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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. twisting of portion of bowel around its mesentery leading to obstruction and infarction - usually in elderly
Volvulus
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Elevated amylase - and lipase
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

2. What are the layers of the gut wall from inside out
Via the superior pancreaticduodenal
GERD - may also present with nocturnal cough and dyspnea
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
Mucosa - submucosa - muscularis externa - serosa/adventitia

3. How do secondary biliary cirrhosis - primary biliary cirrhosis and primary sclerosing cholangitis present
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions
Pruritis - jaundice - dark urine - light stools - hepatosplenomegaly
Greater curvature of stomach to transverse colon - gastroepiploic arteries - greater omentum
NAV = nerve artery vein - venous near the penis (NAVEL)

4. vasoactive intestinal polypeptide (VIP) - source - action - regulation
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
Alfatoxin in peanuts
Duodenal lumen - hydrolyzes starch to oligosaccharides and disaccharides
Neural muscarinic pathways

5. final and irreversible alcoholic liver disease with micronodular irregularly shrunken liver with hobnail appearance
Black - rotors syndrome
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine
Decreased intercellular adhesion and increased proliferation
Alcoholic cirrhosis

6. What is contained with in the hepatoduodenal ligament - What two spaces does it connect - and when would you need to compress it
Glucose dependent insulinotropic peptide
Where hindgut meets ectoderm
Portal triad: hepatic artery - protal vein - common bile duct - greater and lesser sac - to control bleeding
Trypsin - chymotrypsin - elastase - carboxypeptidases

7. What test and result confirms H pylori infxn
8-9 waves/min
Positive urease test
Inguninal ligament - sartorius muscle - adductor longus
L1

8. HyperIgM associated with ulcerative colitis can lead to what biliary tract disease
Brunners
2ndary biliary cirrhosis
Lateral to the inferior epigastric artery
Celiac sprue

9. diffuse fibrosis of liver destroying nl architecture with nodular regeneration
Cirrhosis
Alk pho
Alpha amylase
Virchow's node

10. Which IBD has skip lesions and can hit any portion of the GI tract but sprares the rectum - and Which is mainly has continuous lesions in the colon and always has rectal involvement
AST>ALT
Initial diffuse periumbilical pain localizing to mcburney's point with nausea - fever - possible perforation leading to peritonitis
Glucose dependent insulinotropic peptide
Skip lesions =crohns - colon = UC

11. What kind of digestion is bile needed for
Colovesical leading to pneumaturia
Peyers patches
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
Triglycerides and micelle formation - required for absorption of of non polar nutrients in small intestine

12. strictures - fistulas - perianal disease - malabsorption - nutritional depletion - colorectal cancer
Complications of crohns
Bleeding - intussusception - volvulus - obstruction near terminal ileum
Stimulate the H/K ATPase
Punched out - clean margins - carcinoma =raised irregular margins

13. What is a positive murphy's sign
Cushings ulcers - inc vagal stimulation leading to inc vagal stim - inc ACH and inc H+ secretion
Inspiratory arrest on deep palpation due to pain
Jaundice - tender hepatomegaly - ascites - polycythemia - hypoglycemia
Gilbert's

14. What conditions are associated with budd chiari
Hypercoaguability - polycythemia vera - pregnancy - HCC
Barrett's esophagus
Spleen to posterior abdominal wall - splenic artery and vein
CEA - CA-19-9

15. What are the borders of Hesselbach's triangle
Crohns = noncaseating granulomas - UC = crypt abscesses
Pertechnetate - study for uptake
Centrilobular congestion and necrosis - cardiac cirrhosis
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament

16. To what substance is bilirubin conjugated and why
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
In the ileum with bile acids - requires IF
Ceruplasmin
Glucouronate - water soluble (direct)

17. Why does volvulus occur more at cecum and sigmoid colon
Averages 6 months - very aggressive - usually already metastasized at presentation
Spleen to posterior abdominal wall - splenic artery and vein
Redundant mesentary
HPNCC

18. Where is IgA shuttled
IgA receives protective secretory component and is then transported across the epithelium to gut lumen
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
Autoimmune rxn leading to lymphcytic infiltrate + granulomas
Chronic gastritis and pernicious anemia

