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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 nerve innervates the external hemorrhoids
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Inspiratory arrest on deep palpation due to pain
Inferior rectal nerve

2. most common non - neoplastic polyp in colon
Black - rotors syndrome
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Hyperplastic
Small intestine

3. involvement of left supraclavicular node by mets from stomach

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4. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Trypsin - chymotrypsin - elastase - carboxypeptidases
Juvenille polyps - no risk if single
Menetriers disease

5. What layer in the mucosa is responsible for absorption
Epithelium
Enterokinase/enteropeptidase from the duodenal mucosa
Inferior rectal nerve
Skip lesions =crohns - colon = UC

6. What is Trousseau's sign
Redness and tenderness on palpation of extremities
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
Barrett's esophagus
Gardner's syndrome

7. What skin condition is associated with celiac sprue
Brunners
Zollinger Ellison - phenylalanine and tryptophan
Dermatitis herpetiformis
Adhesion

8. What is the sphincter of the pancreatic duct
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Complications of crohns
Sphincter of oddi
Internal thoracic to superior epigastric to inferior epigastric

9. What source of salivary secretion is the most serous and What is the most mucinous
Diverticulum
Serous on the sides parotids - mucinous in the middle sublingual
Primary sclerosing cholangitis
FAP

10. What serum enzyme is decreased in wilsons disease
Stercobilin
Superior rectal
Virchow's node
Ceruplasmin

11. What receptors does ACH bind on the parietal cells and What does it activate
M3 - Gq - inc IP3/Ca
Tropical sprue
Hydrocele
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

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

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13. How are all 3 monosaccharides transported to the blood
Colovesical leading to pneumaturia
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
GLUT 2
Parietal cells in the stomach - B12 binding protein

14. multiple juvenil polyps in GI tract - risk
Zollinger Ellison - phenylalanine and tryptophan
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Cholesterol

15. What does loss of APC cause
Decreased intercellular adhesion and increased proliferation
CF - obstructing cancer - chronic pancreatitis - causes malabsorption of fat and fat soluble vitamins (ADEK)
Gardner's syndrome
12 waves/min

16. Painless bleedgin of submucosal veins in lower 1/3 of esophagus
Esophageal varices
Lateral
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
Hypercoaguability - polycythemia vera - pregnancy - HCC

17. What portion of the bowel does sprue effect
HPNCC
Femoral hernia - through femoral canal - lateral to pubic tubercle and women
IgA secreting plasma cells - ultimately reside in the lamina proporia
The proximal small bowel

18. What kind of diarrhea is produced from a disaccharide def
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Squamous - upper 1/3 - adeno - lower 1/3
Alpha amylase
Osmotic

19. What retroperitoneal structure flanks both sides of the pancreas on CT
Erosive - disruption of mucosal barrier leading to inflammation
Duodenum - 2nd - 3rd and 4th parts
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Closer to isotonic because of less time to reabsorb NaCl

20. Dysphagia in achalasia results from
GLUT 2
Striated
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
The jejunum

21. What is the most common diaphragmatic hernia and What are the two types
Alk phos
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
VZV and influenza B treated with salicylates
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus

22. What separates the right greater and lesser sacs
Closer to isotonic because of less time to reabsorb NaCl
Superior rectal
Repeated phlebotomy - deferoxamine - HLA- A3
Gastrohepatic ligament

23. external hemorrhoids and squamous cell carcinoma occur above or below the pectinate line
PAS- positive globules in liver -
All 3
Uremia
Below

24. Where does crohns usually affect the GI tract
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
2ndary biliary cirrhosis
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Terminal ileum and colon

25. Where is the deep inguinal ring relative to the inferior epigastric vessels
Lateral
Hydrocele
Elevated amylase - and lipase
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

26. What kind of digestion is bile needed for
Inc lower esphogeal tone leading to achalasia
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
GERD - may also present with nocturnal cough and dyspnea
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

27. masses protruding into gut lumen leading to a sawtooth appearance - often rectosigmoid
Krukenbergs tumor
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Downs
Colonic polyps

28. What are the main components of bile
Lamina propora and submucosa
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Inc conj bilirubin - inc cholesterol - inc alk phos
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)

29. which pancreatic enzyme - secreted in its active form - is responsible for starch digestion
Alpha amylase
HPNCC
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
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

30. In jaundice of hepatocellular etiology - is the hyperbilirubinemia conjugate or UN - what happens to urine bili - and urine urobilinogen
Osmotic
Pyoderma gangrenosum - primary sclerosing cholangitis
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Conj/unconj - inc - nl to dec

31. What is a positive murphy's sign
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Necrotizing enterocolitis
Inspiratory arrest on deep palpation due to pain
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC

32. What layer of fascia covers a direct inguinal hernia
External spermatic fascia only
Alk phos
The entire
Unconj - absent (acholuria) - inc

33. Where on the stomach does the gastrohepatic ligament attach to - What does it contain - and How is used in surgery
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
H pylori (almost 100%)

34. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
Epigastric abdominal pain radiating to back - anorexia - nausea
...
Inc conj bilirubin - inc cholesterol - inc alk phos

35. AD syndrome featuring multiple nonmalignant hamartomas throughout GI tract
Peutz jeghers
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
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
Zollinger ellison - brunners glands

36. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Chagas disease
Hepatic steatosis
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
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

37. At what spinal level does the is the bifurcation of aorta
Left gastric vein and esophogeal vein - esophagus
L4
Hypercoaguability - polycythemia vera - pregnancy - HCC
Femoral hernia

38. What layer in the mucosa is responsible for support
Lamina propria
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Oligosaccharide digestion
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

39. What is the frequency of basal electric rhythm of the stomach
Alk phos
Lateral
Cigarettes and chronic pancreatitis - not EtOH
3 waves/min

40. What can hemochromatosis be secondary to...
Barrett's esophagus
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Hernia
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

41. What is the characteristic histo finding in alcoholic hepatitis
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Oral glucose
Mallory bodies
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

42. Progressive dyshphage beginning with solids and moving to liquids and weight loss
Esophageal cancer
Carcinoid syndrome
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Lateral

43. What do the rugae of stomach look like in menetriers disease
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
So hypertrophied they look like brain gyri
Lamina propora and submucosa

44. What does autoimmune destruction of parietal cells lead to...
Enterokinase/enteropeptidase from the duodenal mucosa
Repeated phlebotomy - deferoxamine - HLA- A3
Gastrohepatic ligament
Chronic gastritis and pernicious anemia

45. What is the presentation of pancreatic adenocarcinoma
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Menetriers disease
Stercobilin
Inspiratory arrest on deep palpation due to pain

46. concentric onion skin bile duct fibrosis
Chronic calcifying pancreatitis - inc risk of panreatic cancer
Primary sclerosing cholangitis
Esophageal carcinoma
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

47. With internal hemorrhoids Where is the anastomoses and Where is it
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Superior rectal and middle and inferior rectal - rectum
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
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

48. What are the treatmet options for crohns
Corticosteroids - infliximab
Alk pho
Chronic gastritis and pernicious anemia
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa

49. How does gastrin increase acid secretion?
Jaundice - fever - RUQ
Primarly through ECL leading to histamine release
Positive
Uridine glucuronyl transferase

50. What arteries exit just below the SMA
L/R renal artery around L1
Tropheryma whippelii - gram positive and PAS- positive MACS in intestinal lamina proporia and mesenteric nodes
Hemolytic anemia
Crigler - najjar type 1