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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 do mucins do?
Lubricate food (glycoprotiens)
The entire
ALT>AST
...

2. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Heme metabolism
Serous on the sides parotids - mucinous in the middle sublingual
Carcinoid syndrome
Diverticulum

3. What kind of gall stones are mostly radiolucent and what percentage is opaque and due to what?
Cholesterol - 10-20% opaque due to calcifications
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Pancreatic head causing obstructive jaundice
Hepatic steatosis

4. What is the most important mechanism in gastric acid secretion
8-9 waves/min
Peutz jeghers
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
Mitochondrial abnl - fatty liver - hypoglycemia - coma

5. What are the histological findings in the ileum

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6. What are the midgut structures and what supplies their blood and PANS innervation
Pertechnetate - study for uptake
Alfatoxin in peanuts
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Dense core bodies

7. What skin condition is associated with celiac sprue
Dermatitis herpetiformis
Decreased intercellular adhesion and increased proliferation
Peutz jeghers
Peptic ulcer disease

8. What are the histological findings of the colon
Esophageal varices
Hypotonic because of more time to reabsorb NaCl
Crypts but not villi
Dysphagia (due to esophageal web) - glossitis - iron def anemia

9. How do NSAIDs cause acute gastritis
Dec PGE2 leading to dec gastric mucosa protection
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Inguninal ligament - sartorius muscle - adductor longus
Downs

10. Bile is critical for exrection of what substance
Failure of neural crest migration
Fe2+ in the duod
Neural muscarinic pathways
Cholesterol

11. What are the four Fs of gallstones
In the ileum with bile acids - requires IF
Cystic dilation of the viteline duct
Causes of gall stones
Female - fat - fertile - forty

12. When do you see hypertrophy of brunners glands
Peptic ulcer disease
Uridine glucuronyl transferase
The jejunum
Right and left hepatic duct

13. What are the extraintestinal manifestations of crohns
Primary sclerosing cholangitis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Warthins' tumor
12 waves/min

14. Pain improves with defaction - changes in stool frequency and changes in stool appearance are associated with
CEA - CA-19-9
IBS at least 2 with recurrent abdominal pain
PAS- positive globules in liver -
Menetriers disease

15. At what spinal level does the is the bifurcation of aorta
The proximal small bowel
EtOH
L4
Old men - arthralgias - cardiac and neuro sx

16. What is the sphincter of the pancreatic duct
Pancreatic and bile
Sphincter of oddi
Zollinger ellison - brunners glands
Villi and microvilli inc absorptive surface - brunner's glands and crypts of lieberkuhn

17. Abuse of what substance leads to acute gastritis
Boerhaave's Syndrome - Been heaving syndrome
EtOH
Cystic dilation of the viteline duct
M3 - Gq - inc IP3/Ca

18. Are single polyps malignant in peutz jehgers
HSV-1 - CMV - Candida
Oligosaccharide digestion
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
No

19. What gives stool its characteristic color
Upregulated intracellular signal transduction
Stercobilin
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Unconjugated - water insoluble

20. What serum enzyme is elevated in obstructive liver disease - bone disease and bile duct disease
Normal
Alk pho
IBS at least 2 with recurrent abdominal pain
Failure of neural crest migration

21. What infection causes Whipple disease and What can you see on LM
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
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Decrease - weight gain

22. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Colovesical leading to pneumaturia
Small intestine
No
Complications of crohns

23. What is the arterial supply and venous drainage below pectinate line
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
CCK8 receptor - Gq inc IP3/Ca
Hydrocele
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC

24. inadequate hepatic liver copper excretion and failure of copper to enter circulation as ceruloplasmin
H2 receptor - inc cAMP
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Nonkeritinized stratified sqamous epithelium
...

