of recurrence - most common salivary gland tumor
Hernia
Pleomorphic adenoma
Zollinger Ellison - phenylalanine and tryptophan
Adhesion

46. What are the borders of the femoral triangle
Pleomorphic adenoma
Uremia
Inguninal ligament - sartorius muscle - adductor longus
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

47. FAP + osseous and soft tissue tumors - retinal hyperplasia

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48. What kind of pathways do CCK act on to cause pancreatic secretion
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Punched out - clean margins - carcinoma =raised irregular margins
Colovesical leading to pneumaturia
Neural muscarinic pathways

49. concentric onion skin bile duct fibrosis
Primary sclerosing cholangitis
Lateral
Failure of the processus vagainlis to close
Diarrhea - steatorrhea - weight loss - weakness

50. What causes carcinoid syndrome amd What are the symptoms
Brush border of intestine - produce monosaccharides from oligo and di
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Chronic gastritis and pernicious anemia
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial