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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. Where are peyers patches found
Lamina propora and submucosa
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
AR
Inferior rectal nerve

2. What serum enzyme is decreased in wilsons disease
Ceruplasmin
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
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
Pertechnetate - study for uptake

3. Which viral infxns/treatments are associated with reyes syndrome
VZV and influenza B treated with salicylates
FAP
Hemolytic anemia
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

4. How does brain injury lead to acute gastritis and What is it called
Gardner's syndrome
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Chronic calcifying pancreatitis - inc risk of panreatic cancer

5. Which area of the hindgut is a watershed area
Splenic flexure
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Glucouronate - water soluble (direct)
Black - rotors syndrome

6. What complication can arise from indirect inguinal hernias
Superior rectal and middle and inferior rectal - rectum
Esophageal carcinoma
Budd chiari syndrome
Hydrocele

7. signet ring cells - acanthosis nigracans - dz - character/association - spread
Dense core bodies
...
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis

8. With internal hemorrhoids Where is the anastomoses and Where is it
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
GERD - may also present with nocturnal cough and dyspnea
Superior rectal and middle and inferior rectal - rectum

9. In PUD - with gastric ulcers - does pain inc or dec with meals?
...
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin
Inc - weight loss

10. What is the ddx associated with appendicitis
Lamina propora and submucosa
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Volvulus

11. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Alpha1 antitrypsin def - codominant trait
GLUT 2
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

12. What does a low flow rate mean for saliva
Hypotonic because of more time to reabsorb NaCl
When diffusely infiltrative - thickened rigid appearance like a leather bottle
All 3
High LES opening pressure and uncoordinated peristalsis - both solids and liquids

13. subQ peribumbilical metastasis
Sister mary joseph nodule
AST >ALT - ration is usually 1.5
Oral glucose
Pertechnetate - study for uptake

14. is meckels a true diverticulum and how common is it
Superior rectal and middle and inferior rectal - rectum
True and most common congenital anomoly of GI tract
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Crohns - CF - advanced age - clofibrate - estrogens - multiparity - rapid weight loss - Native American origin

15. In what clinical scenarior do you see portosystemic anastomoses
Pleomorphic adenoma
Portal HTN
Fasting and stress
The gastroduodenal

16. What do mucins do?
Hyperplastic
Lubricate food (glycoprotiens)
Hypotonic because of more time to reabsorb NaCl
Lactase is located at the tips of intestinal villi

17. Which serum enzyme increases with heavy EtOH consumption
Trypsin - chymotrypsin - elastase - carboxypeptidases
Gamma glutamyl transferase GGT
Paraumbilical and superficial and inferior epigastric - umbilicus
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

18. why infxn is implicated in duodenal PUD
Cimetidine
...
Cigarettes and chronic pancreatitis - not EtOH
H pylori (almost 100%)

19. What causes nutmeg liver
Budd chiari syndrome
Backup of blood into the liver - RHF - budd chiari
Dense core bodies
Gastric glands

20. What are the treatmet options for crohns
Above
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
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Corticosteroids - infliximab

21. in jaundice of obstructive etiolgy is the hyperbilirubinemia conj or unconj - what happens to urine bili - and what happens to urine urobilinogen
Conj - inc - dec
H pylori (almost 100%)
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system
Zollinger ellison - brunners glands

22. What structures feed into the common hepatic duct
Right and left hepatic duct
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
The submucosal nerve plexus - meissner's
Cigarettes and chronic pancreatitis - not EtOH

23. bilateral mets to ovaries with abundant mucus - signet ring cells
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
Krukenbergs tumor
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

24. What is the most common cause of gallstones
Older patients
AST>ALT
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Cholecystitis - also ascending cholangitis - acute pancreatitis and bililary infx

25. What is the rule of 2s for meckels
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Hypotonic because of more time to reabsorb NaCl

26. Autodigestion of pancreas by pancreatic enzymes
Hepatic steatosis
Left and right gastroepiploics - left and right gastrics
Neural muscarinic pathways
Acute pancreatitis

27. What skin condition is associated with celiac sprue
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
Crigler - najjar type 1
Dermatitis herpetiformis
Lipase

28. What are the four Fs of gallstones
Epigastric abdominal pain radiating to back - anorexia - nausea
Alcoholic cirrhosis
True and most common congenital anomoly of GI tract
Female - fat - fertile - forty

29. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
HSV-1 - CMV - Candida
Zollinger Ellison - phenylalanine and tryptophan
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Via the middle colic

30. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Crohns = maybe - UC= always
Cystic dilation of the viteline duct
Sister mary joseph nodule
Necrotizing enterocolitis

31. At what spinal level does the is the bifurcation of aorta
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Gardner's syndrome
Skip lesions =crohns - colon = UC
L4

32. What is the presentation of pancreatic adenocarcinoma
Complications of crohns
All 3 gut layers outpouch as in Meckels
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

33. What does extrahepatic biliary obstruction cause
Failure of neural crest migration
Alpha1 antitrypsin def - codominant trait
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis

34. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
Primary sclerosing cholangitis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Below
Acute pancreatitis

35. How is the diagonsis of CRC made
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
Skip lesions =crohns - colon = UC
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

36. What are motilin receptor agonists used for clinically
External (superficial) ring only
Cimetidine
Corticosteroids - infliximab
Stimulate intestinal persistalsis

37. HCC is associated with what other conditions
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Juvenille polyps - no risk if single
Penicillinamine - AR inheritance

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

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39. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Juvenille polyps - no risk if single
Conj - inc - dec
Dubin johnson
Turcot

40. What is the mechanism for reyes syndrome
CCK8 receptor - Gq inc IP3/Ca
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
HPNCC
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

41. Bilirubin is the product of what?
Crigler - najjar type 1
Hirschsprungs
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Heme metabolism

42. What kind of cancer to celiac sprue put you as inc risk for
PAS- positive globules in liver -
3 waves/min
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
T cell lymphoma

43. milk intolerance
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Superior rectal
Zollinger Ellison - phenylalanine and tryptophan
Dissaccharidase def - most commonly lactase

44. What is the leading cause of bowel incarceration
L1
Femoral hernia
Right and left hepatic duct
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia

45. What ligament connects the liver to the abdominal wall - What is contained within it and From what structure is it derived
Punched out - clean margins - carcinoma =raised irregular margins
Low pressure proximal to LES
Alcoholic hepatitis
Falciform - ligamentum teres - fetal umbilical vein

46. Why would a self - limited lactase def occur following an injury (viral diarrhea)
HPNCC
Fe2+ in the duod
Turcot
Lactase is located at the tips of intestinal villi

47. Gq and inc cAMP both work to do what in parietal cells
Stimulate the H/K ATPase
Gut bacteria
Failure of the processus vagainlis to close
VZV and influenza B treated with salicylates

48. How are all 3 monosaccharides transported to the blood
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
Primarly through ECL leading to histamine release
GLUT 2
CEA - CA-19-9

49. What commonly leads to appendicity in kids vs adults
Serous on the sides parotids - mucinous in the middle sublingual
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Duodenal atresia - Downs
Liver metabolizes 5HT

50. 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
CCK8 receptor - Gq inc IP3/Ca
Juvenille polyps - no risk if single
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Skip lesions =crohns - colon = UC