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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. Which IBD is autoimmune and which may be a disordered response to bacteria
Autoimmune= ulcerative colitis - disordered response to bactere = crohns
Gardner's syndrome
Repeated phlebotomy - deferoxamine - HLA- A3
Hypercoaguability - polycythemia vera - pregnancy - HCC

2. Who is at risk for pancreatic adenocarcinoma
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
Jewish and African American men
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion

3. Which IBD usually has transmural inflammation and which has mucosal and submucosal inflammation and What are the characteristic signs of each
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Uridine glucuronyl transferase
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
Gallbladder

4. What reaction does salivary amylase catalyze
Downs
Colonic polyps
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Hyrdolyzes alpha 1-4 linkages to yield disaccharides

5. What cells make pepsin - What does it do - and what regulates it
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid
Gastrohepatic ligament
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Stimulate the H/K ATPase

6. What serum enzyme is decreased in wilsons disease
Ceruplasmin
Peutz jeghers
Positive urease test
Liver metabolizes 5HT

7. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Corticosteroids - infliximab
FAP
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn

8. Why does volvulus occur more at cecum and sigmoid colon
Elevated amylase - and lipase
Alpha1 antitrypsin def - codominant trait
3 waves/min
Redundant mesentary

9. Diaphragmatic hernias occur in infants because of defective development of which membrane
Pleuroperitoneal
Skip lesions =crohns - colon = UC
Celiac sprue
IgA secreting plasma cells - ultimately reside in the lamina proporia

10. What is the presenting course for appendicity

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11. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Zollinger ellison - brunners glands
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

12. In which portion of the esophagus is it sqamous cell cancer and in which portion is adenocarcinoma
Squamous - upper 1/3 - adeno - lower 1/3
Mucosal cells in the stomach - duod - salivary glands - pancreas - brunners glands in the duod - neutralizes acid - inc by pancreatic and biliary secretion with secretin
Conj - inc - dec
Dilated esophagus with an area of distal stenosis - birds beak

13. To what substance is bilirubin conjugated and why
IBS at least 2 with recurrent abdominal pain
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Glucouronate - water soluble (direct)
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

14. What kind of muscle is in the middle 1/3 of esophagus
Cystic dilation of the viteline duct
Striated and smooth
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Alcoholic cirrhosis

15. What is the action of NO as a GI hormone
Juvenile polyposis syndrome - inc risk of adenocarcinoma
Can lead to hematemesis - found in EtOHics and bulimics
Crigler - najjar type 1
Inc smooth muscle relaxation - including lower esophageal sphincter

16. With esophageal varices - between What two vessels is the portosystemic anastomoses and Where is it
Gallbladder
Lateral to the inferior epigastric artery
Parietal cells in the stomach - B12 binding protein
Left gastric vein and esophogeal vein - esophagus

17. What is the cause of physiologic neonatal jaundice
Menetriers disease
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
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
H2 receptor - inc cAMP

18. Who gets gastric ulcers
Hemosiderosis - hemochromatosis
Gallstone - biliary stricture - chronic pancreatitis - carcinoma of the pancreatic head
Older patients
Lamina propora and submucosa

19. early bilious vomiting - with proximal stomach distention - double bubble - due to failure of recanalization of small bowel - dz and association
CCK8 receptor - Gq inc IP3/Ca
Duodenal atresia - Downs
CHF and inc risk of HCC
Mucoepidermoid carcinoma

20. How are all 3 monosaccharides transported to the blood
GLUT 2
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Ceruplasmin
Brush border of intestine - produce monosaccharides from oligo and di

21. telescoping of 1 bowel segment into distal segment which can compromise blood supply - abdominal emergency in early childhood
Falciform - ligamentum teres - fetal umbilical vein
Intussusception
Barrett's esophagus
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

22. What structures feed into the cystic duct
Gallbladder
Pancreatic and bile
Epigastric abdominal pain radiating to back - anorexia - nausea
Turcot

23. What are esophageal strictures associated with
Lye ingestion and acid reflux
Urobilin
Neural muscarinic pathways
External spermatic fascia only

24. rare - often fatal childhood hepatoencephalopathy

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25. trypsinogen is converted to trypsin via what enzyme
Only mucosa or submucosa - occur where vasa recta perforate muscularis externa
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Enterokinase/enteropeptidase from the duodenal mucosa
Transjugular intrahepatic portosystemic shunt between portal and hepatic vein percutaneously by shunting blood to the systemic circulation

26. why infxn is implicated in duodenal PUD
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
H pylori (almost 100%)

27. what percentage of colonic polyps are non - neoplastic
Alcoholic hepatitis
Hernia
90%
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue

28. gastric hypertrophy with protein loss - parietal cell atrophy and inc mucous cells
Lateral to the inferior epigastric artery
Menetriers disease
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
Esophageal varices

29. What causes carcinoid syndrome amd What are the symptoms
Glucouronate - water soluble (direct)
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Appendicitis
Above

30. What arteries exit just below the SMA
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Gamma glutamyl transferase GGT
Crigler - najjar type 1
L/R renal artery around L1

31. What is one potential precipitating factor for intussusception
Ceruplasmin
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
All 3 gut layers outpouch as in Meckels
Epithelium

32. What does a low flow rate mean for saliva
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates
Hypotonic because of more time to reabsorb NaCl
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Peyers patches

33. occlusion of IVC or hepatic veins
Dissaccharidase def - most commonly lactase
Budd chiari syndrome
Parietal cells in the stomach - B12 binding protein
Uridine glucuronyl transferase

34. What receptors does ACH bind on the parietal cells and What does it activate
Early childhood - neuro sx and malabsorption
Where hindgut meets ectoderm
M3 - Gq - inc IP3/Ca
Peyers patches

35. What are the main components of bile
Chronic gastritis and pernicious anemia
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Complications of crohns
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

36. A protrusion of peritoneum through an opening - usually a site of weakness
Myenteric nerve plexus - aurbach
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Inc size - villous histology - inc epithelial dysplasia - precursor to CRC
Hernia

37. Dysphagia in achalasia results from
Alcoholic cirrhosis
GERD - may also present with nocturnal cough and dyspnea
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Budd chiari syndrome

38. Why are most diverticula considered false
Female - fat - fertile - forty
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Inc conj bilirubin - inc cholesterol - inc alk phos
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

39. What are the tumor markers for pancreatic adenocarcinoma
Complications of crohns
CEA - CA-19-9
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial

40. At what level of the spine does the IM exit the aorta
Colonic polyps
L3
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
Myenteric nerve plexus - aurbach

41. most common malignant salivary gland tumor
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
Pyoderma gangrenosum - primary sclerosing cholangitis
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
Mucoepidermoid carcinoma

42. What is the other name for GIP (gastric inhibitory peptide)
Ampulla of vater
Downs
Glucose dependent insulinotropic peptide
Alfatoxin in peanuts

43. What structure is Not contained in the femoral sheath
Copious diarrhea - non alpha - non beta cell pancreatic tumor
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
The femoral nerve - only the vein artyer and canal (with deep inguinal lymph nodes)
Peyers patches

44. inflammatino of gallbadder
Cholecystitis - usually from gallstones rarely ischemia or infxn (CMV)
No - chronic - can present with diarrhea or constipation or alternation - treat sx
Source - SI - action - produces migrating motor complexes - regulation - inc in fasting state
So hypertrophied they look like brain gyri

45. HCC is associated with what other conditions
HBV - HCV - wilsons dz - hemochromatosis - alpha1- antitrypsin def - alcoholic cirrhosis
Inc conj bilirubin - inc cholesterol - inc alk phos
So hypertrophied they look like brain gyri
Chief cells of the stomach - protein digestion - inc by vagal stimulation local acid

46. What do you treat Wilsons disease with and What is the inheritance
With albumin
Skip lesions =crohns - colon = UC
Penicillinamine - AR inheritance
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia

47. What does loss of p53 cause
Portal HTN
Increase tumorigenesis
Above
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome

48. What is the path of a direct inguinal hernia and Where does it travel relative to the inferior epigastric artery

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49. What does loss of APC cause
Can lead to hematemesis - found in EtOHics and bulimics
Decreased intercellular adhesion and increased proliferation
T12
Stimulate intestinal persistalsis

50. What is the mechanism for reyes syndrome
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
...
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
M3 - Gq - inc IP3/Ca