19. Acute gastritis is caused By what process
Chagas disease
Erosive - disruption of mucosal barrier leading to inflammation
Enterokinase/enteropeptidase from the duodenal mucosa
Cirrhosis

20. What does bicarb do in the duodenum
Kids - lymphoid hyperplasia afer viral infxn - adults - obstruction - fecalith
Stomach to proximal duodenum - liver - gall bladder - pancreas and spleen - celiac - vagus
Neutralizes gastric acid allowing pancreatic enzymes to fxn
Hyperplastic

21. What does high flow rate mean
Crypts but not villi
Fe2+ in the duod
Closer to isotonic because of less time to reabsorb NaCl
Stimulate the H/K ATPase

22. What does alpha amylase do and what inactivates it
Jaundice - fever - RUQ
Alk phos
Begins starch digestion - inactivated by low pH upon reaching the stomach
Striated

23. in budd chiari syndrome - Where is the congestion and necrosis
Skip lesions =crohns - colon = UC
Stimulate intestinal persistalsis
Meconium ileus
Centrilobular leading to congestive liver disease

24. What are the branches of the celiac trunk and What do they supply
Common hepatic - splenic - left gastric - main blood supply for stomach
Enterokinase/enteropeptidase from the duodenal mucosa
Ischemic colitis
Stercobilin

25. Which IBD has noncaseating granulomas and lymphoid aggregates - and which has crypt abscesses and ulcers with bleeding
L3
Lipase - phospholipase A - colipase
Inferior rectal nerve
Crohns = noncaseating granulomas - UC = crypt abscesses

26. What are additional risk factors for CRC
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Source - G cells in the antrum - action - inc gastric H+ secretion - inc growth of gastric mucosa - and inc gastric motility - regulation - inc by stomach distention/alkalinaztion - amino acids - peptides - vagal stimulation - dec by stomach pH < 1.5
Viral - adenovirus in kids - rare in adults but associated with intraluminal mass or tumor
Alfatoxin in peanuts

27. What is biliary colic
Pain associated with cholecystitis and galls stones - diabetics may not present with pain
Hepatic steatosis
Necrotizing enterocolitis
Causes of gall stones

28. What does K- ras mutation cause
Upregulated intracellular signal transduction
Serum mitochondrial antibodies including IgM - associated with CREST - RA and celiac dz
Protrudes through the Hesselbach's triangle - bulges directly through abdominal wall medial to inferior epigastric vessels
Neutralizes gastric acid allowing pancreatic enzymes to fxn

29. What is the TX of physiologic neonatal jaundice
Aspirin metabolites dec beta oxidation by reversible inhibition of mitocondrial enzyme - ASPIRIN Not RECOMMENDED FOR CHILDREN
Turcot
Common hepatic - splenic - left gastric - main blood supply for stomach
Phototherapy

30. What is the leading cause of bowel incarceration
Source - K cells (duod - jej) - action - exocrine - dec gastric H+ secretion - endocrine - inc insulin release - regulation - inc by fatty acids - amino acids - oral glucose
Femoral hernia
Virchow's node
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn

31. AD - mutation of APC gene on chromosome 5q - two hit hypothesis - 100% progress to CRC - 1000s of polyps - pancolonic - rectal involvement
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
Upregulated intracellular signal transduction
FAP
Alpha amylase

32. likely infectious form of malabsorption - responds to antibiotics
Inferior epigastric artery - lateral border of rectus abdominis - inguinal ligament
NAV = nerve artery vein - venous near the penis (NAVEL)
Decrease - weight gain
Tropical sprue

33. If trypsin activates more trypsinogen - what kind of feedback loop is established
Distal duodenum to proximal 2/3 of transverse colon - SMA - vagus
Positive
Hypercoaguability - polycythemia vera - pregnancy - HCC
In the mucus that covers the gastric epithelium

34. What kind of muscle is in the lower 1/3 of the esophagus
Budd chiari syndrome
DIC - ARDS - diffuse fat necrosis - hypcalcemia - pseudocyst formation - hemorrhage - infxn - multiorgan failure
Smooth
Ampulla of vater

35. What kind of lesions are characteristic of duodenal PUD vs cancer
Can lead to hematemesis - found in EtOHics and bulimics
Punched out - clean margins - carcinoma =raised irregular margins
Largest nimber of goblet cells in the small intestine - plicae circulares and crypts of lieberkuhn
HSV-1 - CMV - Candida

36. What color is the liver in dubin johnson - and what similar syndrome doesn't have gross color changes in the liver
Centrilobular congestion and necrosis - cardiac cirrhosis
Black - rotors syndrome
IBD - Strep bovis bacteremia - tobacco - large villous adenomas - juvenille polyposis syndrome - peutz jehgers syndrome
Low pressure proximal to LES

37. What cells make gastric acid - What does it do to stomach pH and what substances regulate it
Lateral to the inferior epigastric artery
H pylori (almost 100%)
12 waves/min
Parietal cells in the stomach - decrease pH - inc by histamine - ACH - gastrin - dec by somatostatin - GIP - prostaglandin - secretin

38. What structures feed into the cystic duct
Gallbladder
Volvulus
PAS- positive globules in liver -
Averages 6 months - very aggressive - usually already metastasized at presentation

39. Diaphragmatic hernias occur in infants because of defective development of which membrane
12 waves/min
Pleuroperitoneal
Hyrdolyzes alpha 1-4 linkages to yield disaccharides
Bile salts (bile conjugated to glycine or taurine) phospholipids - cholesterol - bilirubin - water and ions

40. What kind of hernia protrudes below the inguinal ligament - Where does travel relative to pubic tubercle and who gets them
Lack or have an attenuated muscularis externa - often in the sigmoid colon
3rd most common cancer - 3rd deadliest in US - pts > 50 - 1/4 have fam hx
Stimulate intestinal persistalsis
Femoral hernia - through femoral canal - lateral to pubic tubercle and women

41. What does bicab do in the mouth
...
Neutralizes oral bacertial acids and maintains dental health
H pylori (70%) - NSAIDS - dec mucosal protection against gastric acid
Duodenum - 2nd - 3rd and 4th parts

42. What is the rate limiting step of carbohydrate digestion
Oligosaccharide digestion
Esophageal carcinoma
Crypts but not villi
Bleeding - penetration into pancreas - perforation - obstruction

43. Where does copper accumulate in Wilsons and What are ABCD
Decreased intercellular adhesion and increased proliferation
Distal 1/3 of transverse colon to supper portion of rectum - IMA - and PANS
5HT - wheezing - right sided heart murmurs - diarrhea - flushing -
Liver - brain - cornea - kidneys - joints - Asterixis - Basal ganglia degeneration - dec Ceruloplasmin - Cirrhosis - Corneal deposits - Copper accumulation - Carcinoma (HCC) - Choreiform movements - Dementia

44. What histological findings are present in the esophagus
Nonkeritinized stratified sqamous epithelium
M3 - Gq - inc IP3/Ca
True and most common congenital anomoly of GI tract
Via the middle colic

45. In MSI - What is the mechanism for CRC and what syndrome is associated with this defect
Inc pressure in the intrahepatic ducts leading to injury/fibrosis and bile stasis
Internal thoracic to superior epigastric to inferior epigastric
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
DNA mistmatch repair gene mutations lead to sporadic and HNPCC syndrome - mutations accumulate but not define morphologic correlates

46. What does histo show for alpha1 antitrypsin def
Goes through deep inguinal ring - external inguinal ring and into the scrotum
L4
L2
PAS- positive globules in liver -

47. Dysphagia in achalasia results from
Hemolytic anemia
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
High LES opening pressure and uncoordinated peristalsis - both solids and liquids
Amylase

48. What causes nutmeg liver
External spermatic fascia only
...
Backup of blood into the liver - RHF - budd chiari
EtOH

49. What is the most common esophageal cancer worldwide and in the US
Peyers patches
Worldwide - SC - US - adeno
HPNCC
Curling's ulcer - dec plasma volume and sloughing of gastric mucosa

50. At what spinal level does the SMA exit
Distal colon - obstruction - colicky pain - hematochezia - proximal colon - dull pain - iron deficiency anemia - fatigue
L1
Jaundice - fever - RUQ
Autoimmune= ulcerative colitis - disordered response to bactere = crohns