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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 are the layers of the gut wall from inside out
Mucosa - submucosa - muscularis externa - serosa/adventitia
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Black - rotors syndrome
Lamina propora and submucosa

2. List the clinical findings of HCC
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Necrotizing enterocolitis
Duodenum - 2nd - 3rd and 4th parts

3. What receptors does ACH bind on the parietal cells and What does it activate
Inc risk of CRC and other visceral malignancies
Crigler - najjar type 1
M3 - Gq - inc IP3/Ca
Duodenal atresia - Downs

4. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Necrotizing enterocolitis
Black - rotors syndrome
Alpha amylase
Uremia

5. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Hydrocele
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Brunners
Complications of crohns

6. Where and How is iron absorbed
Fe2+ in the duod
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Short gastrics - left greater and lesser
Trypsin - chymotrypsin - elastase - carboxypeptidases

7. What are the labs for primary/secondary biliary cirrhosis and primary sclerosing cholangitis
Colovesical leading to pneumaturia
Inc conj bilirubin - inc cholesterol - inc alk phos
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Pyoderma gangrenosum - primary sclerosing cholangitis

8. What does autoimmune destruction of parietal cells lead to...
So hypertrophied they look like brain gyri
Chronic gastritis and pernicious anemia
Uremia
Gastric glands

9. What is the lumen of the pancreatic duct
Female - fat - fertile - forty
Ampulla of vater
Lye ingestion and acid reflux
Lack or have an attenuated muscularis externa - often in the sigmoid colon

10. What are the effects of atropine on parietal cells and G cells
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
H pylori (almost 100%)
Gastric glands
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells

11. In PUD - with gastric ulcers - does pain inc or dec with meals?
EtOH
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Inc - weight loss
Chronic gastritis and pernicious anemia

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

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13. Bile is critical for exrection of what substance
Peyers patches
Cholesterol
Corticosteroids - infliximab
Lateral to the inferior epigastric artery

14. Where are peyers patches found
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Lamina propora and submucosa
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
IBS at least 2 with recurrent abdominal pain

15. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
Splenic flexure
Right and left hepatic duct
HPNCC
External (superficial) ring only

16. What findings are associated with reyes
Can lead to hematemesis - found in EtOHics and bulimics
Mitochondrial abnl - fatty liver - hypoglycemia - coma
Trypsin - chymotrypsin - elastase - carboxypeptidases
Cystic duct and common hepatic duct

17. What does histo show for alpha1 antitrypsin def
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Stercobilin
Zollinger ellison - brunners glands
PAS- positive globules in liver -

18. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
Dissaccharidase def - most commonly lactase
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides

19. motilin - source - action - regulation
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Uridine glucuronyl transferase
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state

20. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Ischemic colitis
Common hepatic - splenic - left gastric - main blood supply for stomach
Crohns = noncaseating granulomas - UC = crypt abscesses

21. What structures feed into the common hepatic duct
Right and left hepatic duct
Low pressure proximal to LES
Begins starch digestion - inactivated by low pH upon reaching the stomach
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

22. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Menetriers disease
Around the central vein (zone III)
Redness and tenderness on palpation of extremities
Epigastric abdominal pain radiating to back - anorexia - nausea

23. What can hemochromatosis be secondary to...
Positive
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Reye's syndrome

24. What is the frequency of basal electric rhythm in the duodenum
AST>ALT
Inspiratory arrest on deep palpation due to pain
12 waves/min
Portal HTN

25. What test and result confirms H pylori infxn
Black - rotors syndrome
PAS- positive globules in liver -
Positive urease test
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

26. most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Carcinoid syndrome
Begins starch digestion - inactivated by low pH upon reaching the stomach
Closer to isotonic because of less time to reabsorb NaCl

27. What is one potential precipitating factor for intussusception
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Gamma glutamyl transferase GGT
Stercobilin
CCK8 receptor - Gq inc IP3/Ca

28. Why does volvulus occur more at cecum and sigmoid colon
Lactase is located at the tips of intestinal villi
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Gastrohepatic ligament
Redundant mesentary

29. What enzyme is necessary to create conjugated bilirubin
Uridine glucuronyl transferase
Duodenal atresia - Downs
Dissaccharidase def - most commonly lactase
Turcot

30. Autoantibodies to gluten (gliadin) in wheat and other grains
External spermatic fascia only
Phenobarbital - inc liver enzyme synthesis
Femoral hernia
Celiac sprue

31. What type of insults result in micronodular cirrhosis
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Failure of the processus vagainlis to close
Repeated phlebotomy - deferoxamine - HLA- A3
The entire

32. What happens to the short gastics if the splenic artery is blocked
Budd chiari syndrome
Poor anastamoses
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn
Increase tumorigenesis

33. Acute gastritis is caused By what process
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Angiodysplasia
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Erosive - disruption of mucosal barrier leading to inflammation

34. Cholecytsokinin - source - action - regulation
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
Lactase is located at the tips of intestinal villi
All 3 gut layers outpouch as in Meckels
Cystic duct and common hepatic duct

35. What drug blocks the H2R
Lateral
L3
Cimetidine
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum

36. What parts of the small bowel can tropical sprue effect
The entire
Zollinger ellison - brunners glands
Upregulated intracellular signal transduction
Chagas disease

37. Where are carcinoid tumors most commonly malignant
Virchow's node
Small intestine
Epithelium
T12

38. Are single polyps malignant in peutz jehgers
No
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Primary sclerosing cholangitis

39. reduction in intestinal blood flow causes ischemia - pain after eating - weight loss - occurs at splenic flexure and distal colon - elderly
Dermatitis herpetiformis
L/R renal artery around L1
Ischemic colitis
Lateral

40. FAP + malignant CNS tumor
Gallbladder
Pancreatic head causing obstructive jaundice
Hemosiderosis - hemochromatosis
Turcot

41. necrosis of intestinal mucosa and possible perforation - usual colon involvement - more common in preemies
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Pancreatic head causing obstructive jaundice
Necrotizing enterocolitis
Pleomorphic adenoma

42. What are the midgut structures and what supplies their blood and PANS innervation
Pyoderma gangrenosum - primary sclerosing cholangitis
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
External (superficial) ring only

43. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
Enterokinase/enteropeptidase from the duodenal mucosa
In the mucus that covers the gastric epithelium
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

44. What gives stool its characteristic color
L3
Stercobilin
Hirschsprungs
Pancreatic and bile

45. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lateral
With albumin
Esophageal cancer
Begins starch digestion - inactivated by low pH upon reaching the stomach

46. Where does crohns usually affect the GI tract
Right and left hepatic duct
Terminal ileum and colon
Gallbladder
All 3 gut layers outpouch as in Meckels

47. What is the term for deposition of hemosiderin and What is the name of the disease caused by that deposition
90%
Low pressure proximal to LES
Hemosiderosis - hemochromatosis
HSV-1 - CMV - Candida

48. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Esophageal varices
AST>ALT
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

49. What is contained within the submucosa

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50. What is the presentation of pancreatic adenocarcinoma
No
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
L/R renal artery around L1
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)