25. What is the most common esophageal cancer worldwide and in the US
Necrotizing enterocolitis
Worldwide - SC - US - adeno
Superior rectal and middle and inferior rectal - rectum
Inc lower esphogeal tone leading to achalasia

26. motilin - source - action - regulation
AST>ALT
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
T12

27. In what syndrome is gastric very elevatad - and amino acids are potent gastrin stimulators
Dec PGE2 leading to dec gastric mucosa protection
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Neutralizes oral bacertial acids and maintains dental health
Zollinger Ellison - phenylalanine and tryptophan

28. What does autoimmune destruction of parietal cells lead to...
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Chronic gastritis and pernicious anemia
Appendicitis
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

29. What is contained within the muscularis externa
Myenteric nerve plexus - aurbach
Diverticulum
Adhesion
Smooth

30. What structure is Not contained in the femoral sheath
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
PAS- positive globules in liver -
Dissaccharidase def - most commonly lactase
Spleen to posterior abdominal wall - splenic artery and vein

31. Where does type B chronic gastritis occur and What causes it
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Heme metabolism
Antrum - H.pylori - inc risk of MALT lymphoma
Via the middle colic

32. What enzyme is necessary to create conjugated bilirubin
Striated and smooth
H pylori (almost 100%)
Uridine glucuronyl transferase
Unconj - absent (acholuria) - inc

33. Which patients have pigment stones
CHF and inc risk of HCC
Obstruction of the common bile duct
IgA secreting plasma cells - ultimately reside in the lamina proporia
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

34. How does HCC spread - What is a common tumor marker and what syndrome can it lead to...
With albumin
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Copious diarrhea - non alpha - non beta cell pancreatic tumor
CEA - CA-19-9

35. Why does indirect inguinal hernia happen in infacnts
Failure of the processus vagainlis to close
Complications of crohns
Below
Centrilobular leading to congestive liver disease

36. What receptor does histamine bind on the parietal cell and What does it activate
H2 receptor - inc cAMP
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Necrotizing enterocolitis

37. Where is B12 absorbed
Brunners
Phenobarbital - inc liver enzyme synthesis
In the ileum with bile acids - requires IF
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

38. What transforms conjugated bilirubin to urobilinogen
Averages 6 months - very aggressive - usually already metastasized at presentation
Pleomorphic adenoma
Inc conj bilirubin - inc cholesterol - inc alk phos
Gut bacteria

39. What can fistula between the gallbladder and small intestine create and how can you tell
PAS- positive globules in liver -
Air into the biliary tree - if gallstone obstructs ileocecal valve - air can be seen in biliary tree on imaging
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Small intestine

40. What structures feed into the cystic duct
Gallbladder
Erosive - disruption of mucosal barrier leading to inflammation
In the ileum with bile acids - requires IF
Sister mary joseph nodule

41. What causes nutmeg liver
Backup of blood into the liver - RHF - budd chiari
Dilated esophagus with an area of distal stenosis - birds beak
With albumin
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

42. milk intolerance
Portal HTN
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Dissaccharidase def - most commonly lactase

43. What layer in the mucosa is responsible for absorption
Striated
Above
Epithelium
Trypsin - chymotrypsin - elastase - carboxypeptidases

44. Bilirubin is the product of what?
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Glucouronate - water soluble (direct)
Heme metabolism
The entire

45. How does hirschsprung present and appear on imaging
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
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
Gamma glutamyl transferase GGT
Pyoderma gangrenosum - primary sclerosing cholangitis

46. What complication can arise from indirect inguinal hernias
Liver metabolizes 5HT
GLUT 2
Hydrocele
Gut bacteria

47. AD mutation in DNA mismatch repair genes - 80% progress to CRC - proximal colon always involved
HPNCC
Hydrocele
Fe2+ in the duod
Mallory bodies

48. 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
Glucouronate - water soluble (direct)
Meckels
In the ileum with bile acids - requires IF

49. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Alcoholic cirrhosis
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
Gallbladder
GLUT 2

50. What is the cause of Barrett's and the assocaited complications
GERD - esophagitis - esophageal ulcers - inc risk of esophageal cancer
Cholesterol - 10-20% opaque due to calcifications
Right and left hepatic duct
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria