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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 makes a true diverticula
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
All 3 gut layers outpouch as in Meckels
Oligosaccharide digestion
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

2. misfolded gene product protein accumulates in hepatocellular ER - dec in elastic tissu in lungs leading panacinar emphysema
Alcohol/Achalasia - Barretts - Cigarettes - Diverticuli (Zenkers) Esophageal web/Esophagitis - Familial
Krukenbergs tumor
Hemolytic anemia
Alpha1 antitrypsin def - codominant trait

3. At what spinal level does the celiac trunk exit
T12
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
Neural muscarinic pathways
Myenteric nerve plexus - aurbach

4. What are the complications of acute pancreatitis
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Inspiratory arrest on deep palpation due to pain
Nonkeritinized stratified sqamous epithelium

5. If the abdomincal aorta is obstructed - What is the path of blood to the inferior epigastric
Internal thoracic to superior epigastric to inferior epigastric
Sympathetic (T1- T3 superior cervical ganglion) and parasympathetic (facial and glossopharyngeal nerve)
Short gastrics - left greater and lesser
Elevated amylase - and lipase

6. What is the most important mechanism in gastric acid secretion
The submucosal nerve plexus - meissner's
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
PAS- positive globules in liver -
Gastrin stimulating ECL cells to release histamine - histamine stimulation on parietal cells

7. Why does carcinoid syndrome not occur if tumor is confined to GI system
Epithelium
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Liver metabolizes 5HT

8. Dysphagia in achalasia results from
LLQ - fever - leukocytosis - can perforate leading to peritonitis - abscess formation - bowel stenosis - give antiobiotics
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Hepatomegaly - ascitis - abdominal pain - varices - visible abdominal and back veins - absence of JVD

9. What converts inactive pepsinogen to pepsin
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+
Abdominal pain radiating to back - weight loss due to malabsorption - migratory thrombophlebitis - obstructice jaundice with palpable gallbladder
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

10. What arteries exit just below the SMA
True and most common congenital anomoly of GI tract
L/R renal artery around L1
Black - rotors syndrome
Striated and smooth

11. Which monosaccharides are absorbed by the enterocytes and which transporters carry each
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Chagas disease

12. What layer of fascia covers a direct inguinal hernia
Epithelium
Gardner's syndrome
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
External spermatic fascia only

13. Which is used more quickly - an oral glucose load - or that by IV
Oral glucose
Immature UDP- glucuronyl transferase to unconjugated hyperbilirubinemia - jaundice kernicuterus
Femoral hernia
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid

14. What is the sphincter of the pancreatic duct
Serous on the sides parotids - mucinous in the middle sublingual
Repeated phlebotomy - deferoxamine - HLA- A3
Sphincter of oddi
Antrum - H.pylori - inc risk of MALT lymphoma

15. What serum enzyme is elevated inacute pancreatitis
Lipase
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
With albumin
Gastrohepatic ligament

16. Why are most diverticula considered false
Lack or have an attenuated muscularis externa - often in the sigmoid colon
Superior rectal
Stimulate intestinal persistalsis
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

17. most common non - neoplastic polyp in colon
CCK8 receptor - Gq inc IP3/Ca
Corticosteroids - infliximab
Inspiratory arrest on deep palpation due to pain
Hyperplastic

18. in budd chiari syndrome - Where is the congestion and necrosis
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Oral glucose
Centrilobular leading to congestive liver disease
L2

19. What does GET SMASHED stand for in acute pancreatitis
H+
Lubricate food (glycoprotiens)
Gallstones - EtOH - trauma - steroids - mumps - autoimmune - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - Drugs (sulfa)
Cystic dilation of the viteline duct

20. what kind of muscle is in the upper 1/3 of esophagus
L2
Alcoholic hepatitis
Striated
Inferior rectal nerve

21. What are the structures of the femoral triangle and how are they organized
The jejunum
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
NAV = nerve artery vein - venous near the penis (NAVEL)
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS

22. Which IBD may or may not have blood diarrhea - and which will always have bloody diarrhea
Dysphagia (due to esophageal web) - glossitis - iron def anemia
Crohns = maybe - UC= always
Jaundice - fever - RUQ
The proximal small bowel

23. alcoholic liver disease with short term change and moderate EtOH intake - macrovesicular fatty change that may be reversible
Colonic polyps
Downs
Averages 6 months - very aggressive - usually already metastasized at presentation
Hepatic steatosis

24. What cell produces IF and What does it do
Hiatal hernia - sliding - hourglass shape - and paraesophageal hernia where stomach chomes up through the hiatus
Parietal cells in the stomach - B12 binding protein
MSI (15%) and APC/beta catenin chromosomal instability (85%)
Crigler - najjar type 1

25. blind pouch protruding from alimentary tract that communicates with lumen of the gut
Diverticulum
Inc conj bilirubin - inc cholesterol - inc alk phos
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Hemolytic anemia

26. mostly sporadic lesions in children < 5 - 80% in rectum - When is there no risk of malignant potential
Crohns = maybe - UC= always
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Diverticulitis in elderly - ectopic pregs use hCG to rule out
Juvenille polyps - no risk if single

27. What are the main components of bile
<3mm nodules - metabolic - etoh - hemochromatosis - wilsons
Coma - scleral icterus - fetor hepaticus - spider nevi - gynecomastia - jaundice - testicular atrophy - hand tremor - bleeding - anemia - ankle edema
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
H+

28. Diaphragmatic hernias occur in infants because of defective development of which membrane
Stercobilin
Pleuroperitoneal
Dermatitis herpetiformis
Brunners

29. What does TOASTED with alcoholic hepatitis stand for
Centrilobular leading to congestive liver disease
Jewish and African American men
Parietal cells in the stomach - B12 binding protein
AST >ALT - ration is usually 1.5

30. What is pancreatic adenocarcinoma associated with
Hernia
Dec synthesis of apo B - inability to generate chylomicrons - dec secretion of cholesterol - VLDL into the bloodstream - fat accumulation in enterocytes
Sister mary joseph nodule
Cigarettes and chronic pancreatitis - not EtOH

31. Where is the pancreatic enzyme concentration highest and what reaction does it catalyze
True and most common congenital anomoly of GI tract
12 waves/min
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Pleuroperitoneal

32. What do tumors that arise in the head of the pancreas cause
Via the middle colic
Can lead to hematemesis - found in EtOHics and bulimics
Obstruction of the common bile duct
Stimulate the H/K ATPase

33. What is the epi for CRC
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Peyer's patches - plicae circulares in the proximal ileum and crypts of lieberkuhn
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

34. What are the borders of Hesselbach's triangle
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
All 3 gut layers outpouch as in Meckels
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
Dysphagia (due to esophageal web) - glossitis - iron def anemia

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

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36. How do NSAIDs cause acute gastritis
Trypsin - chymotrypsin - elastase - carboxypeptidases
Pleuroperitoneal
Tropical sprue
Dec PGE2 leading to dec gastric mucosa protection

37. What is the frequency of basal electric rhythm of the stomach
3 waves/min
Cirrhosis
L/R renal artery around L1
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor

38. GIP - source - action regulation
Appendicitis
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
SGLT1 (Na dependent) glucose - galactose - GLUT 5 fructose (facilitated diffusion)
Chronic hemolysis - alcoholic cirrhosis - advanced age and biliary infxn

39. What are the foregut structures and what supplies their blood and PANS innvervation
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
IBS at least 2 with recurrent abdominal pain
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus

40. What congenital birth defect is associated with Hirschsprung
Positive
Dissaccharidase def - most commonly lactase
Zollinger Ellison - phenylalanine and tryptophan
Downs

41. How many layers of spermatic fascia are covers an indirect inguinal hernia
All 3
Femoral hernia
Alk phos
Neutralizes oral bacertial acids and maintains dental health

42. What tumor cause PUD with duodenal ulcer and what glands become hypertrophied
Unconjugated - water insoluble
Averages 6 months - very aggressive - usually already metastasized at presentation
8-9 waves/min
Zollinger ellison - brunners glands

43. What is the clinical presentation of acute pancreatitis
Hematogenous - alpha fetoprotein - budd chiari (hepatic vein blockage)
Epigastric abdominal pain radiating to back - anorexia - nausea
In the mucus that covers the gastric epithelium
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis

44. What is contained within the submucosa

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45. List the clinical findings of HCC
Backup of blood into the liver - RHF - budd chiari
Uremia
Causes of gall stones
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia

46. What serum enzyme is elevated in acute pancreatitis and mumps
Amylase
Northern european - Abs to gliadin and tissue transglutaminase - blunted villi - lymphcytes in the lamina proporia
Cirrhosis - DM - skin pigmentation - 'bronze diabetes'
Alternating strictures and dilation with beading of intra and extrahepatic bile ducts on ERCP

47. What does loss of p53 cause
Lye ingestion and acid reflux
Fundus/body - autoimmune - autoantibodies to parietal cells - perncious anemia - and achlorhydria
Increase tumorigenesis
Oligosaccharide digestion

48. Where is folate absorbed
Decrease - weight gain
L1
The jejunum
Hyperpigmented mouth - lips - hands - genitalia

49. What is the most common esophageal cancer worldwide and in the US
H pylori (almost 100%)
Worldwide - SC - US - adeno
Cimetidine
Liver metabolizes 5HT

50. What gives stool its characteristic color
Fe2+ in the duod
>3mm nodules - significant liver injury leading to hepatic necrosis - postinfectious - drug induced hepatitis with inc risk of HCC
Stercobilin
Inc smooth muscle relaxation - including lower esophageal sphincter