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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. secretin - source - action - regulation
Decrease - weight gain
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Duodenum - 2nd - 3rd and 4th parts
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

2. What does a low flow rate mean for saliva
Cirrhosis
Peutz jeghers
Hypotonic because of more time to reabsorb NaCl
Smooth

3. inc cholesterol and/or bilirubin - dec bile salts and gallbladder stasis
Causes of gall stones
Positive urease test
Common hepatic - splenic - left gastric - main blood supply for stomach
8-9 waves/min

4. What is the epi for CRC
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
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
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx

5. rare - often fatal childhood hepatoencephalopathy

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6. What are causes of extrahepatic biliary obstruction
Low pressure proximal to LES
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Jewish and African American men

7. What does primary sclerosing cholangitis lead to...
Heme metabolism
Gastrin secreting tumor that causes continuous high levels of acid secretion and ulcers
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

8. In PUD with a duodenal ulcer does pain inc or dec with meals
AST >ALT - ration is usually 1.5
Alpha amylase
Goes through deep inguinal ring - external inguinal ring and into the scrotum
Decrease - weight gain

9. What intervention will intervention will relieve portal HTN
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation
Early childhood - neuro sx and malabsorption
Superior rectal from IMA - superior rectal vein to inf mesenteric to portal system

10. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Cystic duct and common hepatic duct
CHF and inc risk of HCC
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
FAP

11. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Via the middle colic
Lateral to the inferior epigastric artery
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Zollinger ellison - brunners glands

12. 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
Unconj - absent (acholuria) - inc
Hyperplastic
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)

13. What are the complications of acute pancreatitis
Averages 6 months - very aggressive - usually already metastasized at presentation
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Worldwide - SC - US - adeno
In the ileum with bile acids - requires IF

14. What is the TX of physiologic neonatal jaundice
Stercobilin
Phototherapy
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Esophageal cancer

15. What serum marker increases with primary biliary cirrhosis and what other autoimmune conditions are it associated with
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
GLUT 2
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz

16. What are the layers of the gut wall from inside out
Positive urease test
Stomach cancer (usually adenocarcinoma) - early aggressive spread - node/liver mets - associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood
Mucosa - submucosa - muscularis externa - serosa/adventitia
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema

17. When do you see hypertrophy of brunners glands
Uremia
Peptic ulcer disease
With albumin
Lesser curvature - gastric arteries - cut in surgery to access lesser sac

18. crigler - najjar type II responds to which therapy and How does it work
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
AST
Phenobarbital - inc liver enzyme synthesis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM

19. is meckels a true diverticulum and how common is it
Gamma glutamyl transferase GGT
Low pressure proximal to LES
True and most common congenital anomoly of GI tract
Intussusception

20. Why does indirect inguinal hernia happen in infacnts
Duodenal atresia - Downs
Failure of the processus vagainlis to close
Old men - arthralgias - cardiac and neuro sx
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'

21. In an MI - which liver enzyme is elevated
Hemolytic anemia
Oral glucose
AST
So hypertrophied they look like brain gyri

22. Why does carcinoid syndrome not occur if tumor is confined to GI system
GERD - may also present with nocturnal cough and dyspnea
Zenkers - halitosis - dysphagia and obstruction
3 waves/min
Liver metabolizes 5HT

23. Between what structures do strong anastamoses exist
Left and right gastroepiploics - left and right gastrics
Internal thoracic to superior epigastric to inferior epigastric
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

24. what kind of fistula is associated with diverticulitis
Pancreatic insuff - steatorrhea - fat soluble vitamin def - DM
Myenteric nerve plexus - aurbach
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Colovesical leading to pneumaturia

25. multiple juvenil polyps in GI tract - risk
Alcoholic hepatitis
Causes of gall stones
Old men - arthralgias - cardiac and neuro sx
Juvenile polyposis syndrome - inc risk of adenocarcinoma

26. A protrusion of peritoneum through an opening - usually a site of weakness
Lamina propora and submucosa
Hernia
Amylase
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)

27. What commonly leads to appendicity in kids vs adults
Paraumbilical and superficial and inferior epigastric - umbilicus
Lipase - phospholipase A - colipase
Obstruction of the common bile duct
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith

28. Why does volvulus occur more at cecum and sigmoid colon
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Via the middle colic
EtOH
Redundant mesentary

29. At what spinal level does the SMA exit
Inhibits parietal cells because of ACH is NT - while GRP works at the G cells
...
The gastroduodenal
L1

30. What is the most common esophageal cancer worldwide and in the US
Common hepatic - splenic - left gastric - main blood supply for stomach
Worldwide - SC - US - adeno
Chronic transfusion therapy in beta thal major - inc ferritin - inc iron - dec TIBC - inc transferrin saturation
Redness and tenderness on palpation of extremities

31. In PUD - with gastric ulcers - does pain inc or dec with meals?
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Inc - weight loss
Esophageal cancer
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus

32. What are the main components of bile
Stercobilin
Striated and smooth
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
8-9 waves/min

33. What gives urine its characteristic color
Superior rectal
Urobilin
M3 - Gq - inc IP3/Ca
Positive

34. How does brain injury lead to acute gastritis and What is it called
Oligosaccharide digestion
Meckels
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Female - fat - fertile - forty

35. What is the rule of 2s for meckels
8-9 waves/min
Reye's syndrome
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Inc - weight loss

36. Which IBD is autoimmune and which may be a disordered response to bacteria
Squamous - upper 1/3 - adeno - lower 1/3
2 inches long - 2 feet from ileocecal valve - 2% of pop - first 2 years of life - 2 types of epithelia
Liver metabolizes 5HT
Autoimmune= ulcerative colitis - disordered response to bactere = crohns

37. What histological findings are present in the stomach
Penicillinamine - AR inheritance
Gastric glands
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells
2ndary biliary cirrhosis

38. What does bicarb do in the duodenum
Failure of the processus vagainlis to close
Neutralizes gastric acid allowing pancreatic enzymes to fxn
90%
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)

39. If the abdominal aorta is blocked - How does blood get to the inferior pancreaticduodenal arter
Via the superior pancreaticduodenal
L3
Hyperplastic
Mitochondrial abnl - fatty liver - hypoglycemia - coma

40. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Inferior rectal nerve
Primary sclerosing cholangitis
Menetriers disease
CCK8 receptor - Gq inc IP3/Ca

41. What serum enzyme is elevated in acute pancreatitis and mumps
Inspiratory arrest on deep palpation due to pain
Liver metabolizes 5HT
HSV-1 - CMV - Candida
Amylase

42. What is the mechanism for reyes syndrome
Dilated esophagus with an area of distal stenosis - birds beak
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Unconj - absent (acholuria) - inc

43. How does gastrin increase acid secretion?
Primarly through ECL leading to histamine release
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
Mucosa - submucosa - muscularis externa - serosa/adventitia
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)

44. What is contained within the submucosa

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45. How are all 3 monosaccharides transported to the blood
Inferior rectal nerve
Esophageal cancer
Crigler - najjar type 1
GLUT 2

46. What is the other name for GIP (gastric inhibitory peptide)
Left gastric vein and esophogeal vein - esophagus
Lesser curvature - gastric arteries - cut in surgery to access lesser sac
Inferior rectal artery - inferior rectal vein to pudendal vein to internal iliac vein to IVC
Glucose dependent insulinotropic peptide

47. Esophagitis can result From which 3 infectious agents - or chemical ingestion
T cell lymphoma
Punched out - clean margins - carcinoma =raised irregular margins
HSV-1 - CMV - Candida
Lipase

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

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49. Abuse of what substance leads to acute gastritis
Fe2+ in the duod
Common hepatic - splenic - left gastric - main blood supply for stomach
EtOH
External - receive somatic innervation - internal receive visceral innervation - not painful but sign of portal HTN

50. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Migratory polyarthritis - erythema nodusum - anklyosing spondylitis - uveitis - immunologic disorders
Increase tumorigenesis
Lesser curvature - gastric arteries - cut in surgery to access lesser